THORAX PART 2 – THORACIC CAVITY

Thoracic Cavity
- Bounded by the Chest Wall & below by the
Diaphragm
- Extends upward into the roof of the Neck about 1
fingerbreadth above the Clavicle on each side
- Divided into: Mediastinum, Pleurae & Lungs
_______________________________________________
MEDIASTINUM
 Central partition of the Thoracic Cavity
 Thick; Movable partition
 Extends to:
o Superior: Outlet & Root of the Neck
o Inferior: Diaphragm
o Anterior: Sternum PLEURAE
o Posterior: T12 vertebra
 Lie on both sides of Mediastinum
o Lateral: Pleura
 Structures inside:
o Remains of the thymus Parietal Layer Visceral Layer
o Heart & Large Blood Vessels  Lines the Thoracic Wall  Covers Completely the
o Trachea & Esophagus  Covers Thoracic Surface of Surface of the Lungs
o Thoracic Duct the Diaphragm  Extends into the depth of the
o Lymph Nodes  Extends root of the Neck Interlobar Fissures
o Vagus & Phrenic nerves
o Sympathetic Trunk  Other parts:
 Divisions of the Mediastinum: o Pleural Cuff
o Divided by the imaginary plane passing the  Surrounds the structures entering &
Sternal Angle anteriorly top the lower boarder leaving the Lung & Hilum
of the body of the 4th Thoracic Vertebra o Pulmonary Ligament
posteriorly.  Allow for movement of the Pulmonary
Vessels & Large Bronchi during
Superior Mediastinum Inferior Mediastinum
respiration, the pleural cuff hangs down
as a loose fold
Thymus Thymus o Pleural Space/Cavity
Large Veins Heart the Pericardium &  Slit-like space
Large Arteries Phrenic Nerve  Contains tissue fluid called PLEURAL
Trachea Esophagus & Thoracic Duct FLUID
- The fluid covers the surface of the
Esophagus & Thoracic Duct Descending Aorta
Pleura as a thin film & permits the
Sympathetic Trunks Sympathetic Trunks 2 layers to move on each other
the minimum of friction
Bounded in front by the Bounded in front by the body
Manubrium Sterni & behind of the Sternum & behind by
by the 1st 4 thoracic Vertebrae the lower 8 thoracic Vertebrae

The Inferior Mediastinum is further subdivided into:

