PERICARDIUM AND HEART

anteriorlyby the ascending aorta and pulmonary trunk, 4 Lower half of the superior vena cava.
and posteriorly by the superior vena cava and inferiorly 5 Terminal part of the inferior vena cava.
by the left atrium; on each side it opens into the general 5 The terminal parts of the pulmonary veins.
pericardial cavity (Fig. 18.5).
The oblique sinus is a narrow gap behind the heart. It BIood Supply
is bounded anteriorly by the left atrium, and posteriorly The fibrous and parietaT pericardia are supplied by
by the parietal pericardium and oesophagus. On the branches from:
right and left sides it is bounded by reflections of
pericardium as shown in Fig. 18.5. Below, and to the 1 Internal thoracic.
left, it opens into the rest of the pericardial cavity. The 2 Musculophrenic arteries.
oblique sinus permits pulsations of the left atrium to 3 The descending thoracic aorta.
take place freely (Figs 18.4 and 18.5). 4 Veins drain into corresponding veins
Conlents of the Pericordium Nerve Supply
1 Heart with cardiac vessels and nerves. The fibrous and parietal pericardia are supplied by the
2 Ascending aorta. phrenic nerves. They are sensitive to pain. The
3 Pulmonary trunk. epicardium is supplied by autonomic nerves of the
heart, and is not sensitive to pain. Pain of pericarditis
originates in the parietal pericardium alone. On the
Ascending aorta other hand, cardiac pain or angina originates in the
cardiac muscle or in the vessels of the heart.
Arterial tube of pericardium

Pulmonary trunk

Arrow in transverse sinus Collection of fluid in the pericardial cavity is

referred to as pericardial effusion or cardiac
Left pulmonary veins tamponade. The fluid compresses the heart and
restricts venous filling during diastole. It also
reduces cardiac output. Pericardial effusion can
be drained by puncturing the left fifth or sixth
Arrow in oblique sinus intercostal space just lateral to the sternum, or in
the angle between the xiphoid process and left
Right pulmonary veins costal margin, with the needle directed upwards,
lnferior vena cava backwards and to the left (Fig. 18.6,).
Fig, 18.4: The pericardial cavity seen after removal of the heart. In mitral stenosis left atrium enlarges and com-
Note the reflections of pericardium, and the mode of formation presses the oesophagus causing dysphagia.
of the transverse and oblique sinuses

Parietal pericardium
Pulmonary Ascending
trunk aorta

Arrow in Right atrium

transverse
sinus

Left pulmonary vein Right

pulmonary
Left oblique sinus veln

Fig. 18.5: Transverse section through the upperpartof the heaft. Fig. 18.6: Drainage of pericardial effusion
Note that oblique sinus forms posterior boundary of left atrium
 THORAX

The surfaces are demarcated by upper, inferior, right

and left borders.
Feolules Grooves or Sulci
The heart is a conical hollow muscular organ situated The atria are separated from the ventricles by a circular
in the middle mediastinum. It is enclosed within the atrioaentricular or coronary sulcus. It is divided into
pericardium. It pumps blood to various parts of the anterior and posterior parts. Anterior part consists of
body to meet their nutritive requirements. The Greek right and left halves. Right half is oblique between right
name for the heart is cardin from which we have the auricle and right ventricle, lodging right coronary
adjective cardia. The Latin name for the heart is cor from artery. Left part is small between left auricle and left
which we have the adjective cororutry. ventricle, lodges circumflex branch of left coronary.
The heart is placed obliquely behind the body of the The coronary sulcus is overlapped anteriorly by the
sternum and adjoining parts of the costal cartilages, so ascending aorta and the pulmonary trunk. The inter-
that one-third of it lies to the right and two-thirds to atrial grootse is faintly visible posteriorly, while ante-
the left of the median p1ane. The direction of blood flow, riorly it is hidden by the aorta and pulmonary trunk.
from atria to the ventricles is downwards forwards and TIne anterior interaentricular grootse is nearer to the left
to the left. The heart measures about 12 x 9 cm and margin of the heart. It runs downwards and to the left.
weighs about 300 g in males and 250 g in females. The lower end of the groove separates the apex from
the rest of the inferior border of the heart. The posterior
EXIERNAT FEATURES interaentricular grootse is situated on the diaphragmatic
The human heart has four chambers. These are the right or inferior surface of the heart. It is nearer to the right
and left atria and the right and left ventricles. The atria margin of this surface (Fig. 18.8). The two
(Latin chamber) lie above and behind the ventricles. On interventricular grooves meet at the inferior border near
the surface of the heart, they are separated from the the apex.
ventricles by an atrioventricular groove. The atria are The crux of the heart is the point where posterior
separated from each other by an interatrial groove. The interventricular sulcus meets the coronary sulcus.
ventricles are separated from each other by an
interventricular groove, which is subdivided into Apex of the Heort
anterior and posterior parts (Fig. 18.7). Apex of the heart is formed entirely by the left ventricle.
It is directed downwards, forwards and to the left and
is overlapped by the anterior border of the left lung. It
is situated in the left fifth intercostal space 9 cm lateral
to the midstemal line just medial to the midclavicular
line. In the living subject, pulsations may be seen and
felt over this region (Fig. 18.7).
Upper border
Right border In children below 2years, apex is situated in the left
Left anterior part fourth intercostal space in midclavicular line.
of coronary (AV)
sulcus

Right Left border Upper border

anterior part
of coronary Anterior
(AV) sulcus interventri-
cular sulcus Superior
vena cava
Apex
Posterior part
lnferior border
of coronary
Fig. 18.7: Gross features: Sternocostal sufface of heart (AV) sulcus Right
pulmonary
VEINS

Left surface
The heart has
. An apex directed downwards, forwards and to
the left,
. Abase (posterior surface) directedbackwards; and
. Anterior/sternocostal
. Inferior and
. Left lateral surfaces. Fig. 18.8: The posterior aspect of the heart
 PEBICARDIUM AND HEART

4 The left border is oblique and curved. It is formed

mainly by the left ventricle, and partly by the left
Normally the cardiac apex or apex beat is on the left auricle. It separates the anterior and left surfaces of
side. In the condition called dextrocardia, the apex
the heart (Fig. 18.7). It extends from apex to left
is on the right side (Fig. 18.9). Dextrocardia may be
auricle.
part of a condition called situs inaersus in which all
thoracic and abdominal viscera are a mirror image Surfoces of the Heorl
of normal.
The anterior or sternocostal surface is formed mainly by
the right atrium and right ventricle, and partly by the
left ventricle and left auricle (Fig. 18.15). The left atrium
is not seen on the anterior surface as it is covered by
the aorta and pulmonary trunk. Most of the stemocostal
surface is covered by the lungs, but a part of it that
lies behind the cardiac notch of the left lung is
uncovered. The uncovered area is dull on percussion.
Clinically it is referred to as the area of superficial cardinc
dullness.
The inferior or diaphragmatic surface rests on the
central tendon of the diaphragm. It is formed in its left
two-thirds by the left ventricle, and in its right one-
third by the right ventricle. It is traversed by the
posterior interventricular groove, and is directed
downwards and slightly backwards (Fig. 18.8).
Theleft surface is formed mostly by the left ventricle,
and at the upper end by the left auricle. In its upper
part, the surface is crossed by the coronary sulcus. It is
related to the left phrenic nerve, the left peri-
cardiacophrenic vessels, and the pericardium.

