ANATOMY OF

CARDIOVASCULAR SYSTEM

MUH.IQBAL BASRI
DEPARTMENT OF ANATOMY
HASANUDDIN UNIVERSITY

Email: iqbal@med.unhas.ac.id or
muh_iqbalbasri@yahoo.com
Our Topics..
Thorax
Pericardium
Cor
Anatomy of The conducting system
Innervation cor
Vascularisation cor
Aorta and Vasa pulmonalis
THORACIC WALL
Bones of the Thoracic Wall :
sternum, ribs and costal cartilages.
Sternum : the manubrium, the body
and the xiphoid process.
The sternal angle (angle of
Louis) is formed by the articulation
of the manubrium with the body of
sternum.
 SKELETON OF THORAX
WALL

Ventral :
- Sternum
- Costae I XII
Dorsal :
Vertebra
Thoracalis I
XII
Importance of sternal
angle
1. The second costal cartilage
2. The intervertebral disc between the
fourth and fifth thoracic vertebrae
3. The junction of ascending aorta and the
aortic arch & the junction of the aortic
arch and the descending thoracic aorta
4. The bifurcation of the trachea
5. The junction of the superior mediastinum
& the inferior mediastinum.
Clinical Notes
Sternum and Marrow Biopsy :
Because the sternum possesses red
hemopoietic marrow throughout life,
the body of the sternum is a common
site for marrow biopsy.
Clinical Notes
Sternal Angle As an Important
Clinical Bony Landmark :The
position of sternal angle,the angle
between the manubrium sterni and
the body of sternum, can be easily
felt and is often seen as a transverse
ridge.It lies at the level of the 2nd
costal cartilage and second rib. All
other ribs and costal cartilages can
be counted from this point.
 MUSCLES OF THORACIC
WALL
M. Serratus posterior
superior
M. Serratus posterior
inferior
M. Intercostalis
Externus
M. Intercostalis Internus
M. Subcostalis
M. Transversus
thoracalis
Nerves of Thoracic Wall
The anterior rami of the first eleven
thoracic spinal nerves.
1st intercostal nerve: joins the
anterior ramus of the 8th cervical
nervebrachial plexus
2nd intercostal nerve: joined to the
medial cut.nerve of the arm by
intercostobrachial nerve skin of
armpit and the upper medial side of
the arm.
 LINEA ON THORACIC WALL

Linea mediana anterior

(ventralis)
Linea sternalis
Linea mammilaris
(=linea
medioclavicularis)
Linea parasternalis
Linea axillaris
Clinical Notes
CORONARY HEART DISEASE AND
THE INTERCOSTOBRACHIAL
NERVE: in coronary heart disease
pain is often referred along the
intercostobrachial nerve to the
medial side of the arm.
Mediastinum
An interpleural partition that extends
superiorly to the thoracic outlet and
the root of the neck and inferiorly to
the diaphragm.
Divided into superior and inferior
mediastina
Mediastinum inferior: anterior,middle
and posterior mediastina.
Middle mediastinum consist of
pericardium and heart.
 MEDIASTINUM
SUPERIUS
MEDIASTINUM
INFERIUS
MEDIASTINUM INFERIOR

MEDIASTINUM
ANTERIOR
MEDIASTINUM
MEDIUS
MEDIASTINUM
POSTERIOR
Pericardium (1)
A fibroserous sac that encloses the heart
and the roots of the great blood vessels
Consist of :fibrous pericardium and
serous pericardium.
Fibrous pericardium:strong, limit
unnecessery movements of the heart
Serous pericardium:parietal and visceral
layer(epicardium) slitlike space between
parietal &visceral layer (pericardial
cavity)
Pericardium (2)
Pericardial fluid: small amount (normal), as
lubricant to facilitate cardiac movements.
Pericardial sinuses: formed by reflection
of the serous pericardium transverse
sinus and oblique sinus
Transverse sinus: between artery and vein
Oblique sinus: between venae cavae and
four pulmonary veins.
Innervation : Phrenic nerve
Pericardium
Serous membrane
lining the pericardial
cavity
Analogous to a fist in a
balloon
Subdivided into visceral
and parietal
pericardium
Visceral layer (brown
arrow) is the outer
layer of the heart
itself a.k.a. the
epicardium
Parietal layer (red
arrow) lines the
inner portion of the
pericardial sac and
is deep to a
meshwork of
collagen fibers that
stabilize the position
of the heart
Pericardium
Space btwn the visceral &
parietal layers is the
pericardial cavity.
Normally contains 10-
20mL of pericardial fluid
secreted by the
membranes
A variety of pathogens may
infect the pericardium,
causing pericarditis.
Pericardial irritation and
inflammation results in an
in pericardial fluid production
which limits the movement
of the heart. Known as
cardiac tamponade.
 Sinus
transversus
pericardii

