SURFACE ANATOMY OF HEART

FSM 2008

AORTA

LEFT BORDER:

STERNAL ANGLE:

RIGHT PULMONARY ARTERY

APEX:

PULMONARY ARTERY

RIGHT BORDER:

SUPERIOR BORDER:

LEFT PULMONARY ARTERY

INFERIOR BORDER:

Surface Markings

APEX:

•Formed by LV corresponds to apex beat.

•Found in 5th intercostal space at mid clavicular line or 3.5” (9cm) from mid sternal line; just below nipple.

STERNAL ANGLE:

•Also called Angle of Louis

•Formed by articulation of manubrium & the body of sternum.

•Recognized by the presence of transverse ridge on anterior aspect of sternum

PRECORDIUMThe anterior aspect of chest wall which overlies the heart.

NIPPLELies normally in 4th intercoastal space 4” away from median plane. It varies with age and sex.

Landmarks on Precordium:

•Midsternal line- a vertical line drawing from the midpoint of suprasternal notch

•Midclavicular line- a vertical line drawn midway between middle of suprasternal notch and the tip of acromion. Axillary FoldsAxillary Folds• The anterior fold is formed by lower border of pectoralis major

muscle. The anterior axillary line runs vertically downward from anterior axillary fold.

• The posterior fold is formed by the tendon of Latissimus dorsi muscle as it passes round the lower border of Teres major muscle. The posterior axillary line runs vertically downward from posterior axillary fold.

• The mid axillary line runs vertically midway between anterior and posterior axillary line from the apex of the axilla.

SUPERIOR BORDER:

•Formed by roots of great vessels.

•Extends from a point on left 2nd costal cartilage (remember sternal angle) 1/2” (1.3cm) from the edge of sternum to a point on right 3rd Costal cartilage 1/2” from the edge of sternum

INFERIOR (Lower) BORDER:

•Formed by RV and apical part of LV.

•Extends from right 6th costal cartilage 1/2” from sternal edge to apex

BORDERS OF THE HEARTBORDERS OF THE HEART

LEFT BORDER:

•Formed by LV extends from a point left 2nd costal cartilage 1/2” from edge of sternum or 1” from the median plane to the apex beat of heart. Join these two points by a line with convexity upwards and to the left. This border corresponds mainly to the left ventricle and partly to the left auricle.RIGHT BORDER:

•formed by right atrium extends from a point on right 3rd costal cartilage 1/2” from the edge of sternum or 1” from median plane, downward to a point on right 6th costal cartilage 1/2” from the sternal margin. Join these two lines by a convex line towards right. Maximum convexity lies at a distance of 1&1/2” from median plane in 4th intercoastal space.

BORDERS OF THE HEARTBORDERS OF THE HEART

The Normal Cardiac outline: XRAY

• The heart is seen as a flask shaped shadow lying between translucent lungs, about 1/3rd of its area to right of midline and two-thirds to left.

• The Right border- From above downwards by two curves:

1. A slight curved portion- the outer edge of SVC with ascending aorta

2. A more convex portion- the outer border of right atrium, the lower margin of which lies at diaphragm.

The Left border- From above downwards:

•The prominent knuckle produced by arch of aorta as it passes backwards, slightly to left then downwards.•The straighter line of pulmonary artery•Left atrial appendages•The wide sweep of the left ventricle, ending at apex where it rests on diaphragm.

AORTIC AORTIC AREA AREA PULMOPULMO

NARY NARY AREA AREA

MITRAL MITRAL AREA AREA

TRICUSPID TRICUSPID AREA AREA

Location at precordium for Heart SoundsLocation at precordium for Heart Sounds

Landmarks on Precordium:

•Mitral area- which corresponds to the apex beat at 5th intercoastal space.

•Tricuspid area- lies just to left of lower sternum at 4th intercostal space

•Pulmonary area- At left 2nd intercoastal space at the margin of the sternal border

•Aortic area- At right 2nd intercoastal space at right border of sternum.