HEART: HEART: Location. Location. External features( Apex, Base, Surfaces, Borders, Chambers, Valves and Great Vessels). External features( Apex, Base,

HEARTHEART::LocationLocation . .

External features( Apex, Base, Surfaces, External features( Apex, Base, Surfaces, Borders, Chambers, Valves and Great Vessels)Borders, Chambers, Valves and Great Vessels)..

PERICARDIUMPERICARDIUM: : LayersLayers: :

Fibrous (Attachment , Nerve supply)Fibrous (Attachment , Nerve supply)..Serous ( Parietal & Visceral)Serous ( Parietal & Visceral)..

Pericardial sinuses ( Transverse & Oblique)Pericardial sinuses ( Transverse & Oblique)..Coronary arteriesCoronary arteries::

Origin, Course & Distribution and BranchesOrigin, Course & Distribution and Branches.).)Coronary SinusCoronary Sinus: :

Origin, Tributaries & TerminationOrigin, Tributaries & Termination..Veins other than Coronary SinusVeins other than Coronary Sinus..

It lies in a centrally It lies in a centrally located partition in located partition in the thoracic cavitythe thoracic cavity

between the two between the two laterally placedlaterally placed LungsLungs..

It has the shape of a full It has the shape of a full PyramidPyramid lying on one of lying on one of its sidesits sides..

It hasIt has::

Sternocostal (Anterior)Diaphragmatic (Inferior)Posterior ( Base)

The heart is divided into The heart is divided into FOUR CFOUR Chambershambers by Cardiac by Cardiac Septa intoSepta into::

Right & Left AtriaRight & Left Atria.. Right & Left VentriclesRight & Left Ventricles..

The The AuriclesAuricles are the are the superior part of the atriasuperior part of the atria..

The right atrium and The right atrium and ventricle are anterior to ventricle are anterior to the left atrium and the left atrium and ventricleventricle..

Anterior & Posterior Anterior & Posterior IVIV GroovesGrooves::

Separate the two Separate the two ventriclesventricles . .

CoronaryCoronary Sulcus:Sulcus: Separates the two Separates the two atria from the two atria from the two ventriclesventricles . .

It is directed It is directed downward, forward downward, forward

and to the leftand to the left . . It is formed by the It is formed by the

Left VentricleLeft Ventricle It lies deep to theIt lies deep to the

left 5th left 5thintercostal spaceintercostal space

((3.53.5 )’’ )’’ 0r (8.5 -9) cm from 0r (8.5 -9) cm fromthethe midlinemidline..

It is directed It is directed downward, forward downward, forward and to the leftand to the left . .

It is formed by the It is formed by the Left VentricleLeft Ventricle

It lies deep to theIt lies deep to the

left 5th left 5th intercostal spaceintercostal space

((3.53.5 )’’ )’’0r (8.5 -9) cm from 0r (8.5 -9) cm from thethe midlinemidline..

L. Ventricle

Apex

It is opposite to the It is opposite to the apex and directed apex and directed posteriorposterior..

It is formed It is formed MMainlyainly byby::

Left atriumLeft atrium..Right atriumRight atrium (small (small

portion)portion)..Proximal parts ofProximal parts of

thethe Great Veins Great Veins..

It is formed It is formed MainlyMainly by: by: RRight ventricleight ventricle. .

SomeSome of the of the RightRight AtriumAtrium . .

SomeSome of the of the Left Left VentricleVentricle . .

It faces inferiorly and It faces inferiorly and rests on the rests on the DiaphragmDiaphragm..

The heart rests on this The heart rests on this surfacesurface . .

It is formed It is formed MainlyMainly by: by: Left and Right VentriclesLeft and Right Ventricles..

Inferior partInferior part ofof Right Right AtriumAtrium..

It is formed It is formed MMainlyainly byby::

Left atriumLeft atrium into into which opens the (4) which opens the (4) pulmonary veinspulmonary veins..

Right Right : : Right atriumRight atriumLeftLeft: :

Left Auricle aboveLeft Auricle above . .Left Ventricle belowLeft Ventricle below . .

Lower (Inferior)Lower (Inferior)::: : Mainly:Mainly: Right Ventricle Right Ventricle..

SharingSharing:: Right AtriumRight Atrium. .

ApexApex..

It receives It receives venous blood venous blood throughthrough: :

Superior vena Superior vena cavacava..

Inferior vena Inferior vena cavacava..

Coronary sinusCoronary sinus..

The outflow of blood leaves The outflow of blood leaves the right ventricle into the right ventricle into the the Pulmonary TrunkPulmonary Trunk..

It communicates with the It communicates with the pulmonary trunkpulmonary trunk through through thethe PPulmonary Orificeulmonary Orifice..

InfundibulumInfundibulum::

It is the upper part of the It is the upper part of the ventricular cavity near ventricular cavity near the pulmonary orificethe pulmonary orifice..

It is in front of the It is in front of the esophagusesophagus..

Its smooth posterior Its smooth posterior part receives the part receives the openings ofopenings of

((44 ) )Pulmonary VeinsPulmonary Veins..The arterial blood The arterial blood

leaves it into the left leaves it into the left ventricle through the ventricle through the Left Atrioventricular Left Atrioventricular OpeningOpening..

Its walls are Its walls are three three times thickertimes thicker than than that of the right that of the right ventricleventricle..

Its outflow of blood Its outflow of blood is continuous is continuous superiorly with the superiorly with the ascending aorta ascending aorta through the through the Aortic Aortic OpeningOpening..

Tricupid ValveTricupid Valve::It guards the It guards the Right Right

Atrioventricular Atrioventricular OrificeOrifice..It consists of It consists of Three CuspsThree Cusps..

Mitral (Bicuspid) ValveMitral (Bicuspid) Valve::It guards the It guards the Left Left

AtrioVentricularAtrioVentricular orifice orifice..It consists of It consists of TwoTwo CuspsCusps..

The cusps are attached to the The cusps are attached to the Papillary muscles of the Papillary muscles of the Ventricular walls by Ventricular walls by CordaeCordae TendineTendine..

They guard the Pulmonary They guard the Pulmonary and Aortic Orificesand Aortic Orifices..

Each one consists of Each one consists of Three Three Semilunar CuspsSemilunar Cusps..

The mouths of the cusps The mouths of the cusps are directed upare directed up..

Their sides are attached to Their sides are attached to the wall of the vesselthe wall of the vessel..

The Right and Left The Right and Left Coronary Coronary ArteriesArteries originate from the originate from the right and left right and left AorticAortic SinusesSinuses..

StructureStructure:: It is a It is a FibroserousFibroserous

membrane that surrounds membrane that surrounds the heart and the adjacent the heart and the adjacent parts of the large vessels parts of the large vessels entering and leaving itentering and leaving it..

LayersLayers: : It consists of two layersIt consists of two layers : :

OuterOuter Fibrous Fibrous.. Inner SerousInner Serous..

SiteSite: : It is in the middle It is in the middle

mediastenum mediastenum behind behind the body of the the body of the sternumsternum and the 2 and the 2ndnd -6 -6thth costal cartilagescostal cartilages..

FunctionsFunctions::ItIt restricts excessive restricts excessive

movements of the movements of the heartheart . .

It acts as a lubricatingIt acts as a lubricating containercontainer..

It is a strong flask It is a strong flask shaped sacshaped sac . .

Its Its Base Base is on the is on the diaphragmdiaphragm..

Its Its ApexApex is continuous is continuous with the adventitia of with the adventitia of the great vesselsthe great vessels..

The base is attached The base is attached to:to: Central Tendon of Central Tendon of thethe DiaphragmDiaphragm..

Anteriorly:Anteriorly: SSternum ternum by the by the SternopericardialSternopericardial

ligamentsligaments..These attachments These attachments

keep the heart in its keep the heart in its position and limits position and limits cardiac distensioncardiac distension..

It is two layersIt is two layers: : VisceralVisceral.. ParietalParietal..

The The pericardial cavitypericardial cavity is is between the twobetween the two..

Parietal layerParietal layer::It It LinesLines the fibrous the fibrous

pericardiumpericardium..It is It is Reflected Reflected around the around the

roots of the great vessels to roots of the great vessels to be continuous with the be continuous with the visceral layervisceral layer..

Visceral layerVisceral layer ((Epicardium)Epicardium)::It is closely applied to the It is closely applied to the

heartheart..

Nerves supplying Nerves supplying the pericardium the pericardium are fromare from::

Vagus nerveVagus nerve..Sympathetic Sympathetic

trunktrunk..Phrenic nervesPhrenic nerves..

They are recesses of They are recesses of pericardium on the pericardium on the Posterior SurfacePosterior Surface of the of the heartheart..

They are due to the They are due to the reflection of the reflection of the (Parietal Layer)(Parietal Layer) of the of the serous pericardiumserous pericardium on on the great vesselsthe great vessels..

Transverse sinusTransverse sinus::It is between the It is between the

AortaAorta , , Pulmonary Pulmonary TrunkTrunk and and Great Great VeinsVeins . .

