THE HEART
The localization of the heart
• Above the diaphragm, in the inferior middle
mediastinum
• 2/3 left, 1/3 right
The external shape of the heart
• Unpaired, hollow,
muscular organ of solid
consistency, reddish
brown colour
• 4.5% of the body weight
(fist-sized)
• Is of a cone shape
• The longitudinal axis of
the heart (connector of
vena cava superior and
the apex)
• basis - basis cordis - faces rightwards, up and
backwards
• apex- apex cordis – directs for-, left- and downwards
• Facies anterior (sternocostalis)
• Facies posterior (diaphragmatica)
• Margo dexter (acutus)
• Margo sinister (obtusus)
The chambers of the heart
•Atrium dextrum
•Atrium sinistrum
•Ventriculus dexter
•Ventriculus sinister
Septum cordis: divides the heart cavity into the right and
left part
Atriums: at basis cordis
- The superficial border between the atriums and the
ventricles is formed by transversally oriented groove –
sulcus coronarius
- auricula dextra et auricula sinistra
- septum interatriale
 The borders are sulcus interventricularis anterior
et posterior, corresponding to the localization of
septum interventriculare
 Right ventricle: truncus pulmonalis
 Left ventricle: aorta
Ventricles : at apex cordis
truncus
pulmonalisaorta
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
ostium
atrioventriculare
dextrum
torus
intervenosus
Atrium sinistrum - venae pulmonales (4 pulmonary veins)
Septal wall: fossa ovalis lined from behind with fold (falx
septi), dorsocranially venae pulmonales
Anterior wall: ostium atrioventriculare sinistrum (valva
bicuspidalis), auricula sinistra
• Smooth walls, have originated from pulmonary veins
• auricle (auricula) corresponds to original atrium (plicated)
Ventriculus dexter
Triangular pyramid shape:
Widen upper part contains:
ostium atrioventriculare dextrum
ostium trunci pulmonalis
Ostium atrioventriculare dextrum
(valva tricuspidalis)
cuspis anterior, posterior, septalis
Musculi papillares
ostium
atrioventriculare
dextrum
ostium aortae
ostium trunci
pulmonalis
ostium
atrioventriculare
sinistrum
posterior
Ostium trunci pulmonalis
• valva trunci pulmonalis
• valvula semilunaris anterior, dextra et sinistra
• Folds form together with the wall of truncus
pulmonalis three semilunar pockets (sinus trunci
pulmonalis)
The medial wall is formed by septum
interventriculare
We can divide the cavity of the right ventricle into
inflow and outflow parts.
The Inflow part (pars trabecularis) with trabeculae
carneae, from ostium atrioventriculare dextrum
till apex of the heart.
The Outflow part (pars glabra) smooth walls, from
apex upwards and forward, towards to truncus
pulmonalis, border between both parts creates
transversely oriented muscular crest (crista
supraventricularis).
Inflow part Outflow part
Ventriculus sinister
• Cone shape
• ostium atrioventriculare sinistrum: valva bicuspidalis
(mitralis), cuspis anterior et posterior
• ostium aortae
• musculus papillaris anterior et posterior
(papillary muscles)
Ostium aortae
• valva aortae
• valvula semilunaris dextra, sinistra et posterior
three semilunar folds form (sinus aortae), on the
surface of the artery vaults as bulbus aortae
• from sinus aortae arise coronary arteries
The cavity of the left ventricle:
• Inflow part contains trabeculae carneae and lies
between ostium atrioventriculare sinistrum and
the apex
• Outflow part directs from apex to aorta and has a
smooth wall
Inflow part Outflow part
Valves of the heart– derivatives of endocardium
Cuspidal valves(valvae atrioventriculares)
• valva tricuspidalis (right)
• valva bicuspidalis (left)
Tops of particular cusps head to hollow of the ventricle, the
cusps are connected to musculi papillares through heart
strings (chordae tendineae)
Semilunar valves (valvae semilunares)
• valva trunci pulmonalis
• valva aortae
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 !
