Bismillahir-Rahmanir-Rahim

The Heart
 Introduction: The heart is a hollow, conical, muscular organ, covered by pericardium that is situated in the
middle mediastinum (1/3rd in the right side and 2/3rd in the left of the median plane). It pumps blood to
various parts of the body to meet their nutritive requirements. It consists of four chambers- Right and Left
atria, and Right and left ventricles. It is relatively heavier in male.

Structures of the heart

Fig: Internal structures of the heart.

Fig: External structures of the heart.

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 Anatomical Position:

1. Conical apex lies anteriorly and is directed forward and to the left.
2. Base lies posteriorly and is directed upwards, backwards and to the right.
3. Sternocostal surface lies upwards and forwards.
4. Diaphragmatic surface lies inferiorly.

 Ease of Identification: The heart should be placed towards the left, with the apex directed prominently
towards the left.

 Presenting Parts:

1. Apex
2. Base
3. 3 Surfaces: Sternocostal surface, Left Surface, and Diaphragmatic Surface.
4. 4 Borders: Right border, Inferior border, left border, and superior border.

 Description about the presenting parts of the heart:

1. Apex: It is conical area formed only by the left ventricle and is directed downwards, forwards and to the
left. It lies in the 5th intercostal space, just medial to the mid clavicular line.
2. Base: It is the posterior or vertebral surface of the heart. It lies posteriorly and is directed backwards,
upwards and to the right. It is formed entirely by the atria: 2/3 rd of the base ids formed by left atrium and
1/3rd of the base is formed by right atrium. It is separated from the diaphragmatic surface by the posterior
part of the coronary sulcus.
3. Surfaces:
A) Sternocostal surface: It faces forwards and upwards. It consists of an atrial part above and to the right
and ventricular part below and to the left of the atrioventricular groove (coronary sulcus).
B) Diaphragmatic surface: It is horizontal or flat. Two ventricles form it entirely. The two ventricles
separated by posterior interventricular groove (1/3rd of the surface formed by right ventricle, and
2/3rd if the surface formed by left ventricle).
C) Left surface: The left surfaces faces upwards, backwards and to the left. It is formed almost entirely by
the (obtuse margin of the) left ventricles and a small part by the left auricle.
4. Borders:
A) Superior border: It is formed by the upper margin of the two atria. The arch of aorta and pulmonary
trunk hides it.
B) Right border: It is formed only by the right atria. It separates the sternocostal surface from the base. It
extends from the right side of the opening of the superior venacova and to that of inferior venacova.
C) Inferior border: It is sharp and separates the sternocostal surface from the diaphragmatic surface. It
extends from the lower end of the right border to the apex of the heart. Mainly the right ventricle and
small part of the left ventricle form it.
D) Left border: It separates the sternocostal surface from the left surface. It is rounded and mainly formed
by the left ventricle and the auricle of the left atrium forms small part superiorly.

 The heart has 4 chambers: Upper 2 are atria and lower 2 are ventricles formed by the coronary sulcus.
 Contents of the anterior atrio-ventricular groove:
1) Anterior atrioventricular branch of left coronary artery.
2) Great cardiac vein.
 The coronary sinus lies left posterior part of the coronary sulcus.
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 Important Relations of the Heart:

A) Base of the heart:

1. Oblique sinus
2. Posterior part of the fibrous pericardium
3. Right pair of pulmonary veins.
4. Right and left bronchi
5. Esophagus with plexus of nerves
6. Descending thoracic aorta.
7. Thoracic duct
8. Azygos vein and hemiazygos vein
9. Greater and lesser splanchnic nerves
10. Posterior mediastinal lymph node

B) Relation of the sternocostal surface of the heart:

1. Covered by three layers of pericardium.
2. Posterior surface of the body of the sternum.
3. 3rd to 6th costal cartilages of both sides.
4. Anterior margins of both lungs and pleurae.