 Middle Mediastinum
o Contains the Pericardium & Heart
 Anterior Mediastinum
o Is a space between the Pericardium &
Sternum
 Posterior Mediastinum
o Lies between the Pericardium &
Vertebral Column
_______________________________________________
Division of the Parietal Pleura Nerve Supply of the Pleura
- According to the region or surface it covers Costal Pleura Intercostal Nerves
 Costal Pleura
Mediastinal Pleura Phrenic Nerve
- Lines the inner surfaces of the Ribs,
the Costal Cartilages, the Intercostal Diaphragmatic Pleura Over the domes of the Phrenic
Spaces, the sides of the Vertebral Nerve & around the periphery
Bodies, & the Back of the Sternum by the lower 6 Intercostal
Nerves
 Diaphragmatic Pleura
- Covers the Thoracic Surface of the
Diaphragm.  Parietal Pleura – Sensitive to pain, temperature,
- In quiet respiration, the Costal & touch & pressure
Diaphragmatic Pleurae are in  Visceral Pleura – Sensitive to stretch; Receives an
apposition to each other below the autonomic; Nerve supply from the Pulmonary
lower border of the Lung. Plexus
- In deep inspiration, the margins of the
base of the Lung descend, & the
Costal & Diaphragmatic Pleurae
separate.
- This lower area of the pleural cavity
into which the lung expands on
inspiration is referred to as the
COSTODIAPHRAGMATIC RECESS
 Are slit-like spaces between the
Costal & Diaphragmatic Parietal
Pleurae that are separated only
by a Capillary layer of Pleural
Fluid.
 During inspiration, the lower
margins of the Lungs descend
into the recesses.
 During expiration, the lower
margins of the lungs ascend so
that the Costal & Diaphragmatic
pleurae come together again. _______________________________________________
 Mediastinal Pleura
TRACHEA
- Covers & forms the lateral boundary
of the Mediastinum.  Mobile tube about 5 in long & 1 in in diameter
- During full inspiration, the lungs  Presence of U-shaped bars of hyaline cartilage
expand & fill the pleural cavities.  Starts below the cricoid cartilage @ the level of C6
- During quiet inspiration, the lungs do & ends @ the level of the Sternal Angle
not fully occupy the pleural cavities @  Bifurcation – carina
four sites: the right & left  During expiration, the bifurcation rises by about 1
Costodiaphragmatic Recesses & the vertebral level, & during deep inspiration may be
right &left Costomediastinal recesses. lowered as far as the 6th thoracic vertebra.
 Are situated along the Ant  The relations of the trachea in the superior
margins of the pleura. mediastinum of the thorax are as follows:
 They are slit-like spaces o Anteriorly: Sternum, Thymus, Left
between the Costal & Brachiocephalic Vein, Origins of the
Mediastinal Parietal Pleurae, Brachiocephalic & Left Common Carotid
which are separated by a Arteries, & Arch of the Aorta
capillary layer of pleural fluid. o Posteriorly: Esophagus & Left Recurrent
 During inspiration & expiration, Laryngeal Nerve
the Ant. borders of the lungs o Right side: Azygos Vein, Right Vagus Nerve,
slide in & out of the recesses. & Pleura
o Left side: Arch of the Aorta, Left Common
Carotid & Left Subclavian Arteries, Left
Vagus & Left Phrenic Nerves, & Pleura
 Blood Supply Lobes & Fissures
 Upper two thirds: inferior thyroid arteries Right Lung Left Lung
 Lower third: bronchial arteries
Slightly Larger Smaller
Lymph Drainage
- Tracheal & Paratracheal lymph nodes
2 Fissures 1 fissure
Nerve Supply
- Oblique - Oblique
- Vagus & Laryngeal Nerves. Sympathetic Nerves - Horizontal
_______________________________________________
Lobes
BRONCHI Lobes - Upper
- The trachea bifurcates behind the arch of the Aorta - Upper - Lower
into the Right & Left Principal (Primary or Main) - Middle
Bronchi. - Lower
Cardiac Notch
Right Principal Left Principal
- Where the heart is
Wider, shorter & more vertical Narrower, longer, more located
horizontal
- more posteriorly
Before entering hilum it gives
off the Superior Lobar On entering hilum, it gives off
Bronchus the Superior & Inferior Lobar Bronchopulmonary Segments
Bronchus - Anatomic, functional & surgical units of the Lungs
Entering hilum, it gives off - Each Lobar Bronchus, which passes to a lobe of
Middle & Inferior Bronchus the lung, gives off branches called SEGMENTAL
BRONCHUS
o Each segmental bronchus passes to a
structurally & functionally independent unit
of a lung lobe called
BRONCHOPULMONARY SEGMENT
o Is accompanied by a branch of the
Pulmonary Artery,
o Each segments has its own Lymphatic
vessels & Autonomic Nerve supply
- On entering a segment, segmental bronchus divides
repeatedly
- U-shape cartilage becomes irregular plates of
cartilage
- Smallest bronchi divides & gives rise to
BRONCHIOLES
o They poses no cartilage in their walls & are
lined columnar layer of circularly
arranges smooth muscles

___________________________________________ o Terminal Bronchioles

o Respiratory Bronchioles
LUNGS
 Branches into alveolar ducts which
- Situated on each side of the mediastinum lead into tubular passages called
- Conical shape ALVEOLAR SACS.
- Covered by the visceral pleura
- Suspended free from its own pleural cavity
- Attached to the mediastinum only by its roots
- Has a blunt apex concave base
- Convex Costal Surface & Concave Mediastinal
Surface
- HILUM is a depression in the middle of the
Mediastinal Surface
- ROOT is where the Bronchi, Vessels & Nerves that
enters & leaves the Lungs
 Blood Supply of the Lungs Nerve Supply of the Lungs
Bronchi, the Connective Tissue Receive their blood supply from  Pulmonary Plexus composed of efferent & afferent
of the Lung & Visceral Pleura the Bronchial Arteries, which are Autonomic Nerve Fibers
branches of the descending aorta.
 Formed from branches of the Sympathetic Trunk
Bronchial Veins Drain into the Azygos & & receives Parasympathetic Fibers from the Vagus
Hemiazygos veins. nerve.
Alveoli receive deoxygenated blood from  Sympathetic Efferent Fibers VS. Parasympathetic
the terminal branches of the Efferent Fibers
pulmonary arteries.
o Sympathetic: Bronchodilation, Vasoconstriction
Oxygenated blood leaving the drains into the tributaries of the o Parasympathetic: Bronchoconstriction,
Alveolar Capillaries pulmonary veins Vasodilation; ↑ glandular secretion

