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Color Atlas of Anatomy. Johannes Chihiro Yokochi. Elke Lütjen- Drecoll. A Photographic Study of the Human Body. Seventh Edition. This Website Provides Over Free Medical Books and more for all Students and Doctors This Website the best choice for medical students during and after. Color Atlas and Textbook of Human Anatomy Vol 2 5th Ed. [xumodaperma.gah,] - Ebook download as PDF File .pdf), Text File .txt) or read book online. Color.

Pelvis and Perineum. Lower Limb. Head and Neck. Exam Skills and Clinical Skills Answers. We are always looking for ways to improve customer experience on Elsevier. We would like to ask you for a moment of your time to fill in a short questionnaire, at the end of your visit. If you decide to participate, a new browser tab will open so you can complete the survey after you have completed your visit to this website.

Thanks in advance for your time. Skip to content. Search for books, journals or webpages All Webpages Books Journals. Published Date: Page Count: Instructor Ancillary Support Materials. Portal circulation is a special part of th. A distinction is made in postnatal life between pulmonary circulation and systemic circulation. Venous blood from un paired abdominal organs stomach.

Systemic circulation.

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Unlike thl system of blood vessels. In terms of function. Human postnatal circulation can be illustrated schematically as a figureof-eight with the heart located at its intersection acting as a suction and pressure pump A.

Venous blood from the legs ani lower half of the trunk is conveyed to the in ferior vena cava A1S. Deoxygenated blood from the systemic circulation flows from the right atrium A1 into the right ventricle Al of the heart and from there into the pulmonary circulation. At the capillar: The inferior and supe rior venae cavae empty into the right atriun Al.

Lymphatic system. Pulmonary circulation begins with the pulmonary trunk AJ which bifurcates into right A4 and left pulmonary arteries AS. In systemic circulation. Oxygenated blood from the lung flows from the left atrium AS of the heart into the left ventricle A9. Large arteries branch off the aorta ani pass to the separate circuits where the: After metabolism in the liver. These vessels divide in the lungs AG parallel to the branchings of the airways as far as the capillaries.

The oxygenated blood leaves the lungs by the pulmonary veins A7 and flows to the left atrium AS. There the blood is enriched with oxygen and carbon dioxide is released into the airways. Oxygen-rich blood is often referred to in clinical usage as arterial blood and deoxygenated blood is referred to as venous blood. Overview Fetal Circulation A During prenatal life. Although some of the blood from the umbilical vein thus enters the portal circulation.

Backflow of blood from the lungs increases the pressure in the left atrium. The umbilical vein enters the fetal abdominal cavity at the navel.

The placenta Al serves as the connecting organ for exchange between mother and fetus. The branches given off by the portion of the aorta after the connection of the ductus arteriosus thus receive blood with a lower oxygen concentration than those before the connection which supply the head and upper limbs. Most of the blood from the pulmonary trunk flows directly into the aorta through the ductus arteriosus A From there the blood is directed by the valve of the inferior vena cava toward the foramen ovale Al0 that lies in the septum between the right and left atria and connects them.

After obliteration the ductus venosus forms the ligamentum venosum and the ductus arteriosus forms the ligamentum arteriosum Deoxygenated blood from the head and arms of the fetus flows through the superior vena cava A14 into the right atrium and crosses the bloodstream from the inferior vena cava to reach the right ventricle A1S. Cutting the umbilical cord disrupts the connection between placenta and umbilical cord vessels. The blood is oxygenated in the lungs and transported by the pulmonary veins into the left atrium.

Circulatory Adjustments at Birth B At birth the fetal circulation is converted into postnatal circulation. The umbilical vein becomes the round ligament of the liver and the umbilical arteries become the cords of the umbilical arteries Oxygen-rich blood carrying abundant nutrients passes from the placenta to the fetus via the umbilical vein A2 which initially lies in the umbilical cord.

A minimal amount of blood passes through the pulmonary arteries A17 into the not yet aerated lungs and from there through the pulmonary veins A1S to the left atrium All. Due to the relatively minimal admixture of deoxygenated blood.

Most of the blood reaches the left atrium All. With the first cry of the infant. The foramen ovale is thus converted into the oval fossa which is normally completely closed. A considerable amount of blood from the fetal aorta is returned to the placenta through the paired umbilical arteries A The shunts. Blood from the ductus venosus thus mixes with deoxygenated blood from the inferior vena cava and hepatic veins AS.

The size of the heart depends upon factors such as the sex. The sulcus contains a branch of the left coronary artery anterior interventricular artery and the accompanying cardiac vein anterior interventricular vein. Aorta and pulmonary trunk wind around each other.

The contour of the left side of the heart is formed by a small portion of the left auricle and the left ventricle. The cut edges of the left pulmonary veins are visible below the left pulmonary artery.