Oblique sinusOblique sinus::It is on the posterior It is on the posterior

surface of the surface of the Left Left AtriumAtrium..

Right and Left Right and Left arteriesarteries..

Arise fromArise from::The initial part of theThe initial part of the

AscendingAscending Aorta.Aorta. Immediately above Immediately above the aortic valvethe aortic valve..

On the anterior On the anterior surface of the heartsurface of the heart::

It lies between the It lies between the right auricle and the right auricle and the pulmonary trunkpulmonary trunk..

At the inferior border At the inferior border of the heartof the heart::

It continues to the It continues to the inferior surfaceinferior surface . .

((11 ) )Right Conus arteryRight Conus artery:: To the infundibulum and To the infundibulum and

the upper part of the the upper part of the anterior wall of the right anterior wall of the right ventricleventricle..

((22)) Anterior Ventricular Anterior Ventricular arteriesarteries: :

To the anterior surface To the anterior surface of the right ventricleof the right ventricle..

The The Marginal arteryMarginal artery is is the largest branchthe largest branch . .

((33 ) )Posterior Posterior ventricular arteriesventricular arteries::

To the To the diaphragmatic diaphragmatic surface of the right surface of the right ventricleventricle..

((44 ) )Atrial branchesAtrial branches:: To the right atriumTo the right atrium. .

The Artery of the The Artery of the SANSAN..

It lies in the posterior It lies in the posterior IVGIVG..

It suppliesIt supplies:: A.A. TheThe diaphragmatic diaphragmatic

surface surface of the right and of the right and left ventriclesleft ventricles..

B. The posterior part of B. The posterior part of the IVS septum the IVS septum excluding its apexexcluding its apex..

C. C. Septal branch to the Septal branch to the AVNAVN..

It descends between It descends between the pulmonary trunk the pulmonary trunk and the left auricleand the left auricle..

It enters the AIV groove It enters the AIV groove and divides into its and divides into its Two Two TerminalTerminal BranchesBranches : : Anterior IV arteryAnterior IV artery..

Circumflex arteryCircumflex artery..

It descends in the IV groove It descends in the IV groove to the apex of the heartto the apex of the heart..

2/32/3 of peopleof people::It It AnastomosesAnastomoses with the right with the right

coronary incoronary in the posterior IV the posterior IV groovegroove . .

It givesIt gives::Ventricular branches to both Ventricular branches to both

ventricles and the IV septumventricles and the IV septum..Left (Lateral) diagonalLeft (Lateral) diagonal artery artery

((33 ) )Left MarginalLeft Marginal::It supplies the left It supplies the left

margin of the left margin of the left ventricle down toventricle down to the the apexapex..

((44)) AnteriorAnterior& & Posterior ventricularPosterior ventricular::

To the left ventricleTo the left ventricle..((55)) AtrialAtrial ::

To the left atriumTo the left atrium..

It drains most of the It drains most of the venous blood of the heartvenous blood of the heart..

It lies in the posterior part It lies in the posterior part of the AV grooveof the AV groove..

OriginOrigin: : It is the direct continuation It is the direct continuation

of the of the Great Cardiac VeinGreat Cardiac Vein..TributariesTributaries::

((11 ) )Cardiac VeinsCardiac Veins::A. GreatA. Great..

B. MiddleB. Middle . .C. SmallC. Small..

((22 ) )Oblique vein of left Oblique vein of left atriumatrium..

It opens inIt opens in:: The The Right AtriumRight Atrium . .

Its opening is to the left Its opening is to the left of the IVCof the IVC..

11 . .Anterior cardiac Anterior cardiac veinsveins::

They open directly They open directly into the right into the right atriumatrium..

22.. Venae Cordis Venae Cordis minimeminime: :

Open into the heart Open into the heart chamberschambers..

11 . .The left coronary artery bifurcates into The left coronary artery bifurcates into the circumflex branch and thethe circumflex branch and the::

a. Posterior interventriculara. Posterior interventricular..b. Anterior interventricularb. Anterior interventricular..

c. Left marginalc. Left marginal..d. Left ventriculard. Left ventricular..

22 . .Structures which can be seen on the Structures which can be seen on the anterior surface of the heart includeanterior surface of the heart include::

a. Right atriuma. Right atrium..b. Right ventricleb. Right ventricle..

c. Pulmonary veinsc. Pulmonary veins..d. Pulmonary trunkd. Pulmonary trunk..