2 Pulmonary Veins leave each lung root to empty into Mechanics of Respiration
the left atrium of the heart.
 Respiration consists of 2 phases
o Inspiration & Expiration
Lymph Drainage of the Lungs  Accomplished by the alternate ↑ & ↓ of the
 The lymph vessels originate in superficial & deep capacity of the Thoracic Cavity.
plexuses; they are not present in the alveolar walls.  Rate varies between 16 & 20 per minute in normal
 Superficial (subpleural) Plexus lies beneath the resting Pt.
visceral pleura & drains over the surface of the  Faster in children & slower in the elderly
lung toward the hilum, where the lymph vessels
enter the Bronchopulmonary nodes.
Inspiration
 Deep plexus travels along the Bronchi &
Pulmonary Vessels toward the hilum of the lung,  Quite Inspiration
passing through pulmonary nodes located within o Capacity can be ↑ by elongating all its
the lung substance; the lymph then enters the diameter
bronchopulmonary nodes in the hilum of the lung. o Results in air under atmospheric entering
 All the lymph from the lung leaves the hilum & the lungs through the tubes
drains into the Tracheobronchial Nodes & then
into the Bronchomediastinal Lymph Trunks.
 3Diameters of the Thoracic Cavity  Forced Inspiration
 Vertical Diameter o Max. ↑ in the capacity of the thoracic
o Roof – Suprapleural Membrane cavity occurs
(Fixed) o Every muscle that can raise the ribs is
o Floor – Diaphragm (mobile) brought into action, including the
Scalenius Ant., Med & SCM
-Theoretically, the roof could be o Serratus Ant. & Pectoralis Minor can pull
raised & the floor lowered. up the ribs, when the Scapula is fixed
- When the diaphragm contracts, o If the Upper Limbs can be supported by
the domes become flattened & the grasping a chair back or table, the Sternal
level of the diaphragm is lowered origin of the Pectoralis Major muscles can
 Anteriorposterior diameter also assist the process.
o Downward-sloping ribs are raised  Lung Exchange
@ their sternal ends; ↑ & Lower o The Root of the Lung descends & the
end of the sternum would thrust level of the bifurcation of the Trachea may
forward. be lowered by much as 2 Vertebra
o Accomplished by contraction of o The bronchi elongate & dilate & the
Scaleni muscles & Intercostal alveolar capillaries dilate, thus assisting
muscles the pulmonary circulation.
o Diaphragm Descends o Air is drawn into the bronchial tree as the
 Transverse Diameter result of difference in atmospheric
o Ribs resemble bucket handles pressure.
o Ribs are raised like bucket handle o expansion of the lungs, the elastic tissue
o ↑ tra sverse d ameter in the bronchial walls & connective tissue
o Accomplished by contraction of are stretched.
Scaleni muscles & Intercostal o As the diaphragm descends, the lower
muscles edges of the lungs descend to a lower
level.
As the diaphragm descends on inspiration, intra-
abdominal pressure rises. This rise in pressure is Expiration
accommodated by the reciprocal relaxation of the  Quiet Expiration
abdominal wall musculature. However, a point is reached o A passive phenomenon brought about by
when no further abdominal relaxation is possible, & the the elastic recoil of the Lungs
liver & other upper abdominal viscera act as a platform o Relaxation of the Intercostal muscles &
that resists further diaphragmatic descent. On further Diaphragm, & an increase in tone of the
contraction, the diaphragm will now have its central muscles of the Ant. Abdominal Wall,
tendon supported from below, & its shortening muscle which forces the relaxing Diaphragm
fibers will assist the intercostal muscles in raising the upward.
lower ribs.  Forced Expiration
Apart from the diaphragam & the intercostals, other o Active process brought about by the
less important muscles also contract on inspiration to assist forcible contraction of the musculature of
in elevating ribs, namely: Leavtores Costarum& Serratus the Ant. Abdominal Wall.
Post. Superior muscles o The Quadratus Lumborum also contracts
& pulls down the 12th ribs.
o Some of the intercostal muscles may
contract, pull the ribs together, & depress
them to the lowered 12th rib
o The Serratus Post. Inferior & the
Latissimus Dorsi muscles may also play a
minor role.
 Lung Exchange
o The roots of the lungs ascend along the
bifurcation of the trachea.
o The bronchi shorten & contract.
o The elastic tissue of the lungs recoils, &
the lungs become reduced in size.
o the upward movement of the diaphragm
diaphragmatic & costal parietal pleura
come into apposition
 o The lower margins of the lungs shrink &
rise to a higher level.

