Heart

Question 1

Heart

Answer 1

Cor

• central organ of circulatory organ, lies in mediastinum medium
• atrium and ventriculus dexter pump blood through circulus sanguinis minor
• -> contain venous blood
• atrium and ventriculus sinister pump blood through circulus sanguinis major
• -> contain arterial blood
• right part is directed forward, left part backward (left rotation)

Question 2

External description:

Answer 2

• basis cordis (upward and backward to the right. Connected with great vessels)
• apex cordis (downward and forward to the left)
• facies sternocostalis  to the inner surface of ribs and sternum
• facies diaphragmatica  formed by ventricles, rests upon centrum tendineum diaphragm
• facies pulmonalis  to the left lung
• margo dexter
• grooves that divide heart into 4 cavities, all filled by BV and fat:
  1. sulcus coronaries (seperates atria from ventricles)
  2. sulcus interventricularis ant. (longitudinal groove from facies sternocostalis –> apex cordis)
  3. sulcus interventricularis post. (longitudinal groove on facies diaphragmatica)
  o sulcus interventricularis ant. and post. form incisura apicis cordis
  o separation between two ventricles
• auricula dextra (larger) + auricula sinistra
• septum cordis –> seperates heart into left/right

4. septum interatriale: between atria
5. septum interventriculare: between ventricle (can be divided into two)
   o pars membranacea
   o pars muscularis

Question 3

Atrium dextrum

Answer 3

6 walls:
- Paries anterior
o auricular dextra
o mm. pectinate

• Paries lateralis
  o mm. pectinati
• Paries superior
  o ostium venae cavae superioris by which vena cava superior opens into atrium
  –> this vein returns blood from upper part of body (above diaphragm)
• Paries posterior
  o ostium venae cavae inferioris guarded by valvula venae cavae inferioris
  –> by this valve during fetal life the blood from vena cava inferior is directed toward
  foramen ovale
  o sinus venarum cavarum
   posterior part in right atrium between v. cava superior and inferior)
• Paries medialis
  o Formed by septum interatriale
  o Depression fossa ovalis which is limited by limbus fossae ovalis
  –> Site of foramen ovale in feta life for venous blood flow from right atrium to the left
  atrium (pulmonary circulation could be passed by)

o foramina venarum minimarum
–> orifices of venae cordis minimae (returns blood directly from the layers of heart ́s wall)

• Paries inferior
  o ostium atrioventriculare dextrum
  –> communication between arium and ventricle
  o ostium sinus coronarii of sinus coronarius cordis
  –> opening between medial and posterior wall (below fossa ovalis)
  –> protected by valvula sinus coronarii
  
  • sinus coronarius cordis returns venous blood from the wall of the heart
  • lies in sulcus coronarius

Question 4

Ventriculus dexter

Answer 4

• Ostium atrioventriculare dextrum (for inflow)

o Closed by valva atrioventricularis dextra. s. valvula tricuspidalis
 3 cusps: formed by doubling endocardium (inner layer of the wall)
 Cuspis anterior
 Cuspis posterior
 Cuspis septalis

o surrounded by annulus fibrosus, which is attached to one margin of each cusp
 other 2 margins are free –> connected by chordae tendineae to mm. papillares
 chordae tendineae prevent turning cusps into atrial direction
o extend from one cusp to 2 mm. papillares

o valva atrioventricularis dextra is closed in systole (contraction of ventricle), open in diastole
(relax of ventricle)

• Ostium trunci pulmonalis (for outflow)
  o Closed by valva trunci pulmonalis
   3 valvulae semilunares
   formed by doubling of endocardium
   bases are attached to anulus fibrosus, surrounding ostium trunci pulmonalis
   free margins are directed upward, contain in its middle thickening nodulus
  valvulae semilunaris
   in between valves and wall of pulmonary trunk is sinus trunci pulmonalis

o conus arteriosus is the place where trunci pulmonalis starts
o in diastole sinuses are fulfilled by the blood and valves are closed
o valve trunci pulmonalis is open in systole

Question 5

Atrium sinistrum

Answer 5

(smaller, thicker, 5 openings)

• Paries anterior
  o auricular sinistra
  o mm. pectinati
• Paries posterior
  o ostia venarum pulmonalium (4x) from venae pulmonales
   no valves
• Paries medialis
  o septum interatriale
• Ostium atrioventriculare sinistrum is orifice between left atrium and left ventricle

Question 6

Ventriculus sinister

Answer 6

(3 times thicker than ventriculus dexter)

• Ostium atrioventriculare sinistrum (for inflow)
  o closed by vavla atrioventricularis sinistra s. valvula bicuspidalis s. mitralis
   cuspis anterior et posterior
   both formed by endocardium
   anchored to mm. papillares by chordae tendineae
• Ostium aortae (for outflow)
  o closed by valve aortae (structure similar to pulmonary valve)
   3 valvulae semilunares with sinus aortae
• Both openings surrounded by anulus fibrosus
• Trabeculae carneae + mm. papillares (2x) form chordae tendineae
  o chordae tendineae connect mm. papillares with both cusps

