Heart

05/17/16 Dr.M.Sikander Ghayas Khan
Riphah international University Lahore Pakistan
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HEART
DR M.SIKANDER GHAYAS KHAN
MBBS, MS-SLP, PGH, Ph.D.
Assistant Professor,
Riphah international University Lahore
Pakistan.
dr.sikander05@gmail.com
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LOCATION
Middle
mediastinum
1/3 lies on the rt &
2/3 on the lt
Second to fifth rib
Rt sternal border
to lt mid clavicular
line
Conical shaped.05/17/16 Dr.M.Sikander Ghayas Khan
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MEDIASTINUM
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HEART
THE HEART IS PART OF THE
CARDIOVASCULAR SYSTEM.
THE FUNCTION OF THE HEART
IS TO PUMP BLOOD.
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HEART
The heart is
enclosed in a double
walled sac called the
pericardium.
The superficial
layer is the fibrous
pericardium, and the
deep layer is the
serous pericardium.05/17/16 Dr.M.Sikander Ghayas Khan
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PERICARDIUM
Fibrous layer
Tough external fibrous layer
pericardiophrenic ligament
sternopericardiac ligament
It fuses with adventitia of all the great
vessels
The parietal layer lines the inner
surface of the fibrous pericardium.05/17/16 Dr.M.Sikander Ghayas Khan
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PERICARDIUM
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PERICARDIUM
FUNCTIONS OF THE FIBROUS
PERICARDIUM
1. PROTECTS THE HEART.
2. FIX THE HEART WITHIN THE THORAX.
3. PREVENTS OVERFILLING OF THE
HEART.
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PERICARDIUM
The serous
pericardium, a thin
slippery serous
membrane, is
composed of two
layers, the parietal
layer and the visceral
layer or epicardium.
Between the two
layers is the
pericardial cavity.
This cavity contains a
film of serous fluid.05/17/16 Dr.M.Sikander Ghayas Khan
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Pericardial Sinuses
Oblique
sinus
On the posterior
surface of the heart,
the reflection of the
serous pericardium
around the large
veins forms a recess.
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Transverse
sinus,
Reflection of
serous pericardium
around the aorta
and pulmonary
trunk and the
reflection around
the large veins..
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Nerve Supply of
the Pericardium
The fibrous
pericardium and the
parietal layer of the
serous pericardium are
supplied by the phrenic
nerves.
The visceral layer of
the serous pericardium
is innervated by
branches of the
sympathetic trunks
and the vagus nerves.
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Surfaces of the Heart
The sternocostal
The diaphragmatic
surface
The base
The
sternocostal
 right atrium and
the right ventricle,05/17/16 Dr.M.Sikander Ghayas Khan
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The diaphragmatic
surface
right and left
ventricles separated
by the posterior
interventricular
groove. The inferior
surface of the right
atrium, into which the
inferior vena cava
opens, also forms part
of this surface.
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The base is
formed mainly by the
left atrium, into which
open the four
pulmonary veins .
The base of the
heart lies opposite
the apex
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The apex of the
heart, formed by the
left ventricle, is
directed downward,
forward, and to the
left .
It lies at the level
of the fifth left
intercostal space, 3.5
in. (9 cm) from the
midline.05/17/16 Dr.M.Sikander Ghayas Khan
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BORDERS OF THE HEART
The four borders of the heart are the
Right border
Left border
Inferior border
Superior border
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Right border
(slightly convex),
Formed by the
right atrium and
extending between
the SVC and the
IVC.
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Left border
(oblique), Formed
mainly by the left
ventricle and slightly
by the left auricle.
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Inferior border
(nearly horizontal),
Formed mainly by
the right ventricle
and only slightly by
the left ventricle.
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Superior border, Formed by the
Right and left atria
Auricles in anterior view
The ascending aorta
Pulmonary trunk emerge from the
superior border
The SVC
Transverse pericardial sinus.
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Cardiac skeleton
Collection of dense,
fibrous connective tissue in
the form of four rings.
Two surround the
atrioventricular orifices,
 And two surround the
aortic orifice and opening of
the pulmonary trunks.
 Anulus fibrosus.
The interconnecting areas
include:
right fibrous trigone,
left fibrous trigone,
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Helps maintain the integrity of the
openings it surrounds
 Provides attachment for the cusps.
Separates the atrial musculature from the
ventricular musculature.
Isolates the atria from the ventricles.
The atrioventricular bundle is the single
connection between these two groups of
myocardium.