Heart Heart The heart Al is a fibromuscular. The boundary between the ventricles is demarcated by a groove known as the anterior interventricular sulcus Viewing the sternocostal surface of the heart. Passing between the inferior aspect of the aortic arch and the superior aspect of the pulmonary bifurcation there is a short band. It is situated in the thorax A where it is positioned obliquely to the body's axis so that the apex of the heart AB2 is directed to the left.

The use of color in the illustrations of internal and external cardiac structures represents as closely as possible the proportions in the living body. The right atrium and right auricle are separated from the right ventricle by the coronary sulcus which is also filled up by coronary vessels and adipose tissue. The boundary between the sternocostal surface and the diaphragmatic surface is demarcated on the right ventricle by the right border Adjacent vessels. External Features Anterior Aspect Structure.

The left ventricle extends toward the left to form the apex of the heart The left auricle lies adjacent to the pulmonary trunk The inferior vena cava is not visible in the anterior view.

These vessels fill up the anterior interventricular sulcus. The right atrium has an outpouching known as the right auricle 89 which occupies the space between the superior vena cava and the root of the aorta The contour of the right side of the heart is formed by the right atrium 87 and superior vena cava The anterior view of the heart in its natural position with an opened pericardium shows the sternocostal surface 8 which is mostly formed by the anterior wall of the right ventricle 84 and a small portion of the wall of the left ventricle The cut edges of the pericardium see p.

External Anatomy of Heart 11 E! A Position of heart in thorax 6 B Ventral view of heart The left ventricle is separated from the right ventricle In patients with posterior wall involvement. Myocardial infarctions involving the anterior wall are divided into anterobasal. The cut edge of the pericardium AS is visible on the posterior wall of the left atrium. After crossing over the pulmonary bifurcation. The view into the right atrium AB3 is roughly along the axis of both venae cavae.


Inferior Aspect 8 Most of the diaphragmatic surface of the heart II rests on the diaphragm. The coronary sulcus contains the venous coronary sinus and a branch of the left coronary artery. Heart External Features. The long axis of both venae cavae is tilted slightly forward. Above the left atrium. This view allows visualization of the openings of the superior vena cava AB1 and inferior vena cava AB2 into the nearly perpendicular right atrium AB3.

The diaphragmatic surface of the heart is chiefly formed by the left ventricle B1S.

Clinical note. In its natural position with the pericardium opened. In clinical practice. The anterior wall describes the part of the left ventricular wall that forms the sternocostal surface while the posterior wall is that part which forms the diaphragmatic surface.

Posterior Aspect A Structure and adjacent vessels. The venae cavae are separated from the base of the right auricle by a groove known as the sulcus terminalis cordis A4.

External Anatomy of Heart. Medial to the valve of the inferior vena cava. During fetal life this valve is large and directs blood from the inferior vena cava directly through the foramen ovale see p.

The inferior vena cava opens at the lowest point of the right atrium. At various sites the tiniest cardiac veins empty via minute openings. The two venae cavae. It returns the greater portion of the backflow of deoxygenated blood from the heart itself.

The conus arteriosus B18 infundibulum has smooth walls and directs blood flow to the pulmonary valve orifice at the opening of the pulmonary trunk. In the interior of the heart. Sinus of venae cavae. The papillary muscles are a special form of trabeculae carneae. Blood flows through the atrioventricularorifice. The tricuspid valve has three cusps. The muscular wall of the right ventricle B12 is thin.

After birth.

The opening of the inferior vena cava A2 a is shielded by a crescent-shaped valve. Muscular ridges. True atrium and right auricle. The posterior portion of the right atrium has smooth walls arising from its embryological origin and is referred to as the sinus of venae cavae. Outflow tract. Heart Chambers ofthe Heart The following sections discuss the chambers of the heart in order of the direction of blood flow. Inflow tract. The pulmonary valve B19 is located at the origin of the pulmonary trunk B20 and consists of three semilunar cusps see p.

Right Ventricle The interior of the right ventricle B is divided by two muscular ridges. The opening of the superior vena cava Al a is directed downward and anteriorly and does not have a valve.

Right Atrium The right atrium A consists of two parts. It is bordered by a prominent margin. The true atrium is continuous anteriorly with the right auricle A4.

The true atrium lies anterior to it and is derived from the original embryologic atrium. The position of the anterior papillary muscle B16 and posterior papillary muscle is constant.

The opening of coronary sinus A8 is also shielded by a valvular fold. On the outer surface of the heart.

In the true atrium. Chambers of the Heart A Right atrium. Much of the cavity is occupied by the right and left pulmonary veins A The anterior cusp of the bicuspid valve is continuous at its origin with the wall of the aorta. The muscular wall of the left ventricle B5 is about three times thicker than that of the right. There are no valves at the openings of the pulmonary veins.

