Cardiovascular system Surface Anatomy By Dr Nabil Khouri

Cardiovascular system Surface Anatomy By Dr. Nabil Khouri MD, MSc, P. h. D

Thoracic landmarks The angle of Louis marks the site of the bifurcation of the trachea into the right and left main bronchi and corresponds with the upper border of the atria of the heart.

Apex And Borders Location n The Apex of the heart: In the left 5 th inter-costal space at mid-clavicular line (~ 9 cm from the midline). n Superior border: From the INF border of the left 2 nd costal cartilage, ~ 1 cm from the sternum, to the SUP border of the right 3 rd costal cartilage, ~ 1 cm from the sternum. n Right border: From the SUP border of the right 3 rd costal cartilage, ~ 1 cm from the sternum, to the right 6 th costal cartilage ~ 1 cm from the sternum. n Left border: From the INF border of the left 2 nd costal cartilage, ~ 1 cm from the sternum, to the apex. n Inferior border: From the apex to the right 6 th costal cartilage ~ 1 cm from the sternum.

Borders of the heart 1 Inf. border of the 2 nd CC 2 3 Sup. border of the 3 rd CC 4 5 6 7 5 th intercostals space The 7 th CC

Cardiac sounds “Ascoltation” Rt 2 nd IC Lower Lt Sternal border 4 th inter-costal space LT 2 nd IC 5 th IC The sounds associated with each heart valve best heard with a stethoscope? 1. Mitral: 5 th left inter-costal space Mid-clavicular line 2. Tricuspid: 4 th left inter-costal space 3. Pulmonary: Lower left sternal border at the 2 nd inter-costal space 4. Aortic: Right upper sternal border 2 nd intercostal space

Simi lunar valve X: The pulmonary orifice is located in the upper angle of the third left sterno-costal articulation; O: The aortic orifice is a little below and medial to pulonary orifice, close to the third left sternocostal articulation;

Tricuspid valve O: The right atrioventricular opening valve is a little lower, opposite the fourth intercostal space of the right side

Bicospidic valve The left atrioventricular opening is opposite the fourth costal cartilage, and rather to the left of the midsternal line

• Trachea. —This may be marked out on the back by a line from the spinous process of the sixth cervical to that of the fourth thoracic vertebra where it bifurcates; from its bifurcation the two bronchi are directed downward and lateralward. In front, the point of bifurcation corresponds to the sternal angle. • Esophagus. —The extent of the esophagus may be indicated on the back by a line from the sixth cervical to the level of the ninth thoracic spinous process, 2. 5 cm. to the left of the middle line.

Aortic arch Pulmonary arch SVC Cardiac notch Lingula Right Atrium Diaphragmatic recess

1. Superior vena cava 2. Inferior vena cava 3. Right atrium (blue) 4. Right ventricle (blue) 5. Left ventricle (red) 6. Aorta 7. Pulmonary trunk

Transverse section at T 2 level

T 3

Level of the Ascending Aorta T 5.

T 8 http: //www. wesnorman. com/thoraxcrosssections. htm

Pulse Points Can also be used as pressure points to stop bleeding

Pulls Superficial Temporal Artery Common Carotid Artery: lies along the line connecting The st-cl-jointwith a point 2 cm lateral to the Superior border of the thyroid carilage

Upper limb Pulse 1 2 1. Brachial Artery: Medpoint between the two epicodiles 2. Basilic Vein Radial Artery: lateral to the flexor carpi radialis tendon

n n Alternating expansion and recoil of arteries with each heart beat Measured in beats per minute Normal resting pulse: 60 – 100 bpm Taken at pulse points: place where pulse is easily palpated (felt) Arterial Pulse

Lower Limbs Pulse Popliteal Artery Femoral Artery Mid inguinal point

Pulls Dorsalis Pedis Artery: lateral to the extensor hallucis longus 5 cm distal to the extensor retinaculae Posterior Tibial Artery posterior to medial malleolus