33 . .The right ventricleThe right ventricle::a. Forms most of the inferior surface of the a. Forms most of the inferior surface of the

heartheart..b. Forms the inferior border of the heartb. Forms the inferior border of the heart..

c. Has a tricuspid valve made of three cuspsc. Has a tricuspid valve made of three cusps..d. Supplied by both coronary arteriesd. Supplied by both coronary arteries..

44 . .The tributaries of the coronary sinus areThe tributaries of the coronary sinus are::a. Venae cordis minimea. Venae cordis minime..

b. Middle cardiac veinb. Middle cardiac vein..c. Great cardiac veinc. Great cardiac vein..d. Small cardiac veind. Small cardiac vein..

55 . .The posterior surface of the heart is The posterior surface of the heart is mainly formed bymainly formed by::

a. Right atriuma. Right atrium..b. Right ventricleb. Right ventricle..

c. Left atriumc. Left atrium..d. Left ventricled. Left ventricle..

66 . .The mitrThe mitral valve guardsal valve guards::a. Right atrioventricular orificea. Right atrioventricular orifice..

b. Aortic orificeb. Aortic orifice..c. Left atrioventricular orificec. Left atrioventricular orifice..

d. Pulmonary orificed. Pulmonary orifice..

77 . .Regarding the pericardiumRegarding the pericardium::a. Its fibrous layer is attached to the diaphragma. Its fibrous layer is attached to the diaphragm..

b. The oblique sinus is behind the right atriumb. The oblique sinus is behind the right atrium..c. It has a nerve supply from the vagus nervec. It has a nerve supply from the vagus nerve..

d. The epicardium is the visceral layer of the d. The epicardium is the visceral layer of the serous pericardiumserous pericardium..

88 . .The coronary arteriesThe coronary arteries::a. Arise from the inferior aspect of the aortic archa. Arise from the inferior aspect of the aortic arch..

b. Anastomose with each otherb. Anastomose with each other..c. Give atrial and ventricular branchesc. Give atrial and ventricular branches..

d. Supply the conducting system of the heartd. Supply the conducting system of the heart..

99 . .The right coronary arteryThe right coronary artery::a. Lies between the left auricle and the pulmonary a. Lies between the left auricle and the pulmonary

trunktrunk..b. Supplies the right atriumb. Supplies the right atrium..

c. Gives off a posterior interventricular branchc. Gives off a posterior interventricular branch..d. Takes part in the arterial supply of the SANd. Takes part in the arterial supply of the SAN . .

1010 . .Regarding the heartRegarding the heart::a. The left ventricle forms most of its anterior a. The left ventricle forms most of its anterior

surfacesurface..b. The right border is formed by the right ventricleb. The right border is formed by the right ventricle..

c. The apex is deep to the left fifth intercostals c. The apex is deep to the left fifth intercostals spacespace..

d. The base is formed mainly by the right atriumd. The base is formed mainly by the right atrium..

1111 . .On the diaphragmatic surface of the On the diaphragmatic surface of the heart, the posterior interventricular septum heart, the posterior interventricular septum separatesseparates::

a. Right ventricle – right atriuma. Right ventricle – right atrium..b. Left ventricle – left atriumb. Left ventricle – left atrium..

c. Left atrium – right atriumc. Left atrium – right atrium..d. Left ventricle – right ventricled. Left ventricle – right ventricle..

1212 . .The fibrous pericardiumThe fibrous pericardium::a. Separated completely from the sternuma. Separated completely from the sternum..

b. Lined by the visceral pericardiumb. Lined by the visceral pericardium..c. Receives nerve supply from the phrenic c. Receives nerve supply from the phrenic

nervesnerves..d. Forms the transverse and oblique pericardial d. Forms the transverse and oblique pericardial

sinusessinuses..

1313 . .The coronary sinus empties intoThe coronary sinus empties into::a. Left atriuma. Left atrium..

b. Right atriumb. Right atrium..c. Right ventriclec. Right ventricle..

d. Superior vena cavad. Superior vena cava..1414 . .The SAN receives its blood supply The SAN receives its blood supply

principally fromprincipally from::a. Anterior interventricular arterya. Anterior interventricular artery..

b. Circumflex arteryb. Circumflex artery..c. Posterior interventricular arteryc. Posterior interventricular artery..

d. Right coronary arteryd. Right coronary artery..

1515 . .The apex of the heart is normally The apex of the heart is normally locatedlocated::

a. At the level of the 5th thoracic vertebraa. At the level of the 5th thoracic vertebra..b. Deeply to the 3rd intercostals spaceb. Deeply to the 3rd intercostals space..c. Deeply to the 5th intercostals spacec. Deeply to the 5th intercostals space..

d. At the level of the 5th ribd. At the level of the 5th rib..