Pericardium external features

pericardium

1. Pericardium and External Features of Heart

2. Life support Feeding Tubes Ionotropes Total Parenteral Nutrition Mechanical ventilation Heart / Lung bypass Urinary catheterization Dialysis Cardiopulmonary resuscitation Defibrillation Artificial pacemaker

3. Vitals Heart Lungs Brain Temperature Respiratory Rate Heart Rate (Pulse) Blood Pressure Assessment of the level at which an individual is functioning

4. Thoracic organs Heart Lungs Thymus (Till puberty) Heart attack / Myocardial infarction is one of the common causes of sudden death

5. Development of Heart Lateral plate mesoderm Single heart tube Initially antero -posterior axis Attached by arterial and venous ends Folds ventrally and bulges in 5 regions Truncus arteriosus Bulbus cordis Primitive ventricle Primitive atrium Sinus venosus

6. Gross structure Two atria Two ventricles Aorta Pumonary Trunk – Pulm . Arteries Pulmonary veins Sup & Inf. Vena cava Conduction system SA Node AV Node Purkinje Fibres

7. Heart functions rhythymically inspite of : Located among other structures in a fixed Thoracic cage Lungs expanding & contracting with Respiration Diaphragm moves from below Post vertebral column moves in various Postures Oesophagus ballooning during ingestion of food Beating 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/vomiting etc.

8. Pericardium Conical fibrous sac Contains heart & roots of great vessels Situated - - in middle mediastinum - behind body of sternum and 2 nd to 6 th costal cartilages - In front of bodies of 5 th to 8 th thoracic vertebrae

9. Components Outer fibrous sac Inner serous sac Heart lies within fibrous pericardium (Intra fibrous) outside serous pericardium (extra serous) Fibrous pericardium Cone shaped bag Truncated apex Keeps heart in position Prevents over distension of heart Open sac pierced by some blood vessels

10. Attachments Above Blends with ext. coat of aorta and Pulm.trunk Continuous with pre-tracheal fascia Below Fuses with upper surface of central tendon and part of Musculature of left part of diaphragm (Heart & Diaphragm develop from septum transversum ) In front Attached to sternum by Superior & Inferior sterno -pericardial ligaments Structures piercing Asceding aorta, Sup. & Inf. Venacavae Rt. & Lt. Pulm . Arteries $ Pulm . Veins

11. Relations In front Ant. Thoracic wall separated by ant. margins of both lungs & Pleura Below Lt. 4 th costal cartilage pericardium comes in direct contact with Lt. half of lower two pieces of body of sternum 3. Before puberty thymus forms ant. Relation

12. Relations Behind Forms ant. boundary of post. Mediastinum Rt and Lt. bronchi Oesophagus , oesophageal plexus Descending thoracic aorta Thoracic duct Azygos & Hemiazygos veins Post. Part of mediastinal surface of lungs

13. Relations On each side Cardiac impression of corresponding lung separated by mediastinal pleura 2. Phrenic nerves and pericadiaco phrenic vessels ( Br.of Int.Thoracic a.) between pleura a nd pericardium

14. Relations Below Left lobe of liver and fundus of stomach separated by diaphragm

15. Serous pericardium Closed sac Lies within fibrous pericardium Heart projects into fibrous pericardium From above and behind Parietal and visceral layers Potential space - capillary layer of fluid (300 ml max. can be accommodated) Parietal layer Lines inner surface of fibrous Pericard ium and blends with it. Visceral layer Covers heart and roots of great vessels Separated from myocardium by subserous areolar and fatty tissue

16. Serous pericardium Continuity between parietal & visceral Layers is established in 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

17. Transverse Sinus Passage between two tubular reflections of serous Pericardium Lined by visceral layer only In front – Ascending aorta & Pulm . Trunk Behind – intra pericardial part of sup.venacava Above – bifurcation of Pulm . Trunk Below – upper surface of left atrium Primitive arterial end ( Truncus arteriosus ) Primitive venous end

18. Oblique Sinus Cul-de-sac behind left atrium Closed on all sides except below It lies within the limbs of inverted “J” In front – Left atrium Behind – parietal layer covering post. Of Fib.Pericardium Right side – Rt.Pulm . Veins & Inf.Venacava Left side – Left Pulm . Veins Above – upper margin of left atrium

19. Blood supply Fibrous & Parietal layers Arterial supply Fibrous & parietal layer – Branches of Int. Thoracic art. - Descending aorta Visceral layer - Coronary arteries Venous drainage Fibrous Parietal layer - Azygos - Int.Thoracic veins Visceral layer - Coronary sinus Nerve supply Fibrous & Parietal layers - Phrenic nerve Visceral layer - Vagus & Sympathetic nerves via coronary plexus

20. Applied anatomy Clinical importance of transverse sinus Ligature around aorta and pulm . Trunk to control to control haemorrhage in cardiac surgery Pericardial tamponade – pericardial effusion Blood or serous – compresses heart – decreases diastolic capacity Paracentisis of pericardial effusion - subcostal route ( Costo-xyphoid angle 45 deg upward) - Parasternal route (Left 4 th / 5 th interspace close to sternum)

21. External features Hollow conical muscular organ Situated in mid. Mediastinum Covered by pericardium Size of clenched fist 4 chambers 2 atria - interatrial septum 2 ventricles – intervent . Sep.

