Mediastinum occupied by the mass of tissue between the two pulmonary cavities, is the central compartment of the thoracic

cavity Contains all thoracic viscera except the lungs

The mediastinum 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.

The superior thoracic aperture is bounded : Posteriorly, by vertebra T1 Laterally, by the 1st pair of ribs and their costal cartilages. Anteriorly, by the superior border of the manubrium

Unlike the rigid structure observed in the embalmed cadaver, the mediastinum in living people is a highly mobile region because it consists primarily of hollow visceral structures united only by loose connective tissue, often infiltrated with fat.

The major structures in the mediastinum are also surrounded by blood and lymphatic vessels, lymph nodes, nerves, and fat

The mediastinum is divided into :

Superior mediastinum

Extends inferiorly from the superior thoracic aperture to the horizontal plane Often referred to as the transverse thoracic planethat includes the sternal angle anteriorly and passes approximately through the junction (IV disc) of T4 and T5 vertebrae posteriorly

From anterior to posterior, the contents of the superior mediastinum are :

Thymus. Great vessels, brachiocephalic veins and SVC arch aorta and roots of its major branches the brachiocephalic trunk, left common carotid artery, and left subclavian artery Related nerves (vagus and phrenic nerves and the cardiac plexus of nerves). Trachea anteriorly and esophagus posteriorly and related nerves (left recurrent laryngeal nerve). Thoracic duct and lymphatic trunks.

Inferior mediastinum

Between the transverse thoracic plane and the diaphragm Is further subdivided by the pericardium into anterior, middle, and posterior parts. The pericardium and its contents (heart and roots of its great vessels) constitute the middle mediastinum.

Lies between : the body of the sternum and the transversus thoracis muscles anteriorly the pericardium posteriorly. Inferiorly by the diaphragm.

` The anterior mediastinum consists of loose connective tissue, fat, lymphatic vessels, a few lymph nodes, and branches of the internal thoracic vessels. .

The pericardium and its contents (heart and roots of its great vessels ascending aorta, pulmonary trunk, and SVCpassing to and from the heart.) constitute the middle mediastinum

Is located : inferior to the transverse thoracic plane, anterior to the T5-T12 vertebrae posterior to the pericardium and diaphragm between the parietal pleura of the two lungs

The pericardium is a fibroserous membrane that covers the heart and the beginning of its great vessels

The pericardium is a closed sac composed of two layers : 1. Fibrous pericardium 2. Serous pericardium Parietal layer Visceral layer

 Continuous superiorly with the tunica adventitia of the great vessels entering and leaving the heart and with the pretracheal layer of deep cervical fascia.

Attached anteriorly to the posterior surface of the sternum by the sternopericardial ligaments, which are highly variable in their development.

Bound posteriorly by loose connective tissue to structures in the posterior mediastinum.

Continous inferiorly with the central tendon of the diaphragm

 The serous pericardium is composed mainly of mesothelium, a single layer of flattened cells forming an epithelium that lines both the internal surface of the fibrous pericardium and the external surface of the heart. The internal surface of the fibrous pericardium is lined with a glistening serous membrane, the parietal layer of serous pericardium. Parietal layer of serous pericardium is reflected onto the heart at the great vessels (aorta, pulmonary trunk and veins, and superior and inferior venae cavae) as the visceral layer of serous pericardium.

 The pericardial cavity is the potential space between opposing layers of the parietal and visceral layers of serous pericardium. It normally contains a thin film of fluid that enables the heart to move and beat in a frictionless environment

 It is about 12 cm long, 9 cm wide at its broadest point, and 6 cm thick, with an average mass of 250 g in adult females and 300 g in adult males About two-thirds of the mass of the heart lies to the left of the bodys midline

The heart : slightly larger than a clenched fist, is a double, self-adjusting suction and pressure pump the parts of which work in unison to propel blood to all parts of the body

The right side of the heart (right heart) receives poorly oxygenated (venous) blood from the body through the SVC and IVC and pumps it through the pulmonary trunk and arteries to the lungs for oxygenation.
The left side of the heart (left heart) receives well-oxygenated (arterial) blood from the lungs through the pulmonary veins and pumps it into the aorta for distribution to the body.

Apex Base Surface Border

The pointed apex is formed by the tip of the left ventricle and rests on the diaphragm.

It is directed anteriorly, inferiorly, and to the left

Lies posterior to the left 5th intercostal space in adults

Is the heart's posterior aspect Is formed mainly by the left atrium, with a lesser contribution by the right atrium. Extends superiorly to the bifurcation of the pulmonary trunk and inferiorly to the coronary sulcus

1. Diaphragmatic (inferior) surface, formed mainly by the left ventricle and partly by the right ventricle; it is related mainly to the central tendon of the diaphragm. 2. Left pulmonary surface, formed mainly by the left ventricle; it forms the cardiac impression in the left lung.

