HEART

✓ Continuously beats (100,000 times every day)

(35 million a year, 2.5 billion in an average
lifetime)
✓ Goal is to continually propel the blood all
throughout the body.
✓ Has Electrical conduction.
✓ When an individual is in a vigorous activity
(exercise) or high stress (having anxiety or
being nervous), the heart beats faster than its
normal pace.
LOCATION COVERINGS OF THE HEART

✓ Located more on the left part of the chest area.

✓ Particularly lies in the mediastinum (in
between pleura or lobes of the lungs.) (Middle
Mediastinum)
✓ Mediastinum, superior and inferior
Inferior: Anterior, Middle, and Posterior
Specifically, the heart lies in the Middle
Mediastinum.

SIZE

✓ Same as the size of a closed fist.

✓ Length: 12 cm long
✓ Width: approximately 9 cm
✓ Thickness: approximately 6 cm
LANDMARK
Position of the heart: Inverted triangle.
✓ Posteriorly: From the 5th thoracic vertebra
to the 8th thoracic vertebra. (T5 to T8)
✓ Heart is like an inverted triangle; base is at
the superior part, apex at the inferior part
✓ Base of the heart is accumulated mostly at
the left atrium.
✓ While the apex is the tip of the left ventricle.
Pericardium - stabilizes the heart, it is a closed
fibrous sac that covers and reinforces the heart,
serves as a boundary of the heart against other
organs/structures found @ middle mediastinum
1.) Fibrous Pericardium
✓ Membrane that surrounds and protects the
heart.
✓ Prevents the excessive movement of the heart
✓ Parang seatbelt, kaya pag nag-contract yung
heart, the heart will remain sa place niya
✓ it is important that the heart has to be
specifically placed in the middle mediastinum,
because even if there’s a slight mediation, it
might be an indication of an abnormal
condition.
Anchor hearts firmly and are attached on the
central tendon of the diaphragm (found in the
inferior part of the pericardium specifically the
fibrous pericardium.)
‼️Remember that the pericardium is a triple-
layered sac that is made up of 2 layers, and the 2nd
layer is subdivided into two more layers.
1st layer - Fibrous Pericardium
-Has several ligaments that allows the
reinforcement of the protection of the
heart.
● Phrenopericardial ligament
-central ligament, also known as the central
tendon of the diaphragm, it attaches the
inferior (apex) of the heart towards the
diaphragm.
● Superior sternopericardial ligament
-A ligament from the fibrous pericardium to
the sternum that attaches your heart.
● Xyphopericardial ligament
-Xiphoid process (The tip of your sternum at
the inferior part) that attaches the anterior
part of the heart from the fibrous
pericardium towards the xiphoid process.
● Vertertebropericardial ligament
- From the vertebrae towards the
pericardium, attaches the superior and
posterior part of the heart.
2.) Serous Pericardium
✓ Thinner, more delicate membrane
✓ Forms a double layer around the heart.
Layer of pericardium that is subdivided into two
layers:
● Parietal Layer of the serous
pericardium (Parietal Pericardium)
-Superficial layer.
● Visceral Layer of the serous
pericardium (Visceral Pericardium)
-Aka Epicardium.
-Continuous with the heart wall.
● Pericardial Space (Pericardial Cavity) - A
cavity that separates the two layers of the
serous pericardium.
● Pericardial Fluid - Located within the
pericardial cavity.
-Should only be 50 ml.
-Serves as a lubricant to facilitate the
movement of the heart.
-upon contraction of the heart, it produces
friction between the heart and the
coverings, to avoid that, the pericardial
fluid exists to prevent friction (para nags-
slide lang sila against each other)
>50 mL = Constriction around the heart that
causes limitation on the contraction of heart
that can lead to insufficient blood supply on
the body.
o Syempre pag sumobra nga ng 50 mL, hindi
na makakacontract yung heart, limited yung
movement niya (‘di makakacontract and
expand kasi wala nang space because of
the accumulation of the pericardial fluid
within the pericardial activity, that is why it’s
very important to remove/extract/aspirate
the fluid)
 o tas syempre imbis na yung fibrous LAYERS OF THE HEART
pericardium yung mag-adjust, hindi rin siya
masyadong makakagalaw kasi tough siya
and inelastic kaya yung heart yung
maaapektuhan kasi siya yung smooth
muscle na gumagalaw.
➢ Parapericardiocentesis: Procedure that
aspirates the fluid in pericardial space.
✓ A needle is to be inserted in the subcostal
space that is inferior to the xyphoid process
➢ Pericarditis: Inflammation around the
pericardium.
➢ Congested heart/ Congestion in the
heart: Accumulation of any fluid within the Epicardium
heart. ❏ Composed of two tissue layers; the
outermost, the visceral layer of the
FIBROUS SEROUS serous pericardium made up of
PERICARDIUM PERICARDIUM mesothelium. Beneath is the variable
layer of delicate fibroelastic tissue and
● Tougher than ● Lines surface of
Serous, inelastic your fibrous adipose tissue.
pericardium. - Extension of visceral pericardium
● Composed of - Outermost layer of the heart.
Dense Irregular ● Extends to the - Thinnest layer because it is made up of
Connective layer of the mesothelium (comprises the lining of
Tissue heart wall. organs)
- Specifically,