Innammation involvingheart valves can be FOllowed by scarring of the valve margins.

The bicuspid valve has two large leaflets. These are attached via the thick and strong chordae tendineae B9 to the papillary muscles which have two or more domed projections. The smooth-walled outflow tract passes along the interventricular septum B12 to the aorta. Left Atrium The predominantly smooth-walled interior of the left atrium A is smaller than that of the right.

Near the interatrial septum dividing the right and left atria is the valve ofthe foramen ovale A3. The aortic valve consists of three strong semilunar cusps.

The left atrium is continuous anteriorly with the left auricle. Heart Chambers of the Heart. The largest portion of the interventricular septum B A small portion lying just caudal to the right and posterior aortic valve is membranous and is referred to as the membranous part see p. It directs blood from the left atrium into the inflow tract of the left ventricle. The left atrioventricular valve mitral valve. Left Ventricle Like the right ventricle. IFscarring shrinks the valve margins.

Stenosis refers to narrowing of the valve opening caused by scarring. The anterior papillary muscle arises from the sternocostal surface of the left ventricle and the posterior papillary muscle from the diaphragmatic surface. The margins of the interventricular septum correspond to the anterior interventricular sulcus B14 and posterior interventricular sulcus on the surface of the heart. Generally there are four pulmonary veins.

There is no clear demarcation in the left atrium between the smooth-walled and muscular portions. Chambers of the Heart. Endocardium and Epicardium The inner surface of the myocardium is lined with endocardium. The cardiac skeleton separates the muscle of the atria and ventricles.

The orifices of the tricuspid valve and bicuspid valve are surrounded by two incomplete fibrous rings. The features of the deep layer are characteristic for each of the two atria. The site where the aortic and bicuspid valves meet is referred to as the left fibrous trigone B5. The superficial layer extends over both atria and is thicker along its anterior aspect C than its posterior aspect D. CD1S Right ventricle.

The pulmonary valve AS is not anchored at all to the cardiac skeleton. The walls of the ventricles contain a highly complex arrangement of myocardial fibers with morphologically distinct subepicardial.

The left ventricle and interventricular septum have a thick middle muscular layer that is usually circular and is absent in the wall of the right ventricle. C Right atrium. C Right auricle. The coronary sulcus CD C Superior vena cava. Ventricular muscle C-E. This area is known as the right fibrous trigone 84 or central fibrous body.

In the valvular plane the surrounding connective tissue is thickened to form the fibrous cardiac skeleton A. The thickest area of condensed connective tissue is found at the site where the aortic valve AB1. The inner. C Left ventricle. In the outer subepicardial layer C-E. At the apex of the two ventricles the superficial subepicardial muscle fibers form the vortex of the heart E9 where they curve around to form the inner subendocardial layer.

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On its outer surface. Myocardium Atrial muscle C. The atrial myocardium can be divided into superficial and deep layers. Layers of the Heart Wall The wall of the heart is made up of three different layers: Its thickness is primarily determined by that of the myocardial layer which varies in different areas of the heart.

Cardiovascular System: Heart Cardiac Skeleton The heart valves all lie approximately in one plane. The transverse cell boundaries where cardiac muscle cells abut against each other are referred to as intercalated discs AS.

Surrounding the nucleus is a perinuclear zone devoid of myofibrils A4. Cardiac muscle cells contain abundant numbers of large mitochondria Cll lying between myofibrils which supply the high amount of energy required for myofibril contraction. As in skeletal muscle. Light Microscopic Appearance AB.

The system composed of longitudinal tubules or L-tubules C13 is formed by the endoplasmic reticulum of the cardiac muscle cell. The system of transverse tubules. Distributed throughout the cardiac muscle cell there are two systems of intracellular canaliculi surrounded by membranes. They are branched cells which establish end-to-end connections with adjacent cells.

Cardiac muscle cells AB1 are up to ". These cells contain fewer fibrils. The nucleus AB3 of a cardiac muscle cell is located centrally. For further information please see textbooks of histology. Heart Layers of the Heart Wall. Electron Microscopic Appearance C.

Hidden behind the intercalated disc is the site where opposing membranes. Although damage resulting from temporary inadequate blood supply is reversible. Cardiac muscle cells cannot regenerate. At the intercalated disc. Heart Wall Layers. The atrial surface of the flap is smooth. The anterior cusp is continuous at its septal origin with the wall of the aorta AB9. In between the three large cusps are small intermediate segments A-C6 that do not reach the fibrous ring.

