Anatomy of the Cardiovascular System 11/7/12

Betty Smoot, PT, DPTSc

BIOGRAPHY: Betty Smoot, PT, DPTSc is Assistant Professor in the Department of Physical Therapy and Rehabilitation Science and in the Department of Anatomy. After completing her undergraduate degree in Biology she received her first physical therapy degree from UCSF in 1983. She earned her Doctor of Physical Therapy Science degree from UCSF in 2009. In 2012, Dr. Smoot completed a 2 year advanced-study program in Anatomy. She is a member of the American Association of Anatomists; the American Physical Therapy Association sections on orthopedics, oncology, acute care, and research; and the International Society of Lymphologists. Dr. Smoot teaches Physical Therapy Assessment, Research Design, Evidence Based Practice, and Anatomy in the UCSF Graduate Program in Physical Therapy. She is course co-director for the Prologue Block, and teaches Anatomy in all blocks for 1st and 2nd year medical students. She also teaches in the anatomy course for UCSF pharmacy students. Dr. Smoot is passionate about anatomy teaching and its importance in clinical medicine. She was awarded the Excellence in Teaching Award in medical education from the Haile T. Debas Academy of Medical Educators in 2012. BIBLIOGRAPHY: Drake R, Vogl W, Mitchell A. Gray’s Anatomy for Students. 2nd Ed. Philadelphia, PA: Churchill Livingstone; 2009 Moore K, Dalley A, Agur A. Clinically Oriented Anatomy. 6th Ed. Baltimore, MD: Lippincott Williams & Wilkins; 2009. Chapter 1. Thorax. Netter FH. Atlas of Human Anatomy. 5th Ed. Philadelphia, PA: Saunders; 2011 Peto J. The Heart. Welcome Trust Collection. 2007 Standring S. Gray’s Anatomy, The Anatomical Basis of Clinical Practice. 40th Ed. Churchill Livingstone; 2008. Section 7. Thorax. Micheal Gatzoulis, Section Editor .

10/29/2012

1

The Cardiovascular

System

Part 1:Anatomy of the heart

Components of the cardiovascular system

o Heart 

o Blood vessels

o Arteries

o Veins

o Capillaries

o Pulmonary circulation

o Systemic circulation

o Coronary circulation

Objectives:  The heart

1. Describe the location of the heart in the thorax and mediastinum.

2. Relate thorax surface anatomy to underlying cardiovascular structures.

3. Describe the anatomy of the heart, including its coverings, chambers, 

and walls.

4. Identify the valves of the heart. Explain their function, and 

consequences of valve incompetence.

5. Apply  your knowledge of anatomy to understanding clinical conditions 

related to the heart.

The thorax

Netter’s Atlas of Human Anatomy 5th Edition 

Costal cartilage

Jugular notch

Sternal angle

Xiphoid process

Clavicle

Manubrium

Body of sternum

Rib

Thoracic vertebra

I

II

III

IV

V

VI

VII

VIII

IX

X

XI

XII

Thoracic cage

Intercostal spaces

Netter’s Atlas of Human Anatomy 5th Edition 

Surface anatomy

Jugular notch

Clavicle

Manubrium

Body of sternum

Sternal angle

Costal cartilage

Costal margin

Rib X

Xyphoid process

Rib I Coracoid process

Sternoclavicular joint

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Surface anatomy

3rd costal cartilage

6th costal cartilage

2nd intercostal space

5th intercostal space

Mid-clavicular

line

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The mediastinumThe heart in situ

Common carotid artery

Internal jugular vein

Phrenic nerveLeft                                  lung

Right                       lung

Diaphragm

Superior vena cava

Aorta

Pericardium

Left subclavian artery and vein

Parietal pleura

Ribs

Netter’s Atlas of Human Anatomy 5th Edition 

PericardiumHeart removed

Left lungRight lung

Diaphragm

Pericardium

Superior vena cava

Aorta

Inferior vena cava

Pulmonary trunk

Left pulmonary veinsRight pulmonary veins

Netter’s Atlas of Human Anatomy 5th Edition 

Pericardium

3 layers of the pericardium:

