In the name of In the name of GODGOD

The heartThe heart Terminology Terminology Definition Definition Position Position Chambers Chambers Layers Layers External featuresExternal features Internal features Internal features Coverings Coverings Vessels Vessels NervesNerves Imaging Imaging Surface anatomy Surface anatomy

The heart : TerminologyThe heart : Terminology

Heart Heart Cor-Cor- Cardiac & Cardio- Cardiac & Cardio-

The heart : Definition The heart : Definition

A hollow A hollow muscularmuscular cone cone located in the middle located in the middle MediastinumMediastinum, covered with a , covered with a fibro-serousfibro-serous covering covering ((pericardiumpericardium) which acts as a ) which acts as a double-pumpdouble-pump

The heart : PositionThe heart : Position

Depends on age, sex, stature, Depends on age, sex, stature, respiration & posturerespiration & posture

Over the diaphragm (central t.)Over the diaphragm (central t.) Located in the middle Located in the middle

Mediastinum thus:Mediastinum thus: Behind the meso-sternumBehind the meso-sternum 22ndnd to 6 to 6thth costal cartilage costal cartilage T4-T8 vertebraeT4-T8 vertebrae

The heart : PositionThe heart : Position

1/3 in right, 2/3 in left1/3 in right, 2/3 in left Conical shapeConical shape

lies obliquely in the chestlies obliquely in the chest lies at 45 degree anglelies at 45 degree angle about size of enclosed fist about size of enclosed fist

The heart : PositionThe heart : Position

Conical shape thus:Conical shape thus: An apex & An apex & A baseA base

The heart : The heart : External External featuresfeatures

4 surface 4 surface A baseA base An apexAn apex 4 border4 border SulciSulci

AV (coronary)AV (coronary) Inter-ventricularInter-ventricular Inter-atrialInter-atrial Sub-epicardial Fat Sub-epicardial Fat

Auricles Auricles

The heart : PositionThe heart : Position

Apex: in left 5Apex: in left 5thth space medial space medial to mid-clavicular lineto mid-clavicular line

Apex beat: Apex beat:

PMI=point of maximum PMI=point of maximum impulseimpulse

Apex is in ant., inferior & leftApex is in ant., inferior & left

Conical Conical shapeshape

Apex Apex & & BaseBase

Base____________Base____________

AApex _____pex _____________________________

Note: A position other than the anatomical position Note: A position other than the anatomical position

___Apex___ApexBase________Base________

ApexApex

4 Surfaces4 Surfaces

Anterior (Sternocostal)Anterior (Sternocostal) Left Left Inferior (Diaphragmatic)Inferior (Diaphragmatic) Right Right Base (posterior surface)Base (posterior surface)

Anterior (Sternocostal)Anterior (Sternocostal)surfacesurface

RA (& right auricle), RV & LV (a part of )RA (& right auricle), RV & LV (a part of ) From LA only its auricleFrom LA only its auricle SulcusSulcus

AV (coronary) : right partAV (coronary) : right part Ant. InterventricularAnt. Interventricular

Pulmonary trunk (emerge from RV )Pulmonary trunk (emerge from RV ) Aorta (its origin from LV Is phantom)Aorta (its origin from LV Is phantom) Outflow tract Outflow tract SVC & IVCSVC & IVC

AAnntteerriioor r

SSuurrFFaaccee

AAnntteerriioor r

SSuurrFFaaccee

AAnntteerriioor r

SSuurrFFaaccee

Inferior surface Inferior surface

4 chambers4 chambers All sulciAll sulci Crux of the Crux of the

heartheart All veins & All veins &

arteries arteries

Inferior surfaceInferior surface (Crux of the heart) (Crux of the heart)

Right surface Right surface

RVRV RA (& auricle)RA (& auricle) AV sulcus AV sulcus 2 pulmonary 2 pulmonary

veinsveins Outflow tract Outflow tract SVC & IVCSVC & IVC

Left surfaceLeft surface

LVLV LA (& auricle)LA (& auricle) AV sulcus AV sulcus 2 pulmonary 2 pulmonary

veinsveins Outflow tract Outflow tract

Left surfaceLeft surface

4 Borders of the heart4 Borders of the heart

Right Right LeftLeft Inferior Inferior superiorsuperior

4 4 BBoorrddeerrss

The heart : ChambersThe heart : Chambers

Two Atrium (Atria)Two Atrium (Atria) Two VentriclesTwo Ventricles Divided from each other by septa & Divided from each other by septa &

valvesvalves Septa: between similar chambersSepta: between similar chambers Valves: between different chambersValves: between different chambers