Types of Circulolion
Bose of lhe Heorl There are two main types of circulations, systemic and
pulmonary. Table 18.1 shows their comparison.
The base of the heart is also called its posterior surface.
It is formed mainly by the left atrium and by a small
part of the right atrium.
In relation to the base one can see the openings of
four pulmonary veins which open into the left atrium; DISSECTION
and of the superior and inferior venae cavae (Latin, Cut along the upper edge of the right auricle by an
empty rsein) which open into the right atrium. It is related
incision f rom the anterior end of the superior vena caval
to thoracic five to thoracic eight vertebrae in the lying opening to the left side. Similarly cut along its lower
posture, and deicends by one vertebra in the erect edge by an incision extending from the anterior end of
posture. It is separated from the vertebral column by the inferior vena caval opening to the left side. lncise
the pericardium, the right pulmonary veins, the the anterior wall of the right atrium near its left margin
oesophagus and the aorla (see Figs 15.2 and 18.8).
and reflect the flap to the right (Fig. 18.10).
Borders of the Heorl On its internal surface, see the vertical crista
terminalis and horizontal pectinate muscles.
L The upper border is slightly oblique, and is formed
The fossa ovalis is on the interatrial septum and the
by the two atria, chiefly the left atrium. opening of the coronary sinus is to the left of the inferior
2 The rightborder is more or less vertical and is formed
vena caval opening.
by the right atrium. It extends from superior vena
Define the three cusps of tricuspid valve.
cava to inferior vena cava (IVC).
3 The inferior border is nearly horizontal and is formed
mainly by the right ventricle. A small part of it near Posilion
the apex is formed by left ventricle. It extends from The right atrium is the right upper chamber of the heart.
IVC to apex. It receives venous blood from the whole body, pumps
 THORAX

Systemic circulation Pulmonary circulation

Left ventricle Bight ventricle
I I
J J
Aortic valve Pulmonary valve
I

noh"
I
Pulmonary trunk and pulmonary arteries
I I
J J
Oxygenated blood to all tissues except lungs Only to lungs
I
I
J
Venous blodd collected Deoxygenated blood gets oxygenated
I I

J J
Superior vena cava and inferior vena cava 4 pulmonary veins
I I

J J
Right atrium left atrium

Left common carotid artery Left subclavian artery

Right brachiocephalic vein Left brachiocephalic vein

Brachiocephalic artery

Superior vena cava Left pulmonary artery

Right pulmonary artery

Pulmonary trunk
Left auricle
Right border Left border

Right akium Left ventricle

Right ventricle
Line of incision
Anterior interventricular g roove
Coronary sulcus
Posterior interventricular groove

Apex
lnferior vena cava
lnferior border
Fig.18.10: Externalfeatures of heart; (1) Line of incision for right atrium, (2) for right ventricle, and (3) for left ventricle

it to the right ventricle through the right notched and the interior is sponge-like, which
atrioventricular or tricuspid opening. It forms the right prevents free flow of blood.
border, part of the upper border, the sternocostal Along the right border of the atrium there is a
surface and the base of the heart (Fig. 18.7). shallow vertical groove which passes from the
superior vena cava above to the inferior vena cava
ExlemolFeotures below. This groove is called the sulcus terminalis.It
is produced by an internal muscular ridge called the
1 The chamber is elongated vertically, receiving the crista terminalis (Fi9.18.11). The upper part of the
superior vena cava at the upper end and the inferior sulcus contains the sinuatrial or SA node which acts
vena cava at the lower end (Fig. 18.11). as the pacemaker of the heart.
2 The upper end is prolonged to the left to form the The right atrioventricular groove separates the right
right auricle (Latin little ear). The auricle covers the atrium from the right ventricle. It is more or less
root of the ascending aorta and partly overlaps the vertical and lodges the right coronary artery and the
infundibulum of the right ventricle. Its margins are small cardiac vein.
 PERICARDIUM AND HEART

Tilbutories or Inlets of lhe Right Atrium d, The venae cordis minimi are numerous small veins
L Superior vena cava. present in the walls of all the four chambers. They
2 Inferior vena cava. open into the right atrium through small foramina.
3 Coronary sinus. 3 The interutenous tubercle of Lower is a very small pro-
4 Anterior cardiac veins. jection, scarcely visible, on the posterior wall of the
5 Venae cordis minimi (thebesian veins). atrium just below the opening of the superior vena
6 Sometimes the right marginal vein. cava, During embryonic life it directs the superior
caval blood to the right ventricle.
Right Atilovenlriculor Orifice
Blood passes out of the right atrium through the right
atrioventricular or tricuspid orifice and goes to the right fheAurusfe
ventricle. The tricuspid orifice is guarded by the 1. Developmentally it is derived from the primitive
tricuspid valve which maintains unidirectional flow of atrial chamber.
blood (Fig. 18.11). 2 It presents a series of transverse muscular ridges
lnlelnol Feolures called musculi pectinati (Fig. 18.11).
The interior of the right atrium can be broadly divided
They arise from the crista terminalis and run for-
into the following three parts. wards and downwards towards the atrioventricular
orifice, giving the appearance of the teeth of a comb.
$moofft FosferfcrFarfor$emus ff#r&,irn In the auricle, the muscles are interconnected to form
1 Developmentally it is derived from the right horn of a reticular network.
the sinus venosus.
2 Most of the tributaries except the anterior cardiac Jffifersfrisl $epfum
veins open into it. L Developmentally it is derived from tl:.e septum
a The superior oena cara opens at the upper end. primum and septum secundum.
b The inferior z)ena cara opens at the lower end. 2 It presents the fossa oaalis, a shallow saucer-shaped
The opening is guarded by a rudimentary valve depression, in the lower part. The fossa represents
of the inferior vena cava or eustachian aalue.Dtrring the site of the embryonic septum primum.
embryonic life the valve guides the inferior vena 3 T}ne annulus oaalis or limbus (Latin a border) fossa oaalis
caval blood to the left atrium through theforamen is the prominent margin of the fossa ovalis. It
oaale. represents the lower free edge of the septum
c. The coronary sinus opens between the opening of secundum. It is distinct above and at the sides of the
the inferior vena cava and the right atrioven- fossa ovalis, but is deficient inferiorly. Its anterior
tricular orifice. The opening is guarded by tl:re rsakte edge is continuous with the left end of the valve of
of the coronary sinus or thebesian aalae. the inferior vena cava.

