Anatomy of the Heart

Internal Features

MOHAMED ELADL
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 Right Atrium
 External features
 Forms the right surface and
right border of the heart.
 The right auricle projects
forwards from the anterior
upper angle of the right
atrium to overlap the right
side of the root of the Rt
pulmonary trunk (The Atrium
auricle has rough inner
wall and crenated(Shell-like)
outer margin).
 The lateral wall of the right
atrium is marked by a
vertical groove known as
sulcus terminalis that
extends from the opening of
the superior vena cava Dr M Eladl

above to the opening of the

Interior of Right Atrium

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 Interior of Right Atrium
 It is composed of :
1. Anterior rough part Musculi
Pectinati
(atrium proper)
 Consists of parallel
muscular ridges that
run from the crista
terminalis. They are
called musculi
pectinati.
 It represents the part
derived from the
Right 1/2 of the atrial
chamber of the
primitive heart tube.
2. Posterior smooth Posterior smooth
part (sinus part
venarum):
 Receives the opening Dr M Eladl
 Interior of Right Atrium
3. Septal wall:
Formed by the inter-atrial Musculi
Septal Pectinati
septum: It shows: part
 Fosa ovalis: An oval
depression represents
the septum primum of
the fetus.
 Annulus ovalis:
Crescentic margin of
fossa ovalis.
Represents Annulus
the caudal
of septum secondum.
Ovalis

Fossa
Ovalis
Posterior smooth
part

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 Openings in Right Atrium
 The posterior smooth
part receives the
following openings:
 Opening of the superior
vena cava:

SVC
 Lies at the upper part,
opposite the right 3rd
costal cartilage.
 Has no valves.
 Opening of the inferior
vena cava:
 Lies at the lower part,

IVC
opposite the right 6th
costal cartilage.
 Guarded by a
rudimentary valve
called valve of the Dr M Eladl
inferior vena cava.
 Openings in Right Atrium
 Openings of anterior
cardiac veins: Three or
four small veins which
open into the anterior part
of the right atrium.

 Venae cordis minimi:

Numerous small veins
which open directly into
the atria and to a less
extent into the ventricles.

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 Tricuspid Orifice
 Definition: large oval
aperture connecting the
right atrium with the right
ventricle.
 Characters:
 Is wider than the left
atrioventricular orifice,
admitting the tips of
three fingers.
 Is surrounded by a
fibrous ring, which gives
attachment to the cusps
of the tricuspid valve.
 Lies behind the sternum
at the level of the 4th
intercostal space.
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Anatomical Locations of the Valves
 The surface markings on the anterior chest wall of
the cardiac valves is typically retrosternal:
 Pulmonary valve: at the
junction of superior and
middle thirds of body of
sternum near to left 3rd
costal cartilage
 Aortic valve: just below
and to the right of the
pulmonary valve; level
with 3rd intercostal
space
 Mitral valve: 4th costal
cartilage and to the left Dr M Eladl
of sternal body
Auscultatory Locations of the Valves
 Because blood tends to
carry the sound in the
direction of its flow, each
area is situated superficial
to the chamber or vessel
through which the blood
has passed.
 Pulmonary valve
sound: 2nd left
intercostal space, just to
the left of sternum.
 Aortic valve sound: 2nd
right IC space at the
edge of the sternum. Dr M Eladl

 Tricuspid Valve
 Valve that guards the tricuspid
orifice.
 Formed of fibrous ring and three
cusps
 Anterior cusp: between
tricuspid orifice and the
infundibulum of the right
ventricle.
 Posterior cusp: is related to
the inferior wall of the right
ventricle.
 Septal cusp: close to the
interventricular septum.
 Features of the cusp:
 Each cusp consists of double
layer of endocardium with thin
fibrous tissue in-between. Dr M Eladl
 Is non-vascular except at its
 Left Atrium
 Similar to the right
atrium, the left atrium
consists of a main cavity
and a left auricle.
 Lies behind the right
atrium and forms the
greater part of the base
of the heart.
 Related to the oblique
sinus of the serous
pericardium, and the
fibrous pericardium
posteriorly that
separates it from the
esophagus.
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 Interior of left Atrium
 The interior of the left
atrium is smooth, but
the left auricle
possesses muscular
ridges as in the right
auricle.
 The wall is slightly
thicker than that of the
right.
 Orifices in the Left
atrium:
 Mitral orifice and
valve
 Four pulmonary veins
 Vena cordis minimi

