GROUP>>>7

Presents :
HEART

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 Agenda:-
To explain the following:

• Pericardium
• Heart
• Hridaya (Heart ayurveda )
• Border and surfaces of heart
• Right atrium
• Right ventricle
• blood vessels
• Clinical anatomy
• Cardiac cycle

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 Pericardium

It is a fibrous sac that encloses the heart and the root of

the great vessels
Consists of fibrous and serous pericardium

Serous pericardium Outer parietal

Inner visceral

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 Pericardium
Fibrous pericardium : a conical sac made up of fibrous
tissue. The parietal layer of serous pericardium is attached to its
deep surface.

1] Apex: the apex is blunt and lies at the level of the sternal
angle. It is fused with the roots of the great vessels and with the
pretracheal fascia.

2] The base is broad and inseparably blended with the central

tendon of the diaphragm.

3] Anteriorly it is connected to the upper and lower ends of body

of the sternum by weak superior and inferior sternopericardial
ligaments.

4]Posteriorly, it is related to the principal bronchi, the oesophagus

with the nerve plexus around it and the descending thoracic
aorta.

5]4 On each side, it is related to the mediastinal pleura.

 Serous pericardium
is thin, double-layered serous membrane lined by
mesothelium.
The parietal pericardium is fused with fibrous pericardium.

The inner layer or the visceral pericardium, or epicardium is fused to

the heart, except along the cardiac grooves, where it is separated
from the heart by blood vessels.

The two layers are continuous with each other at the roots of the
great vessels, i.e. ascending aorta , pulmonary trunk, two venae
cava, and four pulmonary veins.

The pericardial cavity :

a potential space between the parietal pericardium and the
visceral pericardium. It contains only a thin film of serous
fluid which lubricates the apposed surfaces and allows the
heart
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to beat smoothly.
 Utpatti : the term Hridaya is derived from the term word ‘Hrut .’
हरति रक्तं हियते रक्तं वा अनेन

Hridaya organ which receives rakta (blood) or through which rakta

is received in the body is called Hridaya

शोणितकफप्रसादजं हृदयम् । सु. शा. ४/३

Hridaya is formed by the essence of shonita (rakta) and kapha.

Features :

पुण्डरीकेण सदृशं हृदयं स्यादधोमुखम्।जाग्रतस्तद्विकसति स्वपतश्च

निमीलति ।। सु.शा.४/३
Hridaya similar to pundarika (lotus bud) is facing downwards ,
थे दश महामूलः समासक्ता महाफलाः ।
च्चार्थश्च हृदयं पर्यायैरुच्यते बुधैः ।। च.सू.३०/३

According to charaka Artha and mahat are the synonyms of Hridaya .

Ten mula sira are attached to the Hridaya (Artha).

IMPORTANCE :
It is one of the trimarma
It is one of the dosha pranayatna
It is one of the seat of mana (mind)
It is the seat of Chetana

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 Heart Intro
• The heart is a conical hollow muscular
organ situated in the middle mediastinum.
• It is enclosed within the pericardium.

• The heart is placed obliquely behind the

body of the sternum and adjoining parts of
the costal cartilages, so that one-third of it
lies to the right and two-thirds to the left of
the median p1ane.
•
• The direction of blood flow, from atria to
the ventricles is downwards forwards and
to the left. The heart measures about 12 x
9 cm and weighs about 300 g in males and
250 g in females.
 External features of the heart

The external features of heart constitutes of

1. Apex
2. Base
3. Grooves or sulci
4. Borders
5. Surfaces

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 Apex
Apex : it is cone shaped lower and outer end of the heart
Apex of heart is entirely formed by left ventricle
It is directed downwards forward and to the left
It is situated in left 5th intercoastal space 9 cm lateral
to the midsternal line

In children below 2 years apex is situated in the left

4th intercoastal space in the midclavicular line

Apex beat :
it is palpable cardiac impulse
The outermost and the lowermost thrust on the front of left half
of the chest felt by hand
is called apex beat.
• In adult is felt in the left 5th intercoastal space
• In children it is felt in the 3rd intercostal space

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 Base
Base: base of the heart is also called posterior surface .
It lies opposite to the middle 4 th thoracic vertebrae in the supine .
It is formed mainly by the left atrium position and by small part of right atrium

It shows opening for :

1} pulmonary vein : which open who left atrium
2}superior and inferior vena cava :which open into the right atrium

Relations :
1) Thoracic five to the thoracic eight vertebrae
2) It is separated from the vertebral column by pericardium ,
Right pulmonary veins ,the oesophagus and aorta .