1

3

2

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Cardiac tamponade

Pericardiocentesis for diagnosis and decompression

Venous pressure elevated

Neck veins distended

Decreased arterial and pulse pressures

Compression of the heart when blood or fluid accumulates in the 

pericardial cavity

Netter’s Atlas of Human Anatomy 5th Edition 

Anatomy of the heartOrientation

Left                                  lung

Right                       lung

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Anatomy of the heartThe great vessels

Superior vena cava (cut)Carrying de‐oxygenated blood

Pulmonary trunkTo right and left pulmonary arteries to right and left lungs Carrying de‐oxygenated blood

Aorta (cut)Carrying oxygenated blood

Inferior vena cava (cut)Carrying de‐oxygenated blood

Right pulmonary veins from right lung to the left atriumCarrying oxygenated blood

Left pulmonary veins from left lung  to left atrium Carrying oxygenated blood

RA

LA

RV LV

Netter’s Atlas of Human Anatomy 5th Edition 

Anatomy of the heartAnterior view

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Anatomy of the heartPosterior view

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Anatomy of the heartThe 4 chambers & their walls

The heart has 4 chambers.

1. Right atrium (RA)

2. Right ventricle (RV)

3. Left atrium (LA)

4. Left ventricle (LV)

Walls of the chambers:

1. Endocardium

2. Myocardium

3. Epicardium

RV

RA

LV

LASVC

Aorta

Pulmonary veins

Netter’s Atlas of Human Anatomy 5th Edition 

Anatomy of the heartRight atrium

SVC

IVC

Fossa ovalis

Pectinate muscle

Opening of the coronary sinus

Crista terminalis

Right auricle

Septal cusp of                 tricuspid valve

Inter‐atrial septum

Netter’s Atlas of Human Anatomy 5th Edition 

Anatomy of the heartRight  ventricle

Pulmonary trunk

Pulmonary valve

Papillary muscles

Trabeculae carnae

Chordae tendineae

Tricuspid valve

Aorta

SVC

RA

Conus arteriosus

Netter’s Atlas of Human Anatomy 5th Edition 

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Anatomy of the heartLeft atrium

Right pulmonary veins

Left auricle Aorta

Pulmonary arteries

Left atrium

Coronary sinus

LV

IVC

Netter’s Atlas of Human Anatomy 5th Edition 

Anatomy of the heartLeft ventricle

Papillary muscles

Trabeculae carnae

Chordae tendineae

Pulmonary veins

Left atrium

Coronary sinus

IVC

Mitral valve

Pulmonary arteries

Aorta

Left ventricle

Netter’s Atlas of Human Anatomy 5th Edition 

• Network of collagen & elastin fibers

• Consists of 4 dense connective tissue rings surrounding the four cardiac valves 

• 4 important functions:

1. anchors the valve cusps

2. prevents over‐dilation of the valve openings

3. provides attachment point for the myocardium

4. blocks the direct spread of electrical impulses from atria to ventricles

Anatomy of the heartThe valves and fibrous skeleton

Pulmonary valve

Aortic valve

Tricuspid valve

Mitral (bicuspid) valve

Heart in diastole

Heart in systole

Fibrous rings

Netter’s Atlas of Human Anatomy 5th Edition 

Conducting system

SA node

AV node

AV Bundle of His

Right bundle

Purkinje fibers

Fibrous ring or tricuspid valve

Netter’s Atlas of Human Anatomy 5th Edition 

Anatomy of the heartValves of the right 

Pulmonary trunk

Pulmonary valve

Tricuspid valve

RA

Netter’s Atlas of Human Anatomy 5th Edition 

Anatomy of the heartValves of the left

Pulmonary veins

Left atrium

Coronary sinus

Mitral valve

Pulmonary arteries

Aortic valve

Netter’s Atlas of Human Anatomy 5th Edition 

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Valvular heart disease

Netter’s Atlas of Human Anatomy 5th Edition 

Aortic stenosis: Aortic valve becomes narrow; 

Valve fails to open fully

Mitral valve prolapse:Incompetent mitral valve;

Blood regurgitates back into the left atrium during systole and a murmer is heard

Auscultation positions for valves

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