Department of Anatomy, Faculty of Medicine, Masaryk university, Brno1
HEART (COR)
Dentistry – Anatomy II
RNDr. Michaela Račanská, Ph.D.
• above the diaphragm, in the inferior middle mediastinum
• 2/3 left, 1/3 right
• unpaired, hollow, muscular organ
of cone shape
• 4.5% of the body weight
(fist-sized)
Syntopy
Adult 240 – 320 g
Newborn 20 – 30 g
Longitudinal axis of the heart
4
Base
cran., dors, dx.
Apex
caud., ventr., sin.
Heart axis
Facies anterior (sternocostalis)
Facies inferior (diaphragmatica)
Margo dexter (acutus)
Margo sinister (obtusus)
Sulcus coronarius
Sulcus interventricularis ant. et post.
Auricula dextra et sinistra
Heart, chambers external division5
Sulcus coronarius
Sulcus interventricularis ant. et post.
The chambers of the heart
• Atrium dextrum
• Atrium sinistrum
• Ventriculus dexter
• Ventriculus sinister
Septum interatriale
Septum interventriculare
Atrium dextrum
- vena cava sup. et inf.
Ventriculus dexter
- truncus pulmonalis
Atrium sinistrum
vv. pulmonales dextrae et
sinistrae
Ventriculus sinister
- aorta
Atrium dextrum – cube with six walls
outcome: vena cava superior et vena cava inferior
sinus coronarius (the venous sinus of the heart)
1) Superior wall - ostium venae cavae superioris
2) Inferior wall - ostium venae cavae inferioris, ostium sinus
coronarii and ostia venae cordis anteriores
ostium
venae cavae
superioris
ostium venae
cavae inferioris
ostium sinus
coronarii
3) Medial wall - septum interatriale with fossa ovalis with
slightly raised edge (limbus fossae ovalis)
4) On the lateral wall - crista terminalis, which separates
the posterior part – sinus venosus from the anterior one
crista
terminalis
fossa ovalis
limbus fossae
ovalis
5) Posterior wall – between openings of both venae
cavae, it vaults dorsally as torus intervenosus
6) Anterior wall corresponds to atrioventricular septum
with ostium atrioventriculare dextrum (valva
tricuspidalis), right to the opening there is auricula
dextra (mm. pectinati)
ostium
atrioventriculare
dextrum
torus
intervenosus
VENTRICULUS DEXTER
Pars trabecularis - trabeculae carneae (inflow part)
Crista supraventricularis, trabecula septomarginalis
Ostium atrioventriculare dextrum, valva tricuspidalis
– cuspis ant., septalis, post.
Musculi papillares (anterior, septalis, posterior)
Chordae tendineae
VENTRICULUS DEXTER
Pars glabra – conus arteriosus (outflow part)
Ostium trunci pulmonalis – valva trunci pulmonalis –
valvula semilunaris ant., dx., sin. – lunula, nodulus, sinus
ATRIUM SINISTRUM
Ostia venarum pulmonalium
Septum interatriale – fossa ovalis
Auricula sinistra – musculi pectinati
Ostium atrioventriculare sin.
VENTRICULUS SINISTER
Ostium atrioventriculare sin.– valva bicuspidalis (mitralis) –
cuspis ant. et post. – m. papillaris ant. et post. – chordae
tendineae
Ostium aortae – valva aortae – valvula semilunaris dx., sin.
et post. – lunula, nodulus, sinus aortae dx. et sin. – arteriae
coronariae, bulbus aortae
SYSTOLE
DIASTOLE
17
SYSTOLE
DIASTOLE
The structure of the heart
1. Endocardium
Thin, smooth and glossy fibrous
membrane
Covers all cardiac chambers and surface
of all the valves
1. Endocardium
2. Myocardium
A. working
B. conductive
3. Pericardium
2. Myocardium
Main component of the cardiac wall
working myocardium (contractions of cardiac compartements)
conductive myocardium (conductive system of heart)
A) Working myocardium: (muscles of atriums and muscles of ventricles are
separated)
a) Muscles of atriums– 2 layers, spf. layer – common for both atriums,
deep layer- separate
b) Muscles of ventricles (thicker)
3 layers:
• Superficial layer: common, arranged into bands which create whirl
(vortex cordis)
• middle layer is separate, bands oriented circularly
• deep layer organized in reticular arrangement, forms underlay of mm.
papillares and trabecular system
muscles of atriums and ventricles are separated by cardiac skeleton !
MYOCARDIUM
Mm. pectinati
Trabeculae carneae, mm. papillares
Vortex cordis
The fibrous skeleton of the heart
Consists of fibrous connective tissue (forms fibrous arches, anuli fibrosi),
on borderline between atrias and ventricles
Anulus fibrosus dexter, sinister,
aorticus, trunci pulmonalis
Trigonum fibrosum dextrum et sinistrum
B) Conductive myocardium (conductive system of the heart)
(Complexus stimulans cordis)
Consists of an unique type of myocardium,
its cells generate impulses which are stimuli
for the muscular contractions
Nodus sinuatrialis in the right
atrium– generates
impulses (70/min)
Bachmann interatrial, anterior, middle
and posterior internodal tracts)
Nodus atrioventricularis in the right
atrium under the endocardium of
septum
Fasciculus atrioventricularis (His)
passes through aperture in
trigonum fibrosum dextrum
into interventricular septum
and divides into two branches
Crus dextrum et crus sinistrum –
head toward myocardium of
right and left ventricle
Purkyně (Purkinje) fibres create
large subendocardial net
Artificial pacemaker
3. The Pericardium
The heart is stored in a firm fibrous sac, it has two layers:
external layer– pericardium fibrosum
internal layer– pericardium serosum
34
(facies diaphragmatica)
35
pericardium fibrosum
pericardium serosum
(lamina parietalis)
pericardium serosum
(lamina visceralis)
cavum serosum
pericardii
myocardium
endocardium
truncus pulmonalis
Both sheets pass into each other in two places:
porta arteriarum - sinus transversus pericardii
porta venarum - sinus obliqus pericardii
39
A. coronaria cordis dx. - rr. atriales
- rr. ventriculares
- r. marginalis dx.
- r. coni arteriosi
- r. nodi sinuatrialis
- r. nodi atrioventricularis
- r. interventricularis post.
A. coronaria cordis sin. - r. interventricularis ant. (LAD)
- r. circumflexus
A.c.c. dextra
A.c.c. sinistra anterior
posterior
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
Venae cordis
1) sinus coronarius cordis (60% of the blood), confluence of:
2) venae cordis anteriores – 2 till 4 veins, which
collect blood from anterior wall of right ventricle
3) venae cordis minimae – open into cardiac cavities
through separate apertures (foramina venarum
minimarum)
Venae cordis anteriores at minimae (40% of the blood).
c) vena cordis parva
a) vena cordis magna
b) vena cordis media
Lymphatics:
They form three lymphatic nets in the cardiac wall:
• subendocardial
• myocardial
• Subepicardial
There are two lymphatic trunks draining out
the lymph from these nets:
Truncus lymphaticus
anterior sinister +
truncus lymph. post. –
nodus lymph. retroaorticus –
nodi lymphatici tracheobronchiales
Truncus lymph. ant. dx. –
nodus lymph. praeaorticus –
nodi lymphatici mediastinales anteriores
47
Nerves:
ANS (sympathetic and parasymphatetic nerve fibres),
which influence conductive system (changes of cardiac
rhytm) and wall of coronary vessels
Nn. cardiaci (symp., truncus sympaticus)
– accelerantes (aaceleration of heart activity +
vasodilatation of the cardiac arteries
Rr. cardiaci (parasymp., nn. vagi))
– retardantes (deceeleration of heart activity,
vasoconstriction of coronary arteries)
Plexus cardiacus spf.
(ganglion cardiacum)
Plexus cardiacus prof.
Plexus coronarius dx. et sin.
The projection of the heart and
auscultation sites
The heart is located in the middle
inferior mediastinum.
The projection of the heart on the
anterior thoracic wall – it is
bordered with 4 auscultation
points – heart field.
1) Point A – 2nd intercostal
space, circa 1 cm on the
right from the sternal
margin – Auscultation
Point of valva aortae.
2) Point B – 5th intercostal
space, at left edge of
sternum- AP of valva
tricuspidalis.
3) Point C – 5th intercostal
space, left, medially
from medioclavicular
line – AP of valva
bicuspidalis.
4) Point D – 2nd intercostal
space, left, circa 2 cm
from sternal margin AP
of valva trunci
pulmonalis
X – ray (AP projection)
Heart shadow:
53
V. brachiocephalica dx.
Arcus aortae
Atrium dx.
V. cava sup.
Auricula sin.
V. cava inf.
Truncus pulmonalis
Ventriculus sin.
Transverse line = DMd+DMs
Distantia mediodextra
Distantia mediosinistra
Length
Gradient
Area
Coronary angiography – left coronary artery
Right anterior oblique projection Left anterior oblique projection
Coronary angiography – right coronary artery
Left anterior oblique projection
Illustrations were copied from:
Atlas der Anatomie des Menschen/Sobotta.
Putz,R., und Pabst,R. 20. Auflage. München:
Urban & Schwarzenberg, 1993
Netter: Interactive Atlas of Human Anatomy.
Windows Version 2.0
Čihák R: Anatomie 2 (Splanchnologia). Avicenum,
zdravotnické nakladatelství, Praha, 1988.
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