The aortic valve has a posterior semilunar cusp A1S. The attachment of the semilunar cusps is curved. Heart Semilunar Cusps Heart Valves Atrioventricular Valves Each atrioventricular valve consists of a flap of connective tissue that is covered on both sides by endocardium and is devoid of blood vessels. The anterior cusp A-Cl is the largest of the three.

The nodules on the margins of the cusps ensure that the valve is fully closed. The valves of the pulmonary trunk AB11 and aorta AB9 each consist of three nearly equally sized valves.

The pulmonary valve consists of an anterior semilunar cusp A Near the valve. Bicuspid valve. The tricuspid valve has three leaflets known as the anterior cusp A-Cl. In ventricular diastole A while the column of blood is exerting pressure on the walls of the pulmonary trunk and aorta.

Possessing two leaflets. Tricuspid valve. Located in the middle of the free margin of each valve is a nodule of semilunar cusp Functional anatomy. The attachment site of the septal cusp C5 is at the level of the membranous part of the septum. The left coronary artery AD22 arises from the aortic sinus of the left semilunar cusp 0 and the right coronary artery AD23 from the aortic sinus of the right semilunar cusp.

In the ejection phase. In addition to its two large cusps. The wall of the pulmonary trunk opposite the valve protrudes to form a shallow sinus A On either side of the nodule. Pulmonary valve. During ventricular systole 8. Aortic valve. During this process the complex attachment of the subvalvular apparatus prevents the cusps from prolapsing into the atrium. The short and thick chordae tendineae are attached to an anterior and posterior papillary muscle in such a manner that each papillary muscle supports adjacent sides of both valve leaflets.

In the filling phase. The coronary vessels are the blood vessels that supply the heart itself. The vessels responsible for supplying the body are the large "functional" vessels which are situated at the base of the heart. The coronary vessels derive their name from the location of their main stems in the coronary sulcus. The short coronary circulation comprises the coronary arteries the first branches of the aorta.

Coronary Arteries A-C The main stems of the right coronary artery Al and left coronary artery A2 arise in the aortic sinuses of the right and left semilunar valves. Right coronary artery Al. At the site of its entry into the coronary sulcus AJ on the right side. After distributing branches to the right atrium and anterior surface of the right ventricle.

In most people in balanced circulation the right coronary artery supplies the right atrium. Left coronary artery A2. The short stem initially passes between pulmonary trunk AS and left auricle A9 before dividing into the anterior interventricular artery Al0 which travels caudally in the anterior interventricular sulcus All.

The stems of the coronary arteries. In balanced circulation the left coronary artery supplies most of the left ventricle and the anterior portion of the interventricular septum.

Although coronary arteries form small anastomoses with one another. Coronary arteries are therefore considered end arteries in terms of function. Occluded arteries lead to insufficient blood supply to a portion of myocardium.

Coronary Veins A-B Most of the deoxygenated blood leaving thel walls of the heart flows through the veins. The larger tributaries that empty into the coronary sinus are the anterior interventricular vein A14 which becomes the great cardiac vein in the left coronary sulcus.

About two-thirds of deoxygenated blood flows directly into the right atrium via larger veins and the coronary sinus. Smaller veins. Lymphatic Vessels The dense lymphatic network of the heart can be divided into a deep endocardial. Larger collecting vessels travel in the epicardium. The corresponding regional lymph nodes belong to the anterior mediastinal nodes see p.

Heart Conducting System of the Heart Specialized cardiac muscle cells generate and conduct spontaneous rhythmic impulses that stimulate the beating of the heart.

These cells are collectively known as the conducting system of the heart and they differ in terms of histology and function from the rest of the cardiac muscle, the working myocardium. Clusters of cells are found at two sites where they form nodular structures known as the sinuatrial node and atrioventricular node AV node. Most of these cells, however, are arranged into bundles which can be divided into the atrioventricular bundle and the right bundle and left bundle, the bundle branches of the ventricular conducting system.

The pathway traveled by an impulse from where it was generated to its functional spread to the working myocardium is discussed in the following sections on the basis of identifiable morphological structures A-B. The sinuatrial node Al Keith-Flack node lies beneath the epicardium near the opening of the superior vena cava A2 in the sulcus terminalis cordis.

The spindleshaped node is referred to as the cardiac pacemaker as it generates impulses per minute which travel to the rest of the conducting system. The second component of the specialized cardiac muscle tissue is the atrioventricular node Aschoff- Tawara node A3 , located at the atrioventricular septum in the interatrial septum A4 between the opening of the coronary sinus AS and the septal cusp of the tricuspid valve A6.