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 Grooves Or Sulci :
there are 3 grooves in the heart .
a}Atrioventricular groove
b} interatrial groove
C}interventricular groove

4) Atrioventricular groove : The atria and ventricles are separated

from each other by atrioventricular groove
This groove is also called coronary sulcus.
.
This sulcus is overlapped anteriorly by ascending aorta and pulmonary
Trunk .

Interatrial Groove : the 2 atria are separated from each

other by this groove posteriorly it is faintly visible .
While anteriorly its hidden by aorta and pulmonary Unlocking
trunk new horizons
Interventricular groove : this groove separates 2 ventricles
from each other it is divided into:

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 Borders

The heart has 4 borders,

1) Upper border: slightly oblique (formed by left

atrium)
Extends from svc to ivc its verticle formed by
right atrium.

2) Left border : its oblique formed by left ventricle

It extends from apex to left auricle

3) Right border: it is vertical formed by right

atrium ,extends
from superior vena cava to inferior venacava .

4) Inferior border : its horizontal formed by right

ventricle
Extends from ivc to apex .
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Surfaces :

1)Anterior Surface : This surface is also called

sternocostal surface .
Mainly formed by right atrium and right ventricle

2) Inferior Surface : this surface is also called

diaphragmatic surface . .
rests on central tendon of diaphragm

3) Left Surface : Formed mostly by left ventricle

It is related to left phrenic nerve
Left pericardiophrenic vessel Unlocking new horizons
pericardium

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 Right atrium
Has tricuspid opening
Elongated btw opening of SVC and IVC

Exterior of right atrium :

1) Right auricle : projected part of upper end of right atrium
Overlaps root of ascending aorta and infundibulum of right ventricle
2) Sulcus terminalis : posses from SVC to IVC
Upperpart of sulcus terminalis has SA node
3) Right atrioventricular groove
Separates right atrium and right ventricle

Interior part of right atrium

Anterior part/atrium proper / pectinate part
Rough muscular ridge musculi pectinate

Transverse pattern Reticulate pattern

15 Anterior side Right auricle
Anterior part is developed from primitive atrium

Post part / sinus venarum

Smooth
Opening of veins present
svc
Ivc Eustachian valve

Foetal life Blood direct IVC to Foramen ovale to left

Adult atrium
Non Functional
Pulmonary circulation escape

Coronary sinus – btw tricuspid orifice and orifice

Thebasian valve

Venae cardis minimi – opens through foramina venarum minimarum

Post part is developed from sinus venosum
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 Btw anterior and posterior part

Crista terminalis 1) opposite present sulcus terminus

(verticle ridge) 2) heart right border
3) extends from svc to ivc
4) SA node upper part present
Septal wall / inter atrial septum
1] Fossa ovalis
Developed from septum primum
Embryo to foramen ovale to connects right atrium and left atrium
Due to some defects – foramen ovale not enclosed
(atrial septum defect)
2] Limbus fossa ovalis .
Developed from septum secondum
Margin of fossa ovalis
3]Right atrioventricular valve / tricuspid valve :
3 leaflets :
1)anterior
2) posterior
3) septal
Largest opening
Right atrium and right ventricle btw , if there is change or defect
in position of posterior and septal leaflet i.e by ebstein anomaly
Backflow of blood from right ventricle to right atrium ..
Interior of Right atrium
a) Anterior / pectinate part : rough / atrium – has
musculi pectnati from crista terminalis.

b) Posterior / sinus venorum smooth

c) Opening 1)svc at upper end

2)IVC at lower end – eustachian
3) coronary sinus btw opening of IVC and
tricuspid opening – thebesian
4) venae cordis minimae : small veins open
into right atrium

d) Septal wall : Fossa ovalis : shallow depression

(remnants of septum primum)
Right ventricle

• The right ventricle is a triangular chamber which

receives blood from the right atrium
and pumps it .

