• Approximately the size

of your fist
• Location
• Superior surface of
diaphragm
• Left of the midline
• Anterior to the
vertebral column,
posterior to the
sternum
• Hollow, muscular organ
• 300 grams (size of a fist)

HODS - November 2006

• 4 chambers
• found in chest between lungs

3
 Coverings of the Heart:
• Pericardium
Composed of:
• A superficial fibrous pericardium
• A deep two-layer serous pericardium

They are separated by the fluid-filled

pericardial cavity
The clear tissue being
Lifted up by the scalpel
Is the pericardium
External features
➢ Apex –downwards, forwards and to the left
➢ Base - upper region
➢ Has anterior, inferior and left surfaces which are
demarcated by upper, lower, right and left
borders.
• Coronary sulcus or
atrioventricular groove.
Indentation that separates
atria from ventricles.

• Anterior and posterior

interventricular sulcus
Separates right and left
ventricles .
• Interatrial groove which is faintly visible separates
right and left atria.
• Apex- situated in left 5th intercostal space just medial
to midclavicular line.
• Base- formed mainly by left atrium and by small part
of right atrium.
Borders of heart
• Upper border- form by 2 atria mainly left atrium
• Right border- right atrium
• Inferior border- right ventricle mainly
• Left border- mainly left ventricle partly left
auricle.
Surfaces of heart
• Anterior surface- mainly right atrium and right
ventricle and partly by left auricle and left ventricle.
(area of superficial cardiac dullness)
• Left surface- mainly by left ventricle and at upper
end by left auricle.
Inferior surface- left 2/3rd by left ventricle and right
1/3rd by right ventricle
Pathway of Blood Through the
Heart and Lungs
 Right Atrium
• Atria - receiving chambers of the heart.
• It forms the upper border, right border and
sternocostal surface of the heart.
• Receive venous blood from superior and inferior
venae cava and coronary sinus
• Each atrium has a protruding auricle whose
margins are notched and interior is sponge like
which prevent free flow of blood.
• Sulcus terminalis- a shallow groove which passes
from superior to inferior vena cava. It is produced by
internal muscular ridge crista terminalis. Upper part
of sulcus contain sinuatrial node which act as
pacemaker of heart.
• Right atrioventricular groove separates right
atrium from right ventricle. It lodges right
coronary artery and small cardiac vein
 Interior of right atrium
• Smooth posterior wall
➢Most of the tributaries opens here
• Superior vena cava
• Inferior vena cava- opening is guarded by a
rudimentary valve (eustachian valve)
• Coronary sinus opens between the opening of
inferior vena cava and right AV orifice. The
opening is guarded by thebasian valve.
• Vene cordis minimi.
➢Intervenous tubercle present just below the
opening of superior vena cava.
• Rough anterior part
• Musculi Pectinati- series of transverse muscular
ridges in the atrial walls.
• Tendon of todaro
• Triangle of koch- AV node is present here

• Septal wall
• Fossa ovalis - remnant of foramen ovale
• Limbus fossa ovalis prominent margin of fossa ovalis.
 Left atrium
• It forms the upper border, left border and anterior,
left surfaces of heart.

• Pulmonary veins opens into it.

• Greater part of interior is smooth walled.

• Musculi pectinati are present only in the auricle.

• Septal wall shows fossa lunata corresponding to

fossa ovalis of right atrium.
 Right Ventricle
• Ventricles are the discharging chambers of the heart.

• It forms the inferior border, anterior and inferior

surface of heart.

• Interior has 2 parts-

• Inflowing part which is rough
• Outflowing part which is smooth

• The two parts are separated by supraventricular crest

situated between tricuspid and pulmonary orifice.
Interior of inflowing part shows-

Trabeculae carnae- 3 types

1) ridges
2) bridges
3) papillary muscles (with one end attached to
ventricular wall and other to the cusp of tricuspid
valve by chordae tendinae). There are 3 papillary
muscles- anterior, posterior and septal.
 Chordae tendineae
Papillary muscle
• Septomarginal trabeculae (moderator band) is a
muscular ridge extending from the interventricular
septum to the base of anterior papillary muscle. It
contain right branch of AV bundle.

• Cavity of right ventricle is cresentic in shape

• The right ventricle is relatively thin. Left ventricle –

three times thicker than right.
Interventricular
septum
 Left ventricle
• It forms the left border and anterior, inferior and left
surface of heart.
• Interior is divided into 2 parts.
• Lower rough part with trabeculae carnae -ridges,
bridges and 2 papillary muscles (anterior and
posterior). Chordae tendinae from both are
attached to both the cusp of mitral valve.
• Upper smooth part (aortic vestibule).

• Cavity is circular.
Heart Valves
• Two major types
• Atrioventricular valves
• Semilunar valves
(pulmonary and aortic
valve)

• Left AV valve = bicuspid or

mitral valve
• Right AV valve= tricuspid
valve
• Heart valves ensure unidirectional blood flow
through the heart.

• Atrioventricular (AV) valves lie between the atria

and the ventricles.

• AV valves prevent backflow into the atria when

ventricles contract.

• Chordae tendineae anchor AV valves to papillary

muscles.
• Aortic semilunar valve lies between the left ventricle
and the aorta.

• Pulmonary semilunar valve lies between the right

ventricle and pulmonary trunk.