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Cardiac chambers
Interatrial,
interventricular, and
atrioventricular septa
separate the four
chambers of the
heart
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RIGHT ATRIUM
The human heart
consists of 2 atria, right
and left.
The atrium has two
basic parts. The
smooth walled posterior
and the anterior portion
with ridges formed from
pectinate muscles.
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Openings:
Superior vena cava.
Inferior vena cava.
Tricuspid valve divides
the right atrium from the
right ventricle.
Coronary sinus.
Small cardinal veins.
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Additional
strictures
Fossa ovalis
Limbus of ovalis
Crista terminalis
Sulcus terminalis
SA node
AV node
Inter nodal
pathways05/17/16 Dr.M.Sikander Ghayas Khan
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Right ventricle
Anatomic position.
Infundibulum.
Trabeculae
carneae
Papillary muscles.
The chordae
tendineae which
connect to the free
edges of the cusps
of the tricuspid valve.
Moderator band.
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Tricuspid valve
The naming of the three cusps, the
anterior, septal, and posterior cusps,
The base of each cusp surrounds the
fibrous ring. This fibrous ring helps to
maintain the shape of the opening. The
cusps are continuous with each other near
their bases at sites termed commissures.
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Pulmonary valve ,
 The cusps are named
the left, right and anterior
semilunar cusps
Nodule of the semilunar
cusp The free superior
edge of each cusp has a
middle, thickened portion,
Lunule of the semilunar
cusp thin lateral portion
Pulmonary sinuses.
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LEFT ATRIUM
The posterior half receives the four
pulmonary veins. It has smooth walls .
The anterior half is continuous with the left
auricle. It contains musculi pectinati.
The interatrial septum is part of the
anterior wall of the left atrium.
Depression in the septum is the valve of
the foramen ovale.
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LEFT VENTRICALE
Anterior to the left atrium.
 It contributes to the anterior and
diaphragmatic surfaces of the heart, and
forms the apex.
Conical, longer and thickest than the right
ventricle.
The outflow tract (the aortic vestibule) is
posterior to the infundibulum of the right
ventricle, has smooth.
The trabeculae carneae in the left
ventricle are fine.05/17/16 Dr.M.Sikander Ghayas Khan
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Papillary muscles, together with chordae
tendineae. Two papillary muscles, the anterior
and posterior, are larger than those of the right
ventricle .
Posterior to the right ventricle.
Two parts of Septum:
Muscular part, and Membranous part.
The muscular part is thick .
Membranous part is the thin.
 A third part present above the septal cusp of the
tricuspid valve between the left ventricle and
right atrium.05/17/16 Dr.M.Sikander Ghayas Khan
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Mitral valve
Mitral valve present posterior, right side
of the superior part of the left ventricle.
 Also called bicuspid valve because it has
two cusps, the anterior and posterior
cusps.
The bases of the cusps are secured to a
fibrous ring surrounding the opening, and
the cusps are continuous with each other
at the commissures.
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ATRIOVENTRICULAR VALVES
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ATRIOVENTRICULAR VALVES
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Aortic valve
The opening from the left ventricle into the
aorta is closed by the aortic valve.
This valve is similar in structure to the
pulmonary valve.
Between the semilunar cusps and the wall
of the ascending aorta are pocket-like
sinuses-the right, left, and posterior
aortic sinuses.
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VENTRICLES
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VASCULATURE OF THE HEART
Vessels are embedded in the fat just deep
to the epicardium
Vessels receive both sympathetic &
parasympathetic supply
Coronary arteries are the first branches
from aorta
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Arterial Supply of the Heart
Right and
Left coronary
The right coronary artery arises from the
anterior aortic sinus of the ascending aorta and runs
forward between the pulmonary trunk and the right
auricle .
It descends almost vertically in the right atrioventricular
groove, and at the inferior border of the heart it
continues posteriorly along the atrioventricular groove
to Anatomose with the left coronary artery in the
posterior interventricular groove
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The following branches from the right
coronary artery supply the
Right atrium
Right ventricle
Parts of the left atrium
Left ventricle
Atrioventricular septum.
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Branches
The right conus artery anterior surface of the
pulmonary conus (infundibulum of the right
ventricle) and
 upper part of the anterior wall of the right
ventricle.
The anterior ventricular branches supply the
anterior surface of the right ventricle.
The marginal branch is the largest and runs
along the lower margin of the costal surface to
reach the apex.