• To the lungs through the pulmonary trunk and

pulmonary arteries .

• It forms the inferior border and two third part of

.
the
sternocostal surface and one third part of inferior
surface of heart.
 External Features

Externally the right ventricle has 2 surfaces :

• Anterior or sternocostal and inferior or diaphragmatic.

• The interior has 2 parts :
• The inflowing part is rough due to presence of
• muscular ridges called trabeculae carnae.
• It develops from the proximal part of bulbus cordis
• of the heart tube.
• The outflowing part or infundibulum is smooth and forms the upper conical part of the right
• Ventricle which gives rise to pulmonary trunk .
• It develops from the midportion of the bulbus cordis .

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• The septomarginal trabecula or moderator band is a
muscular ridge extending from ventricular septum to the
base of papillary muscle.
• The cavity of the right ventricle is crescentic because of
forward bulge of the interventricular septum .
• The wall of right ventricle is thinner than left in the ratio of
1:3.

INTERVENTRICULAR SEPTUM

• The septum is placed obliquely .Its one surface face towards

and to the right and the other faces backwards and to the left
.
• The upper part of the septum is thin membranous and
separates not only the 2 ventricles but also the right atrium
and left ventricle Unlocking new horizons

• The lowest part is thick muscular and separates the 2

ventricles
• Its position indicated by anterior and posterior
interventricular groove.
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 Internal
Features
The interior shows 2 orifices

The right atrioventricular or tricuspid orifice guarded by

tricuspid orifice,
guarded by tricuspid valve
The pulmonary orifice guarded by the pulmonary valve.
The interior of the inflowing part shows trabeculae
carnae or muscular ridges of 3 types
Ridges or fixed elevations
Bridges
Pillars or papillary muscles with one end attached to the
ventricular wall ,and the
other end connected to the cusps of the tricuspid valve
by chordae tendineae.
There are 3 papillary muscles in the right ventricle
Anterior, posterior, septal
Anterior muscle is the largest .
posterior or inferior muscle is small or irregular .
The septal muscle div into a no. of little nipples.
Each papillary muscle is attached by chordae tendineae
to
2 2 the contagious sides of 2 cusps .
 Blood vessels and its anatomy
Vessels of arterial system:
Aorta
Arteries
Arterioles

Vessels of venous system :

Vena cava
Veins
Venules

Capillaries
It forms a link btw arterial and venous system

Anastomoses:
Anastomoses means link btw 2 tubular structure/ blood vessels .It may be
Pre capillary or post capillary.

Eg : arterial supply of palm of hand

If one artery supplying an area gets blocked anastomotic artery provides another way
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End artery:
It is the artery that is the only source pf blood
to that tissue

Obstruction in the end of the artery may lead to

death of tissue since there is no alternative artery
Eg. Central artery of retina.

Aneurysm
Abnormal bulging of blood vessels due to weaking of
Wall of blood vessel

At point of aneurysm vessels may rupture resulting in

Bleeding (internal hamorrhage)
Anatomy of blood vessels

Blood vessels have 3 layers

Tunica externa :
. .
It is the outermost layer made up of fibrous connective
Tissue with collagen fibres.
.
Tunica media :
Middle layers
Made of smooth muscles
Unlocking new horizons
Tunica interna/intima
Inner layer
Made of endothelium

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 Arteries Veins
Narrow lumen wide lumen
Thick walls Thin walls
No valves present valves present
More elastic less elastic
(due to presence of elastic lamina )
Reddish color bluish color
Supply oxygenated blood Supplies deoxygenated
blood
(except pulmonary artery )
(except pulmonary vein )

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 Clinical anatomy

1] Pericardial effusion/tamponade

• Collection of fluids in the pericardial cavity

• Reduces cardiac output

.
• Pericardiocentesis – Drained by puncturing left
5th /6th intercoastal space

• just lateral to sternum or in angle btw xiphoid

Unlocking new horizons
process and left costal margin.

