Anatomy of the Heart and Pericardium

Dr. Hamd Syed, Asst. Prof.

Anatomy Dept.CIMS
Learning Objectives
At the end of this session students should be able to

Describe the location and relations of the heart within

the thoracic cavity

Describe the pericardium, its constituent layers,

pericardial cavity and different reflections

Define pericarditis and cardiac tamponade

Dr. Hamd Syed, Asst. Prof.Anatomy

Define the borders and surfaces of the heart

Identify and describe the heart chambers and valves;

correlate with circulation of blood through the
chambers and major vessels

Describe the conducting system and fibrous skeleton

of the heart

Dr. Hamd Syed, Asst. Prof.Anatomy

Discuss blood supply of the heart and its relation with
ischemia, angina and myocardial infarction

Define the terms angioplasty, stenting and CABG

(coronary artery bypass surgery)

Describe the nerve supply of the heart

Dr. Hamd Syed, Asst. Prof.Anatomy

Location of the Heart

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed,
Asst. Prof.Anatomy
The heart is a chambered
muscular organ that
pumps blood received
from the veins into the
arteries, thereby
maintaining the flow of
blood through the
entire circulatory
system.

Dr. Hamd Syed, Asst. Prof.Anatomy

 Pericardium

Dr. Hamd Syed, Asst. Prof.Anatomy

The heart is surrounded
by membrane called
Pericardium.

Dr. Hamd Syed, Asst. Prof.Anatomy

 The Pericardium
The pericardium is a
fibroserous sac that
encloses the heart and
the roots of the great
vessels.
The pericardium lies
within the middle
mediastinum.

Dr. Hamd Syed, Asst. Prof.Anatomy

The Pericardium

Dr. Hamd Syed, Asst. Prof.Anatomy

The Pericardium
Its function is to
restrict excessive
movements of the
heart as a whole and
to serve as a
lubricated container in
which the different
parts of the heart can
contract.

Dr. Hamd Syed, Asst. Prof.Anatomy

 The Pericardium
 Pericardium – a double-walled
sac around the heart
composed of:
1. A superficial fibrous
pericardium
2. A deep two-layer serous
pericardium
a. The parietal layer
lines the internal
surface of the fibrous
pericardium
b. The visceral layer or
epicardium lines the
surface of the heart
 They are separated by
the fluid-filled
pericardial cavity
Dr. Hamd Syed, Asst. Prof.Anatomy
The Pericardium

Dr. Hamd Syed, Asst. Prof.Anatomy

The Pericardium

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy
Pericardial sinuses
Transverse sinus
Oblique sinus

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy
The Pericardium
Blood Supply
The pericardium blood
supply is from the
pericardiacophrenic
branches of the internal
thoracic arteries.
Dr. Hamd Syed, Asst. Prof.Anatomy
Nerve Supply
The pericardium nerve
supply the fibrous
pericardium and the
parietal layer of serous
pericardium are
supplied by the phrenic
nerve.
 The Heart

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy
Heart Wall:
• Epicardium – visceral layer of the serous
pericardium.
• Myocardium – cardiac muscle layer forming the
bulk of the heart.
• Fibrous skeleton of the heart – crisscrossing,
interlacing layer of connective tissue.
• Endocardium – endothelial layer of the inner
myocardial surface

Dr. Hamd Syed, Asst. Prof.Anatomy

 The Heart surfaces The Heart Borders

Anterior Right
(sternocostal) Left
Inferior Inferior
(diaphragmatic)
Base (posterior)
Apex

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy
Chambers of the Heart

Dr. Hamd Syed, Asst. Prof.Anatomy

 The Right Atrium
• Receives deoxygenated blood
from the inferior vena cava below
and from the superior vena cava
above.

 Receives the coronary sinus in its

lower part.

• The upper end of the atrium

projects to the left of the superior
vena cava as the right auricle.

Dr. Hamd Syed, Asst. Prof.Anatomy

The sulcus terminalis is a vertical groove on
the outer surface of the atrium. This groove
corresponds internally to the crista
terminalis .

Above the coronary sinus the interatrial

septum forms the posterior wall. The
depression in the septum is the fossa
ovalis which represents the site of the
foramen ovale.

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy
 The Right Ventricle
Receives blood from the right atrium through
the tricuspid valve

The edges of the valve cusps are attached to

chordae tendineae which are, in turn,
attached below to papillary muscles.

Dr. Hamd Syed, Asst. Prof.Anatomy

The Right Ventricle
The wall of the right ventricle is thicker than
that of the atria but not as thick as that of the
left ventricle.
The wall contains a mass of muscular bundles
known as trabeculae carneae.
The infundibulum is the smooth walled
outflow tract of the right ventricle.

Dr. Hamd Syed, Asst. Prof.Anatomy

The moderator band passes from septal to
anterior wall of right ventricle

It conveys right branch of AV bundle

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy
 The Right Ventricle
The pulmonary valve is situated at the top of
the infundibulum.
It is composed of three semilunar cusps.
Blood flows through the valve and into the
pulmonary arteries via the pulmonary trunk to
be oxygenated in the lungs.

