ANATOMY OF THE HEART
Moderator: Dr. Ravi Narayan,
Consultant Paediatric Cardiologist,
Presented by,
Dr. Agilan M.,
I year,...
THE HUMAN HEART
Heart in pericardial cavity

4

Figure 18.1
Pericardium
• Pericardial cavity is lined by the pericardium.
• Pericardium – a double-walled sac around the
heart compose...
The Function of the
Pericardium:
Protects and anchors the
heart
Prevents overfilling of the
heart with blood
Allows for th...
Applied anatomy- Pericarditis
• Various pathogens may infect the
pericardium.
• The inflamed pericardial surfaces rub
agai...
Cardiac Tamponade

Black looking structure is the heart bulging from the
pericardial sac.Not only pathogens can cause a
ca...
External Heart: Anterior View

Chapter 18, Cardiovascular System

10

Figure 18.4b
Gross Anatomy
• A conical hollow muscular organ approximately the
size of your fist
• Location :
Middle mediastinum behind...
External features
• Sulci:
1.Coronary (atrioventicular) sulcia) anterior
b) posterior
1.Interterial groove visible posteri...
Surfaces
• Diaphragmatic or inferior
• Anterior of sternocostal
• Left surface

Borders
• Right- SVC and RA
• Left- LV and...
External Heart: Vessels that Supply/Drain
the Heart (Posterior View)

• Arteries – right coronary artery (in
atrioventricu...
The anterior and posterior interventricular sulci are shallower
depressions that mark the boundary line between the left
a...
Surface Anatomy :

Right atrium anterior and to the right of left atrium.
Left atrium a midline structure
Right ventricle ...
External Heart: Major Vessels of
the Heart (Anterior View)
•

•

Vessels returning blood to the heart include:
1. Superior...
External Heart: Vessels that
Supply/Drain the Heart (Anterior View)
• Arteries – right and left coronary (in
atrioventricu...
External Heart: Posterior View

Chapter 18, Cardiovascular System

19
External Heart: Major Vessels of
the Heart (Posterior View)
•

Vessels returning blood to the heart
include:
1. Right and ...
Anatomical position of the
heart from Grays Anatomy
Anomalous-Anatomical position
of the heart
OVERVIEW OF THE CARDIOVASCULAR
SYSTEM
• Pulmonary circuit
• Systemic circuit
• Arteries (Including the coronary arteries)
...
Pathway of Blood Through the Heart
and Lungs
• Right atrium  tricuspid valve  right ventricle
• Right ventricle  pulmon...
Heart Wall
• Epicardium – visceral layer of the serous
pericardium
• Myocardium – cardiac muscle layer
forming the bulk of...
Walls of the
Heart
Myocardial Thickness and Function

Thickness of myocardium varies according to the function of the
chamber
Atria are thin ...
Thickness of Cardiac Walls

Myocardium of left ventricle is much thicker than the right.
Chambers
of the heart
• Right atrium RA
• Right ventricle RV
• Left Atrium LA
• Left Ventricle LV
• When not filled with b...
Cardiac Chambers
• a) Right atrium Wide based blunt
appendage, crista terminalis separates
trabeculated from non-trabecula...
Gross Anatomy of chambers: Frontal Section

Chapter 18, Cardiovascular System

35

Figure 18.4e
Atria of the Heart
• Atria are the receiving chambers of the
heart
• Each atrium has a protruding auricle
• Pectinate musc...
Right Atrium
•
-

SVC
IVC
Crista terminalis
Coronary sinus
Tricuspid valve
Fossa ovalis
Triangle of Koch
Tendon of Todaro
...
Ventricles of the Heart
• Ventricles are the discharging chambers of
the heart
• Papillary muscles and trabeculae carneae
...
View from the right side of the heart.
1

