EXTERNAL FEATURES

OF
THE HEART
 Introduction
■ Cardia – Greek , cordis – Latin

■ Hollow muscular organ situated

in the mediastinum of the
thoracic cavity -enclosed in the
pericardium

■ Location - obliquely behind the

sternum and adjoining parts of
costal cartilages
 COMPETENCY BASED UNDERGRADUATE
CURRICULUM

AN22.2 - Describe & demonstrate external and internal

features of each chamber of heart

AN22.3 - Describe & demonstrate origin, course and branches

of coronary arteries

AN22.5 - Describe & demonstrate the formation, course,

tributaries and termination of coronary sinus

AN22.7 - Mention the parts, position and arterial supply of the

conducting system of heart
 Case
scenario
A 65-year-old man came to the
emergency room complaining
of chest pain for past one hour.
The patient also complained of
pain radiating to the left arm
and excessive sweating. What
is the most possible diagnosis?
 Apex beat
■ Outermost and lowermost thrust of
the cardiac contraction - during
ventricular systole - felt on the front
of the chest
■ Apex beat is felt as a light tap in left
5th intercostal space in the
midclavicular line – left side
■ Sometimes the heart is malpositioned
with apex on the right side. This
condition is called dextrocardia
■ It may be associated with complete
reversal of thoracic and abdominal
viscera, a condition called situs
inversus
■ The heart is a conical hollow muscular organ situated in the middle
mediastinum.
■ It pumps blood to all parts of the body to meet their requirements.
■ The human heart has four chambers – 2 atria & 2 ventricles.
■ Right side chambers deal with deoxygenated blood.
■ Left side chambers deal with oxygenated blood.
■ Heart is situated in the
middle mediastinum of the
thoracic cavity.

It is enclosed by a fibrous
pericardium & a double layered
serous pericardium enclosing
the pericardial cavity.
It is conical in shape with an apex, base & is
flattened anteroposteriorly.
Average adult heart size is that of a size of a closed fist.

Apex
 POSITION OF THE HEART
■ Heart is rotated 450
around vertical axis
so that the right side
chambers lie anterior
to the corresponding Coronary sulcus
left side chambers.
■ As a result the
coronary or atrio
ventricular groove lies
at a 45o angle with the
transverse axis. 450 angle

Transverse
axis
 Vertical
■ The interatrial & axis
interventricular grooves
representing the
underlying inter atrial
& interventricular
septum lie at a 450
angle with the vertical
axis.
■ During embryonic development the primitive heart tube
bends ventrally so that the atria comes to lie
posterosuperior to the corresponding ventricles.
 APEX OF THE HEART
■ It is directed downwards,
forwards & to the left.
■ It is represented in the
surface at fifth left
intercostal space ½ an inch
medial to mid clavicular
line.

Apex
■ It is formed by left ventricle.
■ It is overlapped by anterior margin of Lt lung &
pleura.

Lt. lung

Apex
 BASE OF THE HEART
■ The base lies
posteriorly & is
Lt.pulmonary
Rt.Pulmonary
veins directed upwards,
veins
backwards & to the
SVC right.
■ It is formed by the
two atria.
■ SVC & IVC opens
Lt. Atrium
Rt.Atrium into Rt. Atrium & 4
Pulmonary veins
open into Lt. atrium.
IVC
 ■ It is related to the
Base of oesophagus, aorta, azygos
the heart veins, thoracic duct &
sympathetic chains
separated by the right
pulmonary veins.
6
7 ■ It lies opposite T6 – T9 in
Heart
8 erect posture & T5 – T8 in
9
lying posture.
■ When enlarged due to mitral
valve stenosis it compresses
Oesophagus
the oesophagus & causes
dysphagia – ORTNER’S
Aorta
SYNDROME.
 STERNOCOSTAL SURFACE.
⮚ Faces anteriorly.
⮚ Related to sternum & costal cartilages overlapped by
the anterior margins of both the lungs & pleura.
⮚ Formed by Rt.Atrium, Rt.& Lt.Ventricles.