The impulses generated by the sinuatrial node are conducted through the working myocardium of the right atrium to the atrioventricular node, where the bundles belonging to the conducting system begin. These consist of the atrioventricular bundle A7 or bundle of His, whose trunk, the trunk of atrioventricular bundle, penetrates the cardiac skeleton as it travels toward the ventricles. The atrioventricular bundle reaches the superior margin of the muscular interventricular septum on the side of the right ventricle and divides into right and left conduction bundle branches.

These travel bilaterally beneath the endocardium in the interventricular septum toward the apex of the heart. The right bundle AS curves downward and enters the septomarginal trabecula A9 to reach the anterior papillary muscle A Its peripheral branches are the subendocardial branches All which form a subendocardial plexus.

The plexus terminates in functional connections with the papillary muscles or the ventricular myocardium near the apex of the heart and then passes with recurrent bundles in the trabeculae cnrnece to reach the myocardium of the base of the heart. A few specialized cardiac muscle cells form pseudo-tendinous cords, Purkinje fibers, which pass to the papillary muscles.

The left bundle B12 fans out in flat bundles along the interventricular septum. These bundles are usually divided into two major bundles which proceed to the base of the papillalY muscles, branch off to form subendocardial networks, form functional connections with the ventricular myocardium near the apex of the heart, and travel as recurrent bundles to reach the myocardium of the base.

All components of the conducting system of the heart are theoretically capable of generating impulses. Pathological conditions can disrupt the conducting system of the heart. Diagnosis of abnormalities can be assisted by an electrocardiogram ECG. Innervation The heartbeat. Nerve supply to the heart A is derived from the sympathetic and parasympathetic parts of the autonomic nervous system.

Cardiac nerves carry autonomic efferent fibers as well as viscerosensory afferent fibers. Sympathetic innervation. Coursing posterior to the neurovascular bundle. Additional thoracic cardiac branches AS arise from the upper thoracic ganglia and likewise pass to the cardiac plexus. The cardiac nerves of the sympathetic nervous system carry postganglionic autonomic fibers whose preganglionic segments arise from the upper segments of the thoracic spinal cord. The sympathetic cardiac nerves also contain viscerosensory fibers particularly pain fibers whose perikarya lie in the cervical and thoracic spinal ganglia.

Stimulation of sympathetic cardiac nerves leads to an increased heart rate greater force of contraction and excitation. Parasympathetic innervation. The parasympathetic cardiac nerves arise from the vagus nerve A6. They branch off at various levels from the cervical portion of the vagus nerve as the superior A7 and inferior AS cervical cardiac branches and pass to the cardiac plexus.

The thoracic cardiac branches A9 also radiate from the thoracic portion of the vagus nerve and pass to the cardiac plexus. The vagal cardiac nerves contain mostly preganglionic autonomic fibers that synapse with postganglionic fibers in subepicardial neurons at the base of the heart.

The viscerosensory fibers of the parasympa-. Stimulation of parasympathetic cardiac nerves leads to decreased heart rate and force of contraction. Cardiac Plexus The sympathetic cardiac nerves and parasympathetic cardiac branches ramify and travel along the base of the heart where they join to form the cardiac plexus A4.

Based on topographical features the cardiac plexus can be divided into superficial A4ai and deep parts A4b. Embedded within the plexus are smaller and larger collections of nerve cells. The superficial. The deep. It contains fibers from the cardiac nerves on bott: The two portions of the cardiac plexus are interconnected and ultimately give off the true cardiac branches.

Al2 Superior cervical ganglion. A13 Middle cervical ganglion. Al4 Cervicothoracic ganglion. Al5 Thoracic ganglia. Al6 Recurrent laryngeal nerve. Pericardium Like all visceral organs that undergo significant changes in volume and displacement relative to adjacent organs, the heart is contained within a serous cavity, the pericardial cavity B.

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The pericardium AB1 encloses the heart and portions of the great vessels near its base. It consists of two components, an outer fibrous pericardium and an inner serous pericardium. The fibrous pericardium is a. The serous pericardium is a dual-layered closed system within the fibrous pericardium. Like all serous membranes it is composed of a parietal and a visceral layer.

The visceral layer or epicardium lies directly on the surface of the heart and roots of the great vessels. It turns back on itself to become the parietal layer B2 which lines the inner surface of the fibrous pericardium B3. Fibrous pericardium.

The fibrous pericardium is fused at various sites with surrounding structures, anchoring the heart in its position in the thorax. Its caudal portion is joined to the central tendon of the diaphragm.

Its anterior portion is attached by the stemopericardial ligaments, variable bands, to the posterior surface of the sternum B4. Thicker connective tissue bands also pass posteriorly to the trachea and vertebral column. Laterally, the fibrous pericardium is separated from the parietal layer of the pleural cavity by loose connective tissue. Serous pericardium. The parietal layer and visceral layer can only be visualized when the pericardial cavity is laid open.

