Anatomy of the Heart

The Heart
• slightly larger then a clinched fist of the self

• Situated in the middle mediastinum

of thorax and is positioned obliquely
behind the body of sternum & costal
cartilages with in the pericardial sac.

• 1/3 of heart lies to the right & 2/3 to

the left of median plane.

• Conical/pyramidal shaped
hollow fibromuscular organ
• Weighing 280 to 340 gms in males,
230 to 280 gms in(female)
POSITION OF HEART
• It is physiologically separated into
a pair of muscular pumps (the
right &left parts) with valves
which work in unison to propel
blood to all parts of the body.

• The right side of the

heart receives poorly oxygenated
blood from the body through the
SVC & IVC and pumps to the
lungs for oxygenation through the
pulmonary trunk.

• The left side receives well-

oxygenated blood from the lungs
through the 4 pulmonary veins
and pumps into the aorta for
distribution to the body.
 The wall of the heart
• The wall of the heart
consists of three layers.
• Endocardium- a thin internal layer,
lining membrane of the heart that also
covers the valves.
• Myocardium - a thick middle layer
composed of cardiac muscle. It is
especially thicker in ventricles.
• Epicardium - a thin external layer
formed by the visceral layer of the
serous pericardium.
• Some fibrous tissue skeleton
supports the musculature &
strengthen the orifices.
 External Features
• 4 borders

• 3 surfaces

• apex and base(posterior surface)

• grooves or sulci
 BORDERS OR MARGINS OF HEART
1. Upper border –This is atrial & formed
mainly by left atrium. Anterior to it are
ascending aorta & pulmonary trunk.

2. Right border – it is vertical & formed

by right atrium which is continuous
superiorly with SVC and inferiorly with
IVC.

3. Inferior(acute) border – it is horizontal

&extends from the lower limit of right
border to cardiac apex. Formed by
right ventricle except at the apex

4. Left(obtuse) border –it descends

obliquely from auricle of left atrium to
cardiac apex. Formed mainly by left
ventricle. separates sternocostal from
left surface.
HEART- BORDERS OR MARGINS
HEART- BORDERS OR MARGINS
Reflections of pericardium
SURFACES OF HEART
 1. STERNOCOSTAL(ANTERIOR) SURFACE
1. Has ventricular
part - formed
mainly by right
ventricle(⅔ rds),
partly by left
ventricle (⅓rd)

& atrial part-

formed almost by
right atrium. (left
atrium hidden by the
ascending aorta &
pulmonary trunk.
Only it’s auricle
projects forwards to
this surface).
 2. DIAPHRAGMATIC(INFERIOR) SURFACE
• formed by both the ventricles
(mainly by the left ventricle ;
Formed in its left 2/3 by left
ventricle & right 1/3 by right
ventricle)
• Rests on the central tendon of the
diaphragm.(But near the apex on
the muscular part)

• Separated from the base by

AV groove.

• This surface is obliquely

traversed by post.interventricular
groove.
3.LEFT SURFACE OF
HEART-
•It faces left side and
includes the obtuse margin
of the heart.
formed mainly by the left
ventricle,but a small part
superiorly contributed by left
atrium & it’s auricle
Pericardium covering this
surface separates the left
phrenic nerve , it’s
accompanying vessels and
left mediastinal pleura from
the heart.
 The base of the
Heart(posterior
surface)

•Directed backwards & to the right.

•Is formed mainly by the left atrium,
with a lesser contribution by the right
atrium.
•Related to the bodies of T6 through
T9 and is separated from them by
pericardium, oblique pericardial sinus,
esophagus , aorta & azygos vein .
•Extends superiorly to the bifurcation
of the pulmonary trunk and inferiorly
upto the coronary or AV groove
 The apex of the heart ( cardiac apex):
• Is formed by the left
ventricle
• Directed downwards,
forwards & to the left

• Lies posterior to the left

5th intercostal space in
adult, usually 9cm from
the median plane or
1.5cm medial to
• midclavicular line.
maximal pulsation of
the heart (apex beat)
heard here.
 GROOVES OR SULCI