The fibrous skeleton of the heart
• Consists of fibrous connective tissue (forms fibrous
arches, anuli fibrosi), on borderline between atriaums
and ventricles
Trigonum fibrosum dextrum et sinistrum
• anulus fibrosus dexter
• anulus fibrosus sinister
• anulus aorticus
• anulus trunci pulmonalis
B) Conductive myocardium (conductive system of the heart)
• Consists of an unique type of myocardium, its cells
generate impulses which are stimuli for the muscular
contractions
It consists of:
a) Nodus sinuatrialis in the right atrium– generates impulses
(70/min)
b) Nodus atrioventricularis in the right atrium under the
endocardium of septum
c) Fasciculus atrioventricularis passes through aperture in
trigonum fibrosum dextrum into interventricular septum
and divides into two branches
d) Crus dextrum et crus sinistrum – head toward myocardium
of right and left ventricle
e) Purkyně (Purkinje) fibres create large subendocardial net
3. The Pericardium
The heart is stored in a firm fibrous sac, it has two layers:
external layer– pericardium fibrosum
internal layer– pericardium serosum
1)Pericardium fibrosum
 base-facies diaphragmatica-basis pericardii
 apex- cupula pericardii
2)Pericardium serosum
 External sheet (lamina parietalis)
 Internal sheet (lamina visceralis) or epicardium
 cavum serosum pericardii: cavity between the both
sheets
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
porta venarum
sinus transversus pericardii: between porta arteriarum
and porta venarum
sinus obliqus pericardii: below the transverse arm of
porta venarum
The coronary arteries (Arteriae coronariae cordis)
The heart is supported by two arteries
(subepicardially):
arteria coronaria cordis sinistra
arteria coronaria cordis dextra
a) ramus interventricularis anterior
b) ramus circumflexus
- Supply of wall of left ventricle (including its papillary
muscles), anterior part of wall of right ventricle
(including musculus papillaris anterior) and anterior part
of interventricular septum
Arteria coronaria cordis sinistra
- Supports majority of wall of
right atrium and ventricle
(including its papillary
muscles), part of posterior
wall of left ventricle
(including musculus
papillaris posterior) and
posterior part of
interventricular septum
Arteria coronaria cordis dextra
a) ramus interventricularis posterior
A.c.c. dextra A.c.c. sinistra
anterior
posterior
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
The lymphatic vessels of the heart
They form three lymphatic nets in the cardiac
wall:
• subendocardial
• myocardial
• subepicardial
There are two lymphatic trunks draining out the
lymph from these nets:
1) Truncus lymphaticus cordis dexter – nodus
lymphaticus praeaorticus - nodi lymphatici
mediastinales anteriores
2) Truncus lymphaticus cordis sinister- nodus
lymphaticus retroaorticus - nodi lymphatici
tracheobronchiales
The innervation of the heart
Sympathetic fibres (truncus sympaticus): nn. cardiaci cervicales
(superior, medius, inferior) a nn. cardiaci thoracici
symp. fibres - nervi accelerantes (acceleration of heart activity+
vasodilatation of the cardiac arteries)
Parasympathetic fibres (nn.vagi): rami cardiaci superiores, medii,
inferiores
parasymp. fibres - nervi retardantes (deceeleration of heart
activity, vasoconstriction of coronary arteries)
1) Plexus cardiacus superficialis: ganglion cardiacum
2) Plexus cardiacus profundus
3) Plexus coronarius sinister et dexter
Symp. and parasymp. fibres form compound plexuses
• autonomic nervous sympathetic and parasymphatetic nerve
fibres), which influence conductive system (changes of cardiac
rhytm) and wall of coronary vessels
The projection of the heart
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.
A
B
C
D
Valva aortae
Valva tricuspidalis
Valva bicuspidalis
Valva trunci
pulmonalis
X – ray (anteroposterior imaging)
Thank you for your attention.
• Images:
• Atlas der Anatomie des Menschen/Sobotta.
• Putz,R., und Pabst,R. 20. Auflage. München:
Urban & Schwarzenberg, 1993
• Netter: Interactive Atlas of Human Anatomy.
• Naňka, Elišková: Přehled anatomie. Galén, Praha 2009.
• Čihák: Anatomie I, II, III.
• Drake et al: Gray´s Anatomy for Students. 2010