Slides of heart surface anatomy borders surfaces chambers righ atrium anatomy left atrium anatomy right ventricle anatomy left ventricle anatomy heart valves aortic sinuses

1. Heart
Startwiththe name of Allah

2. Heart
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3. Apex and base
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4. Apex
The Apex of heart
• Is formed by inferolateral surface of left ventricle
• Lies posterior to left 5th intercostal space in adults, usually approximately 9cm
(a hand breath) from the median plane.
• Remains motionless throughout the cardiac cycle.
• Is where the sound of mitral valve closure are maximal(apex beat),the apex
underlies the site where heart beat may be auscultated on the thoracic wall.

5. Apex
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6. Base
The base of the heart
• Is the heart posterior aspect (opposite the apex).
• Is formed mainly by the left atrium , with a lesser contribution by right
atrium.
• Faces posteriorly toward bodies of vertebraeT6-T9 and is separated
from them by the pericardium , oblique pericardial sinus esophagus and
aorta.
• Extends superiorly to bifurcation of pulmonary trunk and inferiorly to
pulmonary sulcus.
• Receives the pulmonary veins on the right and left sides of its left atrial
portion, and the superior and inferior vena cava at the superior and
inferior end of its right atrial portion.

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8. Surfaces
• The surfaces of the heart
• Anterior (sternocostal) surface: formed mainly by right ventricle.
• Inferior(Diaphragmatic)surface: formed mainly by left ventricle and
partly by right ventricle, it is related
mainly to central tendon of diaphragm
• Right pulmonary surface: formed mainly by right atrium
• Left pulmonary surface: formed mainly by left ventricle, it forms
• cardiac impression in the left lung

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10. Borders
The heart appears trapezoidal in both anterior and posterior view.
The four borders of hearts are:
• Right border(slightly convex) formed by right atrium and extending btwn
SVC and the IVC.
• Inferior border(nearly horizontal) formed mainly by the right ventricle and
slightly by left ventricle.
• Left border(oblique,nearly verticle) formed mainly by left ventricle and slightly
by left auricle.
• Superior border. Formed by right and left atria and auricles in
• anterior view.

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12. Right atrium
• Right atrium forms the right border of the heart and receives venous
blood from the SVC , IVC & Coronary sinus.
• The ear like right auricle is conical muscular pouch that project from this
chamber like an add-on-room, increasing the capacity of right atrium as
it overlaps the ascending aorta.
The interior of the right atrium
• Smooth, thin walled, posterior part (the sinus venarum) on which
venae(SVC & IVC) and coronary sinus open, bringing poorly oxygenated
blood into the heart.
• Rough, muscular anterior wall composed of pectinate muscles(L.musculi
pectinati).
• Right AV orifice or tricuspid orifice through which blood passes from
right atrium to right ventricle.The tricuspid orifice is guarded by
tricuspid valve which maintain unidirectional blood flow.

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14. Continued…
• The smooth and rough parts of atrial wall are separated externally by a shallow vertical
groove, the sulcus terminalis or terminal groove and internally by a vertical ridge , the
crista terminalis or terminal crest.The upper part of sulcus terminalis contains
sinuatrial node or SA node which act as pacemaker of heart.
• The SVC opens into superior part of the right atrium at the level of right 3rd costal
cartilage.
• The IVC opens into inferior part of right atrium almost in line with SVC at level of 5th
costal cartilage.
• The opening of coronary sinus, a short venous trunk receiving most of the cardiac
veins, is between the right AV orifice and IVC orifice
• The interatrial septum separates the atria.
• The interatrial septum has an oval, thumbprint depression the oval fossa(L.fossa ovalis)
which is a remanant of foramen ovale i.e a valve in fetus.

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17. Right ventricle
• The right ventricle forms the largest part of the anterior surface of the heart,
a small part of diaphragmatic surface, and almost the entire inferior border
of the heart.
• Superiorly it tapers into an arterial cone, the conus arterious
(infundibulum), which leads into the pulmonary trunk.
The interior of the right ventricle
• has irregular muscular elevations (trabeculae carneae) .
• A thick mucular rigde, the supraventricular crest, separates the ridge
muscular wall of the inflow part of the chamber from the smooth wall of the
conus arteriosus, or outflow part.
• The inflow part of the ventricle receives blood from the right artrium
through the right AV (tricuspid) orifice, located posterior to the body of the
sternum at the level of the 4th and 5th intercostal spaces.

18. Right ventricle
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19. • The right AV orifice is surrounded by one of the fibrous of the fibrous
skeleton of the heart.
• The fibrous ring keeps the caliber of the orifice constant (large enough to
admit the tips of three fingers), resisting the dilation that might otherwise
result from blood being forced through it at varying pressures.

20. • The tricuspid valve guards the right AV orifice. .
• Tendinous cords (L chordae tendinae) attach to the free edges and
ventriclular surfaces of the anterior, posterior, and septal cusps, much like the
cords attaching to a parachute.
• The tendinous cord arise from the apices of papillary muscles, which are
conical muscular projections with basis attached to the ventricular valve.
• Papillary muscles begin to contract before contraction of right ventricle,
tightening the tendinous cords and drawing the cusps together.

21. Continued…..
• Three papillary muscles in the right ventricle correspond to the cusps of
tricuspid valve.
1. The anterior papillary muscle, the largest and most prominent of three,
arise from the anterior wall of the right ventricle, its tendinous cords attach
to the anterior and posterior cusps of the tricuspid valve.
2. The posterior papillary musscle, smaller than anterior muscle may consist
of several part, it arise from the inferior wall of the right ventricle, and its
tendinous cords attach to the posterior and septal cusps of the tricuspid
valve.
3. The septal papillary muscle arise from the interventricular septum and
tendinous cords attach to the anterior and septal cusps of the tricuspid
valve.