• Atrioventricular (AV)groove or coronary

sulcus

• Interatrial groove- anterior & posterior

• Interventricular(IV) groove- anterior &

posterior
 GROOVES OR SULCI
• The heart has four chambers -
2 atria (right & left) & 2 ventricles (right &
left) which are externally demarcated by
visible grooves or sulci but internally
separated by septa

• Coronary sulcus– a circular sulcus

seperating the atria from the
ventricles.Most of it is occupied by
coronary vessels –so it is also called
coronary sulcus

• Interatrial grooves –anterior & posterior,

separate the two atria . They correspond
to the position of atrial septum inside

• Interventricular grooves— anterior &

posterior , separate the 2 ventricles&
meet at the apical notch-to the right of the
apex.

• Crux- meeting point of posterior

interatrial, posterior interventricular &
coronary grooves
 The heart has four chambers
• 2 atria (right & left) &2 ventricles (right & left) which are
externally demarcated by visible grooves or sulci but
internally separated by septa

• Atria lie above and behind the ventricles

• Atria - are the receiving chambers that pump blood

into the respective ventricles.

• Ventricles - are the discharging chambers

 Right Atrium – External features
• Receives superior vena cava at
the upper end & inferior vena
cava at the lower end.
• Upper end prolonged to form
the auricle.
• Auricle covers root of ascending
aorta and overlaps
infundibulum of right ventricle.
• Sulcus terminalis - groove
passes from superior vena cava
to the inferior vena cava.
Produced by an internal
muscular ridge called the crista
terminalis.
• Upper part of sulcus terminalis
contains sino Atrial node-
pacemaker of heart.
 Right Atrium – Internal features
Interior shows 2 parts:
1.Smooth posterior part-
• Develops from right horn of
sinus venosus.
Most of the tributaries except
• anterior cardiac veins open
into this part.
Opening of inferior vena cava
• guarded by a rudimentary
valve( Eustachian valve).
Opening of coronary sinus
guarded by a valve
• (Thebesian valve)
 Right Atrium – Internal features
2.Rough Anterior Part –
•Develops from the primitive
atrial chamber.
•Presents many transverse
muscular ridges called
musculi pectinati.
•Musculi pectinati arise from
crista terminalis and run
towards the atrio ventricular
orifice.
 Right Atrium – Internal features
Septal wall
•Develops from septum
primum & septum
secondum.
•Presents a depression
called fossa ovalis -site of
septum primum.
•Limbus fossa ovalis seen
in the margin of fossa
ovalis-free margin of
septum secundum. This
ridge is cotinuous with
valve of IVC
 Auricle of right atrium
• Auricle is a ear shaped
projection from the
upper & front part of the
atrium.
• Its interior is occupied
by the muscular
reticulum.
• Its margins are notched.
• Probably serves to
prevent the
overdistension of the
atrium
 Right atrium-Tributaries

• Superior vena cava

• Inferior vena cava
• Coronary sinus
• Anterior cardiac veins
• Venae cordis minimi
 Right
• Ventricle
Receives blood from right atrium.
Interior has 2 parts-
• -Inflowing part is rough due to
the presence of muscular
ridges called trabeculae
carneae develop from
primitive ventricle.

-Outflowing part
(Infundibulum) is smooth
forms upper conical part
giving rise to pulmonary
trunk-develops from bulbus
cordis.
• Interior shows 2 orifices –
atrioventricular
Right or tricuspid
orifice guarded by tricuspid
valve, pulmonary orifice
guarded by pulmonary valve
 Trabeculae carneae

• Are muscular ridges of rough inflow

part of the RV ventricle

They are of 3 types— Ridges,

bridges & papillary muscles

1. Ridges –elevations

2 .Bridges –attached at both ends,

free in the middle.

Eg: The Septomarginal trabecula (moderator band) .It

extends from ventricular septum to the base of
anterior papillary muscle containing right branch of
AV bundle.

3.Papillary muscles -
 Right
3. Papillary muscles: Ventricle
•conical projections whose one end
is attached to the ventricular wall
and the other end is connected to
the cusps of the tricuspid valve by
chordae tendinae.

•There are 3 papillary muscles -

Anterior, posterior & septal
(anterior is the largest).