2

3
Chordae tendineae
Papillary muscle
Ventricular Differences
• The anatomical differences between the
right and left ventricles are as follows:
• The right ven...
Interventricular
septum
Interatrial
Septum. Lateral view
The pectinate muscles
are prominent
muscular ridges found
in the atrial walls
Left
Ventricle
Heart
Wall

Right Ventricle Heart Wall
Fibrous Skeleton Of The Heart
Heart Valves
• Heart valves ensure unidirectional blood flow
through the heart
• Atrioventricular (AV) valves lie between
...
Atrioventricular Valves
• Prevent backflow of blood from the
ventricles back into the atria.
• Chordae tendineae and papil...
Heart Valves

54
Heart Valves
During ventricular systole the ventricles begin to contract
blood moving back towards the atria swings the cusps
together ...
Mitral valve -Anatomy
Anatomic Classification Schema:
Mitral Valve Segments

Duran Classification

Ann Thorac Surg 1998: 65:1025-1031.
J Heart V...
Am Heart J. 2000;139: 378-87.
Mitral Valve Prolapse
Tricuspid Valve
Semilunar Heart Valves
• Semilunar valves prevent backflow of
blood into the ventricles
• Aortic semilunar valve lies betw...
Atrioventricular Valve Function

Chapter 18, Cardiovascular System

65

Figure 18.9
Semilunar Valve Function

Chapter 18, Cardiovascular System

66

Figure 18.10
Aortic valve – Anatomy
Aortic Root - Anatomy
The AORTIC ROOT has four anatomic components:
• The aortic annulus or aortoventricular junction
• Th...
Aortic Annulus (aortoventricular junction
N

L

Fibrous tissue
Anterior leaflet of the mitral valve
Membranous septum

Nor...
Valve Leaflets
They are attached to the aortic root in a semilunar fashion

The triangular space underneath the leaflet
(t...
Sinuses of Valsalva
The segment of the arterial wall
of the aortic root delineated by a
leaflet proximally and by the
sino...
Sinotubular
Junction
It represents the terminal edge of the aortic root and it
is constituted by the imaginary line that c...
aortic valve calcification
aortic stenosis
AORTIC VALVE PATHOLOGY

aortic valve fibrosis
AR due to Abnormalities of the
Leaflets
Infective endocarditis
Trauma
Iatrogenic cause

Cusp perforation
AR due to Abnormalities of the
Leaflets
•
•
•

Excess of tissue
Disrupted commissure
Commissural malposition

Cusp prolaps...
AR due to Abnormalities of the
Leaflets
Fibrous thickening

Restrictive motion
AR - Abnormalities of the Aortic
SinotubularWall dilatation
junction

Dilatation of the sinotubular junction displaces the...
AR - Abnormalities of the Aortic Wall
•
• Marfan syndrome
•

Connective tissue
diseases

•

Ventricular dilatation

•

Chr...
AI due to Abnormalities of the Aortic Wall

Aortic root
aneurysm:
ST junction
dilatation
+
Sinuses of
Valsalva aneurysm
CONDUCTION SYSTEM
Conduction System
• Sinoatrial node - anterolateral RA
• Interatrial conduction pathways - not well defined and
somewhat c...
IMPULSE

SA NODE
Heart Blood Supply
• Coronary circulation demands high
oxygen and nutrients for the cardiac
muscle cells.
• Coronary arter...
Coronary Circulation: Arterial
Supply
Coronary Circulation: Venous
Supply

Chapter 18, Cardiovascular System

94

Figure 18.7b
Great, Posterior, small,
Anterior, Middle Cardiac
Veins carry blood from
The coronary capillaries
To the coronary sinus.
L...
Microscopic Anatomy of Heart
Muscle
• Cardiac muscle is striated, short, fat,
branched, and interconnected
• The connectiv...
Microscopic Anatomy of Heart
Muscle

