Surface Anatomy of the Heart PDF

SURFACE ANATOMY OF THE HEART Surface Anatomy of Heart 2 Orientation and Surfaces The heart has been described by many texts as an upside down. The apex of this pyramid pointing in an anterior-inferior direction. In its typical anatomical orientation, the heart has 5 surfaces, formed by differen...

SURFACE ANATOMY OF THE HEART Surface Anatomy of Heart 2 Orientation and Surfaces The heart has been described by many texts as an upside down. The apex of this pyramid pointing in an anterior-inferior direction. In its typical anatomical orientation, the heart has 5 surfaces, formed by different internal divisions of the heart: • • • • • Anterior (or sternocostal) – Right ventricle. Posterior (or base) – Left atrium. Inferior (or diaphragmatic) – Left and right ventricles. Right pulmonary – Right atrium. Left pulmonary – Left ventricle. Surface Anatomy of Heart 3 Cardiac Surfaces and Relations Surface Anatomy of Heart 4 Orientation and Surfaces Surface Anatomy of Heart 5 Surface Landmarks of Heart Surface Anatomy of Heart 6 Points of Valve Projection The surface markings on the anterior chest wall of the cardiac valves is typically retrosternal: • pulmonary valve: junction of superior and middle thirds of body of sternum and slightly to the left side; near to left third costal cartilage • aortic valve: just below and to the right of the pulmonary valve on left side of middle third of sternum; level with the third intercostal space • tricuspid valve: median plane in the inferior third of the sternal body; opposite the fourth costal cartilage • mitral valve: overlapping tricuspid area but more superior and to the left of sternal body Surface Anatomy of Heart 7 Points of Valve Projection • The surface markings of the valves are not the same locations as the preferred sites of auscultation of murmurs which emanate from them. • This is because the murmurs are dependent on the proximity of the heart chambers to the thoracic cage and the direction of blood flow. Surface Anatomy of Heart 8 Points of Auscultations Surface Anatomy of Heart "lub-dub" 9 All People Enjoy Time Magazine! Surface Anatomy of Heart "lub-dub" 10 Borders Separating the surfaces of the heart are its borders. There are four main borders of the heart: • Right border – Right atrium • Inferior border – Left ventricle and right ventricle • Left border – Left ventricle (and some of the left atrium) • Superior border – Right and left atrium and the great vessels Surface Anatomy of Heart 11 Margins of Heart (Acute and Obtuse margins) Surface Anatomy of Heart 12 Axis and Margins Surface Anatomy of Heart 13 Outline of the heart (Cardiac silhouette) Surface Anatomy of Heart 14 Outline of the heart (Cardiac silhouette) Surface Anatomy of Heart 15 Sulci of the Heart The heart is a hollow structure. On the interior, it is divided into four chambers. These divisions create grooves on the surface of the heart – these are known as sulci. Surface Anatomy of Heart 16 • The coronary sulcus (or atrioventricular groove) runs transversely around the heart – it represents the wall dividing the atria from the ventricles. • The sinus contains important vasculature, such as the right coronary artery. • The anterior and posterior interventricular sulci can be found running vertically on their respective sides of the heart. • They represent the wall separating the ventricles. Surface Anatomy of Heart 17 Sulci of the Heart Surface Anatomy of Heart 18 Pericardial Sinuses The pericardial sinuses are passageways formed the unique way in which the pericardium folds around the great vessels. • The oblique pericardial sinus is a blind ending passageway (‘cul de sac’) located on the posterior surface of the heart. • The transverse pericardial sinus is found superiorly on the heart. • It can be used in coronary artery bypass grafting. Surface Anatomy of Heart 19 Surface Anatomy of Heart 20 Pericardial Sinuses Surface Anatomy of Heart 21 Pericardial Sinuses Surface Anatomy of Heart 22 Clinical Relevance: Transverse Pericardial Sinus The location of the transverse pericardial sinus is: • Posterior to the ascending aorta and pulmonary trunk. • Anterior to the superior vena cava. • Superior to the left atrium. In this position, the transverse pericardial sinus separates the arterial vessels (aorta, pulmonary trunk) and the venous vessels (superior vena cava, pulmonary veins) of the heart. This can be used to identify and subsequently ligate (to tie off) the arteries of the heart during coronary artery bypass grafting. Surface Anatomy of Heart 23 Surface Anatomy of Heart 24