Heart

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The heart is a hollow, muscular organ of the middle mediastinum, designed to pump oxygenated blood around the systemic circulation and de-oxygenated blood around the pulmonary ciruclation

Gross anatomy

The heart has a somewhat conical form and is enclosed by pericardium. It is postioned posteriorly to the body of sternum with one-third of it is situated on the right and two-thirds on the left of the midline.

The heart measures 12 x 8.5 x 6cm and weighs ~310g (males) and ~255g (females) ¹.

Relations

anteriorly -: body of the sternum and adjoining costal cartilages; left lung and pleura (apex)
posteriorly -: oesophagus, descending thoracic aorta, azygos and hemiazygos veins, thoracic duct
superiorly -: bifurcation of main pulmonary trunk
inferiorly -: diaphragm
laterally -: lungs, pleura

Parts

The heart is subdivided by septa into right and left halves, and a constriction subdivides each half of the organ into two cavities, the upper cavity being called the atrium, the lower the ventricle. The heart therefore consists of four chambers:

The division of the heart into four cavities is indicated on its surface by grooves. The atria are separated from the ventricles by the coronary sulcus (atrioventricular groove); this contains the trunks of the nutrient vessels of the heart, and is deficient in front, where it is crossed by the root of the pulmonary artery. The interatrial groove, separating the two atria, is scarcely marked on the posterior surface, while anteriorly it is hidden by the pulmonary artery and aorta.

The ventricles are separated by two grooves, one of which, the anterior longitudinal sulcus, is situated on the sternocostal surface of the heart, close to its left margin, the other posterior longitudinal sulcus, on the diaphragmatic surface near the right margin; these grooves extend from the base of the ventricular portion to a notch, the incisura apicis cordis, on the acute margin of the heart just to the right of the apex.

Heart valves

The outflow of each chamber is guarded by a heart valve:

atrioventricular valves
- tricuspid valve
- mitral valve
aortic valve
pulmonary valve

Surfaces

The heart can be described as having the following surfaces:

posterior surface (base)
- directed upward, backward and to the right
- formed mainly by the left atrium and little by the right atrium
apex
- directed downward, forward and to the left
- formed by the left ventricle
anterior (sternocostal) surface
- directed forward, upward and to the left
- formed mainly by the right ventricle inferiorly and superiorly by the atria
inferior (diaphragmatic) surface
- directed downwared, slightly backward
- formed by the ventricles
- rests mainly upon the central tendon of the diaphragm
right surface
- long; formed by right atrium superiorly and right ventricle inferiorly
left (pulmonary) surface
- shorter, rouned; formed mainly by the left ventricle and a little superiorly by the left atrium

Borders

The heart has four borders:

right border - : IVC, right atrium, SVC
left border -: left ventricle, left atrium, pulmonary trunk and arch of aorta
inferior border -: right ventricle
superior border -: right and left atria, SVC, ascending aorta and pulmonary trunk

Blood supply

See main articles: coronary arteries and coronary veins.

Nerve supply

See main article: innervation of the heart.

Lymphatic supply

Various lymphatic plexuses drain into a right cardiac collecting trunk (draining to anterior mediastinal nodes) and a left cardiac collecting trunk (draining to tracheobronchial nodes and onto paratracheal nodes).

Variant anatomy

The line can become somewhat blurred between what constitutes an anatomical variation and congenital heart disease but the key differentiator could be considered the presence or absence of symptoms in the majority of cases:

aberrant location of the heart in dextrocardia and situs inversus
Eustachian valve -: remnant valve of the IVC
Thebesian valve of the coronary sinus
patent foramen ovale

There is also considerable variation in the anatomy of the coronary circulation and pulmonary veins.

