HEART

General orientation
Site Shape 2 surfaces position

External features
1/ Human heart has 4 chambers, these are right and left atria and right and left ventricles. 2/ On the surface of heart ,atria are seperated from ventricles by an atrioventricular groove. The atria are seperated from each other by an interatrial groove. The ventricles are seperated from each other by interventricular groove.

Sulci

Grooves or Sulci
The atria are seperated from the ventricles by a circular atrioventricular or Coronary sulcus. The interatrial groove is faintly visible posteriorly. The anterior interventricular groove runs downwards and to the left. It seperates the apex from the rest of inferior border of the heart. The posterior interventricular groove is situated on the diaphragmatic or inferior surface of heart
Coronary sulcus Anterior inter Ventricular sulcus

apex

Apex and Base of the heart

Apex is formed entirely by the left ventricle. It is directed downwards, forwards and to the left and is overlapped by left lung.It is situated in the left 5th intercostal space 9 cm lateral to the midsternal line just medial to midclavicular line. Base is also called its posterior surface. It is formed mainly by the left atrium and by a small part of right atrium. It is related to T5-T8 vertebrae in the lying posture.

The Base

Borders and Surfaces

The upper border is slightly oblique and is formed by 2 atria. The right border is more or less vertical and is formed by right atrium. The inferior border is nearly horizontal and is formed mainly by right ventricle, a small part by left ventricle. The left border is oblique and curved ,formed mainly by left ventricle and partly by left auricle.

Anterior surface

Surfaces of heart
Anterior or sternocostal surface is formed mainly by the right atrium and right ventricle and partly by left ventricle and left auricle. Most of it is covered by lungs,except a part behind cardiac notch of left lung,which is uncovered . This area is dull on percussion and referred as area of superficial cardiac dullness.

 rests on the central tendon of the diaphragm. It is formed in its left 2/3rds by the left ventricle and right 1/3rd by the right ventricle.It is traversed by the posterior interventricular groove. the left surface is formed mostly by the left ventricle and at upper end by the left auricle.

The inferior or diaphragmatic surface

apex

Diaphragmatic surface

Arterial supply of Heart

Rt. & Lt. Coronary Arteries Origin - from Ascending aorta
Rt.coronary
-from Ant. Aortic sinus
R A.
SVC.

Ascending Aorta Pulmon.

Tr. L A.

R V.

L V.

Lt.coronary
-from Lt.post.aortic sinus

Arterial supply of the heart

Rt.coronary artery
Course
a. - b/t.rt.auricle & infundibulum
a.

b. - enter atrioventricular groove

R A. b.

Infundibulum

c. - at inf.bder.turns back.& to Lt.

d. - after given off post.interventricular br.on the diaphragmatic surface it b/c much smaller & anastomoses with terminal part of circumflex br. of Lt.coro.artery

b. A/V.groove

R V.
c.

d.

Rt. Coronary artery

Branches

Branches & distribution

Near the beginning

i.conus br. ii.SA.nodal artery
(in 60% of heart )

Near the inf.bder.

iii.(rt.)Marginal artery
On diaphragmatic surface

ii.

iv.Post.interventricular br. Runs t/w. apex

- anastomoses with ant.interventr.br.of Lt.coro.artery in the post.interventri.sulcus v. AV.nodal artery (90% of heart fr. Rt.coro artery where it gives off post.interventri.br. v. i

SA. AV.

Distribution or Areas Supplied by Rt.

Coronary Rt.atrium, Rt.venricle, post.interventri.septum.(+adjoining part of

Lt.ventricle)

SA.node & AV.node

iii.

iv.

Clinical application
Disorders of Rt.coronary may cause - Sinus bradycardia - & AV.nodal block
SA.node AV,node

Lt. coronary artery

Origin
Lt.post.aortic sinus

Course
a.-runs b/h. pulmon.trunk b-appears b/t. infundibu.& Lt.auricle Termination After ashort course (<2.5cm.) it divides into

a.
Lt.auri. Infundi. b. i.

ii.

i.Circumflex br. Ii. Ant.interventricular br.

(Lt.Ant.Descending br.)

Circumflex branch of Lt.coronary

Circumflex artery
(contin.of main trunk)

Course
a. - turns round Lt.margin of heart b. - runs to the rt. in the post. a/v groove (on the Lt.side.)
anastomoses with termination of Rt.coro. a.

Branches
-to Lt.atium & Lt.ventricle
b.

Lt.marginal

(including one large Lt.marginal br.)

note : - In 40% of heart it gives SA.nodal br.

Anterior intervetricular br. of Lt.coronary artery or L.A.D. (most often blocked cardiac vessel)
Course
-runs down in interventr.groove t/w. apex -anastomoses with terminatin of post.interventri.br. Branches i.conus br. anasto.with its counterpart of Rt.coro. ii.diagonal artery a large br.tw. the left

i. LAD.

Distributions (it supplies)

-Lt.ventricle -ant.part of interventri.septum + adjoining Rt. Ventricle Clinical Note ; i. Stenosis of Lt. coro.artery is serious b/c.it supplies majority of the L.V.
ii.LAD. Is most often affected coro.artery.

ii.

Arterial supply of Heart (summary)

Atrium Ventricle Interventri.
septum
Conducting system

Rt.coronary

RA.
Part of LA.

RV.
Part of diaphrag.surface of LV.close to post interventri.groove

Post. interventri. sept.

SA.node AV.node
Left Bundle Branch.

Lt.coronary

LA.

LV.
Part of RV. Close to ant.interventri.gro ove

Ant. interventri. sept.

RBB.
LBB.

Anastomoses of coronary arteries

i.b/t.termination of Rt.coro.& Circumflex ii.b/t.posterior & anterior interventricular brs. iii.b/t.conal branches Note; Also b/t.coronary & pericardial brs.at the roots of maj.vessels Are the coronary arteries true end arteries? No! because there are anastomoses at artiolar level

Clinical application
If there is a blockage -i. thro the anastomoses collateral circulation may form to make the cardiac muscle viable -ii. Sudden blockage of one large branch usually lead to myocardial infarction (death of myocardial tissue) That is why coronary arteries are regarded as Functional end arteries What is angina pectoris ? Cardiac pain on exertion d/t. myocardial ischemia

Venous drainage of heart

Most of venous blood drains into Coronary sinus

It receives
i. Great cardiac vein

i. Ant. Cardiac veins. ii. iii. v.

- along the ant.interven.artery -along post.interven.artery -along rt.marginal artery Iv.Oblique vein of Lt.atrium &
V.posterior vein of Lt.ventricle

PosteriorView

Ii.Middle cardiac v. Iii.Small cardiac v.

iv.

Note;
-Ant.cardiac veins fr.RV.drain directly into
Rt.atrium

-Venae cordis minimae are small veins drain into

the nearest chamber directly

Guess where????