Sinus obliqus
pericardii
HEART
A muscular organ within the
pericardium
It lies in the middle mediastinum
It has four chambers: right and left
Atria, right and left ventricles.
It has three surfaces: sternocostal,
diaphragmatic and the base.
The wall consist of 3 layers:
epicardium, myocardium and
endocardium.
COR
(=Cordis, cardia ,heart)
Location in Thorax
MORFOLOGI COR
Basis cordis
Facies sternocostalis
Facies sinister
Facies diaphragmatica
Position :
Basis on cranial
Apex on caudal
2/3 parts in left
linea mediana
Axis cordis :
from basis to
apex
Oblique from
craniodorsal to
caudoventral
 APEX CORDIS
Part of ventriculus
sinister
Position :
Left intercostal
Space V
9 cm from linea
mediana
2 fingers medial
linea
medioclavicularis
sinistra
BASIS CORDIS
cranialis : toward right craniodorsal
Formed by:
- atrium sinistra anddextra
- proximal part: Great vessels
Adult cor:
size : l = 12 cm, w =
8-9 cm, h = 6 cm
Weigh: men: 280-340
gr , women= 230-280
gr
Gross Anatomy of Heart: Frontal
Section

Figure 18.4e
 Chambers
atrium dextra
atrium sinister
ventriculus dexter
ventriculus sinister
 ATRIUM DEXTER
Bigger than sinister
Thin wall
2 parts : Sinus venorum
& auricula dextra
There is auricula dexter

openings :
- Vena cava superior
- Vena cava inferior
- Sinus coronaries
- Right atrioventricular orifice
Blood Flow
back to the
Heart
Blood high in CO 2
and low in O2
arrives at the RA
from 3 vessels:
Superior Vena Cava
Drains head, upper
torso, and arms
Inferior Vena Cava
Drains abdomen,
pelvis, and legs
Coronary Sinus
Drains coronary
circulation
AURICULA DEXTRA
The part of the atrium posterior to
the ridge is smooth walled, whereas
the interior of the auricle is
roughened by bundles of muscle
fibers (MUSCULI PECTINATI)
 ATRIUM SINISTER

auricula sinistra
vena pulmonalis
Between Atrium Sinister & Dextra

SEPTUM INTERATRIORUM
(=septum atriorum)

remain FORAMEN OVALE

(FOSSA OVALIS)
 VENTRICULUS DEXTER
Ostium atrioventriculare
dexter with 3 cusps
(VALVULA
TRICUSPIDALIS)
Chordae tendinae
Trabeculae carnae
M. papillaris
A. Pulmonalis
 Valves
Semilunar Valves:
Pulmonary Semilunar Valve
Prevents backflow of blood from pulmonary artery into
RV
Aortic semilunar valve
Prevents backflow of blood from aorta into LV
VENTRICULUS SINISTER
form apex cordis
wall 3 x thicker
Ostium Atrioventriculare sinister 2
cusps (VALVULA BICUSPIDALIS =
VALVULA MITRALIS)
Chordae tendinae
Trabeculae carnae
M. papillaris
 Atria have thin flaccid
walls corresponding to
their light workload. Why
is it light?
Right and left atria are
separated by the
interatrial septum.
RA and both auricles
exhibit internal ridges of
myocardium called
pectinate muscles. S
The thick interventricular E
septum separates the LV P
and RV. T
U
LV is 2-4x as thick as the M
LV
RV because of its large
workload. RV
Both ventricles exhibit
internal muscular ridges
known as trabeculae
The walls of the
heart:
Epicardium (outer):
visceral layer of
serous pericardium
Myocardium
(middle): thick
layer, cardiac
muscle
Endocardium
(inner): thin layer
THE CONDUCTING
SYSTEM
nodus sinuatrialis
(= keith-flack)
nodus
atrioventricularis
(= aschoff-
tawara)
fasciculus
atrioventricularis
Blood Supply of The Heart
ARTERIAL SUPPLY
Right Coronary Artery:arises from the
anterior aortic sinus of the ascending aorta,
descends in the right atrioventricular groove, it
ends by anastomosing with the left coronary
artery (posterior interventricular groove)
Left Coronary Artery: the left posterior aortic
sinus of the ascending aorta, larger, in the
atrioventricular groove,divides into an anterior
interventricular branch & a circumflex branch.
Right dominance, Left dominance
Right Coronary Artery
Branches:
The right conus artery
The anterior ventricular branches (2-
3) the marginal branch (largest)
The posterior ventricular branches
(2)
The posterior interventricular
(descending ) artery
The atrial branches
Left Coronary Artery
BRANCHES:
The anterior interventricular
(descending) branch
The circumflex artery: around the left
margin of the heart in the
atrioventricular groove.
Venous drainage
Most of veins drains into the right
atrium through coronary sinus.
The remainder drains directly into
the right atrium through anterior
cardiac vein and small veins
(venae cordis minimae)
Venous drainage
Coronary Sinus
Great Cardiac vein
Middle Cardiac Vein
Small Cardiac Vein
Anterior Cardiac Vein
AORTA
AORTA ASCENDENS: a.coronaria
sinistra and a.coronaria dextra
ARCUS AORTA
AORTA DESCENDENS (=AORTA
THORACALIS)
Continous with ARTERI ABDOMINALIS
 a.Carotis communis sinistra

