Surface anatomy of heart
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flow of cardiac conuducting system
SA node → internodal pathways → AV node → Bundle of His → RBB & LBB → Purkinje fibres → ventricles
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cardiac conducting system (internodal pathways)
• Location: Interatrial wall (between right & left atrium)
• Function: Rapid conduction from SA node (Sinoatrial node) to AV node (Atrioventricular node)
• Cells: Modified cardiac muscle cells + Purkinje-like fibres
Types
• Anterior internodal pathway
• Passes in front of SVC (Superior Vena Cava) opening
• Conducts to AV node
• Gives Bachmann bundle → conducts impulse to left atrium
• Middle internodal pathway (Wenckebach bundle)
• Passes behind SVC (Superior Vena Cava)
• Conducts to superior part of AV node
• Posterior internodal pathway (Thorel bundle)
• Passes behind SVC (Superior Vena Cava)
• Conducts to posterior part of AV node
• Function: Rapid conduction from SA node (Sinoatrial node) to AV node (Atrioventricular node)
• Cells: Modified cardiac muscle cells + Purkinje-like fibres
Types
• Anterior internodal pathway
• Passes in front of SVC (Superior Vena Cava) opening
• Conducts to AV node
• Gives Bachmann bundle → conducts impulse to left atrium
• Middle internodal pathway (Wenckebach bundle)
• Passes behind SVC (Superior Vena Cava)
• Conducts to superior part of AV node
• Posterior internodal pathway (Thorel bundle)
• Passes behind SVC (Superior Vena Cava)
• Conducts to posterior part of AV node
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cardiac conducting system (AV bundle/ bundle of his)
• Site: Membranous IVS (Interventricular Septum)
• Function: Only electrical connection between atria and ventricles
• Divides into:
• RBB (Right Bundle Branch) → right ventricle
• LBB (Left Bundle Branch) → left ventricle
• Function: Only electrical connection between atria and ventricles
• Divides into:
• RBB (Right Bundle Branch) → right ventricle
• LBB (Left Bundle Branch) → left ventricle
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cardiac conducting system (RBB= right bundle branch)
• Origin: AV bundle in membranous IVS (Interventricular Septum)
• Structure: Narrow fascicles
• Course:
• Runs within myocardium
• Moves to subendocardial layer
• Travels along right side of IVS
• Passes through moderator band (septomarginal trabecula)
• Supplies anterior papillary muscle & right ventricular wall
• Structure: Narrow fascicles
• Course:
• Runs within myocardium
• Moves to subendocardial layer
• Travels along right side of IVS
• Passes through moderator band (septomarginal trabecula)
• Supplies anterior papillary muscle & right ventricular wall
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Cardiac conducting system (LBB/ left bundle branch)
• Origin: AV bundle in membranous IVS (Interventricular Septum)
• Structure: Flattened sheets of fascicles
• Course:
• Left half of muscular IVS
• Subendocardial space
• Toward ventricular apex
• Trifurcates into:
• Anterior division
• Septal division
• Posterior division
• Supplies left ventricular wall, IVS & papillary muscles
• Structure: Flattened sheets of fascicles
• Course:
• Left half of muscular IVS
• Subendocardial space
• Toward ventricular apex
• Trifurcates into:
• Anterior division
• Septal division
• Posterior division
• Supplies left ventricular wall, IVS & papillary muscles
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cardiac conducting system (purkinje fibres)
• Location: Subendocardial layer of the ventricles (just beneath the endocardium)
• Cell size: Much larger than surrounding ventricular muscle cells
• Arrangement: Run as bundles and branches throughout the ventricular walls
• Course:
• Reach the cardiac apex
• Then curve upward and backward through ventricular walls
• Cell connections:
• Contain many more gap junctions than:
• Atrioventricular nodal cells
• Ordinary ventricular myocytes
• Conduction speed:
• 6× faster than ventricular muscle fibres
• 150× faster than atrioventricular nodal fibres
• Function:
• Rapid, synchronized activation of both ventricles
• Ensures coordinated ventricular contraction from apex → base
• Cell size: Much larger than surrounding ventricular muscle cells
• Arrangement: Run as bundles and branches throughout the ventricular walls
• Course:
• Reach the cardiac apex
• Then curve upward and backward through ventricular walls
• Cell connections:
• Contain many more gap junctions than:
• Atrioventricular nodal cells
• Ordinary ventricular myocytes
• Conduction speed:
• 6× faster than ventricular muscle fibres
• 150× faster than atrioventricular nodal fibres
• Function:
• Rapid, synchronized activation of both ventricles
• Ensures coordinated ventricular contraction from apex → base
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nerve supply of heart
• Supplied by Autonomic Nervous System
• Sympathetic fibres
• Parasympathetic fibres
• Nerves form cardiac plexuses
• Located below the arch of the aorta
• Sympathetic fibres
• Parasympathetic fibres
• Nerves form cardiac plexuses
• Located below the arch of the aorta
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nerve supply of heart (sympathetic supply)
• Origin: Cervical and upper thoracic segments of the sympathetic trunks
• Effect:
• Increases heart rate
• Increases conductivity
• Increases contractility
• Effect:
• Increases heart rate
• Increases conductivity
• Increases contractility
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nerve supply of heart (parasympathetic supply)
• Origin: Vagus nerve
• Effect:
• Decreases heart rate
• Decreases conductivity
• Decreases contractility
• Effect:
• Decreases heart rate
• Decreases conductivity
• Decreases contractility
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cardiac plexus
network of autonomic nerves that supplies the heart.
Two cardiac plexuses
1. Superficial cardiac plexus
2. Deep cardiac plexus
Two cardiac plexuses
1. Superficial cardiac plexus
2. Deep cardiac plexus
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superficiacl cardiac plexus
• Location:
• Below the arch of the aorta
• In front of the right pulmonary artery
• Sympathetic input:
• Left sympathetic chain
• Superior cervical cardiac branch
• Parasympathetic input:
• Left vagus nerve
• Inferior cervical cardiac branch
• Below the arch of the aorta
• In front of the right pulmonary artery
• Sympathetic input:
• Left sympathetic chain
• Superior cervical cardiac branch
• Parasympathetic input:
• Left vagus nerve
• Inferior cervical cardiac branch
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Deep cardiac plexus
• Location:
• In front of the bifurcation of the trachea
• Behind the arch of the aorta
• Sympathetic input:
• All cervical and thoracic ganglia of sympathetic chains
• Cardiac branches
• Parasympathetic input:
• Vagus nerve
• Recurrent laryngeal nerve (branch of vagus nerve)
• Distribution:
• Divides into right and left halves
• Supplies:
• Corresponding coronary plexuses
• Pulmonary plexuses
• In front of the bifurcation of the trachea
• Behind the arch of the aorta
• Sympathetic input:
• All cervical and thoracic ganglia of sympathetic chains
• Cardiac branches
• Parasympathetic input:
• Vagus nerve
• Recurrent laryngeal nerve (branch of vagus nerve)
• Distribution:
• Divides into right and left halves
• Supplies:
• Corresponding coronary plexuses
• Pulmonary plexuses
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Nerves flow
Autonomic nerves → cardiac plexuses (superficial & deep) → coronary vessels, myocardium & conducting system