Chapter 18, Cardiovascular System

97

Figure 18.11
Extrinsic Innervation of the Heart
• Heart is
stimulated by the
sympathetic
cardioaccelerator
y center
• Heart is inhibite...
Thank
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
Heart anatomy written  copy
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  • The morphologic characteristics and function of the aortic valve are interrelated to the aortic root and are best described as a single functional unit. The diameter of the aortic annulus is 15% to 20% larger than the diameter of the sinotubular junction. The lenghts of the free margins of the leaflets areslightly larger than the diameter of the sinotubular junction
  • Vd lavoro di T David su Current Problem (pag 431-432): scambiare immagini
  • Heart anatomy written copy

    1. 1. ANATOMY OF THE HEART Moderator: Dr. Ravi Narayan, Consultant Paediatric Cardiologist, Presented by, Dr. Agilan M., I year, PGDCC, M.S. Ramaiah- Narayana Hrudayalaya.
    2. 2. THE HUMAN HEART
    3. 3. Heart in pericardial cavity 4 Figure 18.1
    4. 4. Pericardium • Pericardial cavity is lined by the pericardium. • Pericardium – a double-walled sac around the heart composed of: 1. A superficial fibrous pericardium 2. A deep two-layer serous pericardium a. The parietal layer lines the internal surface of the fibrous pericardium b. The visceral layer or epicardium lines the surface of the heart They are separated by the fluid-filled pericardial cavity. Pericardial fluid acts as a lubricant reducing friction.
    5. 5. The Function of the Pericardium: Protects and anchors the heart Prevents overfilling of the heart with blood Allows for the heart to work in a relatively friction-free environment The clear tissue being Lifted up by the scalpel Is the pericardium
    6. 6. Applied anatomy- Pericarditis • Various pathogens may infect the pericardium. • The inflamed pericardial surfaces rub against one another. • Makes a distinct scratching sound. • Cardiac tamponade could occur due to the increased pericardial fluid in the pericardial cavity. This condition restricts the movement of the heart.
    7. 7. Cardiac Tamponade Black looking structure is the heart bulging from the pericardial sac.Not only pathogens can cause a cardiac tamponade, but blunt force trauma can also cause it.
    8. 8. External Heart: Anterior View Chapter 18, Cardiovascular System 10 Figure 18.4b
    9. 9. Gross Anatomy • A conical hollow muscular organ approximately the size of your fist • Location : Middle mediastinum behind sternum, costal cartilages of 3,4,5 ribs Superior surface of diaphragm Left of the midline Anterior to the vertebral column, • Directed forward and to left . • Anterior most is the apex. • Average measurement: 12cm X9cm • Weight: 325±75 g in men 275± 75 g in women
    10. 10. External features • Sulci: 1.Coronary (atrioventicular) sulcia) anterior b) posterior 1.Interterial groove visible posteriorly 2.Interventricular sulci/ groove 3.Crux is the posterior basal surface at juction of coronary and posterior interventricular sulci and internally atrial septum joins the venticular septum
    11. 11. Surfaces • Diaphragmatic or inferior • Anterior of sternocostal • Left surface Borders • Right- SVC and RA • Left- LV and La • Inferior- RV and laterally LV
    12. 12. External Heart: Vessels that Supply/Drain the Heart (Posterior View) • Arteries – right coronary artery (in atrioventricular groove) and the posterior interventricular artery (in interventricular groove) • Veins – great cardiac vein, posterior vein to left ventricle, coronary sinus, and middle cardiac vein
    13. 13. The anterior and posterior interventricular sulci are shallower depressions that mark the boundary line between the left and right ventricles. These areas usually contain a large amount of fat. The sulci contain the arteries and veins that feed the heart. The heart has an attached base and a free apex. The inferior tip is called the apex. In a typical adult the heart measures approximately 12.5 cm from the base to the tip. The apex reaches to the fifth intercostal space, 7.5 cm to the left of the midline.