Ascending aorta

Pulmonary trunk

Superior vena cava

Right auricle
Right pulmonary artery

Rlght pulmonary veins Musculi pectinati

lnteratrial septum

Limbus fossa ovalis

Crista terminalis
Right atrioventricular
Fossa ovalis orifice and valve

Opening of coronary sinus

Valve of inferior vena cava

Fig. 18.11: lnterior of right atrium

 THORAX

4 The remains of the foramen oaale are occasionally a. The inflowing part is rough due to the presence of
present. This is a small slit-like valvular opening muscular ridges called trabeculae carneae. It
between the upper part of the fossa and the limbus. It develops from the proximal part of bulbus cordis
is normally occluded after birth, but may sometimes of the heart tube.
persist. b. The outflowing part or infundibulurn is smooth
and forms the upper conical part of the right
ventricle which gives rise to the pulmonary trunk.
It develops from the mid portion of the bulbus
cordis.
The two parts are separated by a muscular ridge called
the supraaentricular crest or infundibulo-ventriculat crest
till you reach the inferior border. Continue to incise
along the inferior border till the inferior end of anterior situated between the tricuspid and pulmonary orifices.
interuentricular groove. Next cut along the infundibulum.
lnternol Feoiures
Now the anterior walFof right ventricle is reflected to
the left to study its interior. 1 The interior shows two orifices:
a The right atrioventricular or tricuspid orifice,
Position
guarded by the tricuspid valve.
b. The pulmonary orifice guarded by the pulmonary
The right ventricle is a triangular chamber which valve (Fig. 1.8.12).
receives blood from the right atrium and pumps it to 2 The interior of the inflowing part shows trabeculae
the lungs through the pulmonary trunk and pulmonary carneae or muscular ridges of three types:
arteries. It forms the inferior border and a large part of a. Ridges or fixed elevations
the sternocostal surface of the heart (Fig. 18.7). b. Bridges
c. Pillars or papillary muscles with one end attached
Exlelnol Feolules to the ventricular wall, and the other end
1. Externally, the right ventricle has two surfaces- connected to the cusps of the tricuspid valve by
anterior or sternocostal and inferior or diaphrag- chordae tendinae (Latin strings to stretch). There
matic. are three papillary muscles in the right ventricle,
2. The interior has two parts: anterior, posterior and septal. The anterior muscle

Arch of aorta with three branches

Superior vena cava

Supraventricular crest

Anterior cusp of tricuspid valve

Moderator band

lnferior vena cava

Chorda tendinae
Apex of heart
Anterior papillary muscle

Fig. 18.12: lnterior of the right ventricle. Note the moderator band and the supraventricular crest
 PERICARDIUM AND HEART

is the largest (Fig. 18.12). The posterior or inferior

muscle is small and irregular. The septal muscle is
divided into a number of little nipples. Each
papillary muscle is attached by chordae tendinae
to the contiguous sides of two cusps (Fig. 18.13). SA node

The septomarginal trabecula or moderator band is AV bundle and

left branch
a muscular ridge extending from the ventricular
septum to the base of the anterior papillary muscle.
AV node
It contains the right branch of the AV bundle
(Figs 18.12 and 18.14).
The cavity of the right ventricle is crescentic in section Right branch of
because of the forward bulge of the interventricular AV bundle

septum (Fig. 18.15).

Purkinje fibres

Fibrous ring Cusp

Moderator band
Fig. 18.14: The conducting system of the heart

5 The wall of the right ventricle is thinner than that

of the left ventricle in a ratio of 1:3.
lntervenlliculor Seplum
The septum is placed obliquely. Its one surface faces
forwards and to the right and the other faces backwards
and to the left. The upper part of the septum is thin
and membranous and separa-tes not only the two
ventricles but also the right atrium and left ventricle'
The lower part is thick muscular and separates the two
ventricles. Its position is indicated by the anterior and
Fig. 18.13: Structure of an atrioventricular valve posterior interventricular grooves (Fig. 18.15).

Sternocostal/anterior surface
2l3rd 1/3rd

Pulmonary orifice Anterior interventricular groove

Right ventricle Aortic orifice

Septal papillary muscle Left ventricle

Anterior papillary muscle

Tricuspid orifiie

Anterior papillary muscle Mitral orifice

Posterior or inferior papillary muscle Posterior papillary muscle

Posterior interventricular groove

lnterventricular septum

1/3rd 2l3rd
Diaphragmaticiinferior surface

Fig. 1 8.15: Schematic transverse section through the ventricles of the heart showing the atrioventricular orif ices, papillary muscles,
and the pulmonary and aoftic orifices
 THORAX

