Slides of

Please note : These slides were edited by our colleague Sara Rahhal to fit the slides of spring 2019

Spring2019 Dr. Maher Hadidi, University of Jordan 1 [Type here]

Pericardium & Dr.Maher AL-Hadidi School of Medicine University of Jordan Spring 2019

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Spring 2019 Dr,Maher AL-Hadidi , University of Jordan 1

Pericardium A double-walled fibroserous conical-shaped sac, inside middle mediastinum. Enclose the heart and roots of its large vessels.

PericardiumVagus nerves Pericardium Pericardium SVC

Pericardiophrenic A.

Pericardiophrenic V.

MusculophrenicRt. Pericardiophrenic vessels branches Diaphragm Base Spring2019 Dr. Maher Hadidi, University of Jordan 3 Diaphragm

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Pericardium – Sagittal section

Parts: 1 1. Fibrous pericardium. (outer) 2. Serous pericardium. 2 Fibrous pericardium (Inner) Conical-shaped fibrous sac. . Base: Attached to central tendon of diaphragm. Layers . Apex: Attached to roots of large of heart vessels. Wall  Prevent overextension of the Base [Typeheart. here]

(potential)

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Serous pericardium

Complete serous sac invaginated by 1 the heart. Like pleura by the lung. (outer) 2  2 layers:  Parietal layer lines fibrous pericardium. (Inner)  Visceral layer covers the heart as (Epicardium). Layers of heart  Wall Pericardial cavity: dium A potential space between 2 serous Base

layersSpring2019. Dr. Maher Hadidi, University of Jordan 5 (potential)

Contents of pericardium: Superior vena cava Contents: Arch of Ascending Aorta 1. Heart and all arteries, cava Transverse sinus Pulmonary (separates arteries

veins and nerves. from veins) Artery 2 3 2. All Ascending aorta. 4 8 Left pulmonary vs. 3. All . 7 Right pulmonary vs. 9 6 4. Last 2cm of SVC. 1 5. Last 2cm of IVC. Serous pericardium + Oblique sinus 5 6. First part of the 4 diaphragm Fibrous pericardium pulmonary veins. Inferior vena cava 7. Transverse sinus. Thoracic aorta 8. Oblique sinus.

Spring 201 9 Dr. Maher Hadidi, University of Jordan 6

Heart

 Pyramidal-shaped muscular organ. SVC  About the size of the person’s own fist. Ligamentum arteriosum Ascending aorta Apex: -Inside pericardium. -From to aortic arch.  Directed downward , forward and to the left. -Give 2 coronaries. th Pericardium Located at the left 5 intercostal space Right coronary A. Anterior interventricular A. about 9cm from midline.  Form by the left . Ant. Interventricular groove Base:  Directed posteriorly , form by left .

Spring 2019 Dr. Maher Hadidi, University of Jordan 7

Chambers of heart

Form of 4 chambers:  2 atriums above.  2 ventricles below.

 Atriums separated from inside by the .

 Ventricles separated from inside by the .

Spring 2019 Dr. Maher Hadidi, University of Jordan 8

Borders of the Heart Due to the rotation of the heart 45° to the left, the right side becomes anterior and the left side becomes posterior. Has 3 borders:  Right: Right atrium.  Left: left ventricle.  Inferior: Right ventricle.

Spring2019 Dr. Maher Hadidi, University of Jordan 9 Surfaces of the heart

1. Anterior surface.

2. Inferior surface. Ligamentum arteriosum

3. Base.

Anterior Anterior interventricular A.

(Sternocostal)

Ant. interventricular groove

Form by

 Right ventricle.

 Right atrium. 10

Inferior surface of the heart

(Diaphragmatic surface)

 Form mainly by left ventricle and right ventricle.

Lt. sup. pulmonary v.

Left auricle

Left atrium

Lt. inf. Pulmonary v.

Left ventricle

Right ventricle Base of the heart

 Directed posterior , opposite the apex.

 Form by left atrium.

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Interior of right Atrium

 Receives venous blood from the whole body

by: Arch of aorta

1. SVC from upper ½ .

2. IVC from lower ½ .

3. Coronary sinus (coronary vein) from SVC Right auricle (reserve part)

the heart itself. Limbus  Send blood to right ventricle by Tricuspid

valve. Crista terminalis Right Has 2 walls: ventricle

 Anterior wall, rough.

- Pectinate muscles . Fossa ovalis - Crista terminalis.

IVC  Posterior wall , smooth Valve of IVC Coronary sinus -Fossa ovalis. Valve of coronary sinus -SA Node.

Interior of right atrium

Interior of right Ventricle -1

 Receives blood by Tricupsid valve.

 Send blood to both lungs via .

 Wall thicker than right atrium.  Blood inflow part is rough and outflow part is smooth

Pulmonary valve

Septomarginal band ()

Corda tendineae 14

(spongelike appearance) Interior of right Ventricle -2

Has 2 walls:  Anterior wall (inflow part).

Rough with a network of projecting bundles. E.g.

 Trabeculae carnea.

 Septomarginal band. Pulmonary valve

 Papillary muscles.

 Posterior wall, (outflow part).

Septomarginal band Smooth in part. E.g. (moderator band)

 Infundibulum of pulmonary artery. Corda tendineae

(spongelike appearance)

Left Atrium

 Form base of the heart.

 Receive blood by:

4 pulmonary veins. (Reverse part)

 Send blood by : Bicuspid valve

to the left ventricle.

Right Pulmonary veins  Ant. Wall: Rough, especially its

auricle.

Left atrium  Post. Wall: Smooth.

16 APEX

Left Ventricle

 Main chamber of the heart.

 Form apex of the heart. Aortic vestibule (smooth)  Receive blood by: Bicupsid valve. Anterior cusp of bicuspid valve  Send blood by : Aortic valve.

 Has thicker wall.

 Ant. Wall (I.V septum) : Smooth in part.

-Aortic vestibule.

 Post. Wall: Rough. Left atrium -Trabeculae carnae.

-Papillary muscles. (coronary vein)

Posterior cusp

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Cardiac conduction System

 A network of a modified cardiac muscle

fibers specialized in conduction only. SAN Left atrium

 It is autorhythmic , it constantly initiates

and coordinates atrial and ventricular AVN

SAN muscle contraction.

 Insulated from myocardium by a sheath

of connective tissue

 Establishes a unidirectional pathway of Left ventricle AV bundle excitation signals and contraction.

 Organized into 4 basic components: Right and left

Purkinje fibers Apex