Dr. I Gusti Ayu Widianti, M.

Biomed
ANATOMY DEPARTMENT
UDAYANA UNIVERSITY

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Cardiovascular system
Circulatory System

The heart (cor)

System of blood vessel
System of lymphatics
 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 general design

Two major components:

The heart and system of blood vessels
Major functions:
Transport of oxygen and nutrients
Transport of CO2 and waste products
Two major divisions
Major or systemic circulation
Lesser or pulmonary circulation
 Lungs
Deoxygenated Oxygenated blood
Pulmonary
blood LA
RV
Heart
circulation
RA LV

Deoxygenated blood Systemic Oxygenated

(CO2 & waste blood (O2 &
products)
circulation nutrients)
Whole body

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

 Heart Aorta
Vena cava

Veins
Arteries 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
MEDIASTINUM:
1. The superior mediastinum : extends
inferiorly from the superior thaoracic 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
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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)
Three 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)
 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

 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
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 vessel (lymphatics)
Lymph nodes
Lymphocytes
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
The thoracic duct (ductus lymphaticus
sinister):
The remainder of the body
Both duct eventually open into the
corresponding subclavian veins
(venous angles)