Mediastinum

It's the movable partition that extend superiorly to the thoracic outlet and the root of the
neck; inferiorly to the diaphragm; exteriorly to the sternum and cervical columns from 2-6
and posterior to thoracic vertebrae.

The sterna angle divide the Mediastinum into two parts:

 Superior Mediastina ; it's anterior to the manubrium ,posterior to the thoracic

column (T1-T4).
 Inferior Mediastina ; it's anterior to
the sternum and posterior to the
thoracic column ( T5-T12).It's
further divided into 3 parts:

Middle ,consists of the pericardium and the

heart

Anterior, tha space between the

pericardium and the sternum

Posterior, lies between the pericardium and

the vertebral column ,, it's posterior to the
heart.

Pericardium:
Is the fibroserous sac that encloses the heart and roots of great vessels.It's composed of two
layers:

 The outer layer ( Fibrous)

Made of single layer and It's loosely attached to the surrounding structures; not loosely
attached but it's fairly attached,like inthe inferior aspect .Anteriorly it's attached to the
sternum by a STERNOPERICARDIAL LIGAMENT.Inferiorly ,the pericardium is fused with the
center of the diaphragm tendon.Superiorly ,this coat fuses with the outer coat of the great
vessels; this outer coat is called TONICA ADVENTITIA .

Of course it receives innervations,sensory innervations by mean of the PHRENIC NERVE.

SLIDE NUM 8: YOU CAN SEE THE PHRENIC NERVE INNERVING THE HEART COVERING
MUSCLE.

If we dissect the heart out ,we'll see that the pericardium is fused with the central tendon of
the diaphragm…see the pictures on the right.
  The inner layer (serous pericardium)

When we talk about serous ,we are talking about mesothelium ,we are talking about two
layers ,the inner serous and the outer serous.The outer we call it "Paretial",in this case it
lines the fibrous coat and it become continuous at the root of the great vessels that emanate
from the heart with the VISCERAL LAYER.As I mentioned before the visceral layer invest the
surface ,which means it goes with the details.

So there's like a space between the part of the vessel and the heart,it will go inside and
makes a recess and this is the basis for having SINUSES within the pericardium space(the
space between the visceral layer and the paretial).

The visceral layer sometimes it's called Epicardium;it's considered to be the outer layer of
the heart wall.

Let’s talk about the heart.

The heart is composed of 3 layers.

-The EPICARDIUM ,which is the visceral layer of serous membrane .

-a thick vascular part in the middle ,we can call it MYOCARDIUM

- We need a lining layer to prevent clotting ,made of the epithelial cells inside ,we call it
ENDOCARDIUM.

we have 4 chambers in the heart, two atria and two ventricles.

Using x-ray photographs ,you can define 3 borders:

- Right border ,that's mainly made by the right atrium and the superior vena cava.
- Inferior border ,made mainly by the right ventricle and the interventicular groove
housing the interventricular blood vessels .
- Left border, which is made by the left ventricle ,the arch of the aorta and pulmonary
trunk.

We can talk about surfaces of the heart ;we have anterior ,posterior and inferior surfaces.

What we are going to call the Inferior surface? DIAPHRAGMATIC SURFACE , is made mainly
by the right and left ventricles separated by the posterior atrioventricular groove.

We have an anterior surface,called STERNOCOSTAL ;formed mainly by the right atrium ,right
ventricle and part of the left ventricle.

The posterior surface mainly made by the left atrium is called BASE OF THE HEART.

The root: whenever we have structures emanating from an organ,it has a root.In our case
we are talking about great vessels.Great vessels is just a term to talk about superior vena
cava ,pulmonary trunk and aorta.
So this is the anatomical position of the heart.In the anatomical position you can’t see all the
four chambers from the anterior view;you can see the right atrium ,the right ventricle ,part
of the left ventricle and part of the left auricle but not the left atrium,it’s hidden in the
posterior surface.

If you look at the posterior surface ,it's mainly made of the left atrium;the atrium has a
rudimental bunch attached to it,it's not filled with blood on each side ,so it's like an
additional space for the atrium and it's made by the same layers of the heart.

So what you can see here is the right auricle covering the right atrium(slide 11)

In slide 13..the line is to tell that here the posterior surface ends and then is the inferior part
and the structure that lies and makes the boundary is the CORONARY SINUS ;it drains the
venous blood from the heart vessels into the heart chambers.

If we dissect the heart out,you can see what we call the base of the heart ( left atrium) ,the
base of the heart lies opposite to the apex. The apex of the heart is the part of the left
ventricle,it's directed forward ,downward and to the left.

Now we'll talk about each chamber of the heart.Starting with the RIGHT ATRIUM:

Receives poorly oxygenated blood from the body.It froms the right border of the heart.It's
composed of two chambers:

- One is smooth surface ,smooth wall which is THE ATRIUM itself

- the auricle. The auricle is cut and open and made of rough muscle,we can call it
PECTINATE MUSCLE.