DISSECTION DISSECTION
Cut off the pulmonary trunk and ascending aorta, Open the left ventricle by making a bold incision on the
immediately above the three cusps of the pulmonary ventricular aspect of atrioventricular groove below left
and aortic valves. Remove the upper part of the left auricle and along whole thickness of left ventricle from
atrium to visualise its interior (Fig. 18.29b). See the above downwards till its apex. Curve the incision
upper surface of the cusps of the mitral valve. Revise towards right till the inferior end of anterior inter-
the fact that left atrium forms the anterior wall of the ventricular groove. Reflect the flap to the right and clean
oblique sinus of the pericardium (Fig. 18.5). the atrioventricular and aortic valves (Fig. 18.10).
Remove the surface layers of the myocardium. Note
Posilion
the general directions of its fibres and the depth of the
The left atrium is a quadrangular chamber situated coronary sulcus, the wall of the atrium passing deep to
posteriorly. Its appendage, tii.e left auricle projects the bulging ventricular muscle. Dissect the musculature
anteriorly to overlap the infundibulum of the right and the conducting system of the heart.
ventricle. The left atrium forms the left two-thirds of
the base of the heart, the greater part of the upper
Posilion
border, parts of the sternocostal and left surfaces and
of the left border. It receives oxygenated blood from The left ventricle receives oxygenated blood from the
the lungs through four pulmonary veins, and pumps it left atrium and pumps it into the aorta. It forms the
to the left ventricle through the left atrioventricular or apex of the hearf, a part of the sternocostal surface, most
bicuspid (Latin two tooth point) or mitral orifice (Latin of the left border and left surface, and the left two-thirds
like bishop's mitre) which is guarded by the valve of the of the diaphragmatic surface (Figs 18.7 and 18.8).
same name.
Feolures
Feotures L Externally, the left ventricle has three surfaces-
1 The posterior surface of the atrium forms the anterior anterior or sternocostal, inferior or diaphragmatic,
wallof the oblique sinus of pericardium (Fig. 18.5). and left.
2 The anterior wall of the atrium is formed by the 2 The interior is divisible into two parts.
interatrial septum. a. The lower rough part with trabeculae carneae
3 Two pulmonary veins open into the atrium on each develops from the primitive ventricle of the heart
side of the posterior wall (Fig. 18.8).
tube (Fig. 18.16).
4 The greater part of the interior of the atrium is smooth b. The upper smooth part or aortic vestibule gives
walled. It is derived embryologically from the
origin to the ascending aorta: It develops from the
absorbed pulmonary veins which open into it.
mid portion of the bulbus cordis. The vestibule
Musculi pectinati are present only in the auricle where
lies between the membranous part of the inter-
they form a reticulum. This part develops from the
ventricular septum and the anterior or aortic cusp
original primitive atrial chamber of the heart tube.
of the mitral valve.
The septalwall shows the fossa lunata corresponding
to the fossa ovalis of the right atrium. In addition to 3 The interior of the ventricle shows two orifices.
the four pulmonary veins, the tributaries of the atrium a. The left atrioventricular or bicuspid or mitral
include a few venae cordis minimi. orifice, guarded by the bicuspid or mitral valve.
Table 18.2 compares the right atrium and the left b. The aortic orifice, guarded by the aortic valve
atrium. (Fig. 18.15).

Table 18.2: Comparison of right atrium and left atrium

Right atrium Left atrium
Receives venous blood of the body Receives oxygenated blood from lungs
Pushes blood to right ventricle through tricuspid valve Pushes blood to left ventricle through bicuspid valve
Forms right border, paft of sternocostal and Forms major part of base of the heart
small part of base of the heart
Enlarged in tricuspid stenosis Enlarged in mitral stenosis
 PERICARDIUM AND HEART

is the largest (Fig. 78.12). The posterior or inferior

muscle is small and irregular. The septal muscle is
divided into a number of little nipples. Each
papillary muscle is attached by chordae tendinae
to the contiguous sides of two cusps (Fig. 18.13). SA node

The septomarginal trabecula or moderator band is AV bundle and

left branch
a muscular ridge extending from the ventricular
septum to the base of the anterior papillary muscle.
AV node
It contains the right branch of the AV bundle
(Figs 18.12 and L8.14).
The cavity of the right ventricle is crescentic in section Right branch of
because of the forward bulge of the interventricular AV bundle
septum (Fig. 18.15).
Purkinje fibres

Fibrous ring Cusp

Moderator band
Fig. 18.14: The conducting system of the heart

5 The wall of the right ventricle is thirurer than that

of the left ventricle in a ratio of 1:3.
!nlervenlilculol Seplum
The septum is placed obliquely. Its one sudace faces
forwards and to the right and the other faces backwards
and to the left. The upper part of the septum is thin
and membranous and separa-tes not only the two
ventricles but also the right atrium and left ventricle.
The lower part is thick muscular and separates the two
ventricles. Its position is indicated by the anterior and
Fig. 18.13: Structure of an atrioventricular valve posterior interventricular grooves (Fig. 18.15).

Sternocostal/anterior su rface
2l3rd 1/3rd

Pulmonary orifice Anterior interventricular groove

Right ventricle Aortic orifice

Septal papillary muscle Left ventricle

Anterior papillary muscle

Tricuspid orifiCe

Anterior papillary muscle Mitral orifice

Posterior or inferior papillary muscle Posterior papillary muscle

Posterior interventricular groove

lnterventricular septum

1l3rd 2l3rd
Diaphragmatic/inferior su rface

Fig. 18.15: Schematic transverse section through the ventricles of the heart showing the atrioventricular orifices, papillary muscles,
and the pulmonary and aortic orifices
 THORAX

DISSECTION DISSECTION
Cut off the pulmonary trunk and ascending aorta, Open the left ventricle by making a bold incision on the
immediately above the three cusps of the pulmonary ventricular aspect of atrioventricular groove below left
and aortic valves. Remove the upper part of the left auricle and along whole thickness of left ventricle from
atrium to visualise its interior (Fig. 18.29b). See the above downwards till its apex. Curve the incision
upper surface of the cusps of the mitral valve. Revise towards right till the inferior end of anterior inter-
the fact that left atrium forms the anterior wall of the ventricular groove. Reflect the flap to the right and clean
oblique sinus of the pericardium (Fig. 18.5). the atrioventricular and aortic valves (Fig. 18.10).
Remove the surface layers of the myocardium. Note
Posilion
the general directions of its fibres and the depth of the
The left atrium is a quadrangular chamber situated coronary sulcus, the wall of the atrium passing deep to
posteriorly. Its appendage, the left auricle projects the bulging ventricular muscle. Dissect the musculature
anteriorly to overlap the infundibulum of the right and the conducting system of the heart.
ventricle. The left atrium forms the left two-thirds of
the base of the heart, the greater part of the upper
Position
border, parts of the sternocostal and left surfaces and
of the left border. It receives oxygenated blood from The left ventricle receives oxygenated blood from the
the lungs through four pulmonary veins, and pumps it left atrium and pumps it into the aorta. It forms the
to the left ventricle through the left atrioventricular or apex of the heart, a part of the stemocostal surface, most
bicuspid (Latin two tooth point) or mitral orifice (Latin of the left border and left surface, and the left two-thirds
like bishop's mitre) which is guarded by the valve of the of the diaphragmatic surface (Figs 18.7 and 18.8).
same name.
Feotures
Feotures L Externally, the left ventricle has three surfaces-
L The posterior surface of the atrium forms the anterior anterior or sternocostal, inferior or diaphragmatic,
wall of the oblique sinus of pericardium (Fig. 18.5). and left.
2 The anterior wall of the atrium is formed by the 2 The interior is divisible into two parts.
interatrial septum. a. The lower rough part with trabeculae carneae
3 Two pulmonary veins open into the atrium on each
develops from the primitive ventricle of the heart
side of the posterior wall (Fig. 18.8).
tube (Fig. 18.15).
4 The greater part oI the interior of the atium is smooth b. The upper smooth part or aortic vestibule gives
walled. It is derived embryologically from the origin to the ascending aorta: It develops from the
absorbed pulmonary veins which open into it. mid portion of the bulbus cordis. The vestibule
Musculi pectinati are present only in the auricle where
lies between the membranous part of the inter-
they form a reticulum. This part develops from the
ventricular septum and the anterior or aortic cusp
original primitive atrial chamber of the heart tube. of the mitral valve.
The septalwall shows the fossa lunata corresponding
to the fossa ovalis of the right atrium. In addition to 3 The interior of the ventricle shows two orifices.
the fourpulmonaryveins, the tributaries of the atrium a. The left atrioventricular or bicuspid or mitral
include a few venae cordis minimi. orifice, guarded by the bicuspid or mitral valve.
Table 18.2 compares the right atrium and the left b. The aortic orifice, guarded by the aortic valve
atrium. (Fig. 18.15).