Related pathology

-<li>anteriorly - body of the <a href="/articles/sternum">sternum</a> and adjoining <a href="/articles/costal-cartilages">costal cartilages</a>; left <a href="/articles/lung">lung</a> and <a href="/articles/pleura">pleura</a> (apex)</li>
-<li>posteriorly - <a href="/articles/oesophagus">oesophagus</a>, <a href="/articles/descending-thoracic-aorta">descending thoracic aorta</a>, <a href="/articles/azygos-vein">azygos</a> and <a href="/articles/hemiazygos-vein">hemiazygos veins</a>, <a href="/articles/thoracic-duct">thoracic duct</a>
+<li>anteriorly: body of the <a href="/articles/sternum">sternum</a> and adjoining <a href="/articles/costal-cartilages">costal cartilages</a>; left <a href="/articles/lung">lung</a> and <a href="/articles/pleura">pleura</a> (apex)</li>
+<li>posteriorly: <a href="/articles/oesophagus">oesophagus</a>, <a href="/articles/descending-thoracic-aorta">descending thoracic aorta</a>, <a href="/articles/azygos-vein">azygos</a> and <a href="/articles/hemiazygos-vein">hemiazygos veins</a>, <a href="/articles/thoracic-duct">thoracic duct</a>
~~-<li>superiorly - bifurcation of main <a href="/articles/pulmonary-trunk">pulmonary trunk</a>~~
+<li>superiorly: bifurcation of main <a href="/articles/pulmonary-trunk">pulmonary trunk</a>
~~-<li>inferiorly - <a href="/articles/diaphragm">diaphragm</a>~~
+<li>inferiorly: <a href="/articles/diaphragm">diaphragm</a>
~~-<li>laterally - lungs, pleura</li>~~
+<li>laterally: lungs, pleura</li>
-</ul><p>The division of the heart into four cavities is indicated on its surface by grooves. The atria are separated from the ventricles by the coronary sulcus (atrioventricular groove); this contains the trunks of the nutrient vessels of the heart, and is deficient in front, where it is crossed by the root of the pulmonary artery. The interatrial groove, separating the two atria, is scarcely marked on the posterior surface, while anteriorly it is hidden by the <a href="/articles/pulmonary-artery">pulmonary artery</a> and aorta. The ventricles are separated by two grooves, one of which, the anterior longitudinal sulcus, is situated on the sternocostal surface of the heart, close to its left margin, the other posterior longitudinal sulcus, on the diaphragmatic surface near the right margin; these grooves extend from the base of the ventricular portion to a notch, the incisura apicis cordis, on the acute margin of the heart just to the right of the apex.</p><h5>Heart valves</h5><p>The outflow of each chamber is guarded by a heart valve:</p><ul>
+</ul><p>The division of the heart into four cavities is indicated on its surface by grooves. The atria are separated from the ventricles by the coronary sulcus (atrioventricular groove); this contains the trunks of the nutrient vessels of the heart, and is deficient in front, where it is crossed by the root of the pulmonary artery. The interatrial groove, separating the two atria, is scarcely marked on the posterior surface, while anteriorly it is hidden by the <a href="/articles/pulmonary-artery">pulmonary artery</a> and aorta.</p><p>The ventricles are separated by two grooves, one of which, the anterior longitudinal sulcus, is situated on the sternocostal surface of the heart, close to its left margin, the other posterior longitudinal sulcus, on the diaphragmatic surface near the right margin; these grooves extend from the base of the ventricular portion to a notch, the incisura apicis cordis, on the acute margin of the heart just to the right of the apex.</p><h5>Heart valves</h5><p>The outflow of each chamber is guarded by a heart valve:</p><ul>
~~-<li>right border - <a href="/articles/inferior-vena-cava-1">IVC</a>, right atrium, <a href="/articles/superior-vena-cava">SVC</a>~~
+<li>right border: <a href="/articles/inferior-vena-cava-1">IVC</a>, right atrium, <a href="/articles/superior-vena-cava">SVC</a>
~~-<li>left border - left ventricle, left atrium, pulmonary trunk and arch of aorta</li>~~
~~-<li>inferior border - right ventricle</li>~~
~~-<li>superior border - right and left atria, SVC, ascending aorta and pulmonary trunk </li>~~
+<li>left border: left ventricle, left atrium, pulmonary trunk and arch of aorta</li>
+<li>inferior border: right ventricle</li>
+<li>superior border: right and left atria, SVC, ascending aorta and pulmonary trunk </li>
~~-<li>aberrant location of the heart in <a href="/articles/dextrocardia">dextrocardia</a> and <a href="/articles/situs_inversus">situs inversus</a>~~
+<li>aberrant location of the heart in <a href="/articles/dextrocardia">dextrocardia</a> and <a href="/articles/situs-inversus">situs inversus</a>
~~-<a href="/articles/eustachian-valve">Eustachian valve</a> - remnant valve of the IVC</li>~~
+<a href="/articles/eustachian-valve">Eustachian valve</a>: remnant valve of the IVC</li>

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