The posterior ventricular branches supply the
diaphragmatic surface of the right ventricle.05/17/16 Dr.M.Sikander Ghayas Khan
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The posterior interventricular It gives off branches to
the right and left ventricles, including its inferior wall.
posterior part of the ventricular septum but not to the
apical part, which receives its supply from the anterior
interventricular branch of the left coronary artery.
atrioventricular node A large septal branch supplies the
AV node. In 10% of individuals the posterior
interventricular artery is replaced by a branch from the
left coronary artery.
The atrial branches supply the anterior and lateral
surfaces of the right atrium. One branch supplies the
posterior surface of both the right and left atria.
 The artery of the sinuatrial node supplies the node and
the right and left atria; in 35% of individuals it arises from
the left coronary artery.
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The left coronary artery, which is usually
larger than the right coronary artery,
 supplies the greater part of the left atrium,
 left ventricle, and ventricular septum.
It arises from the left posterior aortic sinus of the
ascending aorta and passes forward between
the pulmonary trunk and the left auricle .It then
enters the atrioventricular groove and divides
into an anterior interventricular branch and a
circumflex branch.
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Branches
The anterior interventricular (descending) branch
runs downward in the anterior interventricular groove to
the apex of the heart .In most individuals it then passes
around the apex of the heart to enter the posterior
interventricular groove and anastomoses with the
terminal branches of the right coronary artery. In one
third of individuals it ends at the apex of the heart. The
anterior interventricular branch supplies the right and left
ventricles with numerous branches that also supply the
anterior part of the ventricular septum. One of these
ventricular branches (left diagonal artery) may arise
directly from the trunk of the left coronary artery. A small
left conus artery supplies the pulmonary conus
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Branches
The circumflex artery is the same size as the
anteriorinterventricular artery .It winds around
the left margin of the heart in the atrioventricular
groove. A left marginal artery is a large branch
that supplies the left margin of the left ventricle
down to the apex.
Anterior ventricular and posterior ventricular
branches supply the left ventricle.
Atrial branches supply the left atrium.
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VENOUS DRAINAGE OF HEART
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Venous Drainage of the Heart
Most blood from the heart wall drains into the
right atrium through the coronary sinus .which
lies in the posterior part of the atrioventricular
groove and is a continuation of the great
cardiac vein. It opens into the right atrium to the
left of the inferior vena cava. The small and
middle cardiac veins are tributaries of the
coronary sinus. The remainder of the blood is
returned to the right atrium by the anterior
cardiac vein and by small veins that open
directly into the heart chambers.
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MI & BYPASS GRAFTING
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CONDUCTING SYSTEM OF
HEART
 Components
Sinuatrial node
Internodl pathway
Atrioventricular node
Atrioventricular bundle
Rt bundle branch
Lt bundle branch
Perkunji fibres
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CONDUCTING SYSTEM
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CONDUCTING SYSTEM OF
HEART
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Nerve Supply of the Heart
 The heart is innervated by sympathetic
and parasympathetic fibers of the
autonomic nervous system via the
cardiac plexuses situated below the arch
of the aorta. The sympathetic supply
arises from the cervical and upper
thoracic portions of the sympathetic
trunks, and the parasympathetic supply
comes from the vagus nerves.
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 HISTOLOGY OF HEART
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HEART WALL
THE HEART WALL CONSISTS OF 3
LAYERS
1. EPICARDIUM
2. MYOCARDIUM
3. ENDOCARDIUM
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Epicardium
Epicardium is a dense sheet of fibrocollagenous
tissue F which also contains elastic fibres.
 Mesothelial cells Me responsible for secretion of
lubricating fluid.
large branch of the coronary artery CA, with a
smaller branch penetrating the myocardium M.
Adipose tissue A. Micrograph (b) shows the
appearance of the epicardium over most of the
heart surface where the fibrocollagenous layer lies
directly on the myocardium without adipose tissue.
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Myocardium
longitudinal section
cardiac muscle fibres form
an interconnecting network,
joined to each other by
intercalated discs D,
central nuclei and
regular cytoplasmic
striations.
Extensive capillary
network C between the
myocardial fibres
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Endocardium
The endocardium has
a surface layer of
flattened endothelial
cells E
Supported by a
fibrous layer F,
containing variable
amounts of elastic
tissue, which merges
with the collagen fibres
surrounding adjacent
cardiac muscle M and
the larger Purkinje
fibres P
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THANKS FOR ATTENTION
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