Download - Pericardium external features
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Pericardium andExternal Features of Heart
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Life support Feeding Tubes
Ionotropes
Total Parenteral Nutrition
Mechanical ventilation
Heart / Lung bypass
Urinary catheterization
Dialysis
Cardiopulmonary resuscitation
Defibrillation
Artificial pacemaker
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Vitals
HeartLungsBrain
TemperatureRespiratory RateHeart Rate (Pulse)Blood Pressure
Assessment of the level at which an individual is functi oning
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Thoracic organs
HeartLungsThymus (Till puberty)
Heart att ack / Myocardial infarcti on is one of the common causes of sudden death
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Development of Heart
Lateral plate mesodermSingle heart tubeInitially antero-posterior axisAtt ached by arterial and venous endsFolds ventrally and bulges in 5 regions
1. Truncus arteriosus2. Bulbus cordis3. Primitive ventricle4. Primitive atrium5. Sinus venosus
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Gross structure
Two atriaTwo ventriclesAortaPumonary Trunk – Pulm. ArteriesPulmonary veinsSup & Inf. Vena cavaConduction system SA Node AV Node Purkinje Fibres
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Heart functions rhythymically inspite of :Located among other structures in a fi xedThoracic cage
Lungs expanding & contracti ng withRespirati on
Diaphragm moves from below
Post vertebral column moves in variousPostures
Oesophagus ballooning during ingesti on of food
Beati ng at 72 beats per minute
Receiving and pumping blood of 5 liters
Chambers are not at geometrical convenience
Intra-thorcic pressures altering with coughing/sneezing/vomiti ng etc.
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PericardiumConical fi brous sacContains heart & roots of great vessels
Situated -- in middle mediasti num - behind body of sternum and 2nd to 6 th costal carti lages- In front of bodies of 5 th to 8 th thoracic vertebrae
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Components
Outer fi brous sacInner serous sacHeart lies within fi brous pericardium (Intra fi brous) outside serous pericardium (extra serous)
Fibrous pericardium
Cone shaped bagTruncated apexKeeps heart in positi onPrevents over distension of heartOpen sac pierced by some blood vessels
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Att achments
AboveBlends with ext. coat of aorta and Pulm.trunkConti nuous with pre-tracheal fasciaBelowFuses with upper surface of central tendon and part ofMusculature of left part of diaphragm(Heart & Diaphragm develop from septum transversum)In frontAtt ached to sternum bySuperior & Inferior sterno-pericardial ligamentsStructures piercingAsceding aorta, Sup. & Inf. Venacavae Rt. & Lt. Pulm. Arteries$ Pulm. Veins
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Relations
In front1. Ant. Thoracic wall separated by ant. margins of both lungs & Pleura2. Below Lt. 4 th costal carti lage pericardium comes in direct contact with Lt. half of lower two pieces of body of sternum3. Before puberty thymus forms ant. Relati on
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RelationsBehind
Forms ant. boundary of post. Mediasti numRt and Lt. bronchi Oesophagus, oesophageal plexusDescending thoracic aortaThoracic ductAzygos & Hemiazygos veinsPost. Part of mediasti nal surface of lungs
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RelationsOn each side1. Cardiac impression of corresponding lung separated by mediasti nal pleura2. Phrenic nerves and pericadiaco phrenic vessels (Br.of Int.Thoracic a.) between pleura and pericardium
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RelationsBelow1. Left lobe of liver and fundus of stomach separated by diaphragm
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Serous pericardiumClosed sac Lies within fi brous pericardiumHeart projects into fi brous pericardium From above and behindParietal and visceral layersPotenti al space - capillary layer of fl uid(300 ml max. can be accommodated)
Parietal layerLines inner surface of fi brous Pericardium and blends with it.Visceral layerCovers heart and roots of great vesselsSeparated from myocardium by subserousareolar and fatt y ti ssue
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Serous pericardiumConti nuity between parietal & visceral Layers is establishedin the form of two Tubes – One tube surrounds arterial end (Aorta, Pulm. Trunk)- One tube surrounds venous end (Sup. & Inf. Vena cavae 4 pulm. Veins)
Primitive arterial end
Primitive venous end
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Transverse SinusPassage between two tubular refl ecti ons of serousPericardiumLined by visceral layer onlyIn front – Ascending aorta & Pulm. TrunkBehind – intra pericardial part of sup.venacavaAbove – bifurcati on of Pulm. TrunkBelow – upper surface of left atrium
Primitive arterial end(Truncus arteriosus)
Primitive venous end
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Oblique SinusCul-de-sac behind left atriumClosed on all sides except belowIt lies within the limbs of inverted “J”In front – Left atriumBehind – parietal layer covering post. Of Fib.PericardiumRight side – Rt.Pulm. Veins & Inf.VenacavaLeft side – Left Pulm. VeinsAbove – upper margin of left atrium
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Blood supplyFibrous & Parietal layersArterial supplyFibrous & parietal layer – Branches of Int. Thoracic art. - Descending aortaVisceral layer - Coronary arteries
Venous drainageFibrous Parietal layer - Azygos - Int.Thoracic veinsVisceral layer - Coronary sinus
Nerve supply Fibrous & Parietal layers - Phrenic nerveVisceral layer - Vagus & Sympatheti c nerves via coronary plexus
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Applied anatomy
Clinical importance of transverse sinusLigature around aorta and pulm. Trunk to controlto control haemorrhage in cardiac surgery
Pericardial tamponade – pericardial eff usion Blood or serous – compresses heart – decreases diastolic capacityParacenti sis of pericardial eff usion - subcostal route (Costo-xyphoid angle 45 deg upward) - Parasternal route (Left 4 th / 5 th interspace close to sternum)
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External features
Hollow conical muscular organSituated in mid. Mediasti num
Covered by pericardium
Size of clenched fi st
4 chambers2 atria - interatrial septum2 ventricles – intervent. Sep.
