The superior part of the heart is positioned at the sternal
angle. The apex is located at the 5th intercostal space
midclavicular on the left.
The heart is part of the mediastinum in the thorax. The mediastinum is the space between the left and
right pleural cavity. It runs from the thoracic inlet to the diaphragm and from the sternum to the
vertebrae.
It can be divided into 4 parts.
- Superior mediastinum
- Inferior mediastinum
o Anterior
o Middle
o Posterior
Superior and inferior are
separated at sternal angle.
Parts of many systems pass through the mediastinum.
Cardiovascular, nervous, respiratory, digestive and lymphoid.
→ werk uit welke delen precies en waar. Maak tekeningen
.
,The heart is surrounded by a pericardial cavity inside the
mediastinum. The cavity contains pericardial fluid and is
surrounded of a visceral and a parietal pericardium.
- visceral pericardium: in contact with the
myocardium of the heart
- parietal pericardium: the outer layer. Attached to
the diaphragm.
The two layers are connected. The transition from visceral
to parietal can be noted on two places.
- Transverse sinus
- Oblique sinus
Function pericardial cavity:
- Less friction
- Free movement in cavity
NB: fluid in cavity can build up due to trauma or infection of the
pericardium → compression of the heart. = cardiac tamponade.
Blood flow
Vena cava > right atrium > right ventricle > pulmonary trunk >
left atrium > left ventricle > aorta
NB: pulmonary artery only artery with deoxygenated blood
and pulmonary vein only vein with oxygenated blood.
Right atrium, most important structures
- inferior and superior vena cava → blood supply
- Auricle on anterior surface → volume increase
- Interatrial septum/ fossa ovalis → remnant of embryological heart. Originally connection between
left and right atrium
- Crista terminal → remnant of embryological heart. Originally junction between sinus venosus and
heart.
Right ventricle, most important structures
- Tricuspid valves/ right atrio-ventricular valves → valves between the right atrium and ventricle.
Made up of
o Septal
o Anterior
o Posterior
The free edges of the cusps are connected to the chordae tendineae. These fibers originate at the
papillary muscles.
- Pulmonary valve → semilunar valve from ventricle to pulmonary trunk
- Pulmonary trunk → artery to lungs.
Left atrium, most important structures
- Auricle on anterior surface → volume increase
- Pulmonary vein → blood supply
- Interatrial septum/ fossa ovalis → remnant of embryological heart. Originally connection between
left and right atrium.
, Left ventricle, most important structures
- Mitral/ bicuspid/ left atrio-ventricular valves → valves between left atrium and ventricle. Made up
of
o Anterior
o Posterior
The free edges of the two cusps are connected to the chordae tendineae. These fibers originate at
the papillary muscles. The chordae tendineae prevent fibrillation of the valves towards the atria →
prevention of backflow.
- Interventricular septum → wall separating the two ventricles
- Ascending aorta → artery for blood supply through body. The aorta is also closed off by semi-lunar
valves that prevent backflow.
Work out which valves are closed, and which are open during systole and diastole.
The valves can be heard at certain positions when listening with a
stethoscope.
Aortic valve = 2nd intercostal space parasternal on the right
Pulmonary valve = 2nd intercostal space parasternal on the left
Right AV valve = 5th intercostal space parasternal on the right
Left AV-valve = 5ht intercostal space parasternal on the left
Heart skeleton
The cardiac skeleton consists of 4 dense bands of tough elastic tissue
(anulus fibrosi) that encircle the valves and bases of the pulmonary trunk
and aorta. They anchor the valve and influences the forces going through
then.
- help stabilize the position of valves and ventricular muscle cells
- insulate the ventricular cells from the atrial cells. Allows pause
between contraction of atria and ventricles by reducing conduction.
Blood supply to the heart
Above the aortic semi-lunar valves are the openings to the coronary arteries.
These are positioned there to collect blood flow with less pressure from the
heart. The coronary arteries are not capable to withstand such high pressures
of the blood that is pumped into the aorta.
These arteries and veins are very susceptible for the formation of plaques on
the wall. This leads to occlusion, which results in damages heart muscles aka
heart problems.
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