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Anatomy of heart (Auscultation (Erb's point (Third left ICS, left…
Anatomy of heart
Auscultation
Erb's point
- Third left ICS, left sternal border
Tricuspid valve area
- Fourth left ICS, left sternal border
Pulmonic vlavle area
- Second left ICS, Left sternal border
Mitral valve area
- Fifth ICS, left mid clavicular line
Aortic valve area
- Second right ICS, right sternal border
Venous drainage
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Anterior cardiac veins very small, draining only ant portion right ventricle
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Histology
- Walls heart cardiac muscle: myocardium
- Covered externally serous pericardium: Epicardium
- Lined internally layer of endothelium
Endocardium
- Cardiac muscle: Striated muscle fibres: branch and unite form myocardium
- Fibres arranged whorls and spirals
- Coordinated contraction cardiocytes: propels blood from atria to ventricles
- Cardiocytes connected intercalated discs, cardiac syncytium enable transmission electrical impulses through netwrok and coordiate contraction of myocardium
Endocardium: Endothelial cells
Myocardium: Specilaised muscle: myocytes
- Epicardium: mesothelial cells and connective tissue
- Pericardium: fibrous sac that encloses heart
Heart in situ
Mediastinum
- Chest cavity divided into
- Median partition - mediastinum
- Lateral pleura and lungs
- Mediatinum extends to
- Root of neck above
- Diaphragm below
- Sternum anteriorly
- Vertebral column posteriorly
- Lies within pericardium of mediastinum
- Pericardium is fibro-serous sac that encloses heart and roots of great vessels
- Function:
- Restrict excessive movements of heart as whole
- Serve as lubricated container in which different parts of heart can contract
Pericardium
Serous pericardium
- Two layers
- Parietal lines fibrous pericardium
- Visceral closely covers heart (epicardium)
- Space between called pericardial cavity
- Contains pericardial fluid;lubricant
Fibrous pericardium
- Strong, fibrous layer
- Firmly attached below to central tendon diaphragm
- Attached in front to sternum by sternopericardial ligaments
- Fuses with outer coats of great blood vessels that pass through it
Anatomy
Right atrium
Anatomy
Musculi pectinati
- Anterior to crista terminalis
- Walls roughened bundle muscle fibres
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Crista terminalis
- Ridge inside between atrium and right auricle
- SVC to IVC
- Posterior to wall is smooth
AVT orifice
- Communication with ventricle
- Closed by tricuspid valve
Right auricle
- Ear-like, conical, muscular pouch overlapping aorta
- Right border heart
- Receives blood SVC, IVC and coronary sinus (medial IVC)
- Coronary sinus returns blood from walls of heart itself
Right ventricle
- Blood entering from right atrium: horizontal and anterior
- Outflow tract lead to pulmn trunk: conus arteriosus (infundibulum): smooth walled
- Pulm trunk closed Pulmn valve
3 semilunar cusps (L/R/Ant.)
Anatomy
Chordae Tendinae
- Free edges cusps attach to tendon-like fibrous cords
- These attach papillary muscles: (Ant, post, sept)
Trabeculae carnae
- Muscular , irregular structures
-Few known as papillary muscles
Tricuspid valve
- AVT orifice
- Form fold endocardium and connective tissue
- 3 cusps: Ant./septal/inf.
Septomarginal trabecula
- Bridge between lower interventricular septum and base of anterior papillary muscle
- Carries portion cardiac conduction system to ant. wall right ventricle
Anatomy
Left atrium
- Most of base of heart
- Blood enters *4 pulmn veins
- Ant half continuous left auricle
No equivalent of crista terminalis
- Depression on interatrial septum valve of foramen ovale
- Blood moves left ventricle atrioventricular orifice: mitral valve
Left ventricle
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- Ant left atrium
- Anterior, diaphragmatic, left pulmonary surfaces and apex
- Blood Av orifice apex
- Blood Aortic vestibule: guarded aortic valve
- Similar structure aortic valve
- Blood recoils after ventricular contraction, fills aortic sinuses formed by cusps, forced into coronary arteries
Cardiac skeleton
- Collection dense, fibrous tissue form four rings: interconnect plane between atria and ventricles
- Surround AV orifices, aortic orifice and opening pulmn trunk
- Helps maintain integrity of openings and attachment for cusps
- Separates msucular wall atria from ventricles + electrically isolating ventricles:
AV bundle: single connection between two groups of myocardium
Coronary circ
- Right and left arise from aortic sinuses and ascending aorta
- Distributed surface of heart in sub-epicardial connective tissue
Left
- Arises aorta passes foward between pulm trunk and left auricle
- Enters atrioventricular groove and divides into anterior inter ventricular branch and circumflex branch
- Left atrium
- Left ventricle (most)
- Right ventricle (partially)
- Interventricular septum (Ant. 2/3)
- SA node (40% peeps)
- AV node and bundle
Right
- Arises from aorta, runs forward between pulmn trunk and right auricle
- Descends vertically right AVT groove
- Inferior border, continues posteriorly to anastamose left coronary artery
- Marginal branch + posterior interventricular branch
- Right atrium
- Right ventricle (most)
- Left ventricle (diaph part)
- Interventricular septum (post 1/3)
- SA node (60% peeps)