The Middle Mediastinum:

Pericardium & Heart

Mediastinum
The space between 2 lungs Sup.: thoracic inlet Inf.: diaphragm Ant.: sternum & 2-6 CC Post.: thoracic vertebrae

By Imaginary line superior & inferior mediastina

Divisions
2 divisions by imaginary line: sternal angle T4-T5

Superior:
Ant.: manubrium Post.: T1-T4 Sup.: ?? Inf.: ??

Inferior:
Ant.: sternal body Post.: T5-T12 Sup.: ?? Inf.: ??

Inferior Mediastinum
3 parts:
Ant.: from sternum heart covering (pericardium)
Middle: heart & pericardium Post.: post. to heart

Pericardium

Pericardium
Covering fibroserous sac of 2 layers of tissues that encloses the heart Outer: fibrous (fibrous pericardium) Inner: serous (serous pericardium)

Fxn.: 1. Protection

2. Lubrication (friction)

Fibrous Pericardium
Strong single layer Attached: Ant.: sternum (sternopericardial lig.) Inf.: diaphragm (central tendon) Sup.: fuse to great vessels (t. adventitia) Sensory innervations by phrenic nerve (very sensitive) What are the cervical spinal segments of the phrenic nerve origin?

Serous Pericardium
2 layers of mesothelial cells that are continuous with each other Outer (Parietal): lines over fibrous pericardium reflects around the roots of large vessels to become continuous with Inner (Visceral): closely attached to the heart Epicardium (outer heart layer)

Review
Sup & Inf mediastinum Inf middle: pericardium & heart Fibrous: Protection Serous: Lubrication visceral epicardium

Heart
Read Your Textbook For Details

3 layers

4 chambers
3 borders (examining X-ray) 3 surfaces

Apex & Root

Heart Surfaces
1. Anterior (sternocostal): Rt. Atrium, Rt. V., Lf. V., ant. intervent. groove 2. Inferior (diaphragmatic): Rt. & Lf. Vs, & post. interventricular groove 3. Posterior: Lf. Atrium Base of the heart 4. Apex: part of Lf. V. (lf. 5th intercostal space, 9 cm from ??) 5. Root: origin of great vessels (aorta, pulmonary trunk, SVC)

Posterior Surface

Inferior Surface

Anterior Surface

Site for posterior surface of the heart (Base)

Site for inferior surface of the heart (Diaphragmatic)

Right Atrium
Read Your Textbook For More Details - Receives deO2 bld. From the body - Forms Rt. Border of the heart - Composed of: smooth walled chamber & rough out pouch (auricle)

Rough = pectinate muscle

- Border between: crista terminalis Outside: sulcus terminalis - Atrial septum (fetal remnants): Fossa ovalis Anulus ovalis

Openings of Rt. Atrium

1. SVC: bld. from upper body 2. IVC: bld. From lower body / larger

3. A-V orifice: Ant. to IVC Guarded by tricuspid valve 4. Coronary Sinus: Between IVC & A-V orifice Bld form heart wall 5. ant. cardiac veins

Rt. Ventricle
Read Your Textbook For More Details Crescent shaped from inside (cross-section) 3 muscular projections: 1. Papillary muscles: Finger-like projections Attach the cusps of A-V valve via Chordae tendineae

2. Moderator band: inf. septal wall base of ant. Papillary muscle contains nervous bundle to Rt. Ventricular wall 3. Trabeculae carneae: prominent muscular ridges

Openings
A-V orifice:
guarded by tricuspid valve

Pulmonary opening:
smooth funnel-shaped wall (infundibulum)
infundibulum = conus arteriosus

guarded by pulmonary valve

Lf. Atrium
Most of the posterior wall

Small lf. Auricle (muscular ridges)

Usually 4 openings for P. V.& 1 for mitral valve

Left Ventricle
Wall 3x thicker than Rt. V. Circular in cross-section 2 large papillary m. (groups)

Aortic vestibule: smooth surface inf. to aortic valve No moderator band

Heart Position
Behind the sternum & slightly to the left strong sounds = left to the sternum
Dextrocardia: The heart is on the right side of the chest heart sounds = right to the sternum - 1 in 12,000