Visceral
Pericardium Myocardium
extends until ❏ Is responsible for the pumping action of
Epicardium the heart and is composed of cardiac
- Mostly made muscle tissue which makes up approx
up of 95% of the heart wall. The cardiac
Mesothelium,
muscle fibers are organized in bundles
more of an
epithelial lining that swirl diagonally around the heart
of an organ and generate the strong pumping
actions of the heart.
- Thickest part of heart wall
- Made up of cardiac muscle
- 95% of the heart wall
 -Responsible for the pumping activity of the
heart.
Endocardium
❏ Is a thin layer of endothelium overlying a
thin layer of connective tissue. It
provides a smooth lining for the
chambers of the heart and covers the
valves of the heart.
- Thinner layer of the heart wall
- Service lining on the chambers of the heart
and valves
- Minimizes the friction within the surface of
the heart
- In direct contact with the blood which
contains different components that might
scratch the lining of the heart.
CHAMBERS OF THE HEART
Right Atrium
- It is the chamber of the heart that receives
blood from the inferior vena cava , superior
vena cava and coronary sinus
- Comprises by two cavity:
- Contains auricle
- Auricle is the rough part of the atrium
- Auricle is the small conical mascular
outpouching in the right atrium
- Purpose: increases the atrial capacity
- Main cavity receives the blood in the inner part
of the right atrium
- Contains interatrial septum / fossa ovalis
- Tricus valves / right atrioventricular valve
- Sulcus Terminalis is found at the outer part of
the right atrium. It serves as the lining or
boundary between the auricle and main cavity
- Crista Terminalis is the counterpart of the
sulcus terminalis. It is found on the inner part of
the right atrium. It is in the smooth area of the
right atrium.
- Sulcus and Crista Terminalis are ridges and
boundaries
- Pectinate Muscle is the bundle of muscle
fibers which runs from the crista terminalis to
the auricle and it is the muscle surrounding the
right atrium. It is capable to expand and
contract the atrium Also called as the musculi
pectinati
- During the Feta, l heart inside the utero of the
mother, we have an opening between the right
atrium and left atrium. Wherein the opening
allows the exchange of oxygenated blood in
the two atrium because during the embryonic
stage or the time of the fetal inside the
mother’s womb there is still no supply or
lungs are not functioning in order to
provide oxygen. Most commonly the fetal will
rely on the oxygen from the blood of the
mother in the umbilical vein. Umbilical vein
will go in the right atrium meaning the blood is
already oxygenated wherein it allows to enter
in the Foramen Ovale
- Foramen Ovale allows the passage of
oxygenated blood to the left atrium in order to
descend to other tissues around the body. It
 usually closes when the lungs are already
functioning upon giving birth. There will be a
closure in the foramen ovale because there’s
already an increased pressure from the lungs
because of the blood supply of the lungs. Now,
it will be the fetal remnant of fossa ovalis
- Coronary sinus drains from the blood heart
wall in order to have oxygenated blood, it will
go back to the right atrium in order to send in
the pulmonary trunk going to the lungs.
Coronary Sinus is found between Inferior Vena
Cava and Atrioventricular orifice
- Atrioventricular orifice is the entry of the
blood in the right atrium going to the left
ventricle
- Tricuspid Valve it prevents the backflow of the
blood from the right ventricle going back to the
right atrium. It is made of three cusps
(anterior, posterior and septal ) attached to
the ventricular septum. That’s why the tricuspid
valve has the capability to close it’s valve
because of the cusps
- Endocardium that lines in the valve
- The tricuspid valve opens in the right atrium
and right ventricle.
- Blood entering in the right atrium comes from
the superior vena cava, wherein it drains the
blood from the brain and upper extremity.
Inferior vena cava drains the blood from the
lower extremity as well in the abdominal. While
in the coronary sinus drains the blood from the
coronary artery or the blood supply of the heart
itself.
OPENING OF THE RIGHT ATRIUM
➢ Superior Vena Cava
- No valve it is the reason why there is no
back flow is solely dependent on the
pressure of the blood
➢ Inferior Vena Cava
- Eustachian Valve is non- functional
- The valve in the right atrium or any part of
the heart is made of the Endocardium
- Sinuatrial Node is the pacemaker of the
electrical conductivity of the heart. It is
found in the right atrium so as
atrioventricular node
➢ Left Ventricle
- The left ventricle is the thickest chamber of
the heart, averaging 10–15 mm (0.4–0.6 in.),
and forms the apex of the heart. Like the
right ventricle, the left ventricle contains
trabeculae carneae and has chordae
tendineae that anchor the cusps of the
bicuspid valve to papillary muscles.
- During fetal life, a temporary blood vessel,
called the ductus arteriosus, shunts blood
from the pulmonary trunk into the aorta.
The ductus arteriosus normally closes
shortly after birth, leaving a remnant known
