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The atrium (; : atria) is one of the two upper chambers in the
heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...
that receives blood from the
circulatory system In vertebrates, the circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the body. It includes the cardiovascular system, or vascular system, that consists of the heart ...
. The blood in the atria is pumped into the heart ventricles through the atrioventricular
mitral The mitral valve ( ), also known as the bicuspid valve or left atrioventricular valve, is one of the four heart valves. It has two Cusps of heart valves, cusps or flaps and lies between the atrium (heart), left atrium and the ventricle (heart), ...
and tricuspid heart valves. There are two atria in the human heart – the left atrium receives blood from the
pulmonary circulation The pulmonary circulation is a division of the circulatory system in all vertebrates. The circuit begins with deoxygenated blood returned from the body to the right atrium of the heart where it is pumped out from the right ventricle to the lun ...
, and the right atrium receives blood from the venae cavae of the
systemic circulation In vertebrates, the circulatory system is a organ system, system of organs that includes the heart, blood vessels, and blood which is circulated throughout the body. It includes the cardiovascular system, or vascular system, that consists of ...
. During the
cardiac cycle The cardiac cycle is the performance of the heart, human heart from the beginning of one heartbeat to the beginning of the next. It consists of two periods: one during which the heart muscle relaxes and refills with blood, called diastole, fo ...
, the atria receive blood while relaxed in diastole, then contract in
systole Systole ( ) is the part of the cardiac cycle during which some chambers of the heart contract after refilling with blood. Its contrasting phase is diastole, the relaxed phase of the cardiac cycle when the chambers of the heart are refilling ...
to move blood to the ventricles. Each atrium is roughly cube-shaped except for an ear-shaped projection called an atrial appendage, previously known as an auricle. All animals with a closed circulatory system have at least one atrium. The atrium was formerly called the 'auricle'. That term is still used to describe this chamber in some other animals, such as the ''
Mollusca Mollusca is a phylum of protostome, protostomic invertebrate animals, whose members are known as molluscs or mollusks (). Around 76,000 extant taxon, extant species of molluscs are recognized, making it the second-largest animal phylum ...
''. Auricles in this modern terminology are distinguished by having thicker muscular walls.


Structure

Humans have a four-chambered heart consisting of the right and left atrium, and the right and left ventricle. The atria are the two upper chambers which pump blood to the two lower ventricles. The right atrium and ventricle are often referred to together as the
right heart The heart is a muscular organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrients to the tiss ...
, and the left atrium and ventricle as the left heart. As the atria do not have valves at their inlets, a venous pulsation is normal, and can be detected in the jugular vein as the jugular venous pressure. Internally, there are the rough pectinate muscles, and the crista terminalis of His, which act as a boundary inside the atrium and the smooth-walled part of the right atrium, the ''sinus venarum'', which are derived from the
sinus venosus The sinus venosus is a large quadrangular cavity which precedes the atrium on the venous side of the chordate heart. In mammals, the sinus venosus exists distinctly only in the embryonic heart where it is found between the two venae cavae; i ...
. The sinus venarum is the adult remnant of the sinus venosus and it surrounds the openings of the venae cavae and the coronary sinus. Attached to each atrium is an atrial appendage.


Right atrium

The right atrium receives and holds deoxygenated blood from the superior vena cava,
inferior vena cava The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the ...
,
anterior cardiac veins The anterior cardiac veins (or anterior veins of right ventricle) are a variable number of small veins (usually 2-5) which drain blood from the anterior portion of the right ventricle into the right atrium. Anatomy The right marginal vein fr ...
,
smallest cardiac veins The smallest cardiac veins (also known as the Thebesian veins (named for Adam Christian Thebesius) are small, valveless veins in the walls of all four heart chambers that drain venous blood from the myocardium directly into any of the heart c ...
and the
coronary sinus The coronary sinus () is the largest vein of the heart. It drains over half of the deoxygenated blood from the heart muscle into the right atrium. It begins on the backside of the heart, in between the left atrium, and left ventricle; it begi ...
, which it then sends down to the right ventricle through the tricuspid valve, which in turn sends it to the pulmonary artery for
pulmonary circulation The pulmonary circulation is a division of the circulatory system in all vertebrates. The circuