COR Atrium dextrum - auricula dextra Atrium sinistrum - auricula sinistra Ventriculus dexter Ventriculus sinister Septum cordis = septum interatriale + septum interventriculare Valva tricuspidalis, bicuspidalis (mitralis), trunci pulmonalis, aortae Apex cordis Basis cordis Facies sternocostalis - sulcus interventricularis anterior (ramus interventricularis anterior a. coronariae sinistrae and v. cordis magna) Facies diaphragmatica - sulcus interventricularis posterior (ramus interventricularis posterior a. coronariae dextrae and v. cordis media) Facies pulmonalis sinistra Margo dexter (acutus) Sulcus coronarius (sinus coronarius, a. coronaria dextra, a. coronaria sinistra and v. cordis parva) Atrium dextrum Paries medialis - fossa ovalis, limbus fossae ovalis Paries superior - ostium venae cavae superioris Paries inferior - ostium v. cavae inferioris, valvula v. cavae inf., ostium et valvula sinus coronarii Paries posterior - tuberculum intervenosum Paries lateralis - crista terminalis (sinus venarum cavarum) Paries anterior – ostium atrioventriculare dextrum - valva tricuspidalis, auricula dextra - musculi pectinati Ventriculus dexter Inflow part - trabeculae carneae Outflow part - infundibulum, conus arteriosus Crista supraventricularis Valva tricuspidalis - cuspis anterior, posterior and septalis Mm. papillares (anterior, posterior and septales) - chordae tendineae Trabecula septomarginalis – m. papillaris anterior - its cords are attached to the anterior and septal cusps M. papillaris post. - its cords - to the posterior and septal cusps of the valve Mm. papillares septales send their cords to the posterior and septal cusps Ostium trunci pulmonalis – valva trunci pulmonalis - valvulae semilunares ant., dx. and sin. – lunula, nodulus, sinus Atrium sinistrum Paries posterior - 2 vv. pulmonales dextrae and 2 vv. pulmonales sinistrae Paries anterior – ostium atrioventriculare sinistrum - mitral valve, auricula sinistra – mm. pectinati Paries medialis (septalis) - fossa ovalis Ventriculus sinister Inflow part - trabeculae carneae Outflow part - vestibulum aortae Ostium atrioventriculare sinistrum - valva mitralis s. bicuspidalis - cuspis anterior et posterior M. papillaris anterior et posterior - cords are connected to both cusps. Ostium aortae - valva aortae - valvula semilunaris dextra, sinistra and posterior - lunula, nodulus, sinus - bulbus aortae When systole begins, the tricuspid and mitral valves close; then pulmonary and aortic valves open. The contraction of ventricles ejects the blood from ventricles. The diastole begins by the closure of the pulmonary and aortic valves, continues by opening of atrioventricular valves and the contraction of atria, which ejects the remaining blood from atria, follows. Mitral stenosis - flow restriction reduces left ventricular output, increase in left atrial pressure enlarges the left atrium and raises pulmonary pressure. The resulting pulmonary congestion leads to pulmonary hypertension and right heart failure. Mitral valve insufficiency – one or both leaflets extend back into the left atrium during systole. As a result, blood regurgitates into the left atrium producing a characteristic murmur. Aortic valve stenosis is frequent valve abnormality that results in left ventricular hypertrophy. Aortic valve insufficiency results in aortic regurgitation that causes blood to flow in the reverse direction during ventricular diastole. Structure of the heart Endocardium is a thin and glossy connective tissue membrane that lines all the chambers of the heart and covers the surface of all valves. Its surface is covered by endothelium continuous with the endothelium of the vessels. It is thicker in atria than in ventricles and in the left half than in the right one. The cusped valves are reinforced by fibrous plates (lamina fibrosa) that are at their periphery attached to the cardiac skeleton. Fibrous skeleton of the heart Anuli fibrosi (dexter, sinister, aorticus and trunci pulmonalis) Trigonum fibrosum dextrum and sinistrum Pars membranacea septi cordis Myocardium may be divided into the working myocardium that forms most of the cardiac musculature and the conducting myocardium that generates impulses and conduct them through the heart. Working myocardium Atrial myocardium consists of 2 layers. The superficial layer is common for both atria. The reinforced muscular bundles in this layer: fasciculus interauricularis horizontalis connects ventral sides of both atria, fasciculus interauricularis verticalis indicates the position of the interatrial septum. The deep layer is separate for each atrium. The muscular bands: fasciculus terminalis produces the crista terminalis, fasciculus limbicus anterior and inferior border the fossa ovalis, fasciculus intervenosus forms the basis for the tuberculum intervenosum. Mm. pectinati Ventricular myocardium is thicker and is formed by 3 layers: the superficial layer is common for both ventricles, forms the left-hand spiral to the apex - vortex cordis. The middle layer is separate for each ventricle and is circular. The deep layer forms the basis for trabeculae and papillary muscles. Conducting system: Nodus sinuatrialis Nodus atrioventricularis Fasciculus atrioventricularis (AV bundle) - crus dextrum and sinistrum Rami subendocardiales (Purkinje fibers). Pericardium: Pericardium fibrosum: Basis - ligg. phrenicopericardiaca Cupula Pars sternalis - ligg. sternopericardiaca Partes laterales Pars dorsalis Pericardium serosum: Parietal layer Visceral layer (epicardium) Cavum pericardii - liquor pericardii Vagina serosa arteriarum – sinus transversus pericardii Porta venarum - sinus obliquus pericardii Surface anatomy of the heart valves The valve sounds are listened to at specified auscultatory areas that are situated superficial to the chamber or vessel through which blood has passed. The sites for auscultation of the sounds of individual valves are also points that limit the position of the heart at the anterior thoracic wall. A. The 2^nd intercostal space 1 cm to the right from the margin of the sternum – valva aortae B. The 5^th intercostal space at the margin of the sternum – valva tricuspidalis C. The 5^th intercostal space 8 cm to the left from the sternum (1 cm from medial to the midclavicular line) – valva mitralis. The apex beat can be felt in this area. D. The 2^nd intercostal space 2 cm to the left from the border of the sternum – valva trunci pulmonalis Radiological anatomy of the heart In PA radiograph of the thorax the right border of the cardiac silhouette is formed by: 1 v. brachiocephalica dx., 2. v. cava sup., 3. the right atrium, 4. v. cava inf. The left border: 1. the arch of the aorta (aortic knob), 2. the pulmonary trunk, 3. the left auricle, 4. the left ventricle. It is important to know it to detect abnormalities. Distantia mediodextra (Md) is the greatest distance of the cardiac shadow from the midline to the right (4-4.5 cm). Distantia mediosinistra (Ms) is the greatest distance from the midline to the left (8-9 cm). The transverse line of the heart – the sum of the Md and Ms (15 cm). The length of the heart – connection between the transition of the VCS to the right atrium and the apex of the heart (13 cm) The gradient of the heart determines the angle between the length and transverse lines (45 degrees). The heart shadow area – 100-140cm2. Arterial supply of the heart A. coronaria cordis dx. - rr. atriales dx. - rr. ventriculares dx. - r. marginalis dx. - r. coni arteriosi - r. nodi sinuatrialis - r. nodi atrioventricularis - r. interventricularis post. A. coronaria cordis sin. - r. interventricularis ant. - r. circumflexus Venae cordis 1. Sinus coronarius cordis a) v. cordis magna b) v. cordis media c) v. cordis parva d) v. obliqua atrii sinistri e) v. posterior ventriculi sinistri 2. Vv. cordis anteriores 3. Vv. cordis minimae Lymphatics: Truncus lymphaticus anterior sinister – truncus lymph. post. – nodus lymph. retroaorticus Truncus lymph. ant. dx. – nodus lymph. praeaorticus Nerves: Plexus cardiacus spf. (ganglion cardiacum) Plexus cardiacus prof. Plexus coronarius dx. et sin. Nn. cardiaci (symp.) – accelerantes Rr. cardiaci (parasymp.) – retardantes