Types of Respiration
 In babies & young children rely mainly on the
descent of the diaphragm for inspiration. This is
referred to as the abdominal type of respiration.
 In the adult, the female tends to rely mainly on the
movements of the ribs rather than on the descent
of the diaphragm on inspiration. This is referred to
as the thoracic type of respiration.
 The male uses both the thoracic & abdominal
forms of respiration, but mainly the abdominal
form.
_______________________________________________ _______________________________________________
PERICARDIUM HEART
- Fibroserous Sac that encloses the heart & the roots - a hollow muscular organ that is somewhat pyramid
of the great vessels. shaped & lies within the pericardium in the
- Restrict excessive movements of the heart as a mediastinum
whole & to serve as a lubricated container in which - It is connected @ its base to the great blood vessels
the different parts of the heart can contract. but otherwise lies free within the pericardium.
- Lies within the middle mediastinum,
o Post. to the body of the Sternum & the 2nd to
Surface of the Heart
6th Costal Cartilages
o Ant. to the T5 – T8 vertebrae  Sternocostal Surface (Ant.)
- formed mainly by the right atrium & right
ventricle, separated by atrioventricular
Fibrous Pericardium groove
- Strong fibrous part of the sac
- Attached below to the central tendon of the -
Right border: formed by right atrium
Diaphragm -
Left border: the left ventricle & part of the
- Fuses the outer coats of the great blood vessels left auricle
passing through the heart - Right ventricle: separated from the left
- Attached in front to the Sternum by the ventricle by interventricular groove
Sternopericardial Ligaments.  Diaphragmatic Surface (Inf.)
Serous Pericardium - formed mainly by the right & left ventricles
separated by the interventricular groove
- Lines the Fibrous Pericardium & coats the heart.
- the inferior surface of the right atrium, into
- 2 Divisions:
which the inferior vena cava opens, also
o Parietal layer
form part of this surface
 Lines the Fibrous Pericardium & is
 Base of the Heart (Post.)
reflected around the roots of the great
- the Post. surface, is formed mainly by the
vessels to become continuous the
left atrium, into which open the four
visceral layer
pulmonary veins
o Visceral layer
- the base of the heart lies opposite the apex
 Closely applied to the heart & is often
 Apex of the heart
called the EPICARDIUM
- formed by the left ventricle, directed
- PERICARDIAL CAVITY is the slit-like space
downward, forward & to the left
between the Parietal & Visceral Layers.
- level of the 5th intercostal space
- PERICARDIAL FLUID acts as a lubricant to
- 3.5 inch from midline
facilitate movement of the heart.
- location of the apex beat

