11th

batch notes committee Done by Aseel Alrashed

Anatomy
Week 1
Lecture 2
Internal Features of the Heart
] Objectives
- Heart valves
- Cardiac skeleton
- Fetal circulation
- Heart chambers
- Heart sounds
- Cardiac cycle
- Auscultation area
- Conduction system

] Heart valves
- heart valves act to ensure unidirectional of blood flow
- 4 valves

• atrioventricular (AV)valve
o lie between the atria and ventricles
o prevent blood to backflow to the atria
o Types
Þ Bicuspid valve (mitral, left atrioventricular)
Þ Tricuspid valve
o mechanism
- chordae tendineae are inserted to their free edges
- each chordae tendineae is attached to a papillary muscle
always into the two adjacent cusps
Þ AV open
- allow blood to flow from atria to ventricle
- when the ventricular pressure is lower then the
atrial pressure
- occurs when ventricles are relaxed
§ Chordae tendineae are slack and papillary
muscles are relaxed

Edited by Hiba Raheel

 11th batch notes committee Done by Aseel Alrashed

Þ AV close
-prevent backflow of blood into atria
-occurs when ventricles contract
§ Pushing the valve cusps closed
§ Chordae tendineae are pulled taut
§ Papillary muscles contract to pull cords and
prevent cusps from everting

• semilunar valves
- prevent backflow of blood into the ventricles
1. aortic semilunar valve
- lies between the left ventricle and the aorta
2. pulmonary semilunar vale
- lies between the right ventricle and pulmonary trunk

o mechanism
Þ SL open
-when the ventricle contraction
§ allow blood to flow into pulmonary trunk
and aorta
Þ SL close
- when the ventricle relaxation
§ Prevents blood from returning to ventricles
§ Blood fills valve cusps tightly closing the SL
valves Aortic sinuses
Nodule of
semilunar
valve

Edited by Hiba Raheel

11th batch notes committee Done by Aseel Alrashed

] cardiac skeleton
-

- fibrous skeleton of the heart: the connecting fibers of the connective tissue
from a dense network that reinforcing the myocardium internally
- the fibrous skeleton forms the rings of fibrous tissue around the valves and
serves as the insertion for the cusps of the valves
- they are continuous with the membranous part of the interventricular
septum

] chambers
ª right atrium
- forms the right border of the heart
- receives all the venous blood
- has two walls
• smooth
o thin
o posterior part
o superior and inferior vena cava opens
o bringing poorly oxygenated blood into the heart
• rough
o muscular
o anterior wall
o composed of pectinate muscle

Edited by Hiba Raheel

11th batch notes committee Done by Aseel Alrashed

Crista terminalis

] fetal circulation
- In the fetus, the blood flows from the right atria to the left atria through
foramen ovale.
- Also, the blood flows from the pulmonary trunk to the aorta through
ductus arteriosus.
- The foramen ovale becomes fossa ovalis and ductus arteriosus becomes
ligamentum arteriosus.

] Right ventricle
- forms most of the anterior surface
- blood flow through the right atrium into the right ventricle by passing the
tricuspid valve (3 cusps+ chordae tendanea+3 papillary muscles)
- blood flow from the right ventricle to the pulmonary trunk through the
pulmonary semilunar valve
] left atrium
- forms most of the base of the heart

Edited by Hiba Raheel

11th batch notes committee Done by Aseel Alrashed

- receives blood from lungs – (4 pulmonary veins)
] left ventricle
- forms most of the heart apex
- 3× thicker than the right ventricle
- Mitral valve (2 cusps, 2 papillary muscles and chordae tendinea).
• Blood passes through into left ventricle
- Aortic semilunar valve to the aorta
• Blood passes through the aortic semilunar valve into the ascending
aorta
• Above the valve is the openings to the coronary arteries
- Interventricular septum:
membranous +muscular parts.

] Heart sounds
- caused by the closure of the valves
- lubb: closure of AV valve
- dupp: closure of semilunar valves

] cardiac cycle

- pathway of blood through the heart to the lungs

• right atrium à tricuspid valve à right ventricle
• right ventricle à pulmonary semilunar valveà pulmonary arteries
à lungs
• lungs à pulmonary veins à left atrium
• left atrium à bicuspid valve à left ventricle
• left ventricle à aortic semilunar valve à aorta
• aorta à systemic circulation

Edited by Hiba Raheel

11th batch notes committee Done by Aseel Alrashed

] auscultation area

1. Aortic region (Right 2nd intercostal spaces at the right sternal border) (RUSB
– right upper sternal border).
2. Pulmonic region (Left 2nd intercostal spaces at the left sternal border) (LUSB
– left upper sternal border).
3. Tricuspid region (between 4th and 5th intercostal spaces at the left sternal
border) (LLSB – left lower sternal border).
4. Mitral region (near the apex of the heart at the left 5th intercostal spaces in the
mid-clavicular line) (apex of the heart).

] Conduction system of the heart

- highly specialized cardiac cells
- non-contractile and possess the conducting properties of the nerve cells
- autorhythmic cells
• cells fire spontaneously
• act as pacemaker
• form conduction system for the heart
- SA node
• Cluster of cells in wall of the right atrium
• Begins heart activity that spreads to both atria
• Excitation spreads to AV node
- AV node
• In atrial septum
• Transmits signals to bundle of His
- AV bundle of his
• The connection between atria and ventricle
• Divide into

Edited by Hiba Raheel

11th batch notes committee Done by Aseel Alrashed

o bundle branches
o Purkinje fibers
Þ large diameter fibers that conduct signals quickly

Edited by Hiba Raheel