ANATOMY OF HEART

Presenter: Dr Tanya Gulia

Moderator: Dr Sandip Junghare
 Introduction
• The heart is hollow muscular organ, about 12cm x 9 cm with an average mass
of 250gm in adult females and 300 gm in adult males.
• The heart rests on the diaphragm, near the midline of the thoracic cavity.
• Lies within the pericardium, behind the sternum, 2nd- 6th costal cartilages and
in front of 5th-8th thoracic vertebrae.
• 1/3rd of it lies to the right and 2/3rd of it lies to the left
of median plane.
 Relations of heart
• Superiorly – the aorta, superior vena cava, pulmonary artery
& vein
• Inferiorly – the diaphragm
• Anteriorly – the ribs and intercostal muscles
• Posteriorly – the oesophagus, trachea, right and left
bronchus, descending aorta, inferior vena cava & thoracic vertebrae
• Laterally – the lungs

• The apex is formed by the tip of the left ventricle & is directed anteriorly, inferiorly
and to the left. It is in the left 5th intercostal space, 9cm lateral to midsternal line.
• The base of the heart is its posterior surface. It is formed by both the atriums.
 Surfaces
• The sternocostal or anterior surface is deep to the sternum and
ribs.
• The diaphragmatic or inferior surface is the part of the heart
between the apex and right border.
• The pulmonary or left surface occupies the cardiac notch of the
lung.
Borders
• The superior borer is formed by both atria & slightly oblique.
• The inferior border is formed by right ventricle and partly left
ventricle & is horizontal.
• The right border is formed by right atrium and it faces the right lung
and extends from the inferior surface to the base.
• The left border also called pulmonary border, is formed by left
ventricle and the left auricle and it faces the left lung and extends
from the base to the apex.
Sulci of heart
• It is a groove on the outer surface of the heart marking the division
between the atria and the ventricles.

1. Atrioventricular sulcus
2. Anterior interventricular sulcus
3. Posterior interventricular sulcus
• Atrioventricular sulcus: Separates atria from ventricles, it contains
right coronary, left coronary artery, circumflex artery, coronary sinus.
• Anterior interventricular sulcus: lies between left ventricle and right
ventricle on the the anterior surface, marks location if interventricular
septum contains left anterior descending artery, great cardiac vein.
• Posterior interventricular sulcus: lies between left ventricle and right
ventricle posterior surface, contains posterior interventricular artery
and middle cardiac vein.
 Pericardial sinuses
• The lines of reflection between visceral and parietal pericardium form
two pericardial sinuses.

a. The transverse pericardial sinus lies anterior to the superior vena cava and
posterior to the ascending aorta and pulmonary trunk.
b. The oblique pericardial sinus lies posterior to the heart to the pericardial
sac.
Auricle
• Anterior surface of each atrium is a wrinkled pouch like structure
called an auricle.
• Each auricle slightly increases the capacity of an atrium so thar it can
hold a greater volume of blood.
Coverings of heart
• Pericardium:
• The heart is enclosed in double-walled sac called the pericardium.
• It consist of two main parts:
1. The fibrous pericardium
2. The serous pericardium
• The fibrous pericardium is composed of tough, non elastic, dense irregular
connective tissue. The functions of fibrous pericardium is to
1. Prevent overstretching of the heart
2. Protection of heart
3. Anchors the heart in the mediastinum
• The serous pericardium is a thinner membrane that forms a double layer
around the heart.
• The outer parietal layer: it is fused to the fibrous pericardium.
• The inner visceral layer is also called the epicardium helps the layers
of the heart wall to adheres tightly to the surface of the heart.
• A slipper fluid is present in between the parietal and visceral layers
helps to give lubrication and reduces friction while the hear beats in
the pericardial fluid.
• The space between the two layers are called the pericardial cavity.
Layers of the heart wall
• The wall of heart consists of three layers:
• The epicardium (external layer)
• The myocardium (middle layer)
• The endocardium (inner layer)
Epicardium
• It is thin transparent outer layer of heart wall.
• Composed of mesothelium.
• Contains blood vessels, lymphatics and vessels that supply
myocardium.

