Dr. I Gusti Ayu Widianti, M.

Biomed
ANATOMY DEPARTMENT
UDAYANA UNIVERSITY

08/28/15

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Cardiovascular system
Circulatory System
The heart (cor)
System of blood vessel
System of lymphatics

08/28/15

Heart disease
Malignant neoplasms
Cerebrovascular diseases,
Chronic obstructive pulmonary disease
Pneumonia and influenza
Accidents
Diabetes mellitus
Suicide, nephritis, chronic liver
disease, etc
etc
National Health Statistics,
1999

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The heart: Coronary artery disease

ischemic heart disease
myocardial infarction
The blood vessels: atherosclerosis
hypertension
varicose vein

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The general design

Two major components:

Major functions:

The heart and system of blood vessels

Transport of oxygen and nutrients
Transport of CO2 and waste products

Two major divisions

Major or systemic circulation

Lesser or pulmonary circulation

Lungs
Deoxygenated
blood

RV
RA

Deoxygenated blood
(CO2 & waste
products)

Oxygenated blood

Pulmonary
circulation
Heart

LA
LV

Systemic
circulation

Oxygenated
blood (O2 &
nutrients)

Whole body
RA=right atrium, LA=left atrium, RV=right ventricle, LV=left ventricle

Vena cava

Veins
Arteries

Heart

Aorta

Circulation

Venules
Arterioles

Capillaries small arteries

Venules=very small veins; arterioles=very

OVERVIEW OF THE CARDIOVASCULAR SYSTEM

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The Heart

A four-chamber, powerful, muscular pump

Divided into two halves: left heart & right
heart.

Left heart: left atrium & left ventricle

Receives oxygenated blood (arterial blood)
from the lungs
Distributes it to the whole body.

Right heart: right atrium & right ventricle

Receives deoxygenated blood (venous
blood) from the whole body, sends it to the
lungs.

The walls of the left ventricle is the thickest.

Is the central compartment of the

thoracic cavity
It does not contain the lungs
Extends :
from the superior thoracic aperture to the

diaphragm inferiorly
From the sternum and costal cartilages
anteriorly to the bodies of the thoracic
vertebrae posteriorly

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MEDIASTINUM:
1. The superior mediastinum : extends
inferiorly from the superior thoracic aperture to
the horizontal plane (transverse thoracic plane),
contains:

Superior venae cava

Brachiocephalic veins
Arc of aorta
Thoracic duct
Trachea
Esophagus
Thymus
Vagus nerve
Left recurrent laryngeal nerve
Phrenic nerve

2. The inferior mediastinum:

between the transverse thoracic plane
and the diaphragm

The anterior mediastinum contains:

remnants of the thymus, lymph nodes,
fat and connective tissue
The middle mediastinum contains: the
pericardium, heart, roots of the great
vessels, arch of azygos vein and main
bronchi
The posterior mediastinum contains the
esophagus, thoracic aorta, azygos and
hemiazygos veins, thoracic duct, vagus
nerve, sympathetic trunks and
splanchnic nerves

MIDDLE MEDIASTINUM
Boundaries:

left and right pleural cavities,

diaphragm,
anterior and posterior leaves of fibrous
pericardium, and
superior aspect of the left and right
pulmonary arteries
Contents:

Heart and pericardium

Roots of the great vessels
Arch of azygos vein
Main bronchi

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HEART
The wall consist of three layers:
Epicardium: a thin external layer
(mesothelium) formed by the visceral layer
of serous pericardium
Myocardium : a thick middle layer
composed of cardiac muscle
Endocardium: a thin internal layer
(endothelium and subendothelial
connective tissue) or lining membrane of
the heart that also covers its valves

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PERICARDIUM
Double-walled fibroserous sac, encloses the heart and the

roots of its great vessels

Pericardial cavity:
The potential space between the opposing layers of the
parietal and visceral of serous pericardium. It normally
contains a thin film of serous fluid that enables the heart to
move and beat in a frictionless environment
Transverse pericardial sinus :
Posterior aorta & pulmonary trunk
Anterior SVC
Oblique pericardial sinus
SCV, IVC and pulmonary veins

EXTERNAL HEART
STRUCTURE

Boundaries:
Apex of the heart
apex beat
Base of the heart----the hearts posterior
aspect
Four surfaces of the heart
Four borders of the heart

Apex of the heart:

Is formed by the left inferolateral part of

the left ventricle
Is located posterior to the left 5th
intercostal space in adults, usually 9 cm
from the median plane
Is where maximal pulsation of the heart
(apex beat).