Table 18.2: Comparison of right atrium and left atrium

Right atrium Left atrium
Receives venous blood of the body Receives oxygenated blood from lungs
Pushes blood to right ventricle through tricuspid valve Pushes blood to left ventricle through bicuspid valve
Forms right border, part of sternocostal and Forms major pad of base of the heart
small part of base of the head
Enlarged in tricuspid stenosis Enlarged in mitral stenosis
 PERICARDIUM AND HEART

Arch of aorta

Pulmonary trunk

Left atrium
Anterior papillary muscle

Anterior cusp of left AV opening

Chordae tendinae

Circumflex branch of left coronary

artery and great cardiac vein

Fig" 18.16: lnterior of left atrium and left ventricle

4 There are two well-developed papillary muscles, ultimately the rising back pressure causes right
anterior and posterior. Chordae tendinae from both sided failure (congestive cardiac failure or CCF)
muscles are attached to both the cusps of the mitral which is associated with increased venous
valve. pressure, oedema on feet, and breathlessness on
5 The cavity of the left ventricle is circular in cross- exertion. Heart failure (right sided) due to lung
section (Fig. 18.15). disease is known as cor pulmonale.
6 The walls of the left ventricle are three times thicker
than those of the right ventricle.
Table 18.3 compares the right ventricle and the left
ventricle.
LVES

. The valves of the heart maintain unidirectional flow of

The area of the chest wall overlying the heart is
the blood and prevent its regurgitation in the opposite
called tii.e precordium.
direction. There are two pairs of valves in the heart, a
Rapid pulse or increased heart rate is called
pair of atrioventricular valves and a pair of semilunar
tachycardia (Greek rapid heart).
valves. The right atrioventricular valve is known as the
Slow pulse or decreased heart rate is called tricuspid valve because it has three cusps. The left
bradycardia (Greek slow heart).
atrioventricular valve is known as the bicuspid valve
Irregular pulse or irregular heart rate is called
because it has two cusps. It is also called the mitral
arrhythmia.
o Consciousness of one's heartbeat is called valve. The semilunar valves include the aortic and
pulmonary valves, each having three semilunar cusps.
palpitation.
o Inflammation of the heart can involve more than The cusps are folds of endocardium, strengthened by
an intervening layer of fibrous tissue (Fig. 18.17).
one layer of the heart. Inflammation of the
pericardium is called pericarditis; of the myo- Atrioventriculor Volves
cardium is myocarditis; and of the endocardium is
endocarditis. L Both valves are made up of the following com-
. Normally the diastolic pressure in ventricles is ponents.
zero. Apositive diastolic pressure in the ventricle a. A fibrous ring to which the cusps are attached
is evidence of its failure. Any one of the four (Fig. 18.13).
chambers of the heart can fail separately, but b. The cusps are flat and project into the ventricular
cavity. Each cusp has an attached and a free
 THORAX

Table 1 of right ventricle and left ventricle

Right ventricle Left ventricle
Thinner than left, 1/3 thickness of Much thicker than right, 3 times thicker than right
left ventricle ventricle
Pushes blood only to the lungs Pushes blood to top of the body and down to the toes
Contains three small papillary muscles Contains two strong papillary muscles
Cavity is crescentic Cavity is circular
Contains deoxygenated blood Contains oxygenated blood
Forms 2/3rd sternocostal and 1/3rd Forms 1/3rd sternocostal and 2l3rd diaphragmatic surfaces
diaphragmatic surfaces

Bicuspid valve
Pulmonary
valve Aortic valve

Tricuspid valve

Papillary muscle

lnterventricu lar Left coronary Right coronary

septum artery artery

Fig. 18.17: lnterior of hearl Fig. 18,18: Structure of the aortic valve

margin, and an atrial and a ventricular surface. 3 The tricuspid valve has three cusps and can admit
The atrial surface is smooth (Fig. 18.15). The free the tips of three fingers. The three cusps, the anterior,
margins and ventricular surfaces are rough and posterior or inferior, and septal lie against the three
irregular due to the attachment of chordae walls of the ventricle. Of the three papillary muscles,
tendinae. The aaloes are closed during aentricular the anterior is the largest, the inferior is smaller and
systole (Greekcontraction)by apposition of the atrial irregular, and the septal is represented by a number
surfaces near the serrated margins (Fig. 18.15). of small muscular elevations.
c. The chordae t€ndinae cormect the free margins and 4 The mitral or bicuspid valve has two cusps, a large
ventricular surfaces of the cusps to the apices of the anterior or aortic cusp, and a small posterior cusp. It
papillary muscles. They prevent eversion of the admits the tips of two fingers. The anterior cusp lies
free margins and limit the amount of ballooning between the mitral and aortic orifices. The mitral
of the cusps towards the cavity of the atrium. cusps are smaller and thicker than those of the
d. The atrioventricular valves are kept competent by tricuspid valve.
active contraction of the papillary muscles, which
pull on the chordae tendinae during ventricular Semilunor Volves
systole. Each papillary muscle is connected to the L The aortic and pulmonary valves are called semilunar
contiguous halves of two cusps (Figs 18.13 and valves because their cusps are semilunar in shape.
18.18). Both valves are similar to each other (Fig. 78.17).
Blood vessels are present only in the fibrous ring and 2 Each valve has three cusps which are attached
in the basal one-third of the cusps. Nutrition to the directly to the vessel wall, there being no fibrous ring.
central two-thirds of the cusps is derived directly The cusps form small pockets with their mouths
from the blood in the cavity of the heart. directed away from the ventricular cavity. The free
 PERICARDIUM AND HEART

