HEART

• Hollow muscular organ situated in middle mediastinum.

• Enclosed by pericardium.
• Flattened antero-posteriorly.

FEATURES -

• There are 4 chambers in human heart.

• LEFT ATRIUM
• RIGHT ATRIUM
• LEFT VENTRICLE
• RIGHT VENTRICLE

• Right and left atrium are separated by inter-atrial septum.

• Right and left ventricles are separated by inter-ventricular septum.

PARTS OF THE HEART -

• Apex
• Formed entirely by left ventricle.
• Situated in left 5th intercostal space, 9cm lateral to midsternal line.
• Apex beat underlines the site where heart maybe auscualted. (Mitral valve closure sound.)

CLINICAL ANATOMY – DEXTROCARDIA (Apex is on the right side.)

• Base
• Also called posterior surface.
• Formed mainly by left atrium and a small part of right atrium.
• Faces posteriorly towards the bodies of vertebrae T6-T9.

• Anterior surface (Sternocostal Surface)

• Formed mainly by right atrium and right ventricle.
• Clinically known as the ‘Area of superficial cardiac dullness’.

• Inferior surface (Diaphragmatic Surface)

• Formed by left ventricle and partly by right ventricle.

• Right pulmonary surface

• Formed by right atrium.
• Left pulmonary surface
• Formed by left atrium.
BORDERS
• Right border
• Formed by right atrium.
• Extends from superior vena cava to inferior vena cava.

• Left border
• Formed mainly by left ventricle and partly by left auricle.
• Extends from apex to left auricle.
• Inferior border
• Formed mainly by right ventricle.
• Extends from IVC to apex.
• Superior border
• Formed by two atria (mainly left atrium.)

CRUX OF HEART – Meeting point of interatrial, atrioventricular and posterior interventricular

grooves.
 RIGHT ATRIUM

• Right upper chamber of the heart

• Receives venous blood from the whole body(IMPURE), pumps it to the RV through right AV or tricuspid
orifice.

Borders formed:

Right border, part of upper border, sternocostal surface and base of the heart.

External Features:

1. Vertically elongated, receives SVC at the upper end and IVC at lower end.

2. Upper end prolonged to left forming RIGHT AURICLE (little ear). It covers root of ascending aorta and
partly overlaps infundibulum of RV. (Has notched margins and spongy interior to prevent free flow of
blood)

3. SULCUS TERMINALIS:

i. Produced by an internal muscular ridge called crista terminalis.

ii. Seen along the right border of atrium.

iii. Shallow vertical groove.

iv. Passes from SVC to IVC.

v. Upper part contains SA node (Pacemaker)

4. The right AV groove separates the RA from RV. (Vertical and has RIGHT CORONARY ARTERY and SMALL
CARDIAC VEIN lodging it.

Tributaries or Inlets of RA

1. SVC

2. IVC

3. Coronary sinus

4. Anterior cardiac veins

5. Venae cordis minimae (thebasian veins)

6. Right marginal vein (sometimes)

Right AV Orifice(tricuspid)

>Blood passes out of RA to RV through this.

>Guarded by tricuspid valve.

Internal Features

Can be divided into 3 parts:

1. Smooth Posterior Part or Sinus Venarum

2. Rough Anterior Part or Pectinate Part, including the Auricle.

3. Interatrial Septum.

1. Smooth Posterior Part or Sinus Venarum

a. Derived from the right horn of the sinus venosus.

b. All tributaries except the anterior cardiac veins open to it.

• SVC opens at the upper end.

• IVC opens at the lower end.

Opening of IVC is guarded by Eustachian valve (rudimentary). During embryonic life, it

guides the IVC blood to the LA through foramen ovale.

• Coronary sinus opens between the opening of IVC and right AV orifice. The opening is
guarded by thebasian valve.

• The venae cordis minimae are numerous small veins found in walls of all four chambers.

They open into the RA through small foramina.

• The intervenous tubercule of Lower is a very small projection on the posterior wall of the atrium,
just below opening of SVC.

During embryonic life, it directs the SVC blood to the RV.

• Rough Anterior Part or Pectinate Part, including the auricle

• Derived from the primitive atrial chamber.

• Presents a series of transverse muscular ridges called musculi pectinati.

They arise from the crista terminalis and run forwards and downwards towards the AV orifice,
like the teeth of a comb.

(In auricle, they interconnect to form a reticular network)

• Interatrial Septum
 • Derived from septum primum and septum secundum.

