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HEART (Heart Surface Anatomy (auscultation (S2 (2nd intercostal space…

- - - - acute margin = right sternum
  - - - oblique margin
  - - - 5th intercostal space at the midclavicular line
  - - - 2nd intercostal space
        
        left: Pulmonary valve (left semilunar)
        
        right: Aortic valve (right semilunar)
    - - 5th intercostal space
        
        Mitral = midclavicular (left)
        
        Tricuspid = LEFT of Xiophoid
  - - - Transverse sinus = deep to aorta and pulmonary trunks
      - 2. Oblique sinus = under the apex of the heart to the pulmonary veins
      - *This is where fluid can build up during pericardial effusion
    - - parietal is fibrous
      - visceral = EPICARDIUM
- - - - formed by confluence of pulmonary veins
    - - valve cusps
        
        Mitral valve
        
        Anterior cusp
        
        Posterior cusp
        
        Aortic valve (semilunar) = outlet
      - Myocardium is thicker on left side
      - Trabecula Carneae
        
        fleshy network that lines the ventricle
  - - - Pectinate Muscle
        
        comb-like muscles
      - Sinus Venarum
        
        smooth area on wall of R atrium; formed by confluence of IVC and SVC
      - Crista Terminalis
        
        separates the pec. muscle and sinus vemarum
      - Coronary sinus
        
        confluence of the great, middle, and small cardiac veins
      - Oval fossa
    - - Conus Arteriosus Infundibulum
        
        funnel/outlet to the Pulmonary Trunk
      - Papillary muscle
        
        contract to restrain the prolapse of leaflets in the AV valves
        
        attached by chordae tendineae
      - Trabecula Carneae
        
        fleshy network that lines the ventricle
        
        septomarginal/marginal band
        
        bridges the septal wall to the marginal wall (shortcut)
      - Valve cusps (AV/tricuspid cusp and Semilunar/pulmonary valve cusp)
        
        Tricuspid
        
        anterior cusp
        
        posterior cusp
        
        septal cusp
        
        Pulmonary valve = outlet
  - - - located in the epicardium (visceral layer)
        
        fat pads surround coronary vessels
    - - the left ventricle wall is thicker than the right ventricle all
  - - - separates the 2 ventricles
- - - - Pulmonary Valve = more ANTERIOR
        
        cusps
        
        Left semilunar cusp
        
        Right semilunar cusp
        
        Anterior semilunar cusp
      - Aortic valve = more POSTERIOR
        
        cusps
        
        Left semilunar cusp
        
        Right semilunar cusp
        
        Posterior semilunar cusp
        
        has 2 "ostium" coming from LCA and RCA
  - - - anchored by fibrous trigone (skeleton of the <3)
        
        Mitral
        
        left side
        
        anterior cusp
        
        posterior cusp
        
        Tricuspid
        
        right side
        
        anterior cusp
        
        septal cusp
        
        posterior cusp
  - - - AV valves = OPEN
      - Semilunar CLOSED
    - - AV valves = CLOSED
        
        inflation of AV valves = S1
        
        AV valves are held to prevent prolapse (atrial regurgitation) by papillary muscles
      - Semilunar = OPEN
        
        rising ventricular pressure
        
        blood is EJECTED out the Aorta and Pulm. Trunk
        
        end of contraction, semilunar valves close = S2
- - - - both travel along the coronary suculus valley
        
        Right Coronary Artery (RCA)
        
        acute Marginal Branch = along right ventricle
        
        Posterior Descending Aorta (PDA) = descends in the posterior
        interventricular suculus - supplies blood to the SA node and AV node
        
        Left Coronary Artery (LCA)
        
        LCA branches into the Left Atrial Descending Artery (LAD)
        
        LAD supplies the anterior portion of the interventricular suculus
        
        the Circumflex Branch passes over the obtuse margin of the <3 to give branches that supply the L side of the <3 as it passes within the posterior coronary suculus
  - - - first observed with the PDA
    - - first observed with the RCA Marginal Branch and then with the RCA again in the coronary suculus
    - - first to drain ventricles
        
        runs alongside LAD and Circumflex artery
    - - these bridge over the RCA and empty DIRECTLY into the R atrium
    - - all of the cardiac veins draining blood from the myocardium combine to form this reservoir (C. Sinus).
        
        will empty into the R atrium
        
        1 EXCEPTION: anterior cardiac veins (these will not utilize the coronary sinus to empty into the R atrium, they will empty into the R atrium DIRECTLY)
  - - - encircles <3 between atria and ventricles
    - - encircles <3 between ventricles
        
        includes Purkinje fibers