margin of each cusp contains a central fibrous nodule Fibrous Skelelon

from each side of which a thin smooth margin The fibrous rings surrounding the atrioventricular and
the lunule extends up to the base of the cusp. These arterial orifices, along with some adjoining masses of
oalztes are closed during uentricular diastole when fibrous tissue, constitute the fibrous skeleton of the
each cusp bulges towards the ventricular cavity heart. It provides attachment to the cardiac muscle and
(Fig. 18.17). keeps the cardiac valve competent (Fig. 18.20).
3 Opposite the cusps the vessel walls are slightly The atriouentricular fibrous rings are in the form of
dilated to form the aortic and pulmonary sinuses. the figure of 8. The atria, the ventricles and the
The coronary arteries arise from the anterior and the membranous part of the interventricular septum are
left posterior aortic sinuses (Fig. 18.18). attached to them. There is no muscular continuity
between the atria and ventricles across the rings except
for the atrioventricular bundle or bundle of-between
His.
There is large mass of fibrous tissue the
The first heart sound is produced by closure of atrioventricular rings behind and the aortic ring in front.
the atrioventricular valves. The second heart It is known as the trigonum fibrosum dextrum.In some
sound is produced by closure of the semilunar mammals like sheep, a small bone the os cordis is present
valves (Figs 18.19a and b). in this mass of fibrous tissue.
Narrowing of the valve orifice due to fusion of Another smaller mass of fibrous tissue is present
the cusps is known as 'stenosis', yiz. mitral between the aortic and mitral rings. It is known as the
stenosis, aortic stenosis, etc. trigonum fibrosum sinistrum. The tendon of the infundi-
Dilatation of the valve orifice, or stiffening of the bulum (close to pulmonary valve) binds the posterior
cusps causes imperfect closure of the valve surface of the infundibulum to the aortic ring.
leading to back flow of blood. This is known as
incompetence or regurgitation, e.g. aortic Musculolure of the Heorl
incompetence or aortic regurgitation. Cardiac muscle fibres form long loops which are
attached to the fibrous skeleton. Upon contraction of the
muscular loops, the blood from the cardiac chambers is
wrung out like water from a wet cloth. The atrial fibres
are arranged in a superficial transverse layer and a deep
anteroposterior (vertical) layer.
The ventricular fibres are arranged in superficial
and deep layers.
The superficial fibres arise from skeleton of the heart
to undergo a spiral course. First these pass across the
inferior surface, wind round the lower border and then

Anterior
Pulmonary Tendon of infundibulum
valve
Aortic valve
Origin of left
coronary aftery Origin
of right
coronary
Trigonu
artery
fibrosum
sinistrum
Risht

Tricuspid
valve
Mitral valve Trigonum
Posterior fibrosum dextrum

Fig. 18.20: Heart seen from above after removing the atria. The
mitral, tricuspid, aortic and pulmonary orifices and their valves
Figs 18.1 9a and b: (a) First heart sound, and (b) second heart
are seen. The fibrous skeleton of the heart is also shown
sound (anatomical position)
 THORAX

across the sternocostal surface to reach the apex of

heart, where these fibres form a vortex and continue
with the deep layer.
Superficial fibres are:
a. Fibres start from tendon of infundibulum (1) pass
across the diaphragmatic surface, curve around
inferior border to reach the sternocostal surface.
Then these fibres cross the anterior interventri-
cular groove to reach the apex, where these form
a vortex and end in anterior papillary muscle of
left ventricle (Fig. 19.2la).
b. Fibres arise from right AV ring take same course
as (2) but end in posterior papillary muscle
(Fig. 18.21a).
c. Fibres arise from left AV ring, lie along the
diaphragmatic surface, cross the posterior inter-
ventricular groove to reach the papillary muscles
of right ventricle (Fig. 18.21b).
d. Deep fibres are 'S' shaped. These arise from Fig. 18.21a: Superficial transverse fibres of atria and superficial
papillary muscle of one ventricle, turn in inter- fibres of ventricles 1, 2
ventricular groove, to end in papillary muscle of
other ventricle. Fibres of first layer circle RV, cross
through interventricular septum and end in
papillary muscle of LV. Layers two and three have
decreasing course in RV and increasing course in
LV (Fig. 18.21c).

CONDUCTING SYSTEM
The conducting system is made up of myocardium
that is specialised for initiation and conduction of the Vertical
flbres of atria
cardiac impulse. Its fibres are finer than other
myocardial fibres, and are completely cross-striated.
The conducting system has the following parts.
I Sinuatrial node or SA node: It is known as the
'pacemaker' of the heart. It generates impulses at the
rate of about 70-1,00 beats/min and initiates the
heartbeat. It is horseshoe-shaped and is situated at
the atriocaval junction in the upper part of the sulcus
terminals. The iinpulse travels through the atrial wall Fig.18.21b: Vertical fibres of atria and superficial fibres of
to reach the AV node (Fig. 18.14). ventricle 3
2 Atrioaentricular node or AV node: It is smaller than
the SA node and is situated in the lower and dorsal
part of the atrial septum just above the opening of
the coronary sinus. It is capable of generating
impulses at a rate of about 40 to 60 beats/min.
3 Atriooentricular bundle or AV bundle or bttndle of His: It
is the only muscular connection between the atrial
and ventricular musculatures. It begins as the
atrioventricular (AV) node crosses AV ring and
descends along the posteroinferior border of the
membranous part of the ventricular septum. At the
upper border bf tne muscular part of the septum, it
divides into right and left branches. Fig. 18.21c: Deep fibres of ventricles in three layers
 PERICARDIUM AND HEART

4 The r t brnnch of the AV bundle passes down the

right side of the interventricular septum. A large part 1 It first passes forwards and to the right to emerge
enters the moderator band to reach the anterior wall on the surface of the heart between the root of the
of the right ventricle where it divides into Purkinje pulmonary trunk and the right auricle.
fibres. 2 It then runs downwards in the right anterior
5 The left branch of the AV bundle descends on the coronary sulcus to the junction of the right and
left side of the interventricular septum and is inferior borders of the heart.
distributed to the left ventricle #ter dividing into 3 It winds round the inferior border to reach the
Purkinje fibres. diaphragmatic surface of the heart. Here it runs
6. The Purkinje fibres form a subendocardial plexus. backwards and to the left in the right posterior
They are large pale fibres striated only at their coronary sulcus to reach the posterior inter-
margins. They usually possess double nuclei. These ventricular groove.
generate impulses at the rate oI20-35 beats/minute. 4 It terminates by anastomosing with the circumflex
branch of left coronary artery at the crux.

