Download - Structure of the Heart
![Page 1: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/1.jpg)
Structure of the Heart
2009-07-21
![Page 2: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/2.jpg)
Facts, location, & orientation• Oblique orientation• Apex points inferiosinister (down and left)
– 5th intercostal space
• Base is superior near origins of great vessels– 2nd intercostal space
• 2/3 lies left of the midline• For the most part
– Anterior/inferior aspect of the heart• right atrium/ventricle
– Posterior/superior aspect• left atrium/ventricle
![Page 3: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/3.jpg)
![Page 4: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/4.jpg)
Thoracic Cavity
![Page 5: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/5.jpg)
Surfaces of the Heart
![Page 6: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/6.jpg)
Mediastinum
Mediastinum
Anterior
InferiorSuperior
Middle Posterior
Heart
![Page 7: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/7.jpg)
Structure of the Heart – Coverings• Fibrous pericardium
• Serous pericardium– Parietal pericardium– Visceral pericardium
![Page 8: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/8.jpg)
Sulci of the heart
• Coronary sulcus– Atrioventricular sulcus
• Circumvents the heart
• Interventricular sulcus– Anterior– Posterior
![Page 9: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/9.jpg)
![Page 10: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/10.jpg)
Great vessels
• Aorta– From left ventricle
• Pulmonary trunk– Originates anterior to the aorta from right
ventricle
• Superior Vena Cava
• Inferior Vena Cava– Both empty into right atrium
![Page 11: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/11.jpg)
![Page 12: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/12.jpg)
Transverse pericardial sinus
Oblique pericardial sinus
![Page 13: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/13.jpg)
Aorta• Ascending aorta
– Right and left aortic sinuses
• Arch of aorta– Begins/ends at T4/T5 or sternal angle level
– Brachiocephalic a.– Left common carotid a.– Left subclavian a.
• Thoracic aorta– Lies anterior to trachea
![Page 14: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/14.jpg)
![Page 15: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/15.jpg)
Ligamentum arteriosum
• Remnant of embryonic ductus arteriosus
• Attaches aortic arch superiorly to pulmonary trunk/left pulmonary artery inferiorly
• Identification point for Left recurrent laryngeal nerve
![Page 16: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/16.jpg)
Ligamentum arteriosum Left recurrent laryngeal n.
![Page 17: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/17.jpg)
Heart Features
• Chambers
–Right atrium
–Right ventricle
–Left atrium
–Left ventricle
• Valves– Leaflet valves
• Tricuspid• Bicuspid (mitral)
– Cusped (semilunar) valves• Aortic• Pulmonic
![Page 18: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/18.jpg)
Right atrium• Auricle (ear)
• Pectinate muscles (rough)
• Sinus venarum (smooth)– Crista terminalis
• Division between rough to smooth
• Openings (ostia)– SVC/IVC/Coronary sinus
• Fossa ovalis– Foramen ovale in fetus– Limbus
![Page 19: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/19.jpg)
Right atrium “valves”
• Superior vena cava– No valve
• Inferior vena cava– Eustachian valve
• Incompetent in adult, directs IVC blood though Foramen ovale in fetus
• Coronary Sinus– Thebesian valve
• Prevents backflow into coronary sinus during atrial systole
![Page 20: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/20.jpg)
RA
![Page 21: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/21.jpg)
Left atrium
• Ostia of 4 pulmonary veins– 2 superior– 2 inferior
• Auricle
![Page 22: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/22.jpg)
LA
![Page 23: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/23.jpg)
Right ventricle
• Most anterior aspect of heart• Tricuspid valve (RA-RV)
– Anterior/Posterior/Septal cusps (leafs)
• Papillary muscles– Connected to cusps via Chordae tendinae– Contract to prevent Tricuspid valve regurgitation– Named same as cusps
• Trabeculae carnae• Moderator band
![Page 24: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/24.jpg)
RV
![Page 25: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/25.jpg)
Left ventricle
• Trabeculae carnae
• Bicuspid (mitral) valve– Anterior/Posterior cusps
• Papillary muscles– Chordae tendinae
• Usually a greater number than the right, due to the increased pressures and strength necessary to prevent regurgutation
![Page 26: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/26.jpg)
LV
![Page 27: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/27.jpg)
Pulmonic valve
• From RV to pulmonary trunk
• Lies just anterior to aortic valve
• 3 semilunar cusps– Anterior– Right– Left
![Page 28: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/28.jpg)
A
P
![Page 29: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/29.jpg)
Aortic valve• Posterior to pulmonic valve• Just superior lies the Sinus of Valsalva
– Helps to dampen aortic outflow and prevent cusps from adhering to walls of aorta
• 3 cusps– Posterior (non-coronary) cusp– Right– Left
• Just superior to right and left cusps in the Sinus of Valsalva are the openings of the right and left coronary arteries, respectively
![Page 30: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/30.jpg)
![Page 31: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/31.jpg)
Heart Valves• Tricuspid valve
– RA – RV
• Bicuspid valve– LA – LV– aka “Mitral valve”
• Aortic valve– LV – aorta
• Pulmonic valve– RV – pulmonary trunk
![Page 32: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/32.jpg)
Conducting system
![Page 33: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/33.jpg)
Right coronary blood supply
• Right coronary artery– Originates from ostia in right aortic sinus
• Superior to right aortic cusp
– Travels in right coronary (AV) sulcus– Branches
• Right marginal arteries (acute marginal aa)• Posterior interventricular a. (in post. IV sulcus)• Sinoatrial nodal a.• Atrioventricular nodal a.
![Page 34: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/34.jpg)
![Page 35: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/35.jpg)
Left coronary blood supply
• Left coronary artery– Originates from ostia in left aortic sinus
• Superior to left aortic cusp
– Branches• Left anterior descending (LAD) or anterior
interventricular a. (lies in anterior IV sulcus)– Septal branches.– Diagonal branches
• Left marginal aa. (Obtuse marginal aa.)• Left circumflex a.
![Page 36: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/36.jpg)
![Page 37: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/37.jpg)
Dominance
• Defined by branch that gives rise to posterior interventricular a.– Right (80%)
• From right coronary a.
– Left (15%)• From left circumflex a.
– Co-dominance (5%)
![Page 38: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/38.jpg)
Venous drainage of the heart• Coronary sinus
– Lies in coronary (AV) sulcus on posterior– Opens directly to right atrium– All venous drainage of the heart eventually flows here
• Great cardiac vein– With LAD in anterior IV sulcus
• Left marginal vein
• Middle cardiac vein– With posterior interventricular a.
• Small cardiac vein– With right coronary a.
• Right marginal vein
• Oblique vein (LA)• Posterior vein of the left ventricle
![Page 39: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/39.jpg)
![Page 40: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/40.jpg)
![Page 41: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/41.jpg)
![Page 42: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/42.jpg)
Inside the Heart…a review
![Page 43: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/43.jpg)
Frontal Section of the Heart
![Page 44: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/44.jpg)
Chambers and
Valves
![Page 45: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/45.jpg)
Papillary Muscles
and ChordaeTendinae
![Page 46: Structure of the Heart](https://reader036.vdocuments.us/reader036/viewer/2022062518/56813ff6550346895dab1ba5/html5/thumbnails/46.jpg)
Heart Valves – Transverse Section
Left Ventricle
Aortic Semilunar
Tricuspid
Bicuspid