as the ligamentum arteriosum, which
connects the arch of the aorta and
pulmonary trunk
- The left ventricle communicates with the left
atrium through the atrioventricular orifice
and with the aorta through the aortic orifice.
- The part of the ventricle below the aortic
orifice is called the aortic vestibule
- Aortic Sinus - behind each cusp when
aortic wall bulges
- Patent ductus arteriosus - is a medical
condition in which the ductus arteriosus
fails to close after birth: this allows a portion
of oxygenated blood from the left heart to
flow back to the lungs by flowing from the
aorta, which has a higher pressure, to the
pulmonary artery.
 - ligamentum arteriosum (or arteriosus) is
the small fibrous remnant of the fetal ductus
arteriosum, located between and
connecting the proximal left pulmonary
artery and the undersurface of the junction
of the aortic arch and descending aorta, at
the aortic isthmus.
OPENINGS INTO THE LEFT VENTRICLE
AORTIC ORIFICE
- is the aperture produced in the aortic valve
when there's blood flow across it. It lies
towards the most superior and right side of
the left ventricle, just superior to the aortic
vestibule
Right Ventricle
- Part of the inferior chamber of the heart
where in it has a thicker wall compared to
right atrium. It has a lot of muscles (cardiac
muscles) that makes it thicker.
- About 4-5 mm (0.16-0.2 in.) in average
thickness and forms most of the anterior
surface of the heart. Internally, the right
ventricle is separated from the left ventricle
by a partition called the Interventricular
septum.
- Contains trabeculae carnea
(muscular ridges in the ventricle). It allows the
contraction within your ventricle.
- Contains papillary muscles – cone shaped
muscles which anchors valves in the ventricles. Its
role is to anchor chordae tendineae. Anterior
Papillary Muscles & Septal Papillary Muscles. Have
Moderator Band which is sub connected to your
anterior papillary muscles towards your septum.
Those are the muscles within your ventricle.
- Contains chordae tendinae/heart
strings(connective tissue which connects the
papillary muscles to the valves). It is the
heartstrings that connects the cusps of your valve
towards your papillary muscles. Basically, it
reinforce the stability within your tricuspid valve. It
is sub connected to your papillary muscles.
OPENINGS WITHIN YOUR RIGHT
VENTRICLE
ATRIOVENTRICULAR ORIFICE
- this is the connection within your right
atrium. It communicates with your right
atrium. This is guarded by your Tricuspid
Valve also known as Right Atrioventricular
Valve.
PULMONARY ORIFICE
- This is the communication between your
right ventricle and your pulmonary trunk
(larger arteries within your body). Allows
the flow of the blood from right ventricle
going to pulmonary trunk in order to go to
your lungs because lungs has gas exchange
between the carbon dioxide and your
oxygen, in order for the blood to be
oxygenated so it needs to go to the
pulmonary trunk. We need to allow a
forward direction of the blood only that’s
why we also have a valve within your
pulmonary orifice. It is term as a Pulmonary
Valve also known as Right Semilunar Valve.
It is lined with your endocardium. Guards
the pulmonary orifice and consists of 3
semilunar cusps formed by folds of
endocardium with some connective tissue
enclosed. The curved lower margins and
sides of each cusp are attached to the
 arterial wall. The open mouths of the cusps
are directed upward into the pulmonary
trunk. The attachments of the sides of the
cusps to the arterial wall prevent the cusps
from prolapsing into the ventricle. At the
root of the pulmonary trunk are three
dilatations called the sinuses, and one is
situated external to each cusp.
- Contains 3 cusps (composed of Posterior
Cusps and 2 Anterior Cusps) but there’s no
chordae tendineae and no papillary
muscles.
- As the cavity approaches the pulmonary
orifice, it becomes funnel shaped, at which
point it is referred to as the infundibulum.
OPENINGS INTO THE LEFT ATRIUM
✓ The four pulmonary veins, two from each lung,
open through the posterior wall and have no
valves. The left atrioventricular orifice is guarded
by the mitral valve.
MITRAL VALVE
- placed below and to the left of the aortic
orifice. It is surrounded by a dense fibrous
ring, covered by the lining membrane of
the heart, and is guarded by the bicuspid or
mitral valve

Left Atrium
- Similar to the right atrium, the left atrium
consists of a main cavity and a left auricle.
The left atrium is situated behind the right
atrium and forms the greater part of the
base or the posterior surface of the heart .
Behind it lies the oblique sinus of the serous
pericardium, and the fibrous pericardium
separates it from the esophagus
- Blood passes from the left atrium into the
left ventricle through the bicuspid (mitral)
valve , which, as its name implies, has two
cusps.
- The left atrium is about the same thickness
as the right atrium and forms most of the
base of the heart and receives blood from
the lungs through four pulmonary veins.
- Forms the base of the heart
- two from each lung, open through the
posterior wall and have no valves. The left
atrioventricular orifice is guarded by the
mitral valve.