    14. 14. Surface Anatomy : Right atrium anterior and to the right of left atrium. Left atrium a midline structure Right ventricle anterior and to the right of left Ventricle. Pulmonary artery anterior and to the left of aorta Coronary arteries on surface follow A-V groove and interventricular septum.
    15. 15. External Heart: Major Vessels of the Heart (Anterior View) • • Vessels returning blood to the heart include: 1. Superior and inferior venae cavae 2. Right and left pulmonary veins Vessels conveying blood away from the heart include: 1. Pulmonary trunk, which splits into right and left pulmonary arteries 2. Ascending aorta (three branches) – a. Brachiocephalic b. Left common carotid c. Subclavian arteries 17
    16. 16. External Heart: Vessels that Supply/Drain the Heart (Anterior View) • Arteries – right and left coronary (in atrioventricular groove), marginal, circumflex, and anterior interventricular arteries • Veins – small cardiac, anterior cardiac, and great cardiac veins
    17. 17. External Heart: Posterior View Chapter 18, Cardiovascular System 19
    18. 18. External Heart: Major Vessels of the Heart (Posterior View) • Vessels returning blood to the heart include: 1. Right and left pulmonary veins 2. Superior and inferior venae cavae • Vessels conveying blood away from the heart include: 1. Aorta 2. Right and left pulmonary arteries
    19. 19. Anatomical position of the heart from Grays Anatomy
    20. 20. Anomalous-Anatomical position of the heart
    21. 21. OVERVIEW OF THE CARDIOVASCULAR SYSTEM • Pulmonary circuit • Systemic circuit • Arteries (Including the coronary arteries) • Veins (Including the coronary veins) • Capillaries (Arterioles & Venules) • Four chambers of the heart
    22. 22. Pathway of Blood Through the Heart and Lungs • Right atrium  tricuspid valve  right ventricle • Right ventricle  pulmonary semilunar valve  pulmonary arteries  lungs • Lungs  pulmonary veins  left atrium • Left atrium  bicuspid valve  left ventricle • Left ventricle  aortic semilunar valve  aorta • Aorta  systemic circulation 25
    23. 23. Heart Wall • Epicardium – visceral layer of the serous pericardium • Myocardium – cardiac muscle layer forming the bulk of the heart • Fibrous skeleton of the heart – crisscrossing, interlacing layer of connective tissue • Endocardium – endothelial layer of the inner myocardial surface
    24. 24. Walls of the Heart
    25. 25. Myocardial Thickness and Function Thickness of myocardium varies according to the function of the chamber Atria are thin walled, deliver blood to adjacent ventricles Ventricle walls are much thicker and stronger – right ventricle supplies blood to the lungs (little flow resistance) – left ventricle wall is the thickest to supply systemic circulation
    26. 26. Thickness of Cardiac Walls Myocardium of left ventricle is much thicker than the right.
    27. 27. Chambers of the heart • Right atrium RA • Right ventricle RV • Left Atrium LA • Left Ventricle LV • When not filled with blood, the outer portion of each atrium deflates and becomes a lumpy, wrinkled flap. • This extension is called the auricle (looks like an external ear).
    28. 28. Cardiac Chambers • a) Right atrium Wide based blunt appendage, crista terminalis separates trabeculated from non-trabeculated portion. • b) Left atrium Long, narrow appendage, smooth walls. • c) Right ventricle Coarsely trabeculated inlet/sinus, outlet portion. • d) Left ventricle Fine trabeculations inlet/sinus and outlet portions.
    29. 29. Gross Anatomy of chambers: Frontal Section Chapter 18, Cardiovascular System 35 Figure 18.4e
    30. 30. Atria of the Heart • Atria are the receiving chambers of the heart • Each atrium has a protruding auricle • Pectinate muscles mark atrial walls • Blood enters right atria from superior and inferior venae cavae and coronary sinus • Blood enters left atria from pulmonary veins
    31. 31. Right Atrium • - SVC IVC Crista terminalis Coronary sinus Tricuspid valve Fossa ovalis Triangle of Koch Tendon of Todaro Inferior isthmus
    32. 32. Ventricles of the Heart • Ventricles are the discharging chambers of the heart • Papillary muscles and trabeculae carneae muscles mark ventricular walls • Right ventricle pumps blood into the pulmonary trunk • Left ventricle pumps blood into the aorta 41
    33. 33. View from the right side of the heart.
    34. 34. 1 2 3 Chordae tendineae Papillary muscle
    35. 35. Ventricular Differences • The anatomical differences between the right and left ventricles are as follows: • The right ventricle is relaetively thin. The left ventricle has a massive muscular wall.
    36. 36. Interventricular septum
    37. 37. Interatrial Septum. Lateral view
    38. 38. The pectinate muscles are prominent muscular ridges found in the atrial walls
    39. 39. Left Ventricle Heart Wall Right Ventricle Heart Wall
    40. 40. Fibrous Skeleton Of The Heart
    41. 41. Heart Valves • Heart valves ensure unidirectional blood flow through the heart • Atrioventricular (AV) valves lie between the atria and the ventricles – AV valves prevent backflow into the atria when ventricles contract • Chordae tendineae anchor AV valves to papillary muscles 52
    42. 42. Atrioventricular Valves • Prevent backflow of blood from the ventricles back into the atria. • Chordae tendineae and papillary muscles play an important role in this process. • Ventricular diastole the ventricles relax and the ventricles refill. • The chordae tendineae are loose and offer no resistance to the flow of blood.
    43. 43. Heart Valves 54
    44. 44. Heart Valves
    45. 45. During ventricular systole the ventricles begin to contract blood moving back towards the atria swings the cusps together closing the valves. The chordae tendineae and papillary muscles stops the cusps from swinging into the atria. If those two structures are cut or damaged the valves act as swinging doors, and there is backflow, or regurgitation. Mitral valve damage can especially occur in women after pregnancy.
    46. 46. Mitral valve -Anatomy
    47. 47. Anatomic Classification Schema: Mitral Valve Segments Duran Classification Ann Thorac Surg 1998: 65:1025-1031. J Heart Valve Dis 1995; 4:70-75. Cardiol Clin. 2000; 18: 731-50.
    48. 48. Am Heart J. 2000;139: 378-87.
    49. 49. Mitral Valve Prolapse
    50. 50. Tricuspid Valve
    51. 51. Semilunar Heart Valves • Semilunar valves prevent backflow of blood into the ventricles • Aortic semilunar valve lies between the left ventricle and the aorta • Pulmonary semilunar valve lies between the right ventricle and pulmonary trunk 64
    52. 52. Atrioventricular Valve Function Chapter 18, Cardiovascular System 65 Figure 18.9
    53. 53. Semilunar Valve Function Chapter 18, Cardiovascular System 66 Figure 18.10
    54. 54. Aortic valve – Anatomy
    55. 55. Aortic Root - Anatomy The AORTIC ROOT has four anatomic components: • The aortic annulus or aortoventricular junction • The leaflets SINGLE • The aortic sinuses or sinuses of Valsalva FUNCTIONAL UNIT • The sinotubular junction
    56. 56. Aortic Annulus (aortoventricular junction N L Fibrous tissue Anterior leaflet of the mitral valve Membranous septum Normal: Marfan/Bicuspid aortic valve: R Myocardium 55% 65% Histology: The aortic root is in fibrous continuity with the anterior leaflet of the mitral valve and the membranous septum; connective tissue (fibrous strands) unites the aortic root to the interventricular septum. 45% 35% Sinotubular Junctinon
    57. 57. Valve Leaflets They are attached to the aortic root in a semilunar fashion The triangular space underneath the leaflet (trigone) is part of the left ventricle. The highest point of the trigone where the leaflets meet is called the commissure. The commissures are localised immediately below the Sinotubular Junction. The 2 trigones underneath the commissures of the noncoronary leaflet are fibrous structures, whereas the other underneath the commissure between the right and the left leaflets is mostly a muscular structure.
    58. 58. Sinuses of Valsalva The segment of the arterial wall of the aortic root delineated by a leaflet proximally and by the sinotubular junction distally is called the aortic sinus or sinus of Valsalva. They are 3 elliptical inlets that have a very important role in the dynamics of circulation : • Guaranteeing coronary artery perfusion during systole; •Creating eddies to close the aortic leaflets during diastole
    59. 59. Sinotubular Junction It represents the terminal edge of the aortic root and it is constituted by the imaginary line that connects together the 3 commissures. Young adults AA>STJ Adults AA = STJ BASE = Aortic Annulus (AA) Elderly AA<STJ
    60. 60. aortic valve calcification aortic stenosis AORTIC VALVE PATHOLOGY aortic valve fibrosis
    61. 61. AR due to Abnormalities of the Leaflets Infective endocarditis Trauma Iatrogenic cause Cusp perforation
    62. 62. AR due to Abnormalities of the Leaflets • • • Excess of tissue Disrupted commissure Commissural malposition Cusp prolapse
    63. 63. AR due to Abnormalities of the Leaflets Fibrous thickening Restrictive motion
    64. 64. AR - Abnormalities of the Aortic SinotubularWall dilatation junction Dilatation of the sinotubular junction displaces the commissures outward and prevents the aortic leaflets from coapting, with resulting central aortic insufficiency
    65. 65. AR - Abnormalities of the Aortic Wall • • Marfan syndrome • Connective tissue diseases • Ventricular dilatation • Chronic hypertension Annular dilatation
    66. 66. AI due to Abnormalities of the Aortic Wall Aortic root aneurysm: ST junction dilatation + Sinuses of Valsalva aneurysm
    67. 67. CONDUCTION SYSTEM
    68. 68. Conduction System • Sinoatrial node - anterolateral RA • Interatrial conduction pathways - not well defined and somewhat controversial • Inferior isthmus (right atrium) anterior Bachman's bundle (left atrium), middle Wenkebachs, posterior Thorel • Atrioventricular node - triangle of Koch • Bundle of His - AV node to membranous septum, usually located on the inferior/posterior wall of the membranous septum • Left bundle branch - left ventricular septal surface into multiple branches • Right bundle branch - below medial papillary muscle via septal and moderator bands to anterior papillary muscle
    69. 69. IMPULSE SA NODE
    70. 70. Heart Blood Supply • Coronary circulation demands high oxygen and nutrients for the cardiac muscle cells. • Coronary arteries originate at the base of the ascending aorta. • Interconnections between arteries called anastomoses ensure a constant blood supply.
    71. 71. Coronary Circulation: Arterial Supply
    72. 72. Coronary Circulation: Venous Supply Chapter 18, Cardiovascular System 94 Figure 18.7b
    73. 73. Great, Posterior, small, Anterior, Middle Cardiac Veins carry blood from The coronary capillaries To the coronary sinus. Left coronary artery supplies The left ventricle. Circulflex Curves left meeting with The right coronary artery. Left anterior decending Supplies the posterior Decending artery (interventricular).
    74. 74. Microscopic Anatomy of Heart Muscle • Cardiac muscle is striated, short, fat, branched, and interconnected • The connective tissue endomysium acts as both tendon and insertion • Intercalated discs anchor cardiac cells together and allow free passage of ions • Heart muscle behaves as a functional syncytium InterActive Physiology®: Cardiovascular System: Anatomy Review: The Heart 96
    75. 75. Microscopic Anatomy of Heart Muscle Chapter 18, Cardiovascular System 97 Figure 18.11
    76. 76. Extrinsic Innervation of the Heart • Heart is stimulated by the sympathetic cardioaccelerator y center • Heart is inhibited by the parasympathetic cardioinhibitory center
    77. 77. Thank
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