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 Mitral Orifice
 Definition: Is an aperture
connecting the left atrium
with the left ventricle.
 Characters:
 Is smaller than the right
atrioventricular orifice,
admitting only the tips of
two fingers.
 Is surrounded by a fibrous
ring, which gives
attachment to the cusps of
the mitral valve.
 Lies in the middle line, at
the level of the 4th costal Dr M Eladl

cartilage.
 Mitral Valve
 The valve that guards the mitral
orifice.
 Formed of 2 cusps attached to
fibrous ring
 Anterior cusp: larger and lies
anteriorly and to the right.
 Posterior cusp: smaller and lies
posteriorly and to the left.
 Features of the cusp:
 Consists of double layer of
endocardium with a thin fibrous
tissue in between.
 Attached by its base to fibrous ring,
while its apex hang into the
N.B. chordae tendinae
ventricular cavity. are relatively stronger & fewer in
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 Right Ventricle
 The right ventricle forms the following parts of
the heart:
 Most of the sternocostal surface
 Inferior border of the heart (right two-thirds).
 The right third of the diaphragmatic surface.
 Its upper part is conical and lies below the
pulmonary trunk. It is called the
infandibulum.

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 Interior of Right Ventricle
 Consists of 2 parts; rough inflowing part and smooth
outflowing part.
 The two parts are separated by a muscular ridge
called thepart:
 Inflowing supraventricular crest that extends bet.
tricuspid
 Lies below & pulmonary orifices
the
supraventricular crest.
 It has rough walls due
to:
 The presence of
muscular projections
known as
trabeculae carnae.
 Presence of
papillary muscles.
 The papillary muscle
has one end attached The papillary muscles contract prior to contraction of the
to the ventricular wall, ventricle  tightening the chordae tendineae and drawing the
while the other end cusps together  prevent ventricular blood from passing
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gives attachment to into the R. atrium at the time of ventricular contraction.
 Interior of Right Ventricle
 Consists of 2 parts; rough inflowing part and smooth
outflowing part.
 The two parts are separated by a muscular ridge
called thepart:
 Inflowing supraventricular crest that extends bet.
tricuspid
 The & pulmonary
papillary muscles in orifices
right ventricle are:
 Anterior: arises from
the anterior wall.
 Posterior: arises from
the posterior wall.
 Septal: arises from
ventricular septum.

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 Interior of Right Ventricle
 Consists of 2 parts; rough inflowing part and smooth
outflowing part.
 The two parts are separated by a muscular ridge
called the supraventricular
 Outflowing part: crest that extends bet.
tricuspid & pulmonary
 Lies above the orifices
supraventricular
crest.
 Is a smooth conical
pouch, leading to
the pulmonary
orifice and it is
called the
infundibulum
(conus
arteriosus).

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 Interior of Right Ventricle
 Septomarginal Trabecula:
 Between the IV septum and the anterior wall.
 It transmits part of the Right bundle of the
conducting system of the heart  “shortcut”
allowing coordinated contraction of the anterior
papillary muscle.
 Its alternative name (moderator band) indicates
that it prevents ventricular over-distension.

