Anatomy and Physiology of Heart

M. Zadkamali MD Cardiac Electrophysiologist

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 Functional Anatomy of Heart
 Located in mid mediastinum
 From right shoulder to left upper of abdomen
 Base consists of atria and great vessels
 Apex consists of right and left ventricles and interventricular
septum
(in 4th and 5th intercostal spaces)
 Anterior:sternum& cartillages of 3rd & 4th ribs
 To midsternal line:2/3 left
1/3 right

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 mediastinum
 Surrounded by sternum, ribs, spinal column, parietal aspect
of pleura, diaphragm muscle

 Heart, greater vessels, distal trachea, right and left

bronchus, thymus, autonomic nerves, left recurent laryngeal
nerve, vagus nerve, phrenic nerve
 Bromchial arteries, esophagus, thoracic duct, azygos and
hemi azygosneins, lymph nodes

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  Enlargement of cardiac chambers or vessels may compress or
displace adjacent organs
 LA enlargement in rheumatic mitral valve disease may
displace left bronchus upward and esophagus rightward
 Subclavian a. →irregularity in esophagus
 Non-cardiac elements (e.g. neoplastic masses) mat affect
heart especially low pressure parts like atria and SVC
 Intra-abdominal masses can push the heart upward

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 Pericardium
 Surrounds the heart
 2 layers (fibrous and serous)
 Serous layer ; on myocardium (visceral pericardium or
epicardium)
 Covers the root of great vessels and then deflects to parietal
and fibrotic pericardium
 Pericardium is attached to sternum and spinal column and
diaphragm

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  Pericardial fluid normal amount: 15-50cc

 Phrenic n. palsy may occur after pericardial surgery

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 Function of pericardium
 Pericardium restricts heart extension
 Protects from infection
 Negative pressure between 2 layers
 Congenital absence of pericardium or its surgical removal
may have no complications

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  Right side chambers are more sensitive to rise of pericardial
volume and pressure
 LA more extra pericardial
 LV thick wall

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 External topography
 Surface anatomy

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 Crux
 Intersection of atrioventricular and posterior interventricular
grooves
 The artery that reaches this area will supply the AVN and
PDA and determines the dominancy of arterial system

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 Fibrous Skeleton

 Separates atria and ventricles and contributes in

mitral and tricuspide valves annulus and membranous
part of interventricular septum structure

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 Cardiac chambers

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  RA
 LA
 RV
 LV

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 Mitral and tricuspid valves
 Mitral valve
 Tricuspid Valve
 Papillary muscles
 Chordae tendineae
 Aortic and pulmonary valves

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 Papillary muscles

 2 attached to MV
 3 attached to TV
 Along with chordae tendineae sause stability and appropriate
function of mitral and tricuspid valves

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 Aortic valve
 3 cusps
 Right coronary cusp
 Left coronary cusp
 Non coronary cusp

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 Corornary arteries
 Left main
 Left anterior descending (LAD)
 Left Circumflex (LCx)
 Right coronary artery (RCA)

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 LAD (left anterior descending artery)
 From LM
 Anterior interventricular groove
 Septal branches
 Diagonal branches
 Supplies 2/3 of interventricular septum, anterior, lateral and
apex, anterolateral papillary muscle

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 LCx (Left Circumflex Artery)
 From LM
 Left atrioventricular groove
 15% to crux
 SAN branches (25%)
 OM (obtuse marginalis) branches
 PDA (posterior descending artery) (8%) if left dominant

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 RCA (Right coronary artery)
 From RCC
 Right atrioventricular groove
 Conus artery is its first branch (50-60%)
 SAN branch (50-60%)
 Acute marginalis
 AVN branch (85%)
 supplies; proximal of conduction system and his bundle,
posteromedial papillary muscle

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 Conduction system of heart

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 Sinoatrial node
 Located at junction of SVC and RA,
 Subepicardial
 Perfusion 55% from RCA

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 Atrioventricular node
 Subendocardial
 Located at Koch’s triangle (CS posterior, annulus of septal TV
leaflet anterior)
 Perfusion from dominant artery (85% RCA)

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 Bundle of his
 Originates from anterior of AVN
 Near membranous interventricular septum
 Perforates central fibrous body
 Dual perfusion from AVN artery and first perforator branch
of LAD

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 Right bundle branch

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 Left bundle branch
 Left anterior fascicle
 Left posterior fascicle

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 PHYSIOLOGY

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 Cellular principal of contraction
 Excitation:; the action potential

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 ‫شروع پتانسیل عمل در میوسیت با باز شدن کانال های سدیمی در فاز ‪‬‬
‫‪ 0‬و دپالریزاسیون سلول است‪.‬‬
‫فاز ‪ 2‬پتانسیل عمل (پالتو) مختص میوسیتهای قلب است و به علت ‪‬‬
‫تعادل در ورود کلسیم و خروج پتاسیم رخ می دهد‪.‬‬
‫در سلول های ضربانساز مثل گره سینوسی دهلیزی ورود یون های ‪‬‬
‫سدیم از طریق کانال ای اف باعث بروز دپالریزاسیون خودبخودی و‬
‫رسیدن غشا به پتانسیل آستانه می شود‪.‬‬

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 Cardiac Cycle
Systole :
 isovolumic contraction
 ejection

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 Cardiac Cycle
Diastole
 Isovolumic relaxation
 Early rapid filling
 Diastasis
 Atrial contraction

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 LV function indeces
 CO
 SV
 EF
 Preload
Preload is defined as the stretch of myocardium or end-diastolic
volume of the ventricles
 Afterload
is defined as the ventricular wall stress or tension that develops
during systolic contraction and ejection of blood into the
aorta.(presumed equal to aortic pressure)

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