This also reveals the lines of reflection between these two layers which form a cranial border around the superior vena cava A-e5 , aorta A-e6 , and pulmonary trunk A-C7. A segment of the aorta and pulmonary trunk about 3 cm long is contained within the pericardium. Shorter portions of the caudal part of the anterior wall of the inferior vena cava Be8 and the posterior walls of the. The sites of reflection are arranged to form two complex tubes e , one enclosing the aorta and pulmonary trunk at the arterial opening red line and the other enclosing the pulmonary veins and venae cavae at the venousopening blue line.

Lying between the tubes at the arterial and venous openings there is a groove, the transverse pericardial sinus arrow in C. The aorta and pulmonary trunk lie anterior to this passageway and the great veins lie posterior to it. The sites of reflection of the venous opening surround several recesses known as the pericardial recesses. Between the inferior pulmonary veins, the inferior vena cava Be8 and the posterior surface of the left atrium there is the large oblique pericardial sinus The pericardium is covered on its right and left sides by the pleura All.

Passing between the pleura and pericardium, the phrenic nerve A12 runs bilaterally accompanying the pericardiacophrenic artery AB and pericardiacophrenic vein. Blood supply and innervation.

Arterial blood supply to the pericardium is mainly provided by the pericardiacophrenic artery AB which arises from the internal thoracic artery. Innervation of the pericardium is provided by the phrenic nerve A12 , vagus nerve, and sympathetic trunk. Under pathological conditions, larger amounts of fluid can collect in the pericardial recesses pericardial effusion.

Following fibrinous infiammation adhesions between layers of the serous pericardium can form, potentially severely restricting motion of the heart. A rupture in the wall of the aorta can lead to a rapid outpouring of blood into the pericardial cavity.

A portion of the heart is in direct contact with the anterior thoracic wall. The posterior mediastinum extends between the posterior wall of the pericardium and the anterior surface of the thoracic vertebral column and contains large blood vessel and nerve pathways and the esophagus see p. Cardiac borders The mediastinum is bounded cranially at the level of the superior thoracic aperture Al. In the living body. The dimensions described in the following are based on the average adult. Cardiovascular Position Borders System: The borders of the heart projecting toward the anterior thoracic wall form a trapezoid.

The right border becomes continuous at the connection to the 6th rib with the contour formed by the right border and proceeds to the apex of the heart. For this reason. This indicates the true size of the heart. Although the percussion sound is clearer at this site than absolute cardiac dullness. The border between the superior and inferior mediastinum is determined by a transverse plane AS extending from the sternal angle. The inferior mediastinum is divided by the anterior and posterior wall of the pericardium into the anterior mediastinum blue-green.

In its normal position. Sternal percussion reveals an area of hypophonesis or absolute cardiac dullness. For the purposes of describing their location. Even in healthy individuals. Depending on the volume of air in the lung. The mediastinum can be divided into the superior mediastinum A red and inferior mediastinum A blue. It extends from the posterior surface of the sternum AJ to the anterior surface of the thoracic vertebral column A4 in the sagittal plane.

The superior mediastinum contains blood vessel and nerve pathways as well as the thymus see p. The continuation of this line cranially marks the right margin of the superior vena cava.

Its lateral boundary is formed by the mediastinal part of parietal pleura. The left border of the heart extends from its apex. The pleural cavity red extends from either side in front of the heart.

The anterior mediastinum is a narrow space filled with connective tissue between the anterior thoracic wall and the anterior surface of the pericardium. The heart and pericardium are located in the mediastinum. This line corresponds to the lateral profile of the right atrium. The middle mediastinum contains the heart and pericardium. The first heart sound arises during the contraction phase of systole from vibrations of the ventricular wall.

Because the heart shadow is continuous caudally with that of the diaphragm A7 and upper abdominal organs. Right side. Comparison of the radiographic image with the orientation of the heart projecting toward the anterior thoracic wall see p.

The contours of the heart and vessels in the mediastinal shadow normally consist of two curvatures on the right and four on the left. Heart Radiographic Anatomy Conventional radiography of the thorax is part of basic diagnostic testing for heart disease. Deep inspiration can cause the inferior vena cava to also appear at the lower right border. Posteroanterior View Most of the heart lies in the mediastinal shadow.

Pathological heart sounds can be produced by stenosis or valvular insuffi- ciency. The following auscultation sites. Below the aortic arch. The lower curvature.

Heart sounds or noises are best heard where the blood flow passing through the respective valve comes closest to the thoracic wall. The most common method is to visualize the heart on a chest radiograph teleradiography.

The second heart sound arises at the beginning of diastole with closure of the semilunar cusps of the aorta and pulmonary trunk.

