Topography of the heart

The heart surrounded by the pericardium is located in the lower part of the anterior mediastinum and, with the exception of the base, where it is connected to large vessels, can freely move into the pericardial cavity.

The thoracic-rib (anterior) surface of the heart is partially oriented to the sternum and costal cartilages, in part to the mediostinal pleura. The thoracic anterior surface is formed by the anterior surfaces of the right atrium, right ear, upper vena cava, pulmonary trunk, right and left ventricles, as well as the apex of the heart and the apex of the left ear.

The diaphragmatic (inferior) surface of the heart in the upper parts faces the esophagus and thoracic aorta, the lower sections are adjacent to the diaphragm. The upper sections make up the posterior surfaces of the predominantly left and partly right atrium, and the lower ones form the lower surfaces of the right and left ventricles and partly atria.

The lower contour of the heart, formed by the right ventricle, faces the diaphragm, and the left lung (lateral) surface is formed by the left ventricle and faces the left lung. The base of the heart, formed by the left and partly right atrium, faces the vertebral column, the apex of the heart, formed by the left ventricle, is directed anteriorly and projected onto the anterior surface of the thorax in the region of the left fifth intercostal space, 1.5 cm inward from the line drawn through the middle of the left Clavicle, - left nipple (median-clavicular) line, linea medioclavicularis sinistra.

The right contour of the heart is formed by facing the right lung, the outer, right, right atrium and above - the upper vena cava.

The left border of the heart is the left ventricle, facing the left lung, above - the left ear, and even higher - the pulmonary trunk.

The heart is located behind the lower half of the sternum, and the large vessels (the aorta and the pulmonary trunk) are behind its upper half.

In relation to the anterior median line, linea mediana anterior, the heart is asymmetric: almost 2/3 of it lies to the left and about 1/3 to the right of this line.

The longitudinal axis of the heart, extending from the base to the apex, forms an angle of 40 ° with the sagittal and frontal planes of the body. The longitudinal axis of the heart itself is directed from top to bottom, from right to left and from behind in front. The heart, moreover, is slightly rotated about its axis from right to left, so a large part of the right heart is located more anteriorly, and most of the left heart is posterior, so that the anterior surface of the right ventricle is adjacent to the chest wall closest to all other parts of the heart. The right edge of the heart, serving as its lower border, reaches the angle formed by the chest wall and the diaphragm of the right costal-diaphragmatic sinus, recessus costodiaphragmatica dexter; The left atrium of all the cavities of the heart occupies the most posterior position.

To the right of the middle plane of the body are located the right atrium with both hollow veins, an insignificant part of the right ventricle and left atrium; To the left of it - the left ventricle, the greater part of the right ventricle with the pulmonary trunk and the greater part of the left atrium with an eye; The ascending part of the aorta occupies the position to the left and to the right of the anterior median line.

The position of the heart and its parts in a person varies depending on the position of the body and respiratory movements. Thus, in the position on the left side or when tilting anteriorly the heart adjoins the chest wall; In the standing position the heart is located lower than in the position of the body lying, so that the thrust of the apex of the heart moves somewhat; When inhaled, the heart is farther from the chest wall than when exhaled.

The position of the heart changes depending on the phases of the heart activity, age, sex and individual characteristics (height of the diaphragm), the degree of filling of the stomach, small and large intestine.

Projection of the borders of the heart on the front wall of the chest. Rights the border of the heart looks like a slightly convex line, 1.5-2.0 cm from the right edge of the sternum, descends from the upper edge of the cartilage of the 3rd rib to the junction of cartilage V of the rib with the sternum.

The lower border of the heart is located at the level of the lower edge of the body of the sternum and represents a slightly convex downward line running from the place of attachment of the cartilage of the right V rib to the sternum to the point located in the fifth intercostal space on the left side, 1.5 cm inward from the left nipple ) Line.

The left border of the heart from the point lying in the left second intercostal space, 2 cm outward from the edge of the sternum, passes in a convex outward line obliquely downward and to the left to the point located in the left fifth intercostal space at 1.5-2.0 cm from the inside of the left Sredneklyuchichnoy line.

The left eye is projected in the left second intercostal space from the edge of the sternum; Pulmonary trunk - on the cartilage of the second left rib at the place of its attachment to the sternum.

The projection of the heart on the vertebral column corresponds at the top of the level of the spinous process of the V thoracic vertebra, at the bottom to the level of the spinous process of the IX thoracic vertebra.

Projections of atrioventricular apertures and aortic and pulmonary trunk apertures on the anterior wall of the thorax. The left atrioventricular opening (the base of the left atrioventricular valve) is located to the left of the sternum in the third intercostal space; The tones of this valve are heard at the top of the heart.

The right atrioventricular orifice (base of the right atrioventricular valve) is located behind the right half of the sternum, on the line drawn from the point of connection with the sternum of the cartilage of the left III rib to the point of connection to the sternum of the cartilage of the right VI rib; The tones of this valve are listened to the right at the level of cartilages of V-VI ribs and the adjacent sternum.

The aortic opening (the aortic valve) lies behind the sternum, closer to its left margin, at the level of the third intercostal space; The tones of the aortic valve are listened to the right at the edge of the sternum in the second intercostal space.

The hole of the pulmonary trunk (valve of the pulmonary trunk) is located at the level of attachment of the cartilage of the left III rib to the sternum; The tops of the pulmonary trunk are listened to the left at the edge of the sternum in the second intercostal space.