Nerve Supply Note that the base of the heart is called base because
- Fibrous pericardium & Serous pericardium the heart is pyramidal shaped, the base lies opposite the
(Parietal layer) - Phrenic Nerve apex. The heart does not rest on the base, it rests on its
- Serous pericardium (Visceral layer) - branches of diaphragmatic (interior) surface
the sympathetic trunk & Vagus Nerves.
 Borders of the Heart Opening to the Atrium
 Right border – Right Atrium  Superior vena cava
 Left border – Left Auricle & Left Ventricle o Upper part of the right Atrium & has no
 Lower border – mainly by Right Ventricle, also valve
Right Atrium o Drains the blood from the upper half of
 Apex – Left Ventricle the body.
 Inferior vena cava (larger)
o Lower part of the right atrium
Chamber of the Heart o Drains the blood from the lower half of
 Heart is divided by vertical septa into 4 chambers: the body
o Right & Left Atria  Coronary Sinus
o Right & Left Ventricles o Drains most of the blood from the heart
wall & Gauarded by a Rudimentary non-
o Right Atrium lies Ant. to the Left Atrium, & functioning valve
the Right Ventricle lies Ant. to the Left o Opens into Right Atrium between the
Ventricle. Inferior Vena Cava & the
Atrioventricular Orifice
Myocardium Cardiac mm that composed the
walls of the heart  Right Atrioventricular Orifice
o Lies Ant to the Inferior Vena Caval
Epicardium covered externally serous opening & guarded by Tricuspid Valve
pericardium
Right Ventricle
Endocardium lined internally a layer of
endothelium,  Communicates the Right Atrium through the
Atrioventricular orifice the Pulmonary Trunk
through the Pulmonary Orifice
 As the cavity approaches the pulmonary orifice
Right Atruium it becomes funnel shaped referred as
INFUNDIBULUM
 Auricle - A main cavity & a small outpouching
 Walls are much thicker than those of the right
 Sulcus Terminalis - a vertical groove @ the
Atrium & show several internal projecting
junction between Right Atrium & Right Auricle;
ridges formed of muscle bundles known as
which on the inside forms a ridge, CRISTA
TRABECULAE CARNEAE
TERMINALIS
o 3 types
 Musculi pectinati – a roughened or trabeculated
 First Type - papillary muscles
bundles of mm fibers which is part of the Atrium
 Project inward, bases @ the
in front of the ridge, which runs from the crista
ventricular wall; their apices
terminalis to the auricle.
are connected by fibrous
chords to the cusps of the
tricuspid valve
 Second Type - attached @ the ends
to the ventricular wall, being free in
the middle
  E.g. Moderator band: Left Ventricle
crosses the ventricular cavity  Communicates the Left Atrium through the
from the septal to the Ant. Atrioventricular Orifice & the Aorta through
wall. Where it conveys the the Aortic Orifice
right branch\h of the AV  Walls are 3x thicker than those of the Right
bundle, which is part of the Ventricle
conducting system of the  There are well-developed Trabeculae Carneae, 2
heart
Large Papillary muscles, but no moderator band
 Third type - simply composed of
 AORTIC VESTIBULE is the part of the ventricle
prominent ridges
below the Aortic orifice

Valves
Valves
 Tricuspid valve
 Mitral valve
o Guards the atrioventricular orifice
o Guards the Atrioventricular Orifice
o Consists of 3 cusps formed by a fold of
o Consists of 2 cusps, 1 Ant. & 1 Post,
endocardium
which have a structure similar to that of
o Bases of the cusps are attached to the
the cusps of tricuspid valve
fibrous ring of the skeleton of the heart
o Attachment of the Chordae Tendineae to
whereas their free edges & ventricular
the cusps & Papillary Muscles is similar
surfaces are attached to the CHORDAE
to that of tricuspid valve
TENDINEAE
 Aortic valve
 Connects the cusp to PAPILLARY
o Guards the aortic orifice
MUSCLES
o Precisely similar in structure to the
 Pulmonary valve
pulmonary valve
o Guards the pulmonary orifice
o Behind each cusp, the aortic wall bulges
o Consists of 3 semilunar cusps formed by
to form an AORTIC SINUS.
folds of endocardium
 Ant. Aortic Sinus gives origin to
o Curved lower margins & sides of each
the Right Coronary Artery,
cusp are attached to the arterial wall.
 Left Post. Sinus gives origin to the
o Open mouths of the cusps are directed
Left Coronary Artery.
upward into the pulmonary trunk.
o No chordae or papillary muscles are
associated these valve cusps
o @ the root of the trunk are 3 dilatations
called SINUSES

