thorax,heart. Presentation for student.pdf

Thorax , heart anatomy

10. Blood supply
internal thoracic
pericardiacophrenic
Musculophrenic
inferior phrenic
thoracic aorta
Vein drainage
azygos system
internal thoracic
superior phrenic veins
Innervation
vagus nerve [X]
sympathetic trunks
 phrenic nerves.

11. Constrictive pericarditis
Abnormal thickening of the pericardial sac
usually involves only the parietal pericardium, but can also less frequently
involve the visceral layer, can compress the heart, impairing heart
function and resulting in heart failure




Diagnosis:
In normal individuals, the jugular venous pulse drops on inspiration. In patients with
constrictive pericarditis, the reverse happens and this is called Kussmaul’s sign

16. Base of heart:
vertebrae TV to TVIII
TVI to TIX when
standing

29. Mitral valve disease
■ left ventricular hypertrophy (this is appreciably less
marked in patients with mitral stenosis);
■ increased pulmonary venous pressure;
■ pulmonary edema; and
■ enlargement (dilation) and hypertrophy of the left
atrium.
Necrosis of a papillary muscle following a myocardial
infarction (heart attack) may result in prolapse of the
related valve.

36. Right coronary artery
The right coronary artery supplies the right atrium
right ventricle
 sinu-atrial and atrioventricular nodes
 interatrial septum, a portion of the left atrium
posteroinferior one third of the interventricular
septum

40. Cardiac veins
Great cardiac vein
Middle cardiac vein
Small cardiac vein
Posterior cardiac vein
The anterior veins of the right ventricle
(anterior cardiac veins)
smallest cardiac veins (venae cordis
minimae or veins of Thebesius)

43. Coronary lymphatics
brachiocephalic nodes, anterior to the
brachiocephalic veins
 tracheobronchial nodes, at the inferior end of the
trachea.

44. Cardiac conduction system

45. Cardiac innervation

46. Cardiac innervation
Parasympathetic innervation
Stimulation of the parasympathetic system:
■ decreases heart rate,
■ reduces force of contraction, and
■ constricts the coronary arteries.
Sympathetic innervation
Stimulation of the sympathetic system:
■ increases heart rate, and
■ increases the force of contraction.

47. Visceral afferent
afferents associated with the vagal cardiac
nerves return to the vagus nerve [X]:
They sense alterations in blood pressure and blood
chemistry and are therefore primarily concerned
with cardiac reflexes.
afferents associated with the cardiac nerves from
the sympathetic trunks(T1-T4):
Conduct pain sensation from the heart

48. Using the superior vena cava to access
the inferior vena cava
■ transjugular liver biopsy
■ transjugular intrahepatic
portosystemic shunts (TIPS),
■ insertion of an inferior vena cava
filter to catch emboli dislodged from
veins in the lower limb and pelvis
(i.e., patients with deep vein
thrombosis [DVT]).

49. Superior mediastinum
■ thymus,
■ right and left brachiocephalic veins,
■ left superior intercostal vein,
■ superior vena cava,
■ arch of the aorta with its three large branches,
■ trachea,
■ esophagus,
■ phrenic nerves,
■ vagus nerves,
■ left recurrent laryngeal branch of the left vagus nerve,
■ thoracic duct, and
■ other small nerves, blood vessels, and lymphatics.

53. In infants and children the left brachiocephalic vein rises above the superior border of
the manubrium and therefore is less protected.

62. Posterior mediastinum
■ esophagus and its associated nerve plexus,
■ thoracic aorta and its branches,
■ azygos system of veins,
■ thoracic duct and associated lymph nodes,
■ sympathetic trunks, and
■ thoracic splanchnic nerves.

64. Branch of thoracic aorta
Pericardial branch
Bronchial branch
Esophageal branch
Mediastinal branch
Pos. intercostal branch
Sup. Phrenic branch
Subcostal branch

68. Tributaries of the azygos vein
include:
■ the right superior intercostal vein
■ fifth to eleventh right posterior intercostal veins,
■ the hemiazygos vein,
■ the accessory hemiazygos vein,
■ esophageal veins,
■ mediastinal veins,
■ pericardial veins, and
■ right bronchial veins.

69. Azygos
T4=SVC
Hemiazygos
T9=Azygos
Accessory hemiazygos
T8=azygos