•Function- contraction brings about

tightening of chordae, and hold
cusps from entering to the atrium
during ventricular systole and thus
preventing regurgitation.
 Left Atrium
• Forms most of the base of the heart.

• Receives 4 pulmonary veins(have no

valves).

• Greatest part is smooth derived from

absorbed pulmonary veins.

• Musculi pectinati is present only in the

auricle.

• through the mitral (left AtrioVentricular)

orifice it communicates with the left
ventricle and discharges the
oxygenated blood
 Left Ventricle
• Interior has two parts-
-Lower rough part shows trabeculae
carneae, develops from primitive
ventricle.
-Upper smooth part (Aortic vestibule)
gives origin to ascending aorta,
develops from bulbus cordis.

• Two orifices - Left atrioventricular

orifice(bicuspid) guarded by
bicuspid or mitral valve and
aortic orifice guarded by aortic
valve.
OPENED LEFT VENTRICLE AND AORTA
 Left Ventricle
Papillary Muscles
• Two papillary muscles –
anterior & posterior.
• Chordae tendinae
attached to the cusps of
mitral valve
• Cavity of left ventricle is
circular in outline
• The wall of left ventricle is
3 times thicker(15mm)
than those of right
ventricle.
 Interventricular septum
• Seperates the 2 ventricles,its position is indicated by
anterior & posterior Interventricular grooves & apical
notch.
• Its lower ¾ is thick and is - muscular part.

• Upper part is thin – membranous part

• Membranous part gives attachment to septal cusp of the

tricuspid orifice.

• In relation to the attachment of the septal cusp,

membranous part is divided into atrioventricular part
between RA & LV & an interventricular part between the
2 ventricles
The cardiac skeleton consists of Fibrous skeleton of the Heart
dense, fibrous connective tissue
in the form of four rings with
interconnecting areas between
the atria and the ventricles.The
four rings surround the two
atrioventricular orifices, the aortic
orifice and opening of the
pulmonary trunk. They are the
anulus fibrosus.
The interconnecting areas
include:
■ the right fibrous trigone—a
thickened area of connective
tissue between the aortic ring
and right Atrioventricular ring and
■ the left fibrous trigone—a Functions
thickened area of connective
tissue between the aortic ring
and the left Atrioventricular ring
 Valves of the heart
• Maintain unidirectional flow of
blood and prevent its
regurgitation in the opposite
direction.
• 2 pairs of valves:
-a pair of atrioventricular
valves.
-a pair of semilunar valves.
• Right atrioventricular valve or
tricuspid having 3 cusps.
• Left atrioventricular valve or
bicuspid or mitral having 2
cusps.
• Mitral cusps are smaller and
thicker than tricuspid cusps.
• Aortic & pulmonary semi lunar
valves have 3 semi lunar cusps.
 TRICUSPID VALVE
• consists of the orifice and its
associated fibrous anulus, the cusps,
the supporting chordae tendineae and
the papillary muscles.

• Circumference of the oifice

=11.4cm(males),10.8(females)

• It is almost vertical, but at 45° to the

sagittal plane

• possible to distinguish three cusps in

the tricuspid valve, hence the name.
They are located anterosuperiorly,
septally and inferiorly

• Each cusp is a reduplication of

endocardium enclosing a collagenous
core, continuous marginally and on
its ventricular aspect with diverging
fascicles of chordae tendineae
 Tricuspid
Valve

Valve

Chordae tendinae

Papillary muscle
 THE PULMONARY
• VALVE
The pulmonary valve, guarding the outflow from
the right ventricle, surmounts the infundibulum

• has 3 semilunar cusps

which prevent backflow of
blood
• each cusp has convex margin
attached to the fibrous ring surrounding
the orifice and free concave
margin .Nodule –thickening of
connective in the middle of the free
border.Lunule –connective tissue free
area on either side of nodule close to
the free border

• made up of double layer of

endocardium with some connective
tissue between the two layers.
.
• Pulmonary sinuses- outward
bulgings of the wall of the pulmonary
trunk opposite the valves.
 MITRAL VALVE
• It is smaller than the tricuspid orifice (mean
circumference is 9.0 cm in males, 7.2 cm
in females).