Myocardium
• Is responsible for the pumping action of the heart.
• Composed of cardiac muscle tissue.
• Cardiac muscle fibers are organized in bundles that swirl diagonally
around the heart and generate pumping actions of heart.
Endocardium
• Is a glistening white sheet of endothelium.
• Lines the heart chambers.
• Covers the fibrous skeleton of the valves.
• Is continuous with the endothelial linings of the blood vessels leaving
and entering the heart.
 Chambers of heart
• The heart has four chambers.
• The two superior receiving chambers
are the atria and the two inferior
pumping chambers are the ventricles.
 Right Atrium
• The right atrium forms the right border
• Receives blood from three veins: SVC, IVC and coronary sinus.
• Is about 2-3mm in thickness.
• Posterior wall is smooth
• Anterior wall is rough due to presence of muscular ridges called pectinate
muscles.
• Right and left atrium is separated by interatrial septum.
• Prominent feature of this septum is an oval depression called the fossa ovalis.
• Blood passes from the right atrium into the right ventricle through a valve
that is called the tricuspid valve, it consists of three leaflets or cusps.
• The cusps of the tricuspid valve are connected to tendon like cords,
the chordae tendineae which in turn are connected to cone shaped
trabeculae carneae called papillary muscle.
 Right Ventricle
• Is about 4-5 mm in average thickness.
• Forms most anterior surface of heart.
• Contains a series of ridges formed by bundles of cardiac muscles
fibers called trabeculae carneae. Helps the heart for conduction.
• Right ventricle is separated from left by the interventricular septum.
• Blood passes from the right ventricle through the pulmonary valve
into a large artery called the pulmonary trunk, which divides into right
and left pulmonary arteries.
 Left Atrium
• Same thickness as the right atrium.
• Forms most of the base of the heart.
• Receives blood from the lungs through four pulmonary veins.
• Blood passes from left atrium into the left ventricle through the
bicuspid/mitral valve also called as left atrioventricular valve.
Left ventricle
• Thickest chamber of the heart.
• 10-15mm
• Forms apex of heart.
• Contains trabeculae carneae and also has chordae tendineae that anchor the
cusps of the bicuspid valve to papillary muscles.
• Blood passes from the left ventricle through the aortic valve into the ascending
aorta from here blood flows into the coronary arteries, which branch from the
ascending aorta and carry blood to the heart wall.
• The remainder of blood passes into the arch of aorta and descending aorta,
• Branches of arch of aorta and descending aorta carry blood throughout the
body.
 Tricuspid valve
• Consists of three cusps anterior, septal and inferior(posterior).
• Cusps are formed by a fold of endocardium and some connective
tissue.
• Maintain unidirectional flow.
• Base of cusps attach to the fibrous ring of the heart skeleton and their
free edges attach to the chordae tendineae connecting them to the
papillary muscles.
 Mitral valve
• Consists of two cusps: anterior and posterior.
• Structure similar to tricuspid valve.
• Anterior cusps is larger and intervenes between the atrioventricular
and the aortic orifices.
• The chordae tendineae attach the cusps to papillary muscles as in the
tricuspid valve.
• Mitral cusps are smaller & thicker than tricuspid valve.
• Blood vessels are present in the fibrous ring & basal 1/3rd of the cusps.
  Pulmonary valve

• The pulmonary valve has three cusps: anterior

cusp, left cusp, right cusp.
• Formed by folds of endocardium and some connective tissue.
• Lower margins of cusps and their sides are attached to the arterial
wall.
• There are no chordae tendineae or papillary muscles attached to the
valves.
• Closed during ventricular diastole when each cusp bilges towards the
ventricular cavity.
  Aortic valve
• The valves are arranged as one anterior and two posterior;
• The aortic valve has three cusps: left coronary cusp, right coronary
cusp, and non coronary cusp.
• Right artery originates from the anterior
aortic sinus and left coronary from left
posterior sinus.
Reference: BD Chaurasia’s Human Anatomy Volume 1
(upper limb & Thorax) 6th edition.