The Heart

Pathway of Blood Through the Heart and

Lungs

Figure 18.5

Position

Lies within the

pericardium in middle
mediastinum
Behind the body of
sternum and coastal
cartilages 2 to 6
In front of thoracic
vertebrae 5 to 8
A third of it lies to the
right of median plan
and 2/3 to the left

HEART
The real
thing in
ventral
view.
Lungs
have been
removed.

Surface markings of heart

Right border corresponds

to a line running from the upper
border of right third costal
cartilage 1.2cm from the
margin of sternum, downwards
to sixth sternocostal joint
Apex in the fifth left
intercostal space 7~9cm from
the midline
Left border represented by
a line running from apex
upwards and medially to a
point on lower border of left
second costal cartilage 1.2cm
from sternal margin
Lower border represented
by a line joint the lower end of
right border to apex

Pericardium
Fibrous pericardium

Attached to central tendon of

diaphragm inferiorly
Blends with outer coat of great
vessels superiorly

Serous pericardium

Visceral pericardium (epicardium)

Parietal pericardium

Pericardial cavity

Potential space between visceral

and parietal pericardium
Contains film of pericardium fluid

The clear tissue being

Lifted up by the scalpel
Is the pericardium

Pericardial Layers of the

Heart

Figure 18.2

Black looking structure is the heart

bulging from the pericardial sac.
Not only pathogens can cause
a cardiac tamponade, but blunt
force trauma can also cause it.

Pericardium sinus

Transverse sinus of pericardium posterior to ascending

aorta and pulmonary trunk, anterior to superior vena cava and
left atrium.
Oblique sinus of pericardium cul-de-sac , posterior to
heart, bounded by pulmonary veins on either side

External characteristics

a hollow muscular organ,

pyramidal in shape , somewhat
larger than a closed fist; consists
of four chanbers (right and left
atria, right and left ventricles)
Cardiac apex is formed by left
ventricle and is directed
downwards and forwards to the
left. It lies at the level of the fifth
left intercostal space, 1~2cm
medial to the left midclavicular
line (9cm from the midline)
Cardiac base is formed by the
left atrium and to a small extent
by the right atrium. It faces
backward, upward and to the
right

Two surface

Sternocostal surface
is
formed mainly by the right
atrium and right ventricle,
and a lesser portion of its
left is formed by the left
auricle and ventricle. It is
directed forwards and
upwards
Diaphragmatic surface
is formed the ventricles
chiefly the left ventricle,
directed backwards and
downwards, and rest upon
the central tendon of the
diaphragm

Three borders

Right border vertical,

is formed entirely by right
atrium
Left border round, is
mainly formed by the left
ventricle and partly by the
left auricle
Inferior border
horizontal, is formed by
the right ventricle and
cardiac apex

Four grooves

Coronary sulcus (circular sulcus) which

marks the division between atria and
ventricles, contains the trunks of the
coronary vessels and completely
encircles the heart
Interatrial sulcus separates the two
atria and is hidden by pulmonary trunk
and aorta in front
Interventricular grooves anterior
and posterior, mark the division between
ventricles (which separates the RV from
the LV), the two grooves extend from the
base of the ventricular potion to a notch
called: the cardiac apical incisure
Atrioventricular crux a junction of
the posterior interventricular groove and
coronary sulcus

Chambers of the heart

Right atrium (RA)
Three inlets

Orifice of superior vena cava returns

blood to the heart from the upper half of
the body
Orifice of inferior vena cava returns
blood to the heart from the lower half of the
body
Orifice of coronar sinus returns blood
to the heart from the cardiac muscle

One outle
right atrioventricular orifice

Crista terminalis vertical

ridge thatjfrom superior vena cave
to inferior vena cave

Sulcus terminalis groove on

exterior of heart that corresponds
to crista terminalis

Two parts separated externally by

sulcus terminalis and internally by
the crista terminalis

Atrium proper

In front of the ridge

Pectinate muscles in wall
Right auricle a small conical
muscular pouch, projects to the
left from the root of superior
vena cava, pectinate muscles in
wall

Sinus venarum cavarum

Lies posterior to the ridge

Smooth walls
Fossa ovalis an oval
depression, a remnant of the
fetal foramen ovale, on the lower
part of interatrial septum, the
most common location of atrial
septal defects (ASD)
Limbus fossae ovalis
prominent margin of fossa ovalis
Torus aortious

Right ventricle (RV)

Receives deoxygenated blood

from right atrium through right
atrioventricular orifice
One inlet right
artrioventricular orifice
One outlet orifice of
pulmonary trunk
Two parts divided by the
supraventricular crest, a
muscular ridge between right
atrioventricular orifice and orifice
of pulmonary trunk

Inflow tract rough walls

Trabeculae carneae
irregularly arranged bundles of
myocardium
Septomarginal trabecula
extends from
interventricular septum to base
of anterior papillary muscle,
contains right bundle branch
Papillary muscles conicalshaped , anterior, posterior
and septal

Out flow tract

Conus arteriosus coneshaped, smooth area leading

upward to orifice of pulmonary
trunk
Pumps blood through
pulmonary orifice to pulmonary
trunk

Left atrium (LA)

Left auricle projecting to the

right, pectinate muscles in wall
Four inlets four orifices of
pulmonary veins open through
the posterior wall
One outlet left atrioventricular
orifice, blood leaves through left
atrioventricular orifice to left
ventricle

Left ventricle (LV)

Has wall three times thicker

than that of right ventricle
One inlet left
atrioventricular orifice
One outlet aortic orifice
Two parts divided by anterior
cusps of mitral valve

Inflow tract rough walls

Outflow tract aortic vestibule,
smooth area leading to aortic
orifice

Walls of the ventricles:

Left wall is thicker!