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 2] Situs inversus

Genetic condition in which all thoracic and abdominal organs

are mirror images of normal.
Dextro cardies : cardiac apex or apex peak on right side

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 Tachycardia: increases heart rate
Bradycardia: decreases heart rate
Arrhythmia : irregular heart rate

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 Pericarditis: inflammation of pericardium
Myocarditis: inflammation of myocardium
Endocarditis: inflammation of endocardium

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 Stenosis of heart: Narrowing of valve orifice
due to fusion of the cusps

Angina pectoris: Agonising pain in precordial

region and down the medial side of the left arm
and forearm due to insufficient blood flow to the
heart muscle from narrowing of coronary artery

Coronary angiography determines site of .

occlusion

Angioplasty : is used to remove small Blockages

using stents through catheter passed upwards
through femoral artery, aorta into coronary
artery Unlocking new horizons
In case of large segments or multiple blockages,
coronary bypass is done using great saphenous
vein /internal thoracic artery as a graft.

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 Atrial / ventricular septal defects:

Incomplete fusion of septum primum

and septum secondum causes atrial
septal defect
Defect in formation of membranous
part of interventricular septum .
causes ventricular septal defect

Unlocking new horizons

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 Congestive cardiac failure :

• Inability to pump/systolic
• Inability to fill/diastolic
• 2/3rd left sided systolic
• Ventricular compression is affected
due to coronary artery disease ,
dilated cardiomyopathy ,
hypertension , valvular heart disease .

Unlocking new horizons

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• Left sided diastolic : caused by hypertropic
cardiomyopathy , restrictive cardiomyopathy ,
hypertension
• Due to this blood flows backwards into lungs causing
pulmonary edema (fluids in lungs )
• Also causes right sided heart failure because increase in
pulmonary pressure due to left sided heart failure makes
right ventricle to pump into pulmonary artery this results
in systolic dysfunction
• Right ventricle grows thicker to pump harder which
decreases space inside it causing diastolic dysfunction
due to which blood flows backwards causing edema on
feet due to fluid accumulation
•

• Fallots tetralogy :
• Combination of 4 heart defects present at birth
• 1) interventricular foramen
• 2)overriding of aorta
• 3)pulmonary stenosis
• 4) right ventricular hypertrophy
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 [1]Atrial systole [2]Isovolumetric [3]A Fast ventricular [3]B Slow
contraction ejection phase ventricular
ejection phase

[7]Slow passive
ventricular filling [6]Rapid passive vent. Filling
phase [5]Isovolumetric relaxation [4]Protodiastole
 CARDIAC CYCLE
Cardiac cycle is defined as
the sequence of coordinated
events taking place in heart
during each beat.

3. 1 Heart beat = 1 Cardiac Cycle

. Cardiac cycle is of 0.8 sec

2 MAJOR PROCESESS

1. Systole
During this process heart
contracts and pumps the
blood through arteries.

2. Diastole
During diastole heart relaxes
and blood is filled in heart
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 Atrial Systole(0.01SEC)

Also called as last rapid filling phase

Considered as the last phase of ventricular diastole

Atrial muscle contracts and sends the blood to ventricles by AV valve

Only 20 percent of blood is passed to ventricle by atrial systole
Time period 0.11 seconds
.
Q)) What about remaining 80 percent of the blood ?
Before atrial systole , atrial diastole and ventricular diastole ,
i.e joint diastole is completed

During joint diastole AV valves open

SLV closed
80 percent of the blood is passed to the ventricles at that time.
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 Isometric contraction

1st phase of ventricular systole

Lasts for 0.05seconds
This is a type of muscular contraction characterized by increase in
tension
Changes the length of muscle fibre

Blood ejected by atrium during its systolic phase is now in

ventricles

To stop the reverse flow of blood ,

AV valves gets closed and lub sound produced

Both AV valves and SLV are closed

No any way to eject from ventricles

Ventricles are contracting and tension in the ventricular walls

increased but
Volume remains same that’s why its called as isovolumetric or
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isometric Contraction.
 II)Ejection period
1) Due to pressure exerted by blood on SLV,
they get opened and blood is ejected from both ventricles