• Presents the fossa ovalis, a depression (shallow, saucer-shaped) in the lower part.

It represents the site of the embroyonic septum primum.

• The annulus ovalis or limbus (a border) fossa ovalis is the prominent margin of the fossa ovalis.

CLINICAL ANATOMY -
• First heart sound produced by closure of atrioventricular valves.
• Second heart sound is produced by closing of semilunar valves.
• Narrowing of valve orifice due to fusion of cusps is known as stenosis.
• Dilatation of valve orifice causes imperfect closure of valves leading to backflow of blood. This is
known as incompetence or regurgitation.
 BLOOD SUPPLY OF HEART

• Heart is supplied by two coronary arteries arising from ascending aorta.

FEATURES OF CORONARY ARTERIES -

• Blood flow during diastole.
• Functional end arteries ie. Though their branches anastomose with each other but one cannot compensate
for the other artery in case of thrombosis.

RIGHT CORONARY ARTERY LEFT CORONARY ARTERY

Arises from right anterior aortic sinus. Arises from left posterior aortic sinus.
Emerges on the surface of heart between pulmonary Emerges on the surface of heart between pulmonary
trunk and right atrium. trunk and left atrium.
Runs downward in right anterior coronary sulcus. Runs downwards in right anterior interventricular
groove and runs in left anterior coronary sulcus.
Winds around the anterior border of the heart and Winds around the inferior border of the heart.
reaches the diaphragmatic surface.
Runs backwards and to the left in right posterior Runs backwards and to the left in left posterior
coronary sulcus. coronary sulcus.
Reaches posterior interventricular sulcus. Reaches posterior interventricular sulcus.
Anastomosis with left coronary artery. Anastomosis with right coronary artery.
BRANCHES - BRANCHES -
• Larger : Marginal and posterior inter-ventricular • Larger : Diagonal, Anterior Inter-verntricular
arteries. arteries.
• Smaller : Nodal. Right atrial , Infundibular, • Smaller : Left atrial, Pulmonary, Terminal.
Terminal.
DISTRIBUTION - DISTRIBUTION -
• Right atrium and ventricle • Left atrium and ventricle
• Smaller part of left ventricle • Smaller part of right ventricle
• Whole conducting system except Left AV bundle
branch.
CARDIAC DOMINANCE –

• In about 10% of hearts, right coronary is smaller and is not able to give the posterior interventricular
branch. In such cases, circumflex artery provides the posterior interventricular branch. Such hearts are LEFT
DOMINANT.
• Mostly right coronary gives posterior interventricular artery. Such hearts are RIGHT DOMINANT.
VEINS OF THE HEART -

• Heart is drained mainly by veins that empty into coronary sinus and partly by small veins that drain into
right atrium.
• Coronary sinus – Main vein of the heart
• Wide venous channels runs from left to right in the posterior part of coronary sinus.
• Receives Great cardiac vein from left.
• Middle and Small Cardiac Veins from right.
• Left posterior ventricular vein, Left marginal vein open into coronary sinus.

TRIBUTARIES OF CORONARY SINUS -

Great Cardiac Vein – Main tributary of coronary sinus, Accompanies the anterior interventricular artery and
then the Circumflex artery to enter the left end of coronary sinus.
Middle Cardiac Vein – Accompanies the posterior interventricular artery and joins the middle part of
coronary sinus.
Small Cardiac Vein – Accompanies the right coronary artery in right posterior coronary sulcus and joins the
right end of coronary sinus.

Posterior vein of left ventricle

Oblique Vein of Left Atrium of Marshall – Small vessel descends over the posterior wall of left atrium and
merges with great cardiac vein to form coronary sinus.
Smaller Cardiac Veins/ Venae Cordis minimii – Minute vessels begin as capillaries of myocardium and open
into right atrium of heart.
CLINICAL ANATOMY -

• Thrombosis of a coronary artery is a common cause of sudden death in middle aged people. It is due
to myocardial infarction.
• Incomplete obstruction due to spasm of coronary artery causes angina pectoris which is associated
with agonising pain in the chest.
The blocks in coronary artery can be removed by angioplasty.

NERVE SUPPLY OF THE HEART

• Parasympathetic Nerve Fibres - Vagus Nerve

• Sympathetic Nerve Fibres - T2 to T5
• Both the sympathetic and parasympathetic nerve fibres form Deep and Superficial Cardiac Plexuses.

CLINICAL ANATOMY -

• Cardiac pain is an ischemic pain caused by incomplete obstruction of a coronary artery.