 The heart is a muscular double pump with two functions

 It’s right side receives oxygen-poor blood from the body tissues and then pumps this blood to the
lungs to pick up oxygen and dispel carbon dioxide. The blood vessels that carry blood to and from
the lungs form the pulmonary circuit
 Its left side receives the oxygenated blood returning from the lungs and pumps this blood
throughout the body to supply oxygen and nutrients to the body tissues. The vessels that transport
blood to and from all body tissues and back to the heart form the systemic circuit.
 The heart is said to have four corners defined by four points projected onto the anterior thoracic wall:
 The superior right point lies where the costal cartilage of the third rib joins the sternum.
 The superior left point lies at the costal cartilage of the second rib, a finger’s breadth lateral to the
sternum.
 The inferior right point lies at the costal cartilage of the sixth rib, a finger’s breadth lateral to the
sternum.
 Finally, the inferior left point (the apex point) lies in the fifth intercostal space at the midclavicular
line—that is, at a line extending inferiorly from the midpoint of the left clavicle.
 Coverings of the heart: The pericardium is a triple-layered sac that encloses the heart. The outer
layer of this sac, called the fibrous pericardium, is a strong layer of dense connective tissue. It
adheres to the diaphragm inferiorly, and superiorly it is fused to the roots of the great vessels
that leave and enter the heart. The fibrous pericardium acts as a tough outer coat that holds
the heart in place and keeps it from overfilling with blood. Deep to the fibrous pericardium is
the double-layered serous pericardium, a closed sac sandwiched between the fibrous
pericardium and the heart. The outer, parietal layer of the serous pericardium adheres to the
inner surface of the fibrous pericardium. The parietal layer is continuous with the visceral layer
of the serous pericardium, or epicardium, which lies on the heart and is considered a part of
the heart wall. Between the parietal and visceral layers of serous pericardium is a slit like space,
called the pericardial cavity, a division of the embryonic coelom. The epithelial cells of the
serous pericardium that line the pericardial cavity produce a lubricating film of serous fluid into
the pericardial cavity. This fluid reduces friction between the beating heart and the outer wall
of the pericardial sac.
 Layers of the Heart Wall
 The wall of the heart consists of three layers: the epicardium (external layer), the myocardium
(middle layer) and the endocardium (inner layer). The epicardium is the thin, transparent outer
layer of the wall and is composed of delicate connective tissue. The myocardium, comprised of
cardiac muscle tissue, makes up the majority of the cardiac wall and is responsible for its pumping
action. The thickness of the myocardium mirrors the load to which each specific region of the heart
is subjected. Surrounding the cardiac muscle cells in the myocardium are connective tissues that
bind these cells together into elongated, circularly and spirally arranged networks called bundles.
The endocardium is a thin layer of endothelium overlying a thin layer of connective tissue, deep to
the myocardium. It provides a smooth lining for the chambers of the heart and covers the valves.
The endocardium is continuous with the endothelial lining of the large blood vessels attached to the
heart.
 Heart chambers: The four heart chambers are the right and left atria (singular, atrium) superiorly, and
the right and left ventricles inferiorly. The superior chambers consist of the right atrium and left
atrium which lie primarily on the posterior side of the heart.
 Extending anteriorly from each thin-walled atrium is a small, ear shaped appendage called
an auricle (l., auricula, little ear) that expands the volume of the chamber. Blood drains into the atria
from the pulmonary and systemic circulatory systems.
 Making up the lower chambers are the right ventricle and left ventricle which are much larger than
the atria.
 The right ventricle pumps blood through the pulmonary circulatory system and the thicker-walled
left ventricle pumps blood through the long systemic circulatory system.
  Internally, the two ventricles are separated by a thick myocardial wall called the interventricular
septum.
 On the anterior surface of the heart. the interventricular septum is marked by a shallow diagonal
groove known as the anterior interventricular sulcus (or groove), which is occupied by the anterior
interventricular artery, great cardiac vein, and adipose tissue.
 On the posterior surface of the heart, the ventricles are separated by the posterior interventricular
sulcus (or groove), which contains the posterior interventricular artery, middle cardiac vein, and
adipose tissue.

 Right atrium: The right atrium forms the entire right border of the human heart. It is the receiving
chamber for oxygen-poor blood returning from the systemic circuit The right atrium receives blood via
three veins: the superior vena cava and inferior vena cava and the coronary sinus. Externally, the right
auricle, projects anteriorly from the superior corner of the atrium). Internally, the right atrium has two
parts: a smooth-walled posterior part and an anterior part lined by horizontal ridges called the
pectinate muscles. These two parts of the atrium are separated by a large, C-shaped ridge called the
crista terminalis. The crista is an important landmark in locating the sites where veins enter the right
atrium: The superior vena cava opens into the atrium just posterior to the superior bend of the crista;
the inferior vena cava opens into the atrium just posterior to the inferior bend of the crista; and the
coronary sinus opens into the atrium just anterior to the inferior end of the crista. just posterior to this
end of the crista is the fossa ovalis, a depression in the interatrial septum that marks the spot where an
opening existed in the fetal heart: the foramen ovale. Inferiorly and anteriorly, the right atrium opens
into the right ventricle through the tricuspid valve (right atrioventricular valve)
 Right Ventricle The right ventricle forms most of the anterior surface of the heart. It receives blood
from the right atrium and pumps it into the pulmonary circuit via an artery called the pulmonary trunk.
