The document describes the anatomy and structures of the heart. It discusses: - The heart is surrounded by the pericardium, a double-walled sac that has an outer fibrous layer and inner serous layers separated by fluid. - The heart has four chambers - two upper atria that receive blood and two lower ventricles that pump blood out. Blood flows through valves between the chambers. - The heart wall has three layers - the outer epicardium, middle muscular myocardium, and inner endothelial endocardium. - The heart is supplied by the right and left coronary arteries and drains into the coronary sinus vein. - Nerves from the autonomic nervous system

1. ANATOMY OF THE HEART By: Dr Mohammed Faez

2. The Heart The heart is a chambered muscular organ that pumps blood received from the veins into the arteries, thereby maintaining the flow of blood through the entire circulatory system.

3. The Heart The heart is surrounded by membrane called Pericardium.

4. The Pericardium The pericardium is a fibroserous sac that encloses the heart and the roots of the great vessels. The pericardium lies within the middle mediastinum.

5. The Pericardium

6. The Pericardium Its function is to restrict excessive movements of the heart as a whole and to serve as a lubricated container in which the different parts of the heart can contract.

7. The Pericardium Pericardium – a double-walled sac around the heart composed of: A superficial fibrous pericardium A deep two-layer serous pericardium The parietal layer lines the internal surface of the fibrous pericardium The visceral layer or epicardium lines the surface of the heart They are separated by the fluid-filled pericardial cavity

8. The Pericardium

9. The Pericardium

10. The Pericardium

11. The Pericardium Blood Supply The pericardium blood supply is from the pericardiacophrenic branches of the internal thoracic arteries. Nerve Supply The pericardium nerve supply the fibrous pericardium and the parietal layer of serous pericardium are supplied by the phrenic nerve.

12. Heart Wall Epicardium – visceral layer of the serous pericardium Myocardium – cardiac muscle layer forming the bulk of the heart Fibrous skeleton of the heart – crisscrossing, interlacing layer of connective tissue Endocardium – endothelial layer of the inner myocardial surface

13. Heart Wall Endocardium deepest layer of the heart smooth lining to reduce friction of bloodflow Myocardium middle layer of the heart location of muscle fibers responsible for pumping Pericardium outer protective layer composed of : visceral pericardium paricardial cavity parietal pericardium

14. Heart Wall

15. Heart Wall

16. The Heart The heart is a hollow muscular organ that is somewhat pyramid shaped and lies within the pericardium in the mediastinum . It is connected at its base to the great blood vessels but otherwise lies free within the pericardium.

17. The Heart

18. The Heart The heart surfaces: • The anterior (sternocostal) surface comprises the: right atrium, atrioventricular groove, right ventricle, a small strip of left ventricle and the auricle of the left atrium. • The inferior (diaphragmatic) surface comprises the: right atrium, atrioventricular groove and both ventricles separated by the interventricular groove. • The posterior surface (base) comprises the left atrium receiving the four pulmonary veins.

19. The Heart

20. The Heart Chambers Four chambers Two atria (Right and Left) Two ventricles (Right and Left)

23. Superior and Inferior Vena Cava

24. Coronary Sinus (draining the myocardium)

25. Left side

29. The Right Atrium The sulcusterminalisis a vertical groove on the outer surface of the atrium. This groove corresponds internally to the cristaterminalis . Above the coronary sinus the interatrial septum forms the posterior wall. The depression in the septum the fossaovalisare presents the site of the foramen ovale.

31. RA

32. The Right Ventricle Receives blood from the right atrium through the tricuspid valve . The edges of the valve cusps are attached to chordaetendineaewhich are, in turn, attached below to papillary muscles.

33. The Right Ventricle The wall of the right ventricle is thicker than that of the atria but not as thick as that of the left ventricle. The wall contains a mass of muscular bundles known as trabeculaecarneae. The infundibulumis the smooth walled outflow tract of the right ventricle.

34. The Right Ventricle The pulmonary valve is situated at the top of the infundibulum. It is composed of three semilunar cusps. Blood flows through the valve and into the pulmonary arteries via the pulmonary trunk to be oxygenated in the lungs.

36. RV

37. The Left Atrium Receives oxygenated blood from four pulmonary veins which drain posteriorly. The cavity is smooth walled except for the atrial appendage. On the septal surface a depression marks the fossaovalis.

38. The Left Atrium The mitral (bicuspid) valve guards the passage of blood from the left atrium to the left ventricle.

39. LA

40. The Left Ventricle The wall of the left ventricle is thicker than the right ventricle but the structure is similar. The thick wall is necessary to pump oxygenated blood at high pressure through the systemic circulation. Trabeculaecarneaeproject from the wall with papillary muscles attached to the mitral valve cusp edges by way of chordaetendineae.

41. The Left Ventricle The vestibuleis a smooth walled part of the left ventricle which is located below the aortic valve .

43. LV

44. The Heart Valves Heart valves ensure unidirectional blood flow through the heart Composed of an endocardium with a connective tissue core. Two major types Atrioventricular valves Semilunar valves

46. Atrioventricular (AV) Valves Atrioventricular (AV) valves lie between the atria and the ventricles R-AV valve = tricuspid valve L-AV valve = bicuspid or mitral valve AV valves prevent backflow of blood into the atria when ventricles contract Chordaetendineae anchor AV valves to papillary muscles of ventricle wall Prevent prolapse of valve back into atrium

47. AtrioventricularValve

48. Semilunar Heart Valves Semilunar valves prevent backflow of blood into the ventricles Have no chordae tendinae attachments Aortic semilunar valve lies between the left ventricle and the aorta Pulmonary semilunar valve lies between the right ventricle and pulmonary trunk Heart sounds (“lub-dup”) due to valves closing “Lub” - closing of atrioventricular valves “Dub”- closing of semilunar valves

49. SemilunarValve

50. The Heart Valves Atrioventricular valves Semilunar valves Right AV (Tricuspid) separates the right atrium from the right ventricle. Prevents backflow into atrium. Left AV (Bicuspid) separates the left atrium from the left ventricle. Prevents backflow into atrium. Pulmonary valve separates the right ventricle from the pulmonary arteries. Prevents backflow after ventricular contraction. Aortic valve separates the left ventricle from the aorta. Prevents backflow after ventricular contraction .

51. The Heart Valves Pulmonary semilunar valve Right AV (tricuspid) valve Aortic semilunar valve Chordai tendineae Papillary muscle Left AV (bicuspid) valve

52. The Heart Valves

53. Arterial Supply of the Heart The arterial supply of the heart is provided by the right and left coronary arteries, which arise from the ascending aorta immediately above the aortic valve.

54. Coronary Arteries The origins of the coronary arteries are as follows: The left coronary artery arises from the aortic sinus immediately above the left posterior cusp of the aortic valve . The right coronary artery arises from the aortic sinus immediately above the anterior cusp of the aortic valve.

55. Right coronary artery Branches Right marginal arteries (acute marginal artery) Posterior interventricular artery. (in post. IV sulcus) Sinoatrial nodal artery. Atrioventricular nodal artery.

56. Left coronary artery Branches Left anterior descending (LAD) or anterior interventricular artery. (lies in anterior IV sulcus) Septal branches. Diagonal branches Left marginal artery. (Obtuse marginal artery) Left circumflex artery.

57. Coronary Arteries

59. 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 . It is a continuation of the great cardiac vein. It opens into the right atrium to the left of the inferior vena cava

60. Venous Drainage of the Heart

61. 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.

62. THANK YOU

66. External Heart: Anterior View

67. External Heart: Posterior View

68. Gross Anatomy of Heart: Frontal Section