The upper curvature on the left side of the heart is produced by the distal portion of the aortic arch A3. Auscultation Auscultation. Heart sounds are vibrations that are caused by the beating of the heart and transmitted to the thoracic wall. Left side. Located on either side of the mediastinal shadow are the lucent lung fields. Beneath this is a small and often barely distinguishable curve corresponding to the left auricle AS. Oblique and lateral views supplement the posteroanterior view.

Radiographic Anatomy and Auscultation of Heart 35 E! A Schematic illustration of heart radiograph B Projection of heart valves on anterior thoracic wall and auscultation sites. The most commonly used imaging plane is the transverse plane. Evaluation of sectional images proceeds from caudal with the patient lying in the supine position. The descending aorta lies directly adjacent to the inferior lobe of the left lung B Posterior to the bifurcation of the pulmonary trunk are sections through the left Bll and riglJt B12 main bronchi.

Imaging plane levels through the heart and thorax are marked in the illustration showing the position of the heart A. At the site of its ramification in the right lung B13 the right main bronchus is accompanied closely by a branch of the right pulmonary artery B2 while the root of the right pulmonary vein B14 runs at a greater distance branches from it.

Cross-Sectional Heart Anatomy Conventional radiography of the supplemented by cross-sectional made possible by modern imaging ties such as computed tomography heart is imaging. Posterior to the main bronchi is the section through the esophagus B Transverse Section through the 80dy at T6 8 The image is through the bifurcation of the pulmonary trunk Bl into the right pulmonary artery B2 and left pulmonary artery B3.

On the right side of the ascending aorta the superior vena cava B9 is seen. Anterior to the aorta and subepicardial adipose tissue is the pericardial cavity B6. Anterior to the pulmonary trunk is subepicardial adipose tissue 84 which extends to the right as far as the section through the ascending aorta B5.

On the imaged sections the vertebral column. Between the aorta and superior vena cava lies the transverse pericardia I sinus Bl0. Accompanying the of the main bronchi are bronchopulmonary lymph nodes B The following section presents examples of three anatomic. Cross-sectional Anatomy of Heart 37 j. On sections through the subepicardial adipose tissue 84 the right coronary artery and left coronary artery 85 can be identified. The sections through the left and right ventricle are easily distinguished by the varying myocardial thickness of the ventricles.

The posterior section of the heart is identified by the left atrium A7 which is found in the smooth-walled area of the opening of the inferior pulmonary veins A8. The close proximity of the left atrium to the esophagus 89 is depicted again. Curving around the right side of the aorta is the auricle A3 of the right atrium. The strong. The descending aorta lies on the left side of the esophagus along its posterior aspect.

Lying posterior and in close proximity to the left atrium the esophagus A9 is shown. The left ventricle forms the apex of the heart Anterior to the aorta. The interatrial septum can be identified between the two atria. On the left side in the subepicardial adipose tissue A4 near the aorta a section of the left coronary artery AS and left auricle A6 is seen. The anterior cusp of the tricuspid valve projects into the inflow tract of the right ventricle. Heart Cross-Sectional Anatomy.

The azygos vein is seen directly anterior to the vertebra. Cross-SectionalAnatomy of Heart. Common examinations use parasternal I. The left atrium Al and left ventricle A2 are on the right side of the image. The section shows how the anterior cusp of the mitral valve separates the inflow and outflow tracts of the left ventricle. Because the ultrasound transducer can be flexibly manipulated in various positions within a single acoustic window.

The importance of the apical long-axis view lies in its potential for assessing the function of the apical region of the heart.. This plane runs nearly parallel to the anterior and posterior wall of the heart through the inflow tract of both ventricles so that all four chambers of the heart are imaged simultaneously. The most important feature of this plane is the ability to visualize the changing position of the bicuspid and tricuspid valves relative to the membranous part of the septum.

It is also useful for evaluating the mitral valve. Four-chamber view A. In addition. Heart Cross-Sectional Echocardiography Echocardiography.

The four-chamber view is impor- tant for diagnosing congenital heart disease. The semilunar cusps of the aorta are also visible when the valve is closed. The four-chamber view can be obtained from an apical or subcostal transducer position. Apical long-axis plane B.

Two-dimensional 2-D echocardiography obtains pictures from different levels of the patient's heart and vessels in real-time. Ultrasound waves travel poorly through bone and are virtually unable to penetrate air. The ventricles can be readily distinguished as the myocardium of the left ventricle is much thicker than that of the right.

In the left ventricle the anterior cusp of the bicuspid valve can be identified. In this imaging plane. The inflow tract from the left atrium 81 to the apex of the heart.