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External featuresRt.atrium receives deoxygenated bloodVia Sup. & Inf. venacavae, and coronary sinus.Thru’ Rt. atrioventricular orifi ceTo – Rt. VentricleEjected to Pulm. TrunkTo Pulm. Capillary plexus for oxygenati onPulmonary circulati onTo Left atriumVia 4 pulmonary veinsThru’ Lt. atrioventricular orifi ceTo Left ventricleEjected to ascending aorta forSystemic circulati on
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External features MeasurementsApex to base – - 12 cmsAntero-post diameter - 6 cmsWidest transverse diameter 8 to 9 cms(Equal to one half of diameter of thorax)
Weight male – 280 to 340 gms female - 230 to 280 gms
Presenti ng partsApexBase3 surfaces – Sternocostal, diaphragmati c & Left3 borders - Right, Inferior & Left
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External features
Apex Conical area formed by left ventricleDirected downwards, forwards and to leftIn 5 th intercostal space 9 cms from midlineSlightly below & medial to left nippleSeparated from ant.thoracic wall byleft lung & pleura
BasePosterior surface – fi xed part of heartQuadrilateral in outlineFormed 2/3rds by post. Surface of left atrium & 1/3 rd by Rt. Atrium
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External features
Base
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External featuresBoundaries of base
Above Bifurcati on of Pulm. Trunk Below Post. Part of interventricular groove containing coronary sinus & anastomosis of Rt. & Lt. coronary arteries.Rt. Side Rt. Border of Rt. Atrium from sup to Inf. Vena cavaLt. sideLeft border of left atrium from upper to lower Lt. pulm. veins
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External features
Features of the Base
SVC opens in upper post part of Rt.atriumIVC opens in lower post part of Rt.atrium
4 Pulm. Veins 2 on each side open in Post. Surface of Lt. atrium
A shallow verti cal inter atrial groovemay be found between 2 atria –Post. Att achment of Inter atrial septum
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External featuresRight border
Rounded and convexFormed by Rt. Atrium Extends from Rt. Side of opening ofSVC to IVC
The border separates base fromSternocostal surface
Shallow verti cal groove accpmaniesRt. Border – Sulcus terminalisCorresponds to Crista terminalisin theInterior of Rt. atrium
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External features
INCISURA APICIS CORDIS
Inferior Border
SharpSeparates sternocostal from diaphragmati cSurfacesExtends from opening of IVC to apexBorder accompanied by marginal branchof Rt. Coronary artery and veinNotch near apex – Incisura apicis cordisAnt. Interventricular br. of left coronarycurves around it.
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External features
Left Border
ILL defi ned convexConvexity to left and upwards
Separates sternocostal from left surface
Extends from left auricle to apex
Accompanied by marginal br. of Lt.coronary artery.
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External features
Sterno – costal surface
Directed forwards and upwardsSeparated From base to by Rt. BorderFrom diaphragmati c surface by Inf. BorderFrom Left surface by Left border
Formed byAnt. Surface of Rt. atrium & its auriclePart of ant. Surface of Lt. auricleAnt. Surface of Rt. Ventricle (2/3)Ant. Surface of left ventricle (1/3)
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External featuresFeatures of Sterno-Costal Surface
Ant. Part of atrio-ventricular groovePasses downwards & to right betweenRt. Atrium & Rt. Ventricle
Lodges trunk of Rt. Coronary artery
Ant. Interventricular groove passesdownwards parallel to left bordermeets inf. Border at incisura.The groove lodges ant. Interventricularbr. of Lt. coronary artery & great cardiac veinIndicates ant. att achment of interventricular septum
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External features
Left
bor
der
Inferior b
order
Right border
Diaphragmatic or Inferior Surface
FlatFace downwards and backwardsFormed only by ventricles2/3 left ventricle & 1/3 rd by Rt. Ventricle
SeparatedFrom Sternocostal surface by inf. BorderFrom the base by the post. Part of Interventricular grooveFrom left surface by less defi ned unnamed border which is backwardConti nuati on of inferior border
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External features
Left
bor
der
Inferior b
order
Right border
Features of Inferior Surface
Post. Interventricular groove runs forwardsalong this surface & meets incisura epi.cordis
Groove indicates post. att achment ofInterventricular septum
Groove lodges post. Interventricular br. ofRt. Coronary artery
Middle cardiac vein
Anastomosis of interventricular branches of Both coronary arteries
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External features
Left Surface
Directed upwards backwards and to left
Formed mainly by left ventricle andPartly by left atrium & Left auricle
Features
Left part of atrioventricular groove intervenes between Lt. auricle and lt. ventricle
This groove lodges – Trunk and cicumfl ex br. of left cor. art.Terminati on of great cardiac veinCommencement of coronary sinus
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Points of observation
Apex formed by left ventricle
Base formed by 2 atria
Rt. Border formed by Rt. Atrium
Diaphragmati c surface formed by 2 ventricles
Base - 2/3 lt. atrium 1/3 Rt. Atrium
Diaphragmati c surface – 2/3 Lt. ventricle, 1/3 Rt. Ventricle
Sternocostal surface – 2/3 Rt. Ventricle 1/3 Lt. ventricle
From midline 2/3 to left of midline, 1/3 to Rt. Of midline
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If an elderly in your house suff ers from chest painDo not browse net from your cel to verify which Doctor can diagnose the illness
But; equip yourself with suffi cient Knowledge to save your own kith and kin fi rst.
Only grati tude you can return to your “well-wishers”
And it is the ulti mate pride and their ambiti on