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 Left ventricle
 External features: The left
ventricle forms the
following parts of the
heart.
 Apex of the heart.
 Most of the left surface.
 Left 1/3 of sternocostal
surface.
 Left 2/3 of
diaphragmatic surface.
 Left third of the inferior
border.
 Its upper part below the
ascending aorta is called
the vestibule of the
aorta.
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 Left ventricle
 The walls are three times as thick as those of
the right ventricle. Because the blood pressure is
less in the pulmonary circulation than in the
systemic, 25mmHg compared to 120mmHg.
 In cross section the left ventricle is circular while
the right is crescentic. The Interventricular septum
bulges into the cavity of the right ventricle

Cross section of
thorax at 8th
thoracic vertebra,
as seen from
below.

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 Interior of Left ventricle
 Inflowing part:
 From the left atrioventricular
orifice to the apex of the
heart.
 It has rough walls due to:
 Presence of trabeculae
carnae. Which are more Papillary
numerous than right muscle
ventricle.
 Presence of papillary
muscles.
 The papillary muscles in the
left ventricle are:
 Anterior: arises from the
anterior wall of the left
ventricle.
 Posterior: arises from the
posterior wall of the left
ventricle.
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 Interior of Left ventricle
 Outflowing part:
 The part of the left
ventricle, below the
aortic orifice and is
called the aortic
vestibule. Papillary
 The walls of the muscle
vestibule are smooth
and are formed by
fibrous tissue instead of
muscular tissue Aorticto
orifice &
remain patent during valve
ventricular systole.
mitral
orifice &
valve
Aortic
vestibule Dr M Eladl
 Aortic & Pulmonary(Semilunar) Valves
 Guarded by three semilunar
cusps
 In the Aorta, one cusp is
Anterior while in the Pulmonary
trunk, one cusp is Posterior.
 The cusps are cup-shaped.
 The cusps project into the
artery close to its walls as
blood leaves the ventricle.
 The free edge of each cusp is
thickened forming the lunule.
 The apex of the angulated free
edge contains a central
fibrous nodule.
Posterior view of
pulmonary valve
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Aortic & Pulmonary(Semilunar) Valves
 Opposite each valve, the
wall of the artery is slightly
dilated to form a sinus.
The blood in these sinuses
prevents the cusps from
sticking to the wall of the
artery and failing to shut.
 Assists in closing the
central areas of the edges
of the cusps.
 The anterior and left
posterior aortic sinuses
give rise to the right and
left coronary arteries.
Posterior view of Aortic
valve
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 Aortic stenosis

The valve cusps are fused together

 narrow central opening.  Extra
work for the heart  hypertrophy of
the left ventricle.

Left ventricular
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hypertrophy
 Aortic incompetence
Failiure of the aortic valve to close tightly Backflow of the left ventricle.

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 Skeleton of the heart

 Formation:
 Fibrous rings surround the atrioventricular canals
and origins of aorta and pulmonary trunk.
 Right &left fibrous trigones form connections
between the rings. Dr M Eladl

 Skeleton of the heart

 Function:
 Keeps the orifices of the AV and semilunar valves
patent and prevents them from over distension.
 Provides attachment for the the myocardium &
cusps of the valves.
 Forms an electrical “insulator” between the atria
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 Cardiac Referred pain
 Pain originating in the heart as
the result of acute myocardial T1

ischemia is assumed to be T2

caused by oxygen T3

deficiency & metabolites T4

accumulation, which stimulate

the sensory nerve endings
in the myocardium.
 The afferent nerve fibers
ascend to the central nervous
system through the cardiac
branches of sympathetic
trunk & enter the spinal cord
through the posterior roots of
the upper four thoracic Dr M Eladl

nerves.
 Cardiac Referred pain
 The pain is not felt in the heart,
but is referred to the skin
areas supplied by the
corresponding spinal nerves.
The skin areas supplied by the
upper four intercostal nerves
and by the intercostobrachial
nerve (T2) are therefore
affected.
 The intercostobrachial nerve
communicates with the medial
cutaneous nerve of the arm and
 A certain amount of spread of nervous
is distributed to skin on the
information occur within the central nervous
medial side of the upper part of
system, so the pain is sometimes felt in theDr M Eladl
the arm.
Thank You