Base of the heart:

Is the hearts posterior aspect (opposite

the apex) as it lies in the thorax
Is formed mainly by the left atrium , with
a lesser contribution by the right atrium
Faces posteriorly toward the bodies of
vertebrae T6 through T9
Extends superiorly to the bifurcation of
the pulmonary trunk and inferiorly to the
coronary groove (sulcus)

Four surfaces of the heart:

Anterior (sternocostal) surface, formed

mainly by the right ventricle
Diaphragma (inferior) surface, formed
mainly by the left ventricle and partly by the
right ventricle, is related to the central
tendon of the diaphragm
Left pulmonary surface, formed mainly by
the left ventricle, it formed the cardiac
impreeion of the left lung
Right pulmonary surface, formed mainly by
the right atrium

Four borders of the heart:

Right border (vertical, slightly convex), formed by

the right atrium and extending between the SVC and
IVC
Inferior borders (nearly horizontal), formed mainly
by the right ventricle and only slightly by the left
venricle
Left borders (oblique, nearly vertical) formed mainly
by the left ventricle and slightly by the left auricle
Superior borders, formed by the right and left atria
and auricles in an anteriorly view, ascending aorta
and pulmonary thrunk emerge from the superior
border, and the SVC enter its right side.

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Heart

Divisions:
Four chambers:
- right and left atria
- right and left ventricles
The right atrium:
superior & inferior
vena cava
coronary sinus
The right ventricle:
the largest portion
of the anterior (sternocostal) surface

Coronary arteries (RCA and LCA):

The first branches of the aorta
Arises from the corresponding aortic

sinuses at the proximal part of the

ascending aorta, just superior to aortic
valve
Supply the myocardium and epicardium

Coronary arteries: supply both the atria

and ventricles, however the atrial
branches are usually small

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The heart is drained mainly by veins

that empty into the coronary sinus
and partly by small anterior cardiac
veins that empty directly into the right
atrium and the other chambers
(smallest cardiac veins)

SA node: pacemaker of the heart, is located

anterolaterally just deep to the epicardium
at the junction of the SVC and right atrium

AV node is smaller collection of nodal tissue

located in the posteroinferior region of the
interatrial septum near the opening of the
coronary sinus.

 The impuls SA node : conducted to

cardiac m. fibers in the atria, causing
them to contract.
The impuls spreads by myogenic
conduction that rapidly transmits the
impuls from the SA node to the AV node.
From the AV node through the AV bundle
and the right and left bundle branches (on
each side of the IV septum) to supply
subendocardial branches to the papillary
m. and the wall of the ventricle

Sinoatrial node (sinus node)

Conduction through the atrial wall

A-V node (atrioventricular node)

A-V bundle (bundle of His)
Purkinje fibers

Right & left branches

INNERVATION OF HEART :
Autonomic

nerve fibers (from

superficial & deep cardiac plexuses)
sympathetic :
sympathetic stimulation : increase HR &
contraction (tachycardia), dilatasi coronary a.

Parasympathetic :
parasympathetic stimulation : slow HR, reduces
heart beat (bradycardia), constric coronary a. ,
saving energy

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Two most common sites:

In the side of the neck: carotid pulse by
palpating the common carotid artery
At the wrist: radial pulse by palpating
the radial artery

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Lymphatic plexuses
Lymphatics
Lymph nodes
Aggregations of lymphoid tissue
Circulating lymphocytes

The ground plan of lymphatic

drainage
Right

lymphatic duct (ductus

lymphaticus dexter):
The right halves of head, neck and
thorax, and the right upper limb
Left lymphatic duct = The thoracic
duct (ductus lymphaticus sinister):
The remainder of the body
Both duct eventually open into the
corresponding subclavian veins
(venous angles)