External External featuresfeatures

Four chambersFour chambers 2 atria2 atria 2 ventricles2 ventricles

AuriclesAuricles Major veinsMajor veins

Superior & inferior Superior & inferior vena cavavena cava

Pulmonary veinsPulmonary veins

Major arteriesMajor arteries AortaAorta Pulmonary trunkPulmonary trunk

External External featuresfeatures

Anterior (Sternocostal) surfaceAnterior (Sternocostal) surface

Chambers of the Heart Chambers of the Heart – Two Atrium (Atria)– Two Atrium (Atria)

Right and Left (RA & LA)Right and Left (RA & LA) Divided from each other by interatrial Divided from each other by interatrial

septum (internally) & sulcus (externally)septum (internally) & sulcus (externally) Divided from ventricles by atrio-Divided from ventricles by atrio-

ventricular valves (AV valves) (internally) ventricular valves (AV valves) (internally) & sulcus (externally)& sulcus (externally)

Receiving chambersReceiving chambers Each has an Each has an auricleauricle

interatriainteratrial sulcusl sulcus

AV sulcusAV sulcus

Chambers of the Heart - Chambers of the Heart - VentriclesVentricles

Right and Left (RV & LV)Right and Left (RV & LV) Muscular wallsMuscular walls Pumping ChambersPumping Chambers Separated Internally by Interventricular Separated Internally by Interventricular

SeptumSeptum Externally by Externally by Interventricular SulcusInterventricular Sulcus

Inter-ventricular SulcusInter-ventricular Sulcus

Inter-ventricular septum Inter-ventricular septum & Sulcus& Sulcus

Interventricular SeptumInterventricular Septum

Actually belong to LV because:Actually belong to LV because: 1- Its thickness1- Its thickness 2- Its continuity 2- Its continuity

LV is circular in sectionLV is circular in section RV is crescent in sectionRV is crescent in section

3- Its function3- Its function Contracts toward the lumen of LVContracts toward the lumen of LV

Interventricular SeptumInterventricular Septum

The sulciThe sulci

Filled with fatFilled with fat Cardiac vessels lies between these fatCardiac vessels lies between these fat And the pericardium smoothen their And the pericardium smoothen their

surface surface

Sub-epicardial Fat Sub-epicardial Fat

Function Function

smooth surfacesmooth surface Its not a energy source unlessIts not a energy source unless

The end stages of fastingThe end stages of fasting

Fat____________Fat____________

Sulcus_____Sulcus_____

If the If the fat fat removeremoveddMajor Coronary Major Coronary

vessels appearvessels appear

Which lies in the Which lies in the sulcisulci

Double-pumpDouble-pump

A pump in which the apex A pump in which the apex move toward the basemove toward the base

The heart : Internal features The heart : Internal features

AtriaAtria Smooth surfaceSmooth surface Rough surface (pectinate muscles)Rough surface (pectinate muscles)

VentriclesVentricles Smooth surfaceSmooth surface Rough surface (trabeculae carnii)Rough surface (trabeculae carnii)

Internal features of RAInternal features of RA

AtriaAtria Smooth Smooth

surfacesurface Rough Rough

surface surface (pectinate (pectinate muscles)muscles)

Internal Internal featurefeatures of RAs of RA

Internal Internal featurefeatures of RAs of RA

Internal features of RVInternal features of RVBoundary Boundary between between Smooth Smooth &&Rough Rough areasareas

VentriclesVentricles Smooth Smooth

surfacesurface Rough surface Rough surface

(trabeculae (trabeculae carnii)carnii)

Rough Rough surfacesurface

RidgeRidge Bridge Bridge Papillary Papillary

muscle muscle

Papillary musclePapillary muscle

Papillary musclePapillary muscle

Papillary musclePapillary muscle

Papillary Papillary musclemuscle

Papillary musclePapillary muscle

Dirctioon: Why?Dirctioon: Why?

Some Some myocardiamyocardial bundles l bundles end at end at Papillary Papillary musclesmuscles

Internal features of LVInternal features of LV

Aortic Aortic vestibulevestibule

Aortic Aortic vestibulevestibule

Internal Internal features features of LAof LA

Interventricular SeptumInterventricular Septum

A thick muscularA thick muscular portionportion

A membraneous A membraneous portion:portion:

Interventricular partInterventricular part

Atrioventricular partAtrioventricular part

IImmppoorrttaannccee

ValvesValves

ValvesValves

ValvesValves

ValvesValves

ValvesValves