Left Atrium
 consists of a main cavity & a left auricle
 situated behind the right atrium & forms greater
part of the base or the Post. surface of the heart
 Behind it lies the Oblique Sinus of the Serous
Pericardium, & Fibrous Pericardium; separates it
from the Esophagus
 Interior is smooth, but the Left Auricle possesses Structure of the Heart
muscular ridges as in the right auricle  The walls of the heart are composed of a thick
layer of cardiac muscle, MYOCARDIUM
 Covered externally by the ENDOCARDIUM.
Opening of the Left Atrium
 EPICARDIUM
 The 4 Pulmonary Veins, 2 from each Lung,  Atrial portion of the heart has relatively thin walls
open through the Post. wall - no valves & is divided by ATRIAL SEPTUM
 The Left Atrioventricular Orifice is guarded  Ventricular portion of the heart has thick walls &
by the Mitral Valve. divided by VENTRICULAR SEPTUM
 Its position is indicated on the surface of the heart
by the Ant. & Post. interventricular grooves.
Skeleton of the Heart  Crosses to the Ant. wall of
 Consists of fibrous rings that surround right ventricle. It becomes
Atrioventricular, Pulmonary, &Aortic Orifices continuous the fibers of
 Fibrous Rings around Atrioventricular Orifices Purkinje plexus
separate muscular walls of Atria from those of the  Left bundle branch (LBB) pierces
Ventricles the septum & passes down on its left
 Fibrous rings support bases of the valve cusps & side beneath endocardium
prevent valves from stretching & becoming  Eventually become
incompetent continuous the fibers of
 Forms basis of electrical discontinuity between Purkinje plexus of the left
ventricle.
Atria & Ventricles

- It is thus seen that the conducting system of the

Conducting System of the Heart heart is responsible not only for generating
- 70 - 90 bpm: Normal heart contracts rhythmically rhythmic cardiac impulses, but also for conducting
in resting adult these impulses rapidly throughout the myocardium
- Rhythmic contractile process originates of the heart so that the different chambers contract
spontaneously in a coordinated &efficient manner.
- Atria contract first & together, followed later by - The activities of the conducting system can be
the contractions of both ventricles together influenced by the autonomic nerve supply to the
- Slight delay in the passage of impulse from atria to heart. The parasympathetic nerves slow the
the ventricles allows time for atria to empty their rhythm & diminish the rate of conduction of the
blood into the ventricles before the ventricles impulse; the sympathetic nerves have the opposite
contract effect.

Nodes of the Heart

 Sinuatrial (SA) Node
o Located in the wall of Right Atrium in the
upper part of sulcus terminalis just to the
right of the opening of superior vena cava
o Spontaneously gives origin to rhythmic
electrical impulses that spread in all
directions through the cardiac muscle of
atria & cause muscle to contract
 Atrioventricular (AV) Node
o Placed on lower part of atrial septum just
above the attachment of septal cusp of
Tricuspid Valve
o Impulse is conducted to the ventricles by
Atrioventricular Bundle Arterial Supply of the Heart
o Stimulated by excitation wave as it passes
 Right & Left Coronary Arteries, which arise from
through the Atrial Myocardium
the Ascending Aorta
o The speed of conduction of cardiac
impulse through AV node allows
sufficient time for Atria to empty their Right Coronary Artery
blood into the Ventricles before the
 Arises from the Ascending Aorta & runs
Ventricles start to contract
forward between Pulmonary Trunk & Right
 Atrioventricular Bundle / Bundle of His Auricle
o Only pathway of cardiac muscle that
 Descends in the Right Atrioventricular Groove,
connects Myocardium of the Atria &
& @ the Inferior Border of the heart it continues
Myocardium of the Ventricles
posteriorly along Atrioventricular Groove to
o Descends through the fibrous skeleton of
anastomose the Left Coronary Artery in the
the Heart
Post. Interventricular Groove
o @ the border of Interventricular Septum
 Branches from the Right Coronary Artery
Divides into 2 branches;
Supply the Right Atrium & Right Ventricle &
 Right bundle branch (RBB) passes
parts of the Left Atrium & Left Ventricle &
down on the right side of ventricular
Atrioventricular Septum
septum
  Branches:
o Right Conus Artery – Ant. surface of the
Infundibulum of Right Ventricle & Upper
part of the Ant. Wall of the Right
Ventricle
o Anterior Ventricular Branches – Ant.
surface of the right ventricle.
 Marginal Branch is the largest &
runs along the lower margin of the
costal surface to reach the apex.
o Posterior ventricular branches -
Diaphragmatic surface of the Right
Ventricle
o Posterior interventricular (descending)
artery – Post. part of the Ventricular
Septum but not to the apical part
 Large Septal Branch supplies the
AV Node.
o Atrial branches - Supply the Ant. & Lat
surfaces of the Right Atrium.
 Artery of the SA Node supplies the
node & the Right & Left Atria