And why do we have this distinction between the smooth and rough surface ?Because
the auricle and the autrium each come from
different embryological origin.

The boundary between the auricle wall and

the atrium wall is called CRISTA
TERMINALIS(Th

e ridge)
positioned on the inner surface while SULCUS
TERMINALIS is the groove positioned on the
outer surface of the auricle.

Also prominent structures within the atrium

we call it FOSSA OVALIS , that's a depression
in the cavity of the atrium.It's considered to
be a FETAL REMNANTS .

OPENINGS OF THE R.A

 Are either for "superior vena cava" ,the venous drainage of the upper part of the body
will come and coalesce in one great vessel called "SUPERIOR VENA CAVA" that will drain
in the right atrium.

The venous drainage of the lower part of the body it will coalesce in one great vessel
called "INFERIOR VENA CAVA" that drains again in right atrium.

We have an opening between the atrium and ventricle called (atrio ventricular orfice)
,these have valves,because they prevent the back flow of the blood from the ventricle to
the atrium and the valve is a "tricuspid valve",it means it has three cusps or gates.

I've just mentioned to you that the coronary sinus drains the venous blood from the
vessels of the heart into the right atrium ,it also opens in the right atrium as well.

We also have small openings " 5 anterior cardial veins" they are veins of the heart.

RIGHT VENTRICLE:

Its job is to push the blood to the lungs ,so it has an easier task.

It's smaller in size and the lumen in not rounded but crescent shaped ; because the left
one invades its space.

If you look inside the ventricle ,we'll have rough surface;it's made by muscular
ridges;these muscular ridges can be :

- Capillary: if they are finger like projections and they are connected to the cusp of the
valves and the connection is made by fibers we call them CHORDAE TENDINEAE

And this is how we distinguish between muscles…by the type of connection between them
and the cusp of the valves.IF these muscular ridges connect interventricular septum to the
papillary muscle we call them MODERATOR BUNDLES.They are important in spreading the
right ventricle.If they are just ridges ,that doesn't fit either here or here,they can be called ".
Trabeculae carneae". They are well seen in the picture in slide 18.

"the finger like muscle have fibrous connections with the cusps of the valve ,so they are
papillary muscles.This band of muscle connects the interventricular septum to the papillary
muscle so we can call it moderator band.The rest of the ridges is Trabeculae"

The openings of the right ventricle:

We have an AV-ORFICE it's guarded by a tricuspid valve,we have a pulmonary opening,to

send the blood to the lungs ,so the pulmonary trunk takes the blood from the right
ventricle;the transition in the wall of the right ventricle ,before it travels to join the
pulmonary trunk is called conus arteriosus ;it takes the shape of the vessel gradual and the
valve we call it "PULMONARY VALVE"..

LEFT ATRIUM
Also it has an auricle,but it's smaller.It has muscular ridges; pectinate muscles,but they are
fewer and less prominent.

It has 4 opening: for the pulmonary vessels and one for the mitral valve.

The atrioventricular valve between the left atrium and the left ventricle ,it has a special
name,we call it MITRAL VALVE.

LEFT VENTRICLE

It pumps the blood to the hole body;its wall is three times thicker than the right ventricle.It's
cross-section is circular and you can see two large group of papillary muscles.

We don't have a conus arteriosus ,but we have something we can call AORTIC VESTIBULE
;the smooth surface just before the aortic valve ,we call it AORTIC VESTIBULE,the function of
these papillary muscles is to prevent the back flow of the blood into the atrium during
contraction.When the ventricle will contract to push the blood through the aorta ,we need
to prevent the backward opening of the valve and these fibers make sure that this won't
happen;because these papillary muscles contract and grap the cusp so no blood will flow
from the ventricle to the auricle.

We don't have moderator bands.

Dextrocardia:is a disease where people have Their heart on the right side of the chest
instead of the left.

INNERVATION OF THE HEART:

The heart has an autonomic innervations.we have sympathetic and parasympathetic

systems.The parasympathetic will be carried by the vegus nerve .75 of the
parasympathetic responses are carried by this nerve and carries responses to the thorax
and abdomen.

What's the effect of the parasympathetic stimulation on the heart? It decreases the
heart rate and it won't decrease the contractility of the heart.

Where 's the site of action of parasympathetic fibers? it will go just to the atria because
the base maker of the heart which creates the auto-rhythmic action of the heart. It's
beating action is generated within the heart,by itself.

The conducting system of the heart has special structures ,SINUTRIAL NODE(base
maker),that sends signal to the atrioventricular node then the signal will go to the
ventricle.
The parasympathetic inhibits this atrioventricular node and decreases contraction of the
heart ,and this is how it decreases the heart rate.What about the sympathetic
innervation?

The sympathetic will act on both,the heart rate and the contractility,not exactly the
opposite,it's more than the opposite, it will increase the heart rate ,increase contractility
and the force generated by each beat is also going to increase ,so it will increase the
cardiac output of the heart.

Done by Sara Ibdiwi

SRSRT