Defects of or damage to conducting system results

Ss'*n*f:*s
in cardiac arrhythmias, i.e. defects in the normal I La branches
rhythm of contraction. Except for a part of the left a. Marginal.
branch of the AV bundle supplied by the left b. Posterior interventricular.
coronary artery, the whole of the conducting system 2 Small branches
is usually supplied by the right coronary artery. a. Nodallr.60% cases.
Vascular lesions of the heart can cause a variety of b. Right atrial.
arrhythmias. c. Infundibular.
d. Terminal.
e. Right ventricular
f. Conus

Ares *f #gs 6iff#F?

The heart is supplied by two coronary arteries, arising
1 Right atrium
from the ascending aorta. Both arteries run in the
coronary sulcus.
2 Ventricles
a. Greater part of the right ventricle, except the area
adjoining the anterior interventricular groove.
b. A small part of the left ventricle adjoining the
posterior interventricular groove.
DISSECIION 3 Posterior part of the interventricular septum.
Carefully remove the fat from the coronary sulcus. 4 Whole of the conducting system of the heart except
a part of the left branch of the AV bundle. The SA
ldentify the right coronary artery in the depth of the right
part of the atrioventricular sulcus. node is supplied by the left coronary artery in about
40% of cases.
Trace the right coronary artery superiorly to its
origin from the right aortic sinus and inferiorly till it turns
onto the posterior surface of the heart to lie in its
atrioventricular sulcus. lt gives off the posterior inter-
ventricular branch which is seen in posterior inter- DISSECTION
ventriculal groove.
Strip the visceral pericardium from the sternocostal
The right coronary aftery ends by anastomosing with surface of the heart. Expose the anterior interventricular
the circumflex branch of left coronary artery or by branch of the left coronary artery and the great cardiac
dipping itself deep in the myocardium there. vein by carefully removing the fat from the anterior
interventricular sulcus. Note the branches of the artery
Position to both ventricles and to the interventricular septum
which lies deep to it. Trace the artery inferiorly to the
Right coronary artery is smaller than the left coronary diaphragmatic sudace and superiorly to the left of the
artery. It arises from the anterior aortic sinus pulmonary trunk.
(Figs 18.22a and b) of ascending aorta.
 THOBAX

Anterior
Trace the circumflex branch of left coronary artery Pulmonary
on the left border of heart into the posterior part of Anterior
Anterior aortic sinus
the sulcus, where it may end by anastomosing with the interventricu la r Right coronary
right coronary artery or by dipping into the myocardium. branch of the left artery
coronary artery

Posilion Marginal
Left branch
Left coronary artery is larger than the right coronary posterior
artery. It arises from the left posterior aortic sinus of aortic Right
SINUS
ascending aortic.
Left
Caurse
1 The artery first runs forwards and to the left and
emerges between the'pulmonary trunk and the left
auricle. Here it gives the anterior interaentricular
branch which runs downwards in the groove of the A=Anterior P= Posterior S =Septal
same name. The further continuation of the left
coronary artery is called the circumflex artery Fig. 18.23: Origin of the coronary arteriesfrom the aorticsinuses
and their course in the coronary sulcus, as seen after removal
(Figs1B.22a and b and18.23).
of the atria (anatomical position)
2 After giving off the anterior interventricular branch
the artery runs to the left in the left anterior coronary 2 Small branches
sulcus. a. Left atrial
3 It winds round the left border of the heart and b. Pulmonary
continues in the left posterior coronary sulcus. Near c. Terminal
the posterior interventricular groove it terminates by
anastomosing with the right coronary artery. Areoof Eis utian
1 Left atrium
Branches 2 Ventricles
I Large branches a. Greater part of the left ventricle, except the area
a. Anterior interventricular. adj oining the posterior interventricular groove.
b: Branches to the diaphragmatic surface of the left b. A small part of the right ventricle adjoining the
ventricle, including a large diagonal branch. anterior interventricular groove.

Ascending aorta
Left coronary artery

Circumflex branch

Circumflex
branch
of left
coronary
artery

Right
coronary
artery

Marginal branch Anterior

Posterior interventricular branch interventricular
branch
(a)

Figs 18.22a and b: Arterial supply of heart: (a) Sternocostal surface, and (b) diaphragmatic surface
 PERICABDIUM AND HEART

Area supplied by the Posterior Posterior These anastomoses are of little ptactical value. They
right coronary artery interventricular are not able to provide an alternative source of blood
groove
in case of blockage of a branch of a coronary. Blockage
of arteries or coronary thrombosis usually leads to
Left ventricle
death of myocardium. The condition is called myo-
cardial infarction.
Right

Right ventricle Thrombosis of coronary artery is a common cause

of sudden death in persons past middle age. This
is due to myocardial infarction and ventricular
Area supplied
fibrillation (Fig. 18.25).
Anterior Incomplete obstruction, usually due to spasm of
by the left
intenventricular oroove
Anterior coronary artery the coronary artery causes angina pectoris, which
Fig. 18.24: Transverse section through the ventricles showing is associated with agonising pain in the precordial
the areas supplied by the two coronary arteries region and down the medial side of the left arm
and forearm (Fig. 78.26). Pain gets relieved by
putting appropriate tablets below the tongue.
3 Anterior part of the interventricular septum Coronary angiography determines the site(s) of
(Fis. 18.24). narrowing or occlusion of the coronary arteries
4 A part of the left branch of the AV bundle. or their branches.
Angioplasty helps in removal of small blockage.
Cordioc Dominonce It is done using small stent or small inflated
In about 10% of hearts, the right coronary is rather small balloon (Fig. 18.27) through a catheter passed
and is not able to give the posterior interventricular upwards through femoral artery, aorta, into the
branch. In these cases the circumflex artery, the coronary artery.
continuation of left coronary provides the posterior If there are large segments or multiple sites of
interventricular branch as well as to the AV node. Such blockage, coronary bypass is done using either
cases are called left dominant. great saphenous vein or internal thoracic artery
Mostly the right coronary giv inter- as graft(s) (Fig. 18.28).
ventricular artery. Such hearts are ri t. Thus
the artery giving the posterior interventricular branch
is the dominant artery.