Internally, the ventricular walls are marked by irregular ridges of muscle called trabeculae carneae.
Additionally, cone-shaped papillary muscles project from the walls into the ventricular cavity. Thin,
strong bands called chordae tendineae project superiorly from the papillary muscles to the flaps (cusps)
of the tricuspid (right atrioventricular) valve. Superiorly, the opening between the right ventricle and
the pulmonary trunk contains the pulmonary semilunar valve (or simply, pulmonary valve).
 Left Atrium The left atrium makes up most of the heart’s posterior surface, or base. It receives oxygen-
rich blood returning from the lungs through two right and two left pulmonary veins The only part of the
left atrium visible anteriorly is its triangular left auricle . Internally, most of the atrial wall is smooth,
with pectinate muscles lining the auricle only. The left atrium opens into the left ventricle through the
mitral valve (left atrioventricular valve)
 Left Ventricle The left ventricle forms the apex of the heart and dominates the heart’s inferior surface.
It pumps blood into the systemic circuit. Like the right ventricle, it contains trabeculae carneae,
papillary muscles, chordae tendineae, and the cusps of an atrioventricular (mitral) valve. Superiorly, the
left ventricle opens into the stem artery of the systemic circulation (the aorta) through the aortic
semilunar valve
 Heart valves: The heart valves—enforce the one-way flow of blood through the heart, from the
atria to the ventricles and into the great arteries that leave the superior part of the heart.
 Each heart valve consists of two or three cusps, which are flaps of endocardium reinforced by
cores of dense connective tissue
• Located at the junctions of the atria and their respective ventricles are the
atrioventricular valves: the right atrioventricular (tricuspid) valve, which has three
cusps, and the left atrioventricular (bicuspid) valve, which has only two cusps. The
latter is also called the mitral valve because its cusps resemble the two sides of a
bishop’s hat, or miter.
• Located at the junctions of the ventricles and the great arteries are the aortic and
pulmonary (semilunar) valves, each of which has three pocketlike cusps shaped
roughly like crescent moons (semilunar = half moon)
 • The cardiac skeleton lies in the plane between the atria and the ventricles and
surrounds all four heart valves rather like handcuffs. Composed of dense connective
tissue, it has four functions:
1. It anchors the valve cusps.
2. It prevents overdilation of the valve openings as blood pulses through them.
3. It is the point of attachment for the bundles of cardiac muscle in the atria and ventricles
4. It blocks the direct spread of electrical impulses from the atria to the ventricles. This
function is critical for the proper coordination of atrial and ventricular contractions
 Cardiac muscle tissue: Cardiac muscle tissue forms the thick myocardium of the heart wall. It
contains cardiac muscle cells and the connective tissues that surround these cells. The
contractions of cardiac muscle cells pump blood through the heart and into and through the
blood vessels of the circulatory system. Cardiac muscle tissue, like skeletal muscle tissue, is
striated, and it contracts by the sliding filament mechanism. Unlike a skeletal muscle cell, which
is long, multinucleated, and cylindrically shaped, a cardiac muscle cell is a short, branching cell
with one or two large, centrally located nuclei. Each cell averages about 25 μm in diameter and
120 μm in length. Adjacent cardiac muscle cells are joined together at their ends to form cellular
networks. These branching networks of cardiac muscle cells are called cardiac myofibers.
 The complex junctions that join cardiac muscle cells are called intercalated discs. At these
junctions, the sarcolemma of adjacent cells interlock through meshing “fingers,” like one
empty egg carton stacked inside another. Intercalated discs have two distinct regions:
 Transverse regions contain desmosome-like junctions called fasciae adherens (singular:
fascia adherens) that function to bind adjacent cells together and transmit the contractile
force to adjacent cells.
 Longitudinal regions contain gap junctions that allow ions to pass between cells,
transmitting the contractile signal to adjacent cells
 The striated cardiac muscle cells contain myofibrils with typical sarcomeres composed of A
and I bands, H zones, titin, and Z discs and M lines
 The abundant mitochondria make large amounts of ATP by aerobic metabolism; thus,
cardiac muscle is highly resistant to fatigue
 Mechanism of contraction: The molecular mechanism for contraction in cardiac muscle is
similar to that in skeletal muscle. Cardiac muscle cells are triggered to contract by ionic calcium
(Ca2+) entering the sarcoplasm. In response to an action potential, a small amount of Ca2+ from
the extracellular tissue fluid enters the cardiac muscle cell through the sarcolemma. This rise in
intracellular calcium signals the sarcoplasmic reticulum to release its stored Ca2+. These ions
diffuse into the sarcomeres and trigger the sliding of the filaments. Reuptake of calcium by the
sarcoplasmic reticulum ends contraction. Compared to skeletal muscle, the sarcoplasmic
reticulum of cardiac muscle cells is less complex, and the T tubules.
