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Internal Features Of Heart Learning objectives At the end of lecture student will be able to : Describe the part of heart. Identify and describe the chambers and valves of the heart. Discuss the different features of each chamber of heart. Facts, location, & orientation Oblique orientation Apex points inferiosinister (down and left) 5th intercostal space Base is superior near origins of great vessels 2nd intercostal space 2/3 lies left of the midline For the most part Anterior/inferior aspect of the heart right atrium/ventricle Posterior/superior aspect left atrium/ventricle Heart Features Chambers Right atrium Right ventricle Left atrium Left ventricle • Valves – Leaflet valves • Tricuspid • Bicuspid (mitral) – Cusped (semilunar) valves • Aortic • Pulmonic Right atrium Auricle (ear) Pectinate muscles (rough) Sinus venarum (smooth) Crista terminalis Division between rough to smooth Openings (ostia) SVC/IVC/Coronary sinus Fossa ovalis Foramen ovale in fetus Limbus Right atrium • The smooth-walled part, which is developed by the absorption of sinus venosus, receives the opening of two venae cavae and the coronary sinus. • The wall of the vestibule has a ridged surface and that of the auricle is rough. • Both are developed from the embryonic atrium . • The crista terminalis separates atrium proper and the auricle Opening in Right Atrium Superior vena cava Inferior vena cava. Opening of coronary sinus. Atrioventricular (tricuspid) orifice. Right atrium “valves” Superior vena cava No valve Inferior vena cava Eustachian valve Incompetent in adult, directs IVC blood though Foramen ovale in fetus Coronary Sinus Thebesian valve Prevents backflow into coronary sinus during atrial systole RA Right ventricle Most anterior aspect of heart Tricuspid valve (RA-RV) Anterior/Posterior/Septal cusps (leafs) Papillary muscles Connected to cusps via Chordae tendinae Contract to prevent Tricuspid valve regurgitation Named same as cusps Trabeculae carnae Moderator band RV Right ventricle • Supraventricular crest is in between the inlet and outlet components of the ventricle • The inlet component of the ventricle is rough, whereas the outlet portion, the infundibulum, is smooth walled. • The trabeculated appearance is because of muscular ridges and protrusions, which are known as trabeculae carneae, and are lined by endocardium. • The papillary muscles, which are inserted at one end onto the ventricular wall give attachments to chordae tendineae on the free luminal end Valve Structure Dense connective tissue covered by endocardium AV valves chordae tendineae - thin fibrous cords connect valves to papillary muscles TRICUSPID VALVE The atrioventricular valvular complex, in right ventricles, comprises of the orifice and its associated anulus, the cusps, the supporting chordae tendineae of various types and the papillary muscles. The margins of this orifice are recognized as anterosuperior, inferior and septal, related to the lines of attachment of the valvular cusps. PAPILLARY MUSCLES Anterior and posterior are two major papillary muscles in the right ventricle. The third, smaller one is medial in position together with several smaller, and variable, muscles attached to the ventricular septum. Interventricular septum Composed of muscular part and membranous part, strong obliquely placed b/w right and left ventricles. Muscular part –forms majority of IVS bulges into the cavity. Membranous part ---part of fibrous skeleton of heart. Semilunar valves in the arteries that exit the heart to prevent back flow of blood to the ventricles pulmonary semilunar valves aortic semilunar valves Pathologies Incompetent – does not close correctly Stenosis – hardened, even calcified, and does not open correctly PULMONARY VALVE The outflow from the right ventricle is guarded by semilunar pulmonary valve. The three cusps are in part attached to the infundibular wall of the right ventricle and in part to the origin of the pulmonary trunk. The position of these cusps are two anterior cusps, right and left, and one posterior. Left atrium Ostia of 4 pulmonary veins 2 superior 2 inferior Auricle LA Left atrium The part of wall derived embryological from pulmonary vein. Rough part of atrium derived from primitive atrium. Trabeculated muscular part—pectinate muscle. A semilunar depression in the interartrial septum indicates the floor of fossa ovalis. Opening in the Left atrium Four pulmonary veins. Left AV orifice. Left ventricle Trabeculae carnae Bicuspid (mitral) valve Anterior/Posterior cusps Papillary muscles Chordae tendinae Usually a greater number than the right, due to the increased pressures and strength necessary to prevent regurgutation Left ventricle Walls are 2-3 times thicker from the right ventricles. Walls are mostly covered with mesh of trabeculae carnea. Cavity is conical. Papillary muscles are anterior and posterior. Smooth walled, non-muscular, superoanterior outflow part, the aortic vestibule---aortic orifice and aortic valve LV Mitral Valve The mitral valve has arrangement of cusps slightly different then the tricuspid. This valve has as orifice with its supporting anulus, which provide attachment to cusps of the valve. There are 2 cusps anterior and posterior . Aortic valve Posterior to pulmonic valve Just superior lies the Sinus of Valsalva Helps to dampen aortic outflow and prevent cusps from adhering to walls of aorta 3 cusps Posterior (non-coronary) cusp Right Left Just superior to right and left cusps in the Sinus of Valsalva are the openings of the right and left coronary arteries, respectively Heart Valves Tricuspid valve RA – RV Bicuspid valve LA – LV aka “Mitral valve” Aortic valve LV – aorta Pulmonic valve RV – pulmonary trunk Conducting system Inside the Heart…a review