Heart and Major Vessels

Surface anatomy

Borders of the heart

Right border: right atrium extends from 3rd to 6th right costal cartilage 3cm from
midline
Inferior border: right ventricle and apex of left ventricle extends from the lower end of
the right border to the fifth intercostal space of the mid-clavicular line
Left border: narrow strip of left ventricle and left auricle extends from apex to second
left intercostal space 3cm from midline
Apex beat is the lowest and most lateral cardiac pulsation in the precordium
o Heaving: forceful and sustained in hypertension and aortic stenosis
o Thrusting: forceful but not sustained e.g. mitral/aortic regurgitation
o Tapping: mitral stenosis
o Missing: obesity, effusion, emphysema

Coronary arteries

Right Coronary artery

This originates in the right coronary sinus and descends in the right atrioventricular groove,
supplying the right atrium and right ventricle, continuing as the posterior descending artery
supplying the posterior aspect of the interventricular septum and left ventricle.

It supplies the SAN in 60% and the AVN in 90%. Occlusion leads ot inferior MI often
associated with sinoatrial or atrioventricular dysrhythmia
Left coronary artery
This originates in the left coronary sinus and branches include:
Left main coronary artery
Left anterior descending branch which supplies the anterior wall of both ventricles
and most of the interventricular septum
Circumflex branch which lies in the left atrioventricular groove and supplies the left
atrium or ventricle, in 10% the posterior descending artery may be a continuation of
the circumflex

Occlusion of the LCA or its branches leads to anterior and/or lateral MI which often has
substantial ventricular damage and poor prognosis.

Pericardial cavity
The pericardial cavity consists of an outer fibrous and inner serous pericardium (the latter is
divided into the outer serous and inner visceral layers).

Relationships:
Anterior: sternum, 3rd to sixth costal cartilates, lungs and pleura
Posterior: oesophagus, descending aorta, T5-8
Lateral: root of lung, mediastinal pleura, phrenic nerve
Innervation of the fibrous and parietal layers is by phrenic nerves

Pericardiocentesis is performed by inserting a needle into the angle between the xiphoid
process and left 7th costal cartilage which is then directed at 45 degrees towards the left
shoulder, passing through the central tendon of the diaphragm-a danger is puncture of the rigt
ventricle.

Aorta