3. Anterior (sternocostal) surface, formed mainly by the right ventricle.

4. .Right pulmonary surface, formed mainly by the right atrium.

1. Right border, formed by the right atrium and extending between the SVC and the IVC. 2. Inferior border , formed mainly by the right ventricle and slightly by the left ventricle. 3. Left border , formed mainly by the left ventricle and slightly by the left auricle. 4. Superior border, formed by the right and left atria and auricles in an anterior view

The heart has four chambers: right and left atria and right and left ventricles

Valves of the heart : A. Atrioventricular valves - Tricuspid valve - Bicuspid valve B. Semilunar valves - Aortic valve - Pulmonary valve

RIGHT ATRIUM : Pectinate muscle Right auricle Opening Inferior vena cava Opening superior vena cava Opening coronary sinus Ovale fossa Tricuspid valve Interatrial septum

LEFT ATRIUM : Pectinate muscle Left auricle Opening 4 pulmonary vein (2 superior and 2 inferior) Bicuspid valve Interatrial septum A slightly thicker wall than that of the right atrium

RIGHT VENTRICLE : Trabecula carnae AV Tricuspid valve Chorda tendinae Papillary muscle Semilunar pulmonary valve Interventricular septum

LEFT VENTRICLE : Trabecula carnae AV Bicuspid valve Chorda tendinae Papillary muscle Semilunar aortic valve Interventricular septum Walls that are two to three times as thick as those of the right ventricle

Right atrium ??

Left atrium??

Right ventricle??

Left ventricle??

Endocardium, a thin internal layer (endothelium and subendothelial connective tissue) or lining membrane of the heart that also covers its valves.
Myocardium, a thick, helical middle layer composed of cardiac muscle. Epicardium, a thin external layer (mesothelium) formed by the visceral layer of serous pericardium

The isolated fibrous skeleton is composed of : four fibrous rings (or two rings and two coronets) two trigone : 1. Left fibrous trigone 2. Right fibrous trigone

Membranous portions of the interatrial, interventricular, and atrioventricular septa.

Keeps the orifices of the AV and semilunar valves patent and prevents them from being overly distended by an increased volume of blood pumping through them.

Provides attachments for the leaflet & cusps of the valves

Provides attachment for the myocardium

Forms an electrical insulator, by separating the myenterically conducted impulses of the atria and ventricles

Atrioventricular valves

Tricuspid valves Bicuspid valves Aortic valves Pulmonary valves

Semilunar Valves

Operation of the atrioventricular valves When the ventricles are relaxed the papillary muscles are relaxed, the chordae tendineae are slack, and blood moves from a higher pressure in the atria to a lower pressure in the ventricles through open AV valves

Operation of the atrioventricular valves When the ventricles contract, the pressure of the blood drives the cusps upward until their edges meet and close the opening At the same time, the papillary muscles contract, which pulls on and tightens the chordae tendineae. This prevents the valve cusps from everting (opening into the atria) in response to the high ventricular pressure.

Operation of the semilunar valves When the ventricles contract, pressure builds up within the chambers. The semilunar valves open when pressure in the ventricles exceeds the pressure in the arteries, permitting ejection of blood from the ventricles into the pulmonary trunk and aorta

Operation of the semilunar valves As the ventricles relax, blood starts to flow back toward the heart. This backflowing blood fills the valve cusps, which causes the semilunar valves to close tightly

 Systemic circulation

1
Pulmonary circulation

2
Coronary circulation

Nutrients are not able to diffuse quickly enough from blood in the chambers of the heart to supply all the layers of cells that make up the heart wall.

For this reason, the myocardium has its own network of blood vessels, the coronary or cardiac circulation

Left coronary arery

Right coronary artery

anterior interventricular

circumflex branches

supplies small branches (atrial branches) to the right atrium

supplies oxygenated blood to the walls of both ventricles

to the myocardium of the right ventricle

posterior interventricular

marginal branches

To walls of the two ventricles

To the walls of the left ventricle and left atrium.

blood passes through the arteries of the coronary circulation,

flows into capillaries

delivers oxygen and nutrients to the heart muscle and collects carbon dioxide and waste

moves into coronary veins

coronary sinus

Great cardiac vein

Middle cardiac vein

Small cardiac vein

Anterior cardiac veins

While the heart is contracting, little blood flows in the coronary arteries because they are squeezed shut.

When the heart relaxes, however, the high pressure of blood in the aorta propels blood through the coronary arteries, into capillaries, and then into coronary veins