Question 7

Circulus sanguinis major

Answer 7

systemic circulation

Oxygenated blood from left ventricle –> aorta –> via arteries into capillary network of organs –> desoxygenated
blood –> vena cava inferior (legs and lower trunk) / vena cava superior (head, arm, upper trunk) –> atrium
dexter

Question 8

Circulus sanguinis minor

Answer 8

Pulmonary circulation

Deoxygenated blood from right ventricle –> truncus pulmonalis –> a. pulmonalis dextra et sinistra –> capillary
network of lungs –> oxygenation in lungs –> venae pulmonales (4) –> atrium sinistra

Question 9

Wall structure, inner layer

Answer 9

1. Endocardium – inner layer, covers all structures of the wall
   o Continuation of tunica interna s. tunica intima of great vessels
   o Duplication of endocardium form heart valves
    Atrium dextra
   –> Valvula venae cavae inferioris
   –> Valvula sinus coronorii
    Ventriculus dexter
   –> Valva atrioventricularis dextra s. valvula tricuspidalis
   –> Valva trunci pulmonalis
    Ventriculus sinister
   –> Valva atrioventricularis sinistra s. valvula bicuspidalis s. mitralis
   –> Valva aortae

Question 10

Wall structure, middle and external layer

Answer 10

2. Myocardium – middle layer, muscular layer  4x anuli fibrosis (skeleton where muscle fibers
   are attached)
   o Atrium: 2 layers
3. external circular (surrounds both atria)
   2.internal longitudinal (separate each atrium)

o Ventriculus: 3 layers
1. External longitudinal (surround both ventricles)
2. internal longitudinal (surround both ventricles)
3. fibers from external and internal layers run toward apex where they form vortex
cordis

o middle circular (separate for each ventricle)
o Myocardium forms mm. papillares, mm. pectinati, trabeculae carneae

3. Epicardium – external layer, formed by lamina visceralis pericardii serosi
   o continues into lamina parietalis pericardii serosi at great vessels of heart

Question 11

What surrounds the heart ?

Answer 11

Pericardium surrounds the heart
 lies close to sternum, centrum tendineum diaphragmae and pleura mediastinalis
 2 layers:
–> Pericardium fibrosum (sac, enveloping heart  seperates from organs)
–> Pericardium serosum – consists 2 layers
- Lamina parietalis pericardii seriosi, fuses with pericardium fibrosum –> Continues into visceral layer at the region of great vessels of heart
- Lamina visceralis pericardii serosi s. epicardium –> Lies close to myocardium –> form external layer of heart –> Cavum pericardii between 2 serous layers, contains liquor pericardii which
decreases friction

 2 punch-like deepingd in pericardial cavity
o Sinus transversus pericardii
–> Anteriorly – aorta descendens and truncus pulmonalis
–> posteriorly – vena cava superior and venae pulmonales
o Sinus obliquus pericardii
–> between vena cava inferior and venae pulmonales

Question 12

Conducting system

Answer 12

1. Nodus sinuatrialis – between auricular dextra and ostium vena cavae superioris
   a. generates impulses
   b. spred throughout 2 atria and to nodus atrioventricularis
2. Nodus atrioventricularis – in septum interatriale beneath fossa ovalis, near cuspis septalis
   a. Continues into fasciculus atrioventricularis
3. Fasciculus atrioventricularis
   a. truncus (upper part) lies in fibrous part of interventricular sept
   b. at upper muscular part of interventricular sept divides into crus dextrum (3) et sinistrum (2)
   i. run till mm. papillares

Question 13

Topography; holotopia and syntopia

Answer 13

mediastinum medium

Syntopia:
Anteriorly:
- Sternum
- Cartilagines costales

Posteriorly:

• Organs of mediastinum posterius
• Oesophagus
• BV, nerves

Laterally:
- Pleura parietalis pars mediastinalis

Inferiorly:
- centrum tendineum diaphragmae

Superiorly:
- great BVs

Question 14

Skeletopia

Answer 14

• Upper border (basis cordis)
  o along 3rd rib
• Right border
  o parallel to sternal margin 1,5 cm to the right
  o from sternal junction of 3rd to 5th rib
• Lower border
  o obliquely from cartilage of 5th rib to intercostal space of 5th (here is apex cordis)
• Apex cordis
  o 5
  th intercostal space
  o 1,5 cm medially from linea medioclavicularis sinistra / 11 cm to the left from sternal margin
• Left border
  o apex cordis (5th intercostal space) to 3rd rib junction between cartilage and osseous part
• Ostium atrioventricularis
  o On the line extending from sternal junction of 3rd rib (on the left) to sternal junction 6th rib (on
  the right)
• Ostium aortae + Ostium trunci pulmonalis
  o On the line extending from sternal junction of 3rd rib (on the left) to sternal junction of 4th rib (on the right)
  –> Ostium aortae at level of 3rd intercostal space (behind sternum on midline)
  –> Ostium trunci pulmonalis at level of 3rd rib sternal junction (on the left)

Auscultation sites of valves
- Aortic valve
o 2nd intercostal space, right site of sternum

• Pulmonary valve
  o 2nd intercostal space, left site of sternum
• Tricuspid valve
  o 5th intercostal space, right site of sternum (on processus xyphoideus)
• Bicuspid valve
  o 5th intercostal space, 1,5 cm medially from linea medioclavicularis