Download Region 11: Heart, Trachea, and Lungs Landmarks -

Region 11: Heart, Trachea, and Lungs
Landmarks
--apex: about 8cm (5.5-12.5 cm) from median plane in left 5th intercostal space
--base: posterior aspect of heart; mainly formed by left atrium and a small part of
the right atrium
*pulmonary vens, the superior vena cava, and inferior vena cava connect
with the base
--Heart Valves
a. pulmonary valve: listen in 2nd intercostal space on left
b. aortic valve: listen in 2nd intercostal space on right
c. mitral valve: listen in 5th intercostal space about 3 ½ inches to left of
midline
d. tricuspid valve: listen over lower left border of sternum
Arteries of the Heart
--right coronary artery
a. sinoatrial nodal artery: 60% from proximal portion of right coronary a.,
40% from beginning of left circumflex a.
b. posterior interventricular branch/posterior descending artery (PDA): runs
in posterior interventricular sulcus
c. atrioventricular nodal branch: in 80% of population
--left coronary artery
a. anterior interventricular branch/left anterior descending artery (LAD):
runs in anterior interventricular sulcus, has perforating and diagonal
branches
b. circumflex branch
Veins of the Heart (terminate principally in the coronary sinus)
--great cardiac vein
*begins in anterior interventricular sulcus and travels with anterior
interventricular a., then the circumflex a.
--middle cardiac vein
*begins in posterior interventricular sulcus and travels with posterior
interventricular a.
--small cardiac vein
*in posterior right coronary sulcus with right coronary a.
Chambers of the Heart (2 receiving-atria, 2 pumping-ventricles)
--Right Atrium: receives deoxygenated blood from body (via sup. and inf. vena cava)
and the heart (via coronary sinus)
a. sinus venarum: smooth part b/w 2 vena cava
b. crista terminalis: internal to sulcus terminalis
c. pectinate muscles (musculi pectinati): pundled muscle fibers in auricle
d. fossa ovale and limbus of fossa ovale
e. sinuatrial node and atrioventricular node
--Right Ventricle: receives blood from right atrium and pumps it to lungs via
pulmonary a.
a. right atrioventricular/tricuspid valve
b. trabecula carnae: thick muscle bundles giving the ventricle its rugged
texture
c. septomarginal trabecula (septal limb and moderator band): goes from
interventricular septum to the root of the anterior papillary muscle and
carries theright bundle branch
d. papillary muscles; conical projections of ventricular muscle related to the
cusps (anterior, posterior, septal)
e. chorda tendinae: fibrous cords attaching papillary muscles to the valve
cusps
f. infundibulum (conus arteriosus, outflow tract): separated from rough,
trabecular portion (inflow tract) by the supraventricular crest
--Left Atrium: receives oxygenated blood from lungs via pulmonary veins
a. smooth walled portion receives oxygenated blood from 4 pulomonary vv.
b. auricle; has pectinate muscles
c. valve of the foramen ovale
--Left Ventricle: receives blood from the left atrium and pumps it throughout the
body via the aorta
a. left atrioventricular valve (mitral, bicuspid)
b. trabecula carnae
c. papillary muscles (anterior and posterior) and corda tendinae
d. aortic vestibule (outflow tract)
e. membranous part of the interventricular septum: right below the right and
posterior cusps of the aortic valve
Valves of the Heart
--Atrioventricular valves
*separates the atria from the ventricles
*valves have rigns, cusps, chorda tendinae, and papillary muscles
*Right atrioventricular valve/Tricuspid valve (3 cusps)
*Left atrioventricular valve/Mitral/Bicuspid valve (2 cusps)
--Semilunar valves
*pulmonary valve
*aortic valve
Conduction System of the Heart
--Sinuatrial node (pacemaker): junction of the superior vena cava and right atrium,
near the end of the sulcus terminalis just deep to the epicardium
--Atrioventricular node: right side of the interatrial septum above and in front of the
opening for the coronary sinus
--Atrioventricular bundle (Bundle of His)
*runs below the membranous part of the interventricular septum
*divides into right and left bundle branches
Nerves of the Heart (modify the heart’s intrinsic rhythmicity)
--cardiac nerves: from the vagus and sympathetic chain
Trachea and Bronchi (bronchioles: airways less than 1.5 mm diameter)
--Trachea
*2-2.5 cm diameter in adults
*10-12 cm long in adults, beginning at C6, ending at upper T5
*has 16-20 C-shaped cartilage rings deficient in back part, next to esophagus
--last cartilage is carina
*right bronchus (primary) 25 degrees from vertical center
*left bronchus (primary): 37 degrees from vertical center
--Right Primary Bonchus
*enters hilum of right lung
*is wider, shorter (2.5 cm long) and more vertical than left bronchus (why
more foreign objects enter right bronchus)
*primary and secondary bronchi have C-shaped cartilages
*secondary bronchi: 3, 1 each to superior, middle, and inferior lobes
a. eparterial bronchus: the right superior lobar bronchus: named for
its position superior to right pulmonary artery
*tertiary bronchi: supply bronchopulmonary (lobule) segment of each lobe
a. superior lobe
b. middle lobe
c. lower lobe
--Left Primary Bronchus
*enters hilum of left lung
* narrower and longer (5cm) and less vertical than right bronchus
*secondary bronchi: 2, 1 to superior and inferior lobes: there is no epiarterial
bronchus on the left side
*tertiary bronchi
a. superior lobe: has 2 divisions
b. inferior lobe
Lungs
--are free in pleural cavities, except at the hilus, which contains the root of each
lung and pulmonary ligament
--right lung: 2 fissure separate the lung into 3 lobes
a. upper lobe: served by 3 segmentsapical, anterior, posterior
b. middle lobe: 2 segmentslateral and medial
c. lower lobe: 5 segmentssuperior, medial basal, anterior basal, lateral
basal, posterior basal
d. 2 fissures
--oblique fissure: separates the upper and middle lobes from the
lower lobe
--horizontal fissure: separates the middle form the upper lobe
--left lung: oblique fissure separates the lung into 2 lobes
a. upper lobe: 4 segmentsapico-posterior, anterior, superior lingular,
inferior lingular
b. lower lobe: 5 segmentssuperior, medial basal, anterior basal, lateral
basal, posterior basal
Blood Supply
--Right pulmonary artery: at root of the lung it is anterior/inferior to superior lobar
(epiarterial) bronchus
--Left pulmonary artery
--Bronchial arteries
*2 left branches (superior and inferior) and 1 right branch
*left branches come directly off the aorta
*right branch comes off an itnercostal artery or one of the left bronchial
arteries
--2 pulmonary veins
*superior and inferior, serve each lung
*lie anterior and inferior to other structures (bronchi, pulmonary arteries) at
the hilus of the lungs
--lymphatics
*superficial plexus lies in or near the visceral pleura
*deep plexus follows the conducting system
a. bronchopulmonary (hilar) nodes: at primary/secondary bronchial
segment junctions
b. tracheobronchial nodes: at trachea and primary bronchial junctions