Arteri Anonyma
a.Subclavia sinistra
Arcus aorta
Aorta descendens
Aorta ascendens

a.Coronaria sinistra
a.Coronaria dextra
 ARCUS AORTA
a. anonyma (=truncus
brachiocephalicus)
a. carotis communis sinistra
a. subclavia sinistra
 A. ANONYMA
Branches:

A. CAROTIS COMMUNIS DEXTRA

A.SUBCLAVIA DEXTRA
 CIRCULATION
SYSTEMIC CIRCULATION
PULMONALE CIRCULATION
CORONARY CIRCULATION
COR AORTA ARTERI ARTERIOLE
CAPILER JARINGAN
capiler venule vena vena
cava superior et inferior-cor
SYSTEMIC CIRCULATION
Left ventricle - Aorta ascendens
arcus aortae aorta descendens (=
aorta thoracalis ) aorta abdominalis
arteria iliaca communis a.iliaca
interna-a.ilica externa a.femoralis
a.poplitea a.tibialis anterior
a.tibialis posterior a.dorsalis pedis
ALIRAN DARAH VENA :

EXTREMITAS INFERIOR : vena saphena

magna-v.saphena parva v.femoralis
v.iliaca vena cava inferior

EXTREMITAS SUPERIOR : v.cephalica,

v.ulnaris-v.radialis v.brachialis
v.axillaris-v.subclavia
 PULMONALE
CIRCULATION
ventriculus dexter
arteria pulmonalis
pulmo
vena pulmonalis
atrium sinistrum
Pergantian Karbon dioksida dengan
Oksigen ( darah eritrosit )
 Basic Pathway of Blood
CS
Flow
SVC Pulmonary
Right Tricuspid Right
Semilunar
Atrium Valve Ventricle
IVC Valve

Systemic Pulmonary
Capillaries Trunk

Aorta Pulmonary
Arteries

Aortic Semilunar Valve

Pulmonary
Left Capillaries
Bicuspid
Ventricle Left Atrium Pulmonary
Valve
Veins
CORONARY CIRCULATION

vascularisasi myocardium
a.coronaria dextra et sinistra
v.cordis
sinus coronarius
atrium dextrum
 Coronary

Circulation
Why does the heart require a prodigious amt
of O2 and nutrients?
Cardiac muscle is not nourished to any
extent by the blood flowing thru its
chambers, so it has its own network of
arteries, capillaries, and veins the coronary
circulation
5% of circulating blood is delivered to the
heart
After the aorta emerges from the LV it gives
off 2 branches, the left & right coronary
arteries
The coronary circulation has many
anastomoses where 2 arteries come
together and combine their blood flow.
What is the advantage to this?

Blockage of coronary arteries causes ischemia a loss of blood

flow. Temporary and reversible ischemia produces a sense of
pain known as angina pectoris. Prolonged coronary blockage
can lead to myocardial cell death - a myocardial infarction
(a.k.a., heart attack or coronary)
 After blood
passes thru the
coronary
capillaries, it
enters coronary
veins which
combine to form
the coronary
sinus which
empties into the
RA
a.Coronaria dextra a.Coronaria sinistra
Vena cordis
Sinus coronarius
Nerve Supply of The Heart
The autonomic nervous system
(sympathetic and parasympathetic)
via cardiac plexus.
Sympathys:postganglionic
sympathetic fibers terminate on
NSA, NAV cardiac muscle fibers &
coronary arteries.
Parasympathis:NERVUS VAGUS
cardiac plexus, terminate on
NSA,NAV and coronary arteries.
Clinical Notes
CARDIAC PAIN : afferent fibers
sympathetic trunk Th1-4
nerves (intercostal nerve)
The pain is not felt in the heart but
is referred to the skin areas
supplied by the corresponding
spinal nerves.
The skin areas supplied by the 1-4
intercostal nerves and by the
intercostobrachial nerve (T2) are
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