Left Coronary Artery

 Usually larger than the right
 Supplies major part of the heart, including The right coronary artery supplies all of the right
greater part of the Left Atrium, Left Ventricle, & ventricle (except for the small area to the right of the
Ventricular Septum anterior interventricular groove), the variable part of the
 Arises from Aorta & passes forward between the diaphragmaticsurface of the left ventricle, the
Pulmonary Trunk & Left Auricle posteroinferior third of the ventricular septum, the right
 Enters the AV groove & divides into an Ant. atrium and part of the left atrium, and the sinuatrial node
InterventricularBranch & Circumflex Branch and the atrioventricular node and bundle. The LBB also
 Branches: receives small branches.
o Anterior Interventricular (descending) The left coronary artery supplies most of the left
Branch – supplies right & left ventricles ventricle, a small area of the right ventricle to the right
numerous branches that also supply the of the interventricular groove, the anterior two thirds of
Ant. part of the Ventricular Septum. the ventricular septum, most of the left atrium, the RBB,
 One of these Ventricular Branches and the LBB.
(Left Diagonal Artery) may arise
directly from the trunk of the Left
Coronary AArtery Venous Drainage of the Heart
o Circumflex Artery - same size as Ant.  Coronary sinus - most blood from the heart wall
Interventricular Artery; left margin of the drains into the Right Atrium which lies in the Post.
Left Ventricle down to the apex part of the atrioventricular groove & a
 Ant. Ventricular & Post Ventricular continuation;
Branches supply the Left Ventricle.  Great cardiac vein – opens into the right atrium
Atrial Branches supply the Left to the left of the inferior vena cava
Atrium  Small & middle cardiac veins - tributaries of the
coronary sinus. The remainder of the blood is
returned to the right atrium by the Ant. cardiac
vein & by small veins that open directly into the
heart chambers.
 Nerve Supply of the Heart  Inferior Vena Cava
 Sympathetic & Parasympathetic fibers of o Pierces central tendon of the Diaphragm
Autonomic Nervous System via CARDIAC opposite to the T8 Vertebra & almost
PLEXUSES; below the arch of the aorta immediately enters the lowest part of the Right
o Sympathetic supply – from cervical & upper Atrium
thoracic of sympathetic trunks  Pulmonary Veins
o Parasympathetic supply –from vagus nerves o 2 Veins leave each Lung carrying oxygenated
o PostganglionicSympathetic fibers terminate blood to the left atrium of the heart
on SA & AV Nodes, Cardiac muscle fibers,
& Coronary Arteries
 Results in cardiac acceleration,
increased force of contraction of
cardiac muscle, & dilatation of
coronary arteries
o Postgangionic Parasympathetic fibers
terminate on SA & AV nodes & coronary
arteries
 Results in a reduction in the rate &
force of contraction of the heart & a
constriction of coronary arteries