22. Focus cusps, chordae tendinae and papillary muscle
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23. • The interventricular septum, composed of :
1. Muscular part.
2. Membranous part.
• Interventricular septum is a strong obliquely placed partition between the right
and left ventricles.
• Because of the much higher blood pressure on the left ventricle, the muscular
part of the IVS, which forms the majority of septum, has a thickness that is two
to three times of the right ventricle and also bulge into the right ventricle.
• Superior and posteriorly, a thin membrane forms the much smaller membranous
part of the IVS.

24. IVS
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25. Interventricular septum.

26. Left atrium
• The left atrium forms most of the base of the heart.
• The valveless pairs of the right and left pulmonary veins enter the smooth
wall atrium.
• In the embryo, there is only one pulmonary vein.
• The tubublar, muscular left auricle, its wall trabeculated with pectinate
muscles forms the superior part of the left border of heart and overlaps the
root of pulmonary trunk.

27. Continued…
• The interatrial septum has a semilunar depression (oval fossa), and the
surrounding ridge is the valve of the oval fossa.
The interior of the left atrium has:
• A large smooth walled part and a small muscular auricle.
• Four pulmonary veins (two superior and two inferior) entering its smooth
posterior wall.
• A slightly thicker wall than that of right atrium.
• An interatrial septum that slopes posteriorly and to the right.
• A left AV orifice through which the left atrium discharges the oxygenated
blood it receives from the pulmonary veins into left ventricle.

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29. Left ventricle
• The left ventricle forms the apex of the heart nearly all its left (pulmonary)
surface and border and most of the diaphragmatic surface.
• Because the arterial pressure is much higher in the systemic than in the
pulmonary circulation, the left ventricle perform more work than the right
ventricle.

30. The interior of the left ventricle has.
• Walls that are two to three times as thick as those of right ventricle.
• Walls that are mostly covered with the mesh of trabeculae carneae that are finer
and more numerous than those of the right ventricle.
• A conical cavity that is longer than the right ventricle.
• Anterior and posterior papillary muscles that are larger than those in the right
ventricle.
• A smooth-walled non-muscular, supero-anterior outflow part, the aortic vestibule,
leading to the aortic orifice and aortic valve.
• A double-leaflet mitral valve that guards the left AV orifice.
• An aortic orifice that lies in its posterosuperior part, the ascending aorta begins at
the aortic orifice.

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32. Mitral valve
• The mitral valve has 2 cusps, anterior and posterior.
• The mitral valve is located posterior to the sternum at the level of the 4th costal
cartilage.
• Each of its cusps receive tendinous cords from more than one papillary muscle.
• These muscles and their cords support the mitral valve, allowing the cusps to resist
the pressure developed during contraction of the left ventricle.
• The cords become taut just before and during systole, preventing the cusps from
being forced into the left atrium.

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34. Semilunar aortic valve
• The semilunar aortic wall lies between the left ventricle and the ascending
aorta, is obliquely placed.
• It is located posterior to the left side of sternum at the level of third
intercostal space.

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36. Semilunar pulmonary valve
• Each of three cusps of pulmonary wall (anterior right and left), like the semilunar
cusps of the aortic wall (posterior right and left) is concave when viewed superiorly.
• Semilunar cusps do not have tendinous cords to support them.
• They are smaller in area than the cusps of the AV valve, and the force exerted on
them if less than the half that exerted on the cusps of the tricuspid and mitral valve.
• The edge of each cusps is thicken in region of contact, forming the lunule .
• The apex of the angulated free edge is thickened further as nodule.

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38. Continued…
• Immediately superior to each cusps, the walls of the origin of pulmonary trunck and aorta
are slightly dilated, forming a sinus.
• The aortic sinuses and pulmonary sinuses are the spaces at the origin of pulmonary trunck
and assending aorta.
• The blood in sinuses and dilation of the wall prevent the cusps from sticking to the wall of
vessel which might prevent closure.
• The mouth of right coronary artery is in the right aortic sinus.
• The moth of the left coronary is in left aortic sinus.
• No artery arise from the posterior aortic sinus so it is called non-coronary sinus.s

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41. Angina pectoris
• Pain that originate in the heart is called angina pectoris
• In Latin angina=strangling pain pectoris=chest
• Patient with angina complains of tightness or pain in thora, deep to sternum
for( 15sec-15min).
Causes
• The pain is result of ischemia of the myocardium.
• Most often angina result from narrowed coronary arteries.

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Mechanism
Reduced blood flow to myocardium
less oxygen delievry to cardiac striated muscles
As a result, anerobic metabolism of myocyte
Lactic acid accumulates
PH is reduced in effected area
pain receptor are stimulated by lactic acid
As a result angina oocurs

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Treatment
• Angina pain is relieved by period of rest(1-2 minute are often adequate).
• Sublingual nitroglycerine is often given, it dilates the coronary vessels.
Complication
• Myocardial infarction
Note
• angina provides a warning that coronary arteries are compromised

44. Coronary artery bypass grafting
• Patient with obstruction of coronary arteries and severe angina may
undergo a coronary bypass graft operation,
• A segment of any artery or vein is connected to ascending aorta or to the
proximal part of a coronary artery and then to coronary artery distal to
stenosis.
• The great saphenous vein is commonly used for coronary artery bypass
surgery, because 1) it has diameter equal to or greater than coronary
artery, 2) can be easily dissected from lower limb 3) and offer a lenghthy
portion with mininmum valves and branches.
• Use of radial artery is also common.
• A coronary bypass graft shunts blood from aorta to a stenotic coronary
artery to increase flow distal to obstruction

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