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The Heart

Muhammad Iqbal Basri


Department of Anatomy
Hasanuddin University

Position

Lies within the pericardi


um in middle mediastin
um
Behind the body of ster
num and costal cartilag
es 2 to 6
In front of thoracic verte
brae 5 to 8
A third of it lies to the ri
ght of median plan and
2/3 to the left

External characteristics

a hollow muscular organ, pyramid


al in shape , somewhat larger tha
n a closed fist; consists of four ch
anbers (right and left atria, right a
nd left ventricles)
Apex cordis is formed by left ven
tricle and is directed downwards
and forwards to the left. It lies at t
he level of the fifth left intercostal
space, 1~2cm medial to the left
midclavicular line (9cm from the
midline)
Basis cordis is formed by the left
atrium and to a small extent by th
e right atrium. It faces backward,
upward and to the right

Two surface

Facies sternocostalis
i
s formed mainly by the right
atrium and right ventricle, a
nd a lesser portion of its left
is formed by the left auricle
and ventricle. It is directed f
orwards and upwards
Facies diaphragmaticus i
s formed the ventricles c
hiefly the left ventricle, direc
ted backwards and downwa
rds, and rest upon the centr
al tendon of the diaphragm

Three borders

Margo dextra (acutus)


vertical, is formed entir
ely by right atrium
Margo sinistra (obtusu
s) round, is mainly for
med by the left ventricle a
nd partly by the left auricl
e
Margo inferior horizon
tal, is formed by the right
ventricle and cardiac ape
x

Four grooves
Sulcus coronarius (circular sulcus) whi
ch marks the division between atria and
ventricles, contains the trunks of the coro
nary vessels and completely encircles th
e heart

Sulcus interatrialis separates the tw


o atria and is hidden by pulmonary trunk
and aorta in front

Sulcus interventricularis anterior an


d posterior, mark the division between ve
ntricles (which separates the RV from the
LV), the two grooves extend from the bas
e of the ventricular potion to a notch calle
d: the incisura apex cordis
Crux atrioventricularis a junction of the
posterior interventricular groove and coro
nary sulcus

Chambers of the heart


Atrium dextra (RA)
Three inlets

Orificium vena cava superior returns


blood to the heart from the upper half of th
e body
Orifice of inferior vena cava returns blo
od to the heart from the lower half of the bo
dy
Orificium sinus coronarius returns bl
ood to the heart from the cardiac muscle

One outlet
orificium atrioventricularis dextra

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 t
he crista terminalis

Atrium proprius

In front of the ridge


Pectinate muscles in wall
Auricula dextra a small coni
cal muscular pouch, projects to t
he left from the root of superior v
ena cava, pectinate muscles in
wall

Sinus venarum cavarum

Lies posterior to the ridge


Smooth walls
Fossa ovalis an oval depres
sion, a remnant of the fetal fora
men ovale, on the lower part of i
nteratrial septum, the most com
mon location of atrial septal defe
cts (ASD)
Limbus fossae ovalis
prominent margin of fossa oval
is

Ventriculus dextra (RV)

Receives deoxygenated blood fro


m right atrium through right atriove
ntricular orifice
One inlet orificium artrioventr
icularis dextra
One outlet orificium truncus p
ulmonalis
Two parts divided by the crista
supraventricularis, a muscular ri
dge between right atrioventricular
orifice and orifice of pulmonary tru
nk

Inflow tract rough walls

Trabecula carnae
irregularly arranged bundles
of myocardium
Trabecula septomarginal
extends from interventricula
r septum to base of anterior pa
pillary muscle, contains right b
undle branch
Musculus papillaris
conical-shaped , anterior, p
osterior and septal

Out flow tract

Conus arteriosus
con
e-shaped, smooth area leading
upward to orifice of pulmonary
trunk
Pumps blood through pulmona
ry orifice to pulmonary trunk

Atrium sinistra (LA)

Auricula sinistra projecting to t


he right, pectinate muscles in wall
Four inlets four orificium pulm
onalis open through the posterior
wall
One outlet orificium atriovent
ricular sinistra, blood leaves throu
gh left atrioventricular orifice to left
ventricle

Ventriculus sinistra (LV)

Has wall three times thicker tha


n that of right ventricle
One inlet orificium atriove
ntricular sinistra
One outlet orificium aorticu
s
Two parts divided by anterior
cusps of mitral valve

Inflow tract rough walls


Outflow tract vestibulum aortic
us , smooth area leading to aortic
orifice

Valves
Valvula tricuspidalis

Guards right atrioventricular orific


e
Three triangular cusps: anterior, p
osterior and septal, the base of cu
sps are attached to fibrous ring su
rrounding the atrioventricular orific
e
Chorda tendineae fine, white,
connective tissue cords, attach m
argin of cusps to musculus papil
laris