Action of the Heart

 Cardiac cycle - series of changes that take place
within it as it fills blood & empties
 Normal heart beats 70 – 90x/min in the resting
adult & faster in the newborn child
 Ventricular systole (contraction)
 Ventricular diastole (relaxation)
 Conduction system/nodes – initates contraction
of the myocardium _______________________________________________
 Valves – prevents backflow of blood LARGE ARTERIES OF THE THORAX
_______________________________________________  Aorta
LARGE VEINS OF THE THORAX o Main Arterial Trunk that delivers oxygenated
blood from the left ventricle of the heart to the
 Brachiocephalic Veins; tissues of the body
o Right brachiocephalic vein
o Divisions;
 Union of the Right Subclavian & Right
 Ascending aorta
Internal Jugular Veins
 Arch of the aorta
o Left brachiocephalic veins
 Descending thoracic aorta
 Joins the Right Brachiocephalic Vein to
 Descending abdominal aorta
form the Superior Vena Cava.
 Ascending Aorta
 Superior Vena Cava o Begins @ the base of the Left Ventricle &
o Contains all Venous blood from the head &
runs upward & forward to lie behind right half
neck & both upper
of the Sternum @ the level of the Sternal
o Passes downward to end in the Right Atrium
Angle, where it becomes continuous the
of the Heart
Arch of Aorta
o Vena Azygos joins the Post. aspect of the
o Branches;
Superior Vena Cava just before it enters the
 Right Coronary Artery
Pericardium
 Left Coronary Artery
 Azygos Veins
 Arch of the Aorta
o Consist of the main Azygos Vein, Inferior
o a continuation of the ascending aorta
Hemiazygos vein, & superior Hemiazygos
o Lies behind manubrium sterni & arches
Vein
upward, backward, & to the left in front of the
o Drain blood from the Post. parts of the
trachea
Intercostal Spaces, Post. Abdominal Wall,
o passes downward to the left of the trachea &,
Pericardium, Diaphragm, Bronchi, & the
@ the level of the sternal angle, becomes
Esophagus
continuous descending aorta
 o Branches; LYMPH NODES OF THE THORAX
 Brachiocephalic Artery – Divides into  Thoracic Wall
the Right Subclavian & Right Common o Anterior Axillary Nodes - skin of the Ant.
Carotid Arteries Thoracic wall
 Left Common Carotid Artery - Enters o Posterior Axillary Nodes – skin of the Post.
the neck behind the Left Sternoclavicular Thoracic wall
Joint. o Internal Thoracic Nodes – deep lymph
 Left Subclavian Artery - Enter the root vessels of the anterior parts of the intercostal
of the neck spaces
 Descending Thoracic Aorta o Posterior Intercostal Nodes - deep lymph
o Lies in the Post. Mediastinum & begins as a vessels of the Post. parts of the intercostal
continuation of the Arch of the Aorta spaces
o Passes behind Diaphragm (Aortic Opening) in
_______________________________________________
the midline & becomes continuous
Abdominal Aorta NERVES OF THE THORAX
o Branches;  Vagus Nerves
 Posterior Intercostal Arteries - lower 9  Phrenic Nerves
Intercostal Spaces  Thoracic part of the Sympathetic Trunk
 Subcostal Arteries – each side & run
_______________________________________________
along the lower border of the 12th rib to
enter the abdominal wall ESOPHAGUS
 Pericardial, Esophageal, & Bronchial  A tubular structure about 10 in. long that is
Arteries – Small branches that are continuous above Pharynx
distributed to these organs  Passes through the Diaphragm @ the level of T10
 Pulmonary Trunk Vertebra to join the stomach
o Conveys deoxygenated blood from the Right  In the neck, lies in front of the Vertebral Column;
Ventricle of the heart to the Lungs laterally, related to the lobes of Thyroid Gland; &
o Branches anteriorly, in contact Trachea & recurrent
 Right Pulmonary Artery Laryngeal Nerves
 Left Pulmonary Artery  In the Thorax, passes downward & to the Left
 Ligamentum Arteriosum - connects the through superior & Post. Mediastinum.
bifurcation of the Pulmonary Trunk to  Level of the Sternal Angle - Aortic Arch pushes the
the lower concave surface of the aortic Esophagus over to the midline
arch

Blood Supply of the Esophagus

 Upper Third - Inferior Thyroid Artery, Inferior
Thyroid Veins
 Middle Third – Descending Thoracic Aorta,
Azygos Veins
 Lower Third - Left Gastric Artery, Left Gastric
Vein

Drainage of the Esophagus

 Deep Cervical Nodes
 Superior & Post. Mediastinal Nodes
 Nodes along Left Gastric Blood Vessels & Celiac
Nodes

Nerves supply of the Esophagus

 Parasympathetic & Sympathetic Efferent &
Afferent fibers via Vagi & Sympathetic trunks
 Lower part of Thoracic course, surrounded by
Esophageal Nerve Plexus

_______________________________________________ _______________________________________________
THYMUS
 Flattened, bilobed structure lying between the
Sternum & Pericardium
 Site for development of T (thymic) lymphocytes
 Blood Supply;
o Inferior thyroid
o Internal thoracic arteries