Valves
Tricuspid valve

Guards right atrioventricular

orifice
Three triangular cusps: anterior,
posterior and septal, the base of
cusps are attached to fibrous ring
surrounding the atrioventricular
orifice
Chordae tendineae fine,
white, connective tissue cords,
attach margin of cusps to
papillary muscles

Mitral valve

Guards left atrioventricular

orifice
Two triangular cusps
anterior and posterior with
commissural cusps between
them (posteromedial and
anterolateral commissures)
Similar structures to those of
right

Similar functions for right and left atriventricular valves

Open during diastole to allow blood to enter ventricles from
atria
Closed during systole to prevent regurgitation of blood into
atria

Valve of pulmonary trunk

Guards the orifice of

pulmonary trunk
Has three semilunar cusps
each with free border that
has central nodules of
semilunar valve

Aorti vavle

Guards the aortic orifice

Three semilunar cusps (right,
left and post)
Three aortic sinuses bulges
in aortic wall at level of valve
that correspond to cusps

Right contains opening

of right coronary artery

Left contains opening

of left coronary artery

Posterior no opening

Similar functions for

pulmonary and aortic
valves

Opening during systole,

with cusps pressed
toward wall of vessel as
blood is forced upward

Closed during diastole

Ventricular pressure drops

in diastole
Floating together of valve
cusps, with free borders
meeting, thus closing the
valve

Structure of the heart

Walls of heart

Endocardium inner coat

of the heart wall, and
continuous with the valve
flaps
Myocardium
Arranged spirally
Attached to fibrous rings
surrouding the four
orifices of heart
Epicardium serous
membrane (visceral
pericardium)

Interatrial septum
Located between right and
left atria
Contains fossa ovalis and
limbus
Interventricular septum
Located between right and
left ventricles
Has upper membranous
part
Has thick lower muscular
part

Heart Valves

Fibrous skeleton

Fibrous rings that surround

the atrioventricular,
pulmonary, and aortic
orifices
Left and right fibrous trigons

Conducting System

Innervation

Heart rate is altered by

external controls
Nerves to the heart
include:

Visceral sensory fibers

Parasympathetic
branches of the vagus
nerve
Sympathetic fibers from
cervical and upper
thoracic chain ganglia

Conduction system of heart

Consists of specialized
myocardial cells

Sinuatrial node (SA

node)
Called the pacemaker cell
(P cell)
Located at the junction of
right atrium and superior
vena cava, upper part of
the sulcus terminalis,
under the epicardium

Atrioventricular node (AV node)

Located in the lower part of interatrial
septum just above the orifice of
coronary sinus, under the
endocardium
Lower part related to membranous
part of interventricular septum
Atrioventricular bundle (AV
bundle)
Passes forward through right fibrous
trigon to reach inferior border of
membranous part
Divides into right and left bundle
branches at upper border of muscular
part of interventricular septum

Right and left bundle

branches
Right bundle branch passes
down on right side of
interventricular septum to reach the
septomarginal trabecular and into
the base of anterior papillary
muscle. Here it becomes
continuous with the fibers of
Purkinje fibres
Left bundle branch passes down
on left side of interventricular
septum beneath the endocardium.
It usually divides into two branches,
which eventually become
continuous with the Purkinje fibers
Purkinje fibers continuous with
myocardium

Arterial supply
Left coronary artery

Arises from left aortic sinus

Runs between pulmonary trunk and left
auricle into coronary sulcus
Branches

Anterior interventricular branch

travels downward in anterior interventricular
groove around inferior margin of heart to
posterior interventricular groove
Circumflex branch travels to left in
coronary sulcus to posterior aspect

Distribution supplies left atrium and

ventricle, lesser portion of anterior wall of
right ventricle, and anterior 2/3 of
interventricular septum

Right coronary artery

Arises from the right aortic sinus

Runs forward between right auricle

and pulmonary trunk into coronary
sulcus

Branches

Right marginal branch travels

along inferior bord
Posteror interventricular branch
travels downward in posterior
interventricular groove, it
anastomosises near the apex with
the anteriorinterventricular branch of
the left coronary artery

Distribution: supplies right atrium and

ventricle, posterior 1/3 of
interventricular septum, posterior wall
of left ventricle, the sinuatrial node
and atrioventricular node

Venous drainage
Coronary sinus

Located in posterior part

of coronary sinus
Carries most of venous
blood from myocardium to
right atrium
Tributaries

Great cardiac vein

Middle cardiac vein
Small cardiac vein

Anterior cardiac veins

3~4 small vessels,
drain into right atrium
Smallest cardiac veins
drain into all
chambers, mainly atria