• It is almost co-planar with the tricuspid orifice

but posterosuperior to it, whereas it is
posteroinferior and slightly to the left of the
aortic orifice.

• Has two cusps(hence bicuspid) anterior and

posterior. When the cusps of the mitral valve
close, they form a single zone of coaptation,
sometimes termed the commissure.

• When the valve is laid open, the anterior cusp

(aortic, septal, ‘greater' or anteromedial) is
seen to guard one-third of the circumference
of the orifice and to be semicircular or
triangular, with few or no marginal
indentations.

• The posterior cusp (mural, ventricular,

‘smaller' or posterolateral) usually has two or
more minor indentations and has a wider
attachment to the annulus than does the
anterior cusp, guarding two-thirds of the
circumferential attachments.
 The Aortic
• orifice
At the apex of the aortic
vestibule
• Guarded by 3 semilunar
valves 2 anterior & 1
posterior
• Convex margins of valves
are attached to the fibruos
ring of the orifice, concave
margins are free.
• Nodules & lunules are more
prominent than in the
pulmonary orifice
 AORTICVALVE

Each cusp has a fibrous

‘NODULE’ at midpoint of
its free edge + thin
connective tissue area
‘LUNULE’ on each side
of nodule.
Nodule and lunules meet
at centre.

• Heart sounds (“lub-dup”) due to

valves closing
– “Lub” - closing of atrioventricular
valves
– “Dub”- closing of semilunar valves
 Applied Anatomy

• Valve problems(valvular disease)

consist of two basic types:
incompetence (insufficiency), which results from poorly functioning
valves; and
stenosis, a narrowing of the orifice, caused by the valve's inability to
open fully.
• developmental abnormalities
most common types are the defects in the atrial and ventricular septa
atrial septal defect (ASD)
ventriculoseptal defect (VSD)
Position of valves and Sites of Auscultatory
areas

M- MITRAL AREA
T- TRICUSPID AREA
A- AORTIC AREA
P- PULMONARY AREA
Anterior view of the chest wall of a man showing skeletal structures, heart,
location of the heart valves, and auscultation points.
CONDUCTING SYSTEM OF HEART
 Conducting System
• Sinuatrial node(SA node) -pace maker, generates
impulse, situated in the upper part of sulcus terminalis.

• Atrioventricular node (AV node) -also generates impulse,

situated just above the opening of the coronary sinus.

• Atrioventricular bundle(AV bundle) or bundle of His-starts

from the AV node and divides into right & left branches.

• Right branch reaches the right ventricle, divides into

Purkinje fibres.

• Left branch reaches the left ventricle, divides into

Purkinje fibres.
Defects or damage to the conducting system results in
• cardiac arrhythmias.
Conducting System
SURFACE MARKING
 SURFACE MARKING OF THE HEART BORDERS

Point A (Apex)- Left 5th IC space 9cm from midsternal

line.

Point B - on 7th Rt. Sternocostal joint

Point C - on the upper border of 3rd right costal

cartilage I cm from the margin of sternum

Point D - on the lower border of 2nd left I cm

2.5 cm
costal cartilage 2.5 cm from the
margin of sternum

Line joining A & B through the xiphisternal

joint is inferior border
I cm
9cm
Line joining B & C, with the right convexity 4cm
from midsternal line opposite 4th costal
cartilage forms right border

Line connecting C & D is the upper border

Line connecting A & D with lateral convexity

is left border
 SURFACE MARKING OF ORIFICES/VALVES OF HEART

Tricuspid valve- about 4cm broad

• behind the right half of sternum
opposite 4th intercostal space-it is
oblique, passes downwards & to the
right.

• Mitral valve- 3cm wide,deep to left

half of sternum at the level of 4th costal
cartilage- oblique

• Aortic valve- 2.5cm broad,obliquely

placed behind the left half of the
sternum opposite the 3rd intercostal
space.
• Pulmonary valve- 2.5 cm
broad,Partly behind the left 3rd
costal cartilage,partly behind the
sternum.
RADIOLOGICAL ANATOMY OF HEART
Heart in X
ray
Heart in X
ray