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The cardiac plexus is a network of autonomic nerves and ganglia situated at the base of the heart. It is formed by cardiac branches derived from both the sympathetic and parasympathetic nervous systems.
Parasympathetic cardiac nerves reach the heart from the vagus nerve (cranial nerve X) via several cardiac nerves. An upper cardiac nerve arises below the inferior cervical ganglion and a lower branch arises in the root of the neck. The nerves descend anterior to the brachiocephalic artery on the right and over the aortic arch on the left.
Sympathetic cardiac nerves are derived from T1 to T4 segments and partly from the T5 segment of the spinal cord.
Both sympathetic and parasympathetic nerves terminate in the cardiac plexus which has two interconnected components, which in turn contribute to the left and right coronary plexuses:
a superficial component inferior to the aortic arch
a deep component posterior to the aortic arch
Postganglionic fibers from both components pass into the heart and are most densely distributed to the sinoatrial node and atrioventricular node. Some fibers pass directly into the atria and ventricular myocardium. The coronary arteries and cardiac veins also receive adrenergic fibers.
Superficial cardiac plexus
The superficial part of the cardiac plexus lies beneath the aortic arch and anterior to the right pulmonary artery. It is formed by the superior cervical cardiac branch of the left sympathetic trunk and the lower superior cervical cardiac branch of the left vagus trunk. A small ganglion, the cardiac ganglion of Wrisberg, is occasionally found that forms a junction for these nerves.
The superficial cardiac plexus provides branches to the anterior coronary plexus, left anterior pulmonary plexus and deep cardiac plexus.
Deep cardiac plexus
The deep part of the cardiac plexus is located posterior to the aortic arch and anterior of the tracheal bifurcation (carina) above the point of division of the pulmonary trunk. It is formed by the cardiac nerves derived from the superior, middle and inferior cervical ganglia of the sympathetic trunk and the cardiac branches of the vagus and recurrent laryngeal nerves except those that supply the superficial cardiac plexus.
The deep cardiac plexus is divided into halves:
the right half lies along the brachiocephalic trunk
a branch passes anterior to the right pulmonary artery supplying the right pulmonary plexus and continues to contribute to the anterior coronary plexus
a branch passing posterior to the right pulmonary artery supplies the right atrium and continues to contribute to the posterior coronary plexus
the left half lies along the aortic arch
connects with the superficial cardiac plexus
gives small branches to the left atrium and to the anterior pulmonary plexus
continues to contribute to the posterior coronary plexus
Both superficial and deep cardiac plexuses extend laterally becoming coronary plexuses. The left coronary plexus courses along the left coronary artery and supplies the left atrium and left ventricle. The right coronary plexus courses along the right coronary artery and supplies the right atrium and right ventricle.
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