In front of the aort is the outflow tract of the right ventricle This scan plane is obtained from the apical window for imaging the apical region of the left ventricle B2. Cross-Sectional Echocardiography 41 E j 3 A Anatomical section corresponding to echocardiographic four-chamber view 3 B Anatomical section corresponding to echocardiographic apical long-axis view. Proper functioning of the heart's pumping action relies on the intact coupling of the conducting system of the heart to the working myocardium.

The valvular plane El returns to its original position. After blood is ejected during the ejection phase. Nutrient blood supply to the myocardium. Atrial distention is an adequate stimulation for its release. The ventricles eject blood intermittently into the aorta and pulmonary trunk. This causes the atria to expand with a suction effect on venous blood from the venae cavae. During systole. Endocrine Function of the Heart The stretch-sensitive atria.

In systole the ventricles decrease in width and length. The pressure in the aorta and pulmonary trunk causes their valves to close in what is termed the isovolumetric relaxation phase E. For further information please see textbooks of physiology. Both the atrioventricular valves and semilunar cusps of the arteries are initially closed so that the volume of blood in the ventricles remains unchanged in what is termed isovolumetric contraction e.

Once the pressure in the ventricles exceeds that in the aorta and pulmonary trunk. During the ejection phase the valvular plane Dl. During this phase a portion of blood. In diastole the ventricles increase in length and width.

This hormone regulates vascular tone as well as sodium and water excretion from the kidneys. The volume of blood ejected during systole from the right or left ventricle 70 ml each is the stroke volume.

Contraction of the myocardium at the beginning of systole produces a rapid increase in pressure in the ventricles. During systole the coronary arteries are strongly compressed by contraction of the ventricular muscle. Once ventricular pressure falls below that of the atria. Already during ventricular diastole. Abdominal aorta. The subcostal artery runs below the 12th rib. The first branch arises on the right side as the cm long brachiocephalic trunk Al.

Along the left side of the mediastinum the left common carotid artery A4 and left subclavian artery AS emerge from the aortic arch. Descending Aorta Distal to the origin of the left subclavian artery. During embryonic development numerous variations involving the aortic arch can arise. The following parietal branches are given off by the abdominal aorta: Aortic arch. This gives rise to the great vessels supplying the head. The visceral branches include the celiac trunk A The mediastinal branches pass to the posterior mediastinum and the pericardial branches pass to the posterior aspect of the pericardium.

The ascending aorta I then curves to form the aortic arch II. Arising at some distance is the inferior mesenteric artery A The right subclavian artery. Originating about 1 cm distal to the celiac trunk is another unpaired trunk. It ascends obliquely to the right over the trachea and divides into the right subclavian artery A2 and right common carotid artery A3. The thoracic aorta gives rise to parietal branches segmentally that pass as the posterior intercostal arteries A7 to the intercostal spaces as well as numerous branches that supply the body wall and spinal cord and its meninges.

Arterial System Arterial System Aorta The aorta arises from the left ventricle of the heart and initially ascends behind the pulmonary trunk to the right. All arteries of the systemic circulation arise directly or indirectly from the aorta. The following branches arise directly from the aorta: Ascending aorta.

Arising from the aorta as paired visceral branches. The superior phrenic arteries are derived from the inferior portion of the thoracic aorta and are distributed to the diaphragm. The descending aorta can be divided into the thoracic aorta IIIa. Thoracic aorta. This gives rise to the right and left coronary arteries as the first branches of the aorta see p.

At the aortic bifurcation A20 at the level of L4. Also located at the bifurcation is a chemoreceptor organ. Its inferior portion is covered by the sternocleidomastoid. This arises medially from the external carotid artery above the superior thyroid artery and ascends along the lateral wall of the pharynx to the cranial base. Occipital artery A The highest posterior branch. This arises at the level of the hyoid bone as the first anterior branch of the external carotid artery and curves downward to the anterior surface of the thyroid gland.

This branches off just above the lingual artery and initially lies medial to the mandible and then crossing over the margin of the mandible before the insertion of the masseter. Major branches are the stylomastoid artery and posterior tympanic artery. Additional branches include the ascending palo tin artery AtS.Cross-Sectional Heart Anatomy Conventional radiography of the supplemented by cross-sectional made possible by modern imaging ties such as computed tomography heart is imaging.

Femoral Artery The femoral artery A 4 is the continuation of the external iliac artery distal to the inguinalligament. The diaphragmatic surface of the heart is chiefly formed by the left ventricle B1S. In addition to its two large cusps. It directs blood from the left atrium into the inflow tract of the left ventricle. E 10 2 11 12 A Popliteal artery 13 B Anterior tibial artery and dorsal artery of foot.

Modern imaging technologies allow the depiction of internal organ systems in a multitude of ways, making thorough knowledge of the anatomy of organ systems more crucial than ever for physicians and other healthcare practitioners. Instructor Ancillary Support Materials.