Valvula mitralis

Guards left atrioventricular orifi


ce
Two triangular cusps anterio
r and posterior with commissur
al cusps between them (poster
omedial and anterolateral com
missures)
Similar structures to those of ri
ght

Similar functions for right and left atriventricular valves


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

Valvula truncus pulmonali


s

Guards the orifice of pulmon


ary trunk
Has three semilunar cusps
each with free border that
has central nodulus valvul
a semilunaris

Valvula aorticus

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 o


f left coronary artery

Posterior no opening

Similar functions for pulmo


nary and aortic valves

Opening during systole, w


ith cusps pressed toward
wall of vessel as blood is f
orced upward

Closed during diastole

Ventricular pressure drops i


n diastole
Floating together of valve c
usps, with free borders mee
ting, thus closing the valve

Structure of the heart


Walls of heart

Endocardium inner coat


of the heart wall, and contin
uous with the valve flaps
Myocardium
Arranged spirally
Attached to fibrous rings
surrouding the four orifice
s of heart
Epicardium serous me
mbrane (visceral pericardiu
m)

Septum interatrialis
Located between right and
left atria
Contains fossa ovalis and li
mbus
Septum interventricularis
Located between right and
left ventricles
Has upper membranous pa
rt
Has thick lower muscular p
art

Fibrous skeleton

Fibrous rings that surround t


he atrioventricular, pulmona
ry, and aortic orifices
Left and right fibrous trigons

Conduction system of heart

Consists of specialized m
yocardial cells

Nodus Sinoatrialis

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

Nodus atrioventricularis

(AV node)
Located in the lower part of interatrial
septum just above the orifice of corona
ry sinus, under the endocardium
Lower part related to membranous par
t of interventricular septum

Atrioventricular bundle/fascicul
us (AV bundle)

Passes forward through right fibrous tri


gon to reach inferior border of membra
nous part
Divides into right and left bundle branc
hes at upper border of muscular part o
f interventricular septum

Right and left bundle branche


s

Right bundle branch passes do


wn on right side of interventricular
septum to reach the septomarginal
trabecular and into the base of ant
erior papillary muscle. Here it beco
mes continuous with the fibers of P
urkinje fibres
Left bundle branch passes down
on left side of interventricular septu
m beneath the endocardium. It usu
ally divides into two branches, whic
h eventually become continuous wi
th the Purkinje fibers

Purkinje fibers

continuous with myocardium

Arterial supply
Arteri coronaria sinistra

Arises from left aortic sinus


Runs between pulmonary trunk and left a
uricle into coronary sulcus
Branches

Ramus interventricularis anterior


travels downward in anterior interventric
ular groove around inferior margin of heart t
o posterior interventricular groove
Ramus circumflexus travels to left in co
ronary sulcus to posterior aspect

Distribution supplies left atrium and v


entricle, lesser portion of anterior wall of ri
ght ventricle, and anterior 2/3 of interventr
icular septum

Arteri coronaria dextra

Arises from the right aortic sinus

Runs forward between right auricle a


nd pulmonary trunk into coronary sulc
us

Branches

Ramus marginalis dextra travels


along inferior bord
Ramus interventricularis posteror
travels downward in posterior inter
ventricular groove, it anastomosises n
ear the apex with the anteriorinterven
tricular branch of the left coronary arte
ry

Distribution: supplies right atrium an


d ventricle, posterior 1/3 of interventri
cular septum, posterior wall of left ven
tricle, the sinuatrial node and atrioven
tricular node

Venous drainage
Sinus coronarius

Located in posterior part o


f coronary sinus
Carries most of venous bl
ood from myocardium to ri
ght atrium
Tributaries

Vena cordis magna


Vena cordis media
Vena cordis parva

Vena cordis anterior


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

Pericardium
Pericardium fibrosa

Attached to central tendon of diap


hragm inferiorly
Blends with outer coat of great ve
ssels superiorly

Pericardium serosa

Visceral pericardium (epicardium)


Parietal pericardium

Cavum pericardii

Potential space between visceral


and parietal pericardium
Contains film of pericardium fluid

Sinus pericardium

Sinus pericardium transversus posterior to ascending a


orta and pulmonary trunk, anterior to superior vena cava and l
eft atrium.
Sinus pericardium oblique cul-de-sac , posterior to heart,
bounded by pulmonary veins on either side

Surface markings of heart

Right border corresponds t


o a line running from the upper
border of right third costal cartil
age 1.2cm from the margin of
sternum, downwards to sixth st
ernocostal joint
Apex in the fifth left intercos
tal space 7~9cm from the midli
ne
Left border represented by
a line running from apex upwar
ds and medially to a point on lo
wer border of left second costa
l cartilage 1.2cm from sternal
margin
Lower border represented
by a line joint the lower end of
right border to apex

Dissection of the heart