Rt.Atrium

Lt.Ventricle
Rt.Ventricle
It extends from 3rd to 6th costal cartilages.

3rd costal cartilage

6th costal cartilage

 Demarcations of
the heart
■ The two atrial chambers are separated from each other by a
vertical septum—the interatrial septum
■ the two ventricular chambers are separated from each other by a
vertical septum—the interventricular septum
■ The right atrium communicates with the right ventricle through
right atrioventricular orifice, which is guarded by three cusps
■ The left atrium communicates with the left ventricle through the
left atrioventricular orifice, which is guarded by two cusps
 Demarcations of the
heart

■ On the surface the chambers of the

heart is demarcated by
1.Coronary sulcus -
atrioventricular groove
2.Anterior interventricular sulcus.
3.Posterior interventricular sulcus.
⮚ The coronary sulcus
separates the Rt atrium
& Rt. Ventricle.
⮚ It lodges the
Rt.Coronary artery &
Small cardiac vein.
⮚ The two ventricles
are separated by
Anterior interventricular
groove lodging Anterior
interventricular.A &
Coronary Ant.interventricular
Great cardiac vein. sulcus groove
■ It is formed by right Pericardio

atrium & SVC

phrenic
vessels &
Phrenic .N
RIGHT SURFACE
draining into right
atrium.
S
■ It is related to V
medial surface of C

the Rt. Lung,

Rt.Percardio Rt.Atrium

phrenic vessels &

Rt. Lung
Rt.Phrenic nerve.
■ There is a groove in
the surface
extending from
SVC to IVC –
SULCUS
TERMINALIS
 DIAPHRAGMATIC OR INFERIOR SURFACE.
■ It is circular in
outline.
■ Rt. 1/3 rd formed by Post.inter
Rt. Ventricle & Lt Ventricular. A

2/3rd formed by Lt.

Ventricle. Middle
cardiac vein
■ Both the ventricles
are separated by Lt.ventricle Posterior inter
posterior ventricular groove
interventricular
Rt.Ventricle
groove lodging
posterior
interventricular.A &
middle cardiac vein.
■ It is separated from the
base by posterior part
of coronary sulcus
lodging terminations of Rt.Atrium
both coronary arteries Lt.Atrium
Inter atrial
& coronary sinus. Coronary groove
■ The meeting point of sinus
Inter Atrial,
InterVentricular &
Crux
coronary sulci is called
– CRUX OF THE Lt Ventricle Post. Inter Ven.
HEART. Groove
Rt.ventricle
 ■ The inferior surface rests on the central tendon of
the diaphragm which separates it from Lt.lobe of the
Liver & Stomach fundus.

Inferior surface
of the heart
Central tendon

Right dome Left dome

 BORDERS
■ Right border – formed by Rt. Atrium. Related to Rt lung.
■ Left border- Formed by Lt. ventricle & Lt Auricle. Related to
Lt. lung
■ Inferior border – formed by Rt & Lt ventricles. Separates
sternocostal from inferior surface. Related to diaphragm.

Rt.Atrium Lt.Auricle
Rt.border
Lt.border
Rt.ventricle
Lt.ventricle

Inferior border
 SUPERIOR BORDER
■ Formed by Lt Aorta

atrium with Rt. &

Pulmonary trunk
Lt pulmonary
Lt.
veins opening Rt.Pulmonary pulmonary
veins
into it. veins
Lt.atrium
■ It is masked from
the surface by
Superior Border
pulmonary trunk,
ascending aorta &
both the auricles.
 INCISURA APICIS CARDIS
■ A notch 1 cm inside the apex. 4 arteries meet here :
1. Rt. Marginal.A, 2. Lt. Marginal.A, 3. Ant. Interventricular. A
& 4. Post. Interventricular.A

Lt.Marginal.A

Apex
Ant.Inter

Ven.A

Post.Inter. Vent.
A
Rt.Marginal.A

Incisura Apicis Cardis

THANK YOU!