 The cardiac conduction system is a collection of nodes and specialized conduction cells that
initiate and co-ordinate contraction of the heart muscle. It consists of:
 Sinoatrial node: The sinoatrial (SA) node is a collection of specialized cells (pacemaker
cells), and is located in the upper wall of the right atrium, at the junction where the
superior vena cava enters. These pacemaker cells can spontaneously generate electrical
impulses. The wave of excitation created by the SA node spreads via gap junctions across
both atria, resulting in atrial contraction (atrial systole) – with blood moving from the atria
into the ventricles
 Atrioventricular node: After the electrical impulses spread across the atria, they converge
at the atrioventricular node – located within the atrioventricular septum, near the
opening of the coronary sinus.
  Atrioventricular bundle : The atrioventricular bundle (bundle of His) is a continuation of
the specialized tissue of the AV node, and serves to transmit the electrical impulse from
the AV node to the Purkinje fibres of the ventricles.
 Purkinje fibres: The Purkinje fibres (sub-endocardial plexus of conduction cells) are a
network of specialized cells. They are abundant with glycogen and have extensive gap
junctions.
 These cells are located in the subendocardial surface of the ventricular walls, and are able
to rapidly transmit cardiac action potentials from the atrioventricular bundle to the
myocardium of the ventricles. This rapid conduction allows coordinated ventricular
contraction (ventricular systole) and blood is moved from the right and left ventricles to
the pulmonary artery and aorta respectively.
 Innervation: The nerves to the heart consist of visceral sensory fibers, parasympathetic fibers,
and sympathetic fibers. All nerves serving the heart pass through the cardiac plexus on the
trachea before entering the heart.
• The parasympathetic nerves to the heart arise as branches of the vagus nerve in the
neck and thorax. Parasympathetic innervation decreases heart rate and is restricted
to the SA and AV nodes and the coronary arteries.
• The sympathetic nerves travel to the heart from the cervical and upper thoracic chain
ganglia. Sympathetic fibers innervate the same structures as parasympathetic fibers
—the SA node, AV node, and coronary arteries. In addition, sympathetic fibers project
to the cardiac musculature throughout the heart. Sympathetic innervation of the
heart increases heart rate and strength of contraction. The autonomic input to the
heart is controlled by cardiac centers in the reticular formation of the medulla of the
brain. In the medulla, the cardioinhibitory center influences parasympathetic
neurons, whereas the cardioacceleratory center influences sympathetic neurons
 Blood Supply to the heart:
 Coronary Arteries, blood supply to the muscular walls and tissues of the heart is delivered by
the right and left coronary arteries
 These systemic arteries arise from the base of the aorta and run in the coronary sulcus.
 The left coronary artery (LCA) arises from the left side of the aorta, passes posterior to the
pulmonary trunk, then divides into two branches: the anterior interventricular and circumflex
arteries.
 The anterior interventricular artery, or the left anterior descending artery (LAD), descends in
the anterior interventricular sulcus toward the apex of the heart. This vessel sends branches into
and supplies the interventricular septum and anterior walls of both ventricles.
 The circumflex artery (Cx) follows the coronary sulcus posteriorly and supplies the left atrium
and the posterior part of the left ventricle.
 The right coronary artery (RCA) emerges from the right side of the aorta and descends in the
coronary sulcus on the anterior surface of the heart, between the right atrium and right
ventricle.
 At the inferior border of the heart, it branches to form the marginal artery.
 Continuing into the posterior part of the coronary sulcus, the right coronary artery gives off a
large branch in the posterior interventricular sulcus, the posterior interventricular artery,
commonly called the posterior descending artery (PDA).
 The right coronary artery and its branches supply the right atrium and much of the right
ventricle
 Cardiac Veins Cardiac veins, which carry deoxygenated blood from the heart wall into the right
atrium, also occupy the sulci on the heart surfac. The largest of these veins, the coronary sinus,
occupies the posterior part of the coronary sulcus and returns almost all the venous blood from
the heart to the right atrium. Draining into the coronary sinus are three large tributaries: the
great cardiac vein in the anterior interventricular sulcus, the middle cardiac vein in the posterior
interventricular sulcus, and the small cardiac vein running along the heart’s inferior right margin.
The anterior surface of the right ventricle contains several horizontal anterior cardiac veins that
empty directly into the right atrium.