Acd 15.pdf

Rosita, Jasmine Rochelle Rosita D2-2022 Table #26 Facilitator: Dr. Capuz/Dr. Decena ACD 15 PERICARDIUM & EXTERNAL HEART 1. Discuss with illustration the pericardium as to its layers, neurovascular supply, sinuses and attachments Pericardium Layers Serous – lines the fibrous pericardium and covers the heart a. Parietal layer – lines the fibrous pericardium b. Visceral layer – called epicardium and is closely related to the heart

Neurovascular Supply Nerve Supply: • Phrenic Nerves – fibrous pericardium and parietal layer of the serous pericardium • Branches of sympathetic trunks and vagus nerves – visceral layer of serous pericardium

Sinuses • Oblique sinus – on the posterior surface of the heart and is the reflection of the serous pericardium around the large vessels • Transverse sinus – short passage located between the serous pericardium around the aorta and pulmonary trunk and the large veins 2. Illustrate on the diagram of the anterior chest wall the following: a. Topography of the heart (borders & surfaces) Borders • Right – RA • Left – Left auricle • Inferior – LV and RA • Apex – LV Surfaces • Sternocostal (anterior) - Right border: RA - Left border: LV and part of left auricle - Atrioventricular groove: separates RA and RV - Anterior interventricular groove: separates RV and LV

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Diaphragmatic (Inferior) - Posterior interventricular groove: separates RV and LV - Inferior surface of the RA: where the inferior vena cava opens Base (posterior) - Formed mainly by the LA: opens the four pulmonary veins Apex - Formed mainly by the LV - Directed downward, forwards and to the left

b. Coronary sulcus and arteries Separates the ventricles and atria

c. Anatomical and clinical valve areas • Tricuspid Valve - Behind the right half of the sternum opposite the 4th intercostal space - Best heard over the right half of the lower end of the body of the sternum • Mitral Valve - Behind the left half of the sternum opposite the 4th costal cartilage - Best heard at the level of the 5th intercostal space

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Pulmonary Valve - Behind the medial end of the 3rd left costal cartilage and the adjoining part of the sternum - Best heard over the medial end of the 2nd left intercostal space Aortic Valve - Behind the left half of the sternum opposite the 3rd intercostal space - Best heard over the medial end of the 2nd right intercostal space

3. Discuss with illustration the blood supply of the heart as to its origin, commencement/termination, course, branches and areas supplied. Coronary Artery O: Ascending Aorta C: immediately above the aortic valve Right Coronary Artery Ø From the anterior aortic sinus of the ascending aorta Ø Runs forward between the pulmonary trunk and right auricle Ø Descends vertically in the atrioventricular groove Ø Continues posteriorly along the atrioventricular groove at the inferior border Ø Anastomose with the left coronary artery in the posterior interventricular groove Branches: • Right Conus Artery - anterior surface of the pulmonary conus and the upper part of the anterior wall of the RV • Anterior Ventricular Branches - anterior surface of the RV o Marginal branch – largest and runs along the lower margin of the costal surface • Posterior Ventricular Branches - diaphragmatic surface of the RV Ø Runs toward the apex in the posterior interventricular groove • Posterior Interventricular (descending) Artery - runs along the posterior interventricular groove and supplies to the RV, LV and the posterior part of the ventricular septum • Atrial Branches - anterior and lateral surfaces of the RA Left Coronary Artery – usually larger than the right and supplies the major parts Ø From the left posterior aortic sinus of the ascending aorta Ø Runs forward between the pulmonary trunk and left auricle Ø Descends vertically in the atrioventricular groove Ø Enters the atrioventricular groove Ø Divides into an anterior interventricular branch and a circumflex branch Branches • Anterior Interventricular (descending) branch – supplies the RV, LV and the anterior part of the ventricular septum Ø Downward in the anterior interventricular groove to the apex Ø Passes around the apex to enter the posterior interventricular groove Ø Anastomoses with the terminal branches of the right coronary artery (most individuals) *(1/3 of individuals) it end at the apex o Diagonal artery – arise directly from the trunk of the left coronary artery

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o Small left conus artery – supplies the pulmonary conus Circumflex Artery Ø Winds around the left margin in the atrioventricular groove o Left marginal artery – supplies the left margin of the LV down to the apex o Anterior and posterior ventricular branches – LV o Atrial branches – LA

4. Discuss with illustration the venous drainage of the heart as to its commencement/termination, tributaries and areas drained Coronary Sinus – drains most of the blood from the heart wall to the RA O: great cardiac vein C: posterior part of the atrioventricular groove T: to the RA and the left of the inferior vena cava Tributaries: small and middle cardiac veins Anterior Cardiac Vein – returns the remaining blood to the RA 5. Discuss with illustration the great vessels of the heart as to its formation, origin, commencement/termination, branches or tributaries. a. Ascending aorta O: LV C: base of the LV T: sternal angle Branches: • Right coronary artery – from anterior aortic sinus • Left coronary artery – from the left posterior aortic sinus b. Pulmonary trunk/artery O: RV C: upper part of the RV T: concavity of the aortic arch Branches: • Right pulmonary artery – behind the ascending aorta and superior vena cava to enter the root of the right lung • Left pulmonary artery – in front of the descending aorta to enter the root of the left lung c. Pulmonary veins – leave each lung and carries oxygenated blood to the LA O: root of lung T: LA d. Superior vena cava – contains all the venous blood from head, neck and upper limbs O: union of two brachiocephalic veins C: 1st chondro-sternal joint T: RA at 3rd costal cartilage Vena Azygos – joins the posterior aspect before entering the pericardium e. Inferior vena cava – pierces the central tendon of the diaphragm C: 5th lumbar vertebrae T: RA at 3rd costal cartilage