2) Duration : 0.22 seconds

3) It has 2 stages :
a)Rapid / fast ejection period(0.13sec)
b)Slow ejection period (0.09sec)

3A)Rapid ventricular ejection

Period /phase
a) This stage starts immediately after the opening of SLV
b) Large amount of blood is ejected from both ventricles.
c) Duration 0.13 sec
d) Av valve -closed
SLV valve - open
e)LA and Aorta acting as common chamber
LA ->pressure increasing atria acting as reservoir
LV -> pressure reaches peak 120 mm hg
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Aorta ->pressure rise in similar fashion as in ventricle .
.
3B)Slow ventricular ejection period or phase

During this period blood ejected slowly

Duration :0.09 sec

Left ventricle and aorta still acting as a closed chamber

LA: pressure continue to rise (very mild increase)
LV: pressure continue to decrease yet more than intra atrial pressure
(so mitral valves are closed)but less than aortic pressure.

Aorta : aortic valve remains open

Pressure starts decreasing gradually .
3B

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 End systolic volume
Some amount of blood still
remains inside each of the
ventricle
The amount of blood at the
end of ventricular systole is
ESV.

It is 60 to 80 ml per ventricle

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.
4)Protodiastole :

First stage of ventricular diastole

Due to ejection of blood from ventricles the pressure inside aorta
and pulmonary artery increases and that of ventricle decreases
This results in closure of SLV and 2nd heart sound DUB is produced

This phase indicates only end of ventricular systole and beginning of

ventricular diastole av valves are already closed

Duration: 0.04 seconds

Aortic valve closed DUB sound produced

Mitral valve closed acting as reservoir

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 5)Isometric relaxation period
Other names: isovolumetric , isovolume relaxation
Duration : 0.08 sec
Volume of blood in the ventricle remains fixed so named
as
Isometric relaxation period or phase.
Both ventricles relax

Valves: all valves are closed

Left atrium : v wave attains peak

Left ventricle: pressure falls rapidly due to ventricular
relaxation
But more than atrial pressure so mitral valve remain
closed .
Rapid fall in pressure .

Aorta : pressure gradually decreasing.

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6)Rapid passive ventricle filling phase
a) Venticles relax
b) When av valves are opened there is sudden rush of blood
from atria to ventricles.
This sudden rush produces third heart sound .

c) 70 percent of the blood is filled during this phase

d) Duration 0.11 second
.
e) Mitral valve : open
Aortic valve :closed

LA: Pressure is more relative to the ventricles making mitral valve open .
LV : ventricle receives direct blood from atria pressure is approaching zero.

Aorta : pressure is gradually falling .

 7)Slow filling phase(DIASTASIS)

a) 20 percent ventricular filling occurs during this phase

b) Duration:0.19 seconds
c) Blood from vena cava and pulmonary vein enters directly to
ventricles without contraction

Mitral valve : open

Aortic valve : closed
Left atrium: atria acting as channel
LEFT ventricle : minimum atrial pressure attained
Aorta : pressure decreasing towards its minimum value (80 mm hg)

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Last rapid filling phase

This is atrial systole

10 percent ventricular filling
occurs due to atrial contraction

This additional amount of blood

due to atrial systole is called
atrial kick .

End diastolic volume :

Amount of blood remaining in
each ventricle at the end of
diastole

It is about 130 to 150 ml /

ventricle.
Ejection Fraction

EF : SV EDV-ESV .
EDV = EDV

SV : stroke volume
EDV: end diastolic volume
ESV: end systolic volume .
Clinical aspect of EF :
Ejection fraction is measure of left ventricular function

Ejection fraction decreases in myocardial infraction and cardiomyopathy

 Acknowledgement

special thanks to Nandeshwar sir for assigning the project

Resources / references :

BD Chourasia
Sharira Rachana Vigyan human anatomy by : Nandeshwar sir

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