 Blood supply and lymphatic drainage of the heart:

A) Artery supply of the heart: The heart is supplied by 2 coronary arteries arising from each arch of the aorta.
They are the: Right and left coronary arteries. The right coronary artery majorly divides into right marginal
and posterior interventricular artery. Distributing the atrium and ventricles. The left coronary artery
branches into anterior interventricular branch and branches to the diaphragmatic surface of the left
ventricle. It distributes the left atrium and ventricles.
B) Venous Drainage of heart: The heart is drained by:
1. The great cardiac vein.
2. The middle cardiac vein,
3. The right marginal vein.
4. The posterior vein of the left ventricle.
5. The oblique vein of the left atrium.
6. The anterior cardiac vein.

Fig: Artery supply of the heart.

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 Lymphatic drainage of the heart: Lymphatics of the heart accompany the coronary arteries and form two
trunks. The right trunk ends in the brachiocephalic nodes and the left trunk ends in the trachea-bronchial
lymph nodes at the bifurcation of the trachea.

 Nerve supply of the heart:

The heart gets its nerve supply from the superficial and deep cardiac plexuses. The plexuses are formed by
parasympathetic and sympathetic fibers. Parasympathetic fibers arise from the vagus nerve, to cause
decrease in force of contraction, decrease heart rate and decrease blood pressure.

Sympathetic fibers arise from T1 to T5 spinal nerves. They cause increase in force of contraction, increase
heart rate and increase blood pressure.

 Development of the heart:

1. Right atrium: The rough trabeculated part of the right atrium including right auricle develops from
primitive atrium. Smooth part from the absorption of the enlarged right horn if sinus venosus.
2. Left atrium: The posterior smooth part develops from incorporation of endocardial cushion of four
pulmonary veins. The anterior part including left auricle from the left half of primitive atrium. And the
most ventral part from the left half if the atrio-ventricular canal.
3. The interatrial septum develops from septum primum, septum intermedium and septum secondum.
4. The right ventricle’s inflowing rough part develops from proximal dilated part of the bulbus cordis and
partly from the right part of the primitive ventricle. Outflowing smooth part from the dextroventral
component of the conus cordis.
5. Left ventricle’s inflowing rough part from left part of primitive ventricle and outflowing smooth part from
laevo-dorsal component of conus cordis.
6. The interventricular septum develops from interventricular septum, bulbar septum and septum
intermedium.

 Anomaly of the heart:

1. Ventricular septal defect: Complicated ventricular septal formed, blood passes under high pressure in
defects.
2. Other congenital defects include dextrocardia, laevocardia and sinus inversus viscerum.
3. Defects in interatrial septum include: probe patency ovale, persistent foramen secundum, prental
closure of foramen ovale etc.
4. Defects in atrio-ventricular canal include common atrio-ventricular canal, tricuspid atresia.
5. Defects in vulvus cordis are: tetralogy of fallot, undivided trunkus arteriosus, vulvur stenosis of
pulmonary orifice.
6. The components of Tetralogy of Fallot include: Large ventricular septal defect, stenosis o the
pulmonary trunk, hypertrophy of the right ventricle, exit of aorta immediate above the VSD.

 The histology of the heart:

1. As with the rest of the circulatory system, the heart has three layers: epicardium (tunica adventitia),
myocardium (tunica media) and endocardium (tunica intima).
2. Endothelium: The lining epithelium of blood vessels, lymphatic vessels, and the heart constitute a
continuous sheet of simple squamous epithelium known specifically as endothelium.
3. The heart is formed by the cardiac muscles, which are tightly joined by the intercalated disc. The shape of
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cardiac muscle is that it is short cylindrical, with centrally placed nucleus, contains intercalated disc.

 Clinical anatomy of the heart:

1. Myocardial Infarction: Loss of living heart conduction due to occlusion is Myocardial Infarction.
2. Angina Pectoris is reduced oxygen supply to the heart muscle.
3. Mitral Stenosis is the narrowing of the mitral valve.
4. Angina pain is the pain felt along the medial border of the arm and forearm.
5. Edema of the heart: The heart muscles are fluid filled.
6. Pericardial effusion: It is the accumulation of abnormal amount of fluid in the pericardial cavity.