• Semilunar valves prevent backflow of blood into the

ventricles.
• Have no chordae tendinae attachments.
• Each valve has 3 cusps which are attached directly to
vessel wall. There is no fibrous ring. The cusps form
small pockets with their mouth are directed away
from the ventricular cavity.
• The free margin of the cusps contains a central
fibrous nodule from each side of the nodule a thin
smooth margin (lunule) extends upto the base of the
cusps.
• Opposite the cusps the vessel wall are slightly
dilated to form the aortic and pulmonary sinuses.
Coronary arteries arise from the aortic sinuses.
• Heart sounds (“lub-dup”) due to valves closing.

• “Lub” - closing of atrioventricular valves.

• “Dub”- closing of semilunar valves.

Figure 18.8a, b
Conducting System
Coronary Circulation - Arteries
• Right Coronary Artery arise from anterior aortic
sinuses
• Emerge on the surface of heart between root of
pulmonary trunk and right auricle.

• Runs in right anterior coronary sulcus then winds

around the inferior surface runs on the
diaphragmatic surface in the right posterior
coronary sulcus.

• Terminates by anastomosing with the left

coronary artery.
Branches
Marginal artery ,Posterior interventricular artery, nodal
in 60% of cases, right atrial, infundibular and terminal.
Supplies blood to
• Right atrium and greater part of right ventricle
(except the area adjoining the anterior
interventricular groove), a small part of right
ventricle adjoining the posterior interventricular
groove.
• Posterior part of interventricular septum
• Whole of conducting system of heart except left
branch of AV bundle.
• Left Coronary Artery arise from left posterior aortic
sinuses.
• Emerges between the pulmonary trunk and left
auricle. Here it gives an anterior interventricular
artery which runs in the groove of same name.
Further continuation of the left coronary artery is
called as circumflex artery and it runs in the left
anterior coronary sulcus.
• Then it winds around the left border and runs in left
posterior coronary sulcus.
• Near the posterior interventricular groove it
terminates by anastomosing with right coronary
artery.
• Branches-
• Anterior interventricular artery (LAD), a branch to
the diaphragmatic surface of left ventricle, left atrial,
pulmonary and terminal.

• Supplies blood to
• Left atrium and greater part of left ventricle (except
the area adjoining the posterior interventricular
groove), a small part of right ventricle adjoining the
anterior interventricular groove, anterior
interventricular septum and a part of left branch of
AV bundle.
• Cardiac dominance.
Arterial Supply

Figure 18.7a
Collateral circulation
• Cardiac anastomosis between the two coronary
arteries.
• Extra cardiac anastomosis-
• 1) vasa vasora of aorta
• 2) vasa vasora of pulmonary arteries
• 3) internal thoracic arteries
• 4) bronchial arteries.
• 5) phrenic arteries.
• Retrograde flow of blood in veins may irrigate
the myocardium.
 Coronary Circulation - Veins
• Coronary sinus – largest vein, situated in left posterior
coronary sulcus, ends by opening into posterior wall of
right atrium.
• Great cardiac vein – accompanies anterior
interventricular artery and then enter the left end of
coronary sinus
• Middle cardiac vein- accompanies posterior
interventricular artery and joins right end of coronary
sinus.
• Small cardiac vein- accompanies right coronary artery
and joins right end of coronary sinus.
Venous Supply

Figure 18.7b
• Posterior vein of left ventricle- runs on the
diaphragmatic surface of left ventricle and ends in
middle of coronary sinus.
• Oblique vein of left atrium- runs on posterior
surface of left atrium and ends in left side of
coronary sinus.
• Right marginal vein- accompanies marginal branch
of right coronary artery. It either drains into small
cardiac vein or open directly in right atrium
• Anterior cardiac veins- 3-4 veins which runs parallel
to one another on the anterior wall of right ventricle
and opens directly in the right atrium.
• Vene cordis minimi- many small veins present in all 4
chambers which opens directly into the cavity.
 Nerve supply
• Parasympathetic supply-
vagus nerve
• Sympathetic nerve- upper
3-5 thoracic segments of
spinal cord.
• Both of them form
superficial and deep
cardiac plexus.
• Superficial cardiac plexus- situated below the arch of
aorta in front of right pulmonary artery.
• Formed by – superior cervical cardiac branch of left
sympathetic chain and inferior cervical cardiac
branch of left vagus nerve.
• It gives branches to deep cardiac plexus, right
coronary artery and to left anterior pulmonary
plexus.
• Deep cardiac plexus- situated in front of
bifurcation of trachea and behind the arch of
aorta.
• Formed by- all the cardiac branches derived from
cervical and upper thoracic ganglia of
sympathetic chain and cardiac branches of vagus
and recurrent laryngeal nerve except those
which form the superficial plexus.
• Right and left half of plexus supply branches to
corresponding coronary and pulmonary plexus.
Separate branches are given to atria.
Lymphatics of heart
• Right trunk- brachiocephalic nodes
• Left trunk- tracheobronchial nodes.
Disorders of the Heart
• Coronary artery disease
• Atherosclerosis – fatty deposits
• Arteriosclerosis - hardening of the arteries
• Angina pectoris – chest pain
• Myocardial infarction – blocked coronary
artery
• Silent ischemia – no pain or warning
• Fibrillation - irregular heart beat; may occur in
either atria or ventricles.
• Precordium.
• Palpitation.
• Inflammation of the layers of heart.
• Normal diastolic pressure in ventricle is zero. If it
is positive it is an evidence of heart failure.
• When there is heart failure ultimately the rising
back pressure causes right side heart failure in
which the person will have oedema of feet,
increased venous pressure and breathlessness
on exertion.
• Heart failure due to lung diseases is called as cor
pulmonale.
• Dextrocardia.
• Situs inversus.
• Angiography, angioplasty