22. External features Rt.atrium receives deoxygenated blood Via Sup. & Inf. venacavae , and coronary sinus. Thru’ Rt. atrioventricular orifice To – Rt. Ventricle Ejected to Pulm . Trunk To Pulm . Capillary plexus for oxygenation Pulmonary circulation To Left atrium Via 4 pulmonary veins Thru’ Lt. atrioventricular orifice To Left ventricle Ejected to ascending aorta for Systemic circulation

23. External features Measurements Apex to base – - 12 cms Antero-post diameter - 6 cms Widest 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 Presenting parts Apex Base 3 surfaces – Sternocostal , diaphragmatic & Left 3 borders - Right, Inferior & Left

24. External features Apex Conical area formed by left ventricle Directed downwards, forwards and to left In 5 th intercostal space 9 cms from midline Slightly below & medial to left nipple Separated from ant.thoracic wall by left lung & pleura Base Posterior surface – fixed part of heart Quadrilateral in outline Formed 2/3rds by post. Surface of left atrium & 1/3 rd by Rt. Atrium

25. External features Base

26. External features Boundaries of base Above Bifurcation 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 cava Lt. side Left border of left atrium from upper to lower Lt. pulm . veins

27. External features Features of the Base SVC opens in upper post part of Rt.atrium IVC opens in lower post part of Rt.atrium 4 Pulm . Veins 2 on each side open in Post. Surface of Lt. atrium A shallow vertical inter atrial groove may be found between 2 atria – Post. Attachment of Inter atrial septum

28. External features Right border Rounded and convex Formed by Rt. Atrium Extends from Rt. Side of opening of SVC to IVC The border separates base from Sternocostal surface Shallow vertical groove accpmanies Rt. Border – Sulcus terminalis Corresponds to Crista terminalisin the Interior of Rt. atrium

29. External features INCISURA APICIS CORDIS Inferior Border Sharp Separates sternocostal from diaphragmatic Surfaces Extends from opening of IVC to apex Border accompanied by marginal branch of Rt. Coronary artery and vein Notch near apex – Incisura apicis cordis Ant. Interventricular br. of left coronary curves around it.

30. External features Left Border ILL defined convex Convexity to left and upwards Separates sternocostal from left surface Extends from left auricle to apex Accompanied by marginal br. of Lt. coronary artery.

31. External features Sterno – costal surface Directed forwards and upwards Separated From base to by Rt. Border From diaphragmatic surface by Inf. Border From Left surface by Left border Formed by Ant. Surface of Rt. atrium & its auricle Part of ant. Surface of Lt. auricle Ant. Surface of Rt. Ventricle (2/3) Ant. Surface of left ventricle (1/3)

32. External features Features of Sterno -Costal Surface Ant. Part of atrio -ventricular groove Passes downwards & to right between Rt. Atrium & Rt. Ventricle Lodges trunk of Rt. Coronary artery Ant. Interventricular groove passes downwards parallel to left border meets inf. Border at incisura . The groove lodges ant. Interventricular br. of Lt. coronary artery & great cardiac vein Indicates ant. attachment of interventricular septum

33. External features Left border Inferior border Right border Diaphragmatic or Inferior Surface Flat Face downwards and backwards Formed only by ventricles 2/3 left ventricle & 1/3 rd by Rt. Ventricle Separated From Sternocostal surface by inf. Border From the base by the post. Part of Interventricular groove From left surface by less defined unnamed border which is backward Continuation of inferior border

34. External features Left border Inferior border Right border Features of Inferior Surface Post. Interventricular groove runs forwards along this surface & meets incisura epi.cordis Groove indicates post. attachment of Interventricular septum Groove lodges post. Interventricular br. of Rt. Coronary artery Middle cardiac vein Anastomosis of interventricular branches of Both coronary arteries

35. External features Left Surface Directed upwards backwards and to left Formed mainly by left ventricle and Partly by left atrium & Left auricle Features Left part of atrioventricular groove intervenes between Lt. auricle and lt. ventricle This groove lodges – Trunk and cicumflex br. of left cor. art. Termination of great cardiac vein Commencement of coronary sinus

36. Points of observation Apex formed by left ventricle Base formed by 2 atria Rt. Border formed by Rt. Atrium Diaphragmatic surface formed by 2 ventricles Base - 2/3 lt. atrium 1/3 Rt. Atrium Diaphragmatic 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

37. If an elderly in your house suffers from chest pain Do not browse net from your cel to verify which Doctor can diagnose the illness But; equip yourself with sufficient Knowledge to save your own kith and kin first. Only gratitude you can return to your “well-wishers” And it is the ultimate pride and their ambition