Collolerol Circulolion

The two coronary arteries anastomose with each other

in myocardium.

The coronary arteries anastomose with the following:

1 Vasa vasorum of the aorta.
2 Vasa vasorum of the pulmonary arteries.
3 The internal thoracic arteries.
4 The bronchial arteries.
5 The phrenic arteries. The last three anastomose
through the pericardium. These channels may open
up in emergencies when both coronary arteries are
obstructed.
Fig. 18.25: Myocardial infarction due to blockage of anterior
Retrograde flow of blood in the oeins may irrigate the interventricular branch of left coronary artery
myocardium.
 THORAX

These are the great cardiac vein, the middle cardiac

vein, the right marginal vein, the posterior vein of the
left ventricle, the oblique vein of the left atrium, the
Precordium
anterior cardiac veins, and the venae cordis minimi
(Figs 18.291r and b). All veins except the last two drain
into the coronary sinus which opens into the right
atrium. The anterior cardiac veins and the venae cordis
minimi open directly into the right atrium.

Coronory Sinus
The coronary sinus is the largest vein of the heart. It is
situated in the left posterior coronary sulcus. It is about
3 cm long. It ends by opening into the posterior wall of
the right atrium. It receives the following tributaries.

Pulmonary
trunk

Oblique
veln of left
Right atrium
Fig. 18.26: Pain of angina pectoris felt in precordium and atrium
along medial border of left arm Coronary
SINUS Left
marg jnal
Anterior
cardiac vein

Right marginal Great

cardiac
vetn
Small cardiac vein

Posterior vein of Middle cardiac vein

left ventricle
(a)

Fig. 18.27: Stent passed in the blocked coronary artery

Right

Oblique
vein of
left atrium

Coronary
Internal SINUS
mammary
Venous gfaft artery graft
Small
cardiac
vein
Site of Arierial graft
x(l, blockage
L Middle
o
s
F
cardiac
vein
N (b)
c
o
.F
o Fig. 18.28: Grafts put beyond the site of blockage Figs 18.29a and b: Veins of the heaft: (a) Sternocostal surface,
ao and (b) diaphragmatic surface
 PERICARDIUM AND HEART

1 The great cardiac aein accompanies first the anterior cardio-acceleratory, and on stimulation they increase
interventricular artery and then the left coronary the heart rate, and also dilate the coronary arteries.
artery to enter the left end of the coronary sinus Both parasympathetic and sympathetic nerves form
(Fig. 18.2ea). the superficial and deep cardiac plexuses, the branches
2 The middle cardiac oein accompanies the posterior of which run along the coronary arteries to reach the
interventricrlar artery, and joins the middle part of myocardium.
the coronary sinus. The sup erficial c ar diac ple xus is situated below the arch
3 The small cardiac uein accompanies the right coronary of the aorta in front of the right pulmonary artery. It is
artery in the right posterior coronary sulcus and joins formed by:
the right end of the coronary sinus. The right a. The superior cervical cardiac branch of the left
marginal vein may drain into the small cardiac vein sympathetic chain.
(Fig. 18.2eb). b. The inferior cervical cardiac branch of the left
4 The posterior aein of the left ttentricle runs on the vagus nerve.
diaphragmatic surfaee of the left ventricle and ends The plexus is connected to the deep cardiac plexus,
in the coronary sinus. the right coronary artery, and to the left anterior
5 The oblique aein of the left atrium of Marshall is a small pulmonary plexus (Fig. 18.30).
vein running on the posterior surface of the left The deep cardiac plexus is situated in front of the
atrium. It terminates in the left end of the coronary bifurcation of the trachea, and behind the arch of the
sinus. It develops from the left common cardinal vein aorta. It is formed by all the cardiac branches derived
or duct of Cuvier which may sometimes form a large from all the cervical and upper thoracic ganglia of the
left superior vena cava. sympathetic chain, and the cardiacbranches of thevagus
and recurrent laryrrgeal nerves, except those which form
6 The right marginal uein accompanies the marginal
the superficial plexus. The right and left halves of the
branch of the right coronary artery. It may either
drain into the small cardiac vein, or may open plexus distribute branches to the corresponding
directly into the right atrium. coronary and pulmonary plexuses. Separate branches
are given to the atria.

Anterior Cordioc Veins

The anterior cardiac aeins are three or four small veins . Cardiac pain is an ischaemic pain caused by
which run parallel to one another on the anterior wall of incomplete obstruction of a coronary artery.
the right ventricle and usually open directly into the . Axons of pain fibres conveyed by the sensory
right atrium through its anterior wall. sympathetic cardiac nerves reach thoracic one to
thoracic five segments of spinal cord mostly
Venoe Cordis Minimi through the dorsal root ganglia of the left side.
The aenae cordis minimi or Thebesian aeins or smallest Since these dorsal root ganglia also receive sensory
cardiac aeins are numerous small valveless veins present impulses from the medial side of arm, forearm and
in all four chambers of the heartwhichopen directly into upper part of front of chest, the pain gets referred
the cavity. These are more numerous on the right side to these areas as depicted in Fig. 18.26.
of the heart than on the left. This may be one reason why . Though the pain is usually referred to the left side,
left sided infarcts are more common. it may even be referred to right arm, jaw,
epigastrium or back.
LYMPHATICS OF HEARI
Lymphatics of the heart accompany the coronary Developmenlol Components
arteries and form two trunks. The right trunk ends in
the brachiocephalic nodes, and the left trunk ends in
L Right atrium (Fig. 18.11)
a. Rough anterior part-atrial chamber proper.
the tracheobronchial ly*ph nodes at the bifurcation of
b. Smooth posterior part-
the trachea.
- Absorption of right horn of sinus venosus
- Interatrial septum xE
NERVE SUPPLY OF HEARI
Demarcating part-crista terminalis. o
Parasympathetic nerves reach the heart via the vagus. 2 Left atrium (Figs 18.16 and 18.29b) E
F
These are cardioinhibitory; on stimulation they slow a. Rough part-atrial chamber proper Rt
down the heart rate. b. Smooth part- c
.o
Sympathetic nerves are derived from the upper four - Absorption of pulmonary veins. o
o
to five thoracic segments of the spinal cord. These are - Interatrial septum. U)