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy
The Left Atrium
Receives oxygenated blood from four
pulmonary veins which drain posteriorly.

Dr. Hamd Syed, Asst. Prof.Anatomy

The mitral (bicuspid) valve guards the passage of
blood from the left atrium to the left ventricle.

The cavity is smooth walled except for the atrial

appendage.

Dr. Hamd Syed, Asst. Prof.Anatomy

The Left Ventricle
The wall of the left
ventricle is thicker than
the right ventricle but
the structure is similar.
The thick wall is
necessary to pump
oxygenated blood at
high pressure through
the systemic circulation.

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy
Trabeculae carneae project from the wall with
papillary muscles attached to the mitral valve cusp
edges by way of chordae tendineae.

The vestibule is a smooth walled part of the left

ventricle which is located below the aortic valve .

Dr. Hamd Syed, Asst. Prof.Anatomy

 The Heart Valves
Atrioventricular valves Semilunar valves
Pulmonary valve
Right AV (Tricuspid)
separates the right
separates the right atrium
from the right ventricle. ventricle from the
Prevents backflow into pulmonary arteries.
atrium. Prevents backflow after
ventricular contraction.
Left AV (Bicuspid)
Aortic valve
separates the left atrium
separates the left ventricle
from the left ventricle.
Prevents backflow into from the aorta. Prevents
atrium. backflow after ventricular
contraction .
Dr. Hamd Syed, Asst. Prof.Anatomy
 Contraction of ventricles (systole)
Contraction of papillary muscles
Closure of AV orifices by AV valves

Relaxation of ventricles (diastole)

Blood fills up in the sinuses
Closure of pulmonary and aortic orifices by
semilunar valves

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy
Fibrous skeleton of the Heart

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy
Conducting System of the Heart

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy
Interactive 3D model session

Dr. Hamd Syed, Asst. Prof.Anatomy

Arterial Supply of the Heart

Dr. Hamd Syed, Asst. Prof.Anatomy

Arterial Supply of the Heart
The arterial supply of
the heart is provided by
the right and left
coronary arteries, which
arise from the
ascending aorta
immediately above the
aortic valve.

Dr. Hamd Syed, Asst. Prof.Anatomy

 Coronary Arteries
The origins of the coronary arteries are as follows:
The left coronary artery arises from the aortic
sinus immediately above the left posterior cusp of
the aortic valve .
The right coronary artery arises from the aortic
sinus immediately above the anterior cusp of the
aortic valve.

Dr. Hamd Syed, Asst. Prof.Anatomy

Branches of Right Coronary Artery

Rt. Conus
Anterior ventricular branches - marginal
branch is the largest
Posterior ventricular branches -artery of
AV node
Posterior interventricular (descending)
Atrial branches—artery of the SA node

Dr. Hamd Syed, Asst. Prof.Anatomy

Branches of Left Coronary Artery
Anterior interventricular
(descending) branch
Left diagonal
Left conus
Circumflex artery
Left marginal
Anterior ventricular branches
Posterior ventricular branches
Atrial branches

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy
Summary of Overall Arterial Supply to the
Heart in Most Indivuduals

Dr. Hamd Syed, Asst. Prof.Anatomy

 •Almost all of the right ventricle, variable part of
diaphragmatic surface of left
Right coronary ventricle,posteroinferior third of interventricular
artery septum
•Right atrium, part of left atrium. SA,AV nodes and
bundle,LBB

•Most of the left ventricle, small area

of right ventricle, anterior two thirds
Left coronary artery of interventricular septum
•Most of the left atrium, RBB and LBB

Dr. Hamd Syed, Asst. Prof.Anatomy

Cardiac dominance
The artery giving off the posterior interventricular
branch is defined as the “dominant” artery

Right dominance is present in most individuals

(90%)

Dr. Hamd Syed, Asst. Prof.Anatomy

Venous Drainage of the Heart
Mostly by coronary sinus;
great cardiac vein
Middle cardiac vein
Small cardiac vein
Anterior cardiac vein

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy
Coronary Artery Lesions and Infarct
Location

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Dr. Hamd Syed, Asst. Prof.Anatomy
Dr. Hamd Syed, Asst. Prof.Anatomy
Dr. Hamd Syed, Asst. Prof.Anatomy
Dr. Hamd Syed, Asst. Prof.Anatomy
Nerve Supply of the Heart
The heart is innervated by sympathetic and
parasympathetic fibers of the autonomic nervous
system via the cardiac plexuses situated below the
arch of the aorta.

The sympathetic supply arises from the cervical and

upper thoracic portions of the sympathetic trunks,
and the parasympathetic supply comes from the
vagus nerves.
These postganglionic autonomic fibers terminate on
the SA and AV nodes, cardiac muscle fibers and
coronary arteries

Afferent fibers of sympathetic nerves transmit pain

impulses while those running with parasympathetic
nerves take part in cardiovascular reflexes

Dr. Hamd Syed, Asst. Prof.Anatomy

Dr. Hamd Syed, Asst. Prof.Anatomy