Clinical Anatomy of Thorax

1. THE HEART

2. Contents:
1. General features of the heart 2. Relations and surface anatomy 3. Cardiac wall structure
4. Anatomical peculiarities of each heart chamber
Right atrium Right ventricle
Left atrium Left ventricle
5. Anatomy of cardiac valves and Valvular Heart Disease 6. Valve auscultation points 7. Basis principles of echocardiography and Colored Doppler

3. General Features of Heart

4. Surface Anatomy of Heart
LeftRight
2nd
3rd
6th
4th
5th
MCL
1.5 cm
AML
6-10 cm
2/31/3

5. The Sulci
of the Heart
1. Coronary sulcus
/between the atria and ventricles/
2. Anterior interventricular sulcus
/delimits ventricles anteriorly/
3. Posterior interventricular sulcus
/delimits ventricles posteriorly/

6. Wall
Structure

7. Fibrous Skeleton and
Musculature of Heart
The rings
and the
trigones
separate
the atrial
myocardiu
m from the
ventricular.
Ventricular
myocardium:
• external (oblique)
layer (shared)
• transverse fibers
(separated for R and
L ventricles)
• internal longitudinal
layer (trabeculae
carneae, papillary
muscles; shared).
Atrial myocardium:
• transverse muscular
fibers (shared)
• longitudinal fibers
(musculi pectinati )

8. The Cardiac Chambers
Right
ventricle
Right
atrium
Left
ventricle
Left atrium
Pulmonary veins
Venae
Cava
Septum
Atrioventricular
orifices

9. Concept
of Blood
Circulation
William Harvey
(1578-1657)
Marcello Malpighi
(1628-1694)

10. Right Atrium
Right
auricle
SVC
IVC
Coronary
sinus
SVC
IVC
Coronary
sinus
Right
auricle

11. Interior
of Right
Atrium
Crista
terminalis
SVC
opening
Openings:
1) SVC opening
2) IVC opening
3) Coronary sinus opening
4) Right atrioventricular orifice
Structures:
1) Fossa ovalis
2) Limbus fossae ovalis
3) Crista terminalis
4) Musculi pectinate
5) Valve of IVC

12. Septal Defects
Atrial Ventricular
This left to right shunt of blood
overloads the pulmonary vascular
system, resulting in hypertrophy of the
right atrium and ventricle and
pulmonary arteries.

13. Right Atrioventricular Valve
Papillary
muscles
Chordae
tendineae
Right
fibrous
ring
ant
post
sept
Right
atrioventricular
orifice
A
P

14. Right Ventricle
Right AV orifice
Conus
arteriosus
Pulmonary trunk
Right
atrium
Chordae
tendineae Papillary mm
(anterior, posterior,
septal)
Trabeculae
carneae
Supra-
ventricular
crest
Moderator band
Tricuspid valve
Pulmonary valve
Chordae
tendineae
Conus
arteriosus
Papillary mm.

15. Left Atrium
Openings:
1) Four opening
for pulmonary
veins;
2) Left
atrioventricular
opening;
3) Left auricle.
Structures:
1) Fossa ovale;
2) Mitral valve.
Pulmonary veins
Mitral valve

16. Left Ventricle
Structures:
1) left atrioventricular
orifice;
2) mitral valve;
3) aortic orifice;
4) papillary muscles;
5) chordae tendinae;
6) trabeculae carneae.
IVS
RV
LV

17. Ventricular Hypertrophy
IVS

18. Left Atrioventricular Valve (Mitral)
The first heart sound (S1, lab) is produced
by closure of atrioventricular valves.
Anterior valve
Posterior valve
Papillary mm.
a
p

19. Aortic and Pulmonary Valves
Pulmonary
trunk
Pulmonary
valve
Aorta
Aortic valve
The second heart sound (S2, dup) is produced by
closure of the semilunar valves.

20. Cardiac Valves:
Surface Anatomy
and Auscultation
3rd costal cartilage
Behind the sternum,
Level of the 3rd intercostal space
4th costal cartilageLevel of the 5th right
costal cartilage
Apex of heartLeft 5th costal cartilage
Right 2nd intercostal space Left 2nd intercostal space
Auscultation position
for aortic valve
Auscultation position
for pulmonary valve
Auscultation position for
tricuspid valve
Auscultation position
for mitral valve

21. Valvular Heart Disease
Stenosis
Failure to open: slowing blood flow from a chamber
Aortic/pulmonary stenosis
Insufficiency (regurgitation)
Failure to close: blood flows back into the chamber it
was just ejected from
Mitral valve prolapse and regurgitation
normal
prolapsed
apex
base

22. Investigation of Heart
Echocardiography Doppler echocardiography

23. Echo: Parasternal Long View
Probe
orientati
on mark
Orientation
dot
Structures to analyze are: 1) aortic and mitral valves; 2) long axis of the heart: systolic function, pleural vs. pericardial effusion.
Long axis
(sagittal)
Short axis
(transverse)
4-Chamber
(oblique coronal)

24. Echo: Parasternal Short Views
Structures to analyze are: 1) aortic valve; 2)
mitral valve; 3) interatrial pressure (D-shaped IA
septum); 4) pressure in right and left ventricles.

25. Echo: Apical View
probe
Long axis
(sagittal)
Short axis
(transverse)
4-Chamber
(oblique coronal)

26. Summary:
RA
RV
LV
LA
IVC
SVC
Pulmonary
trunkAorta
Mitral valve
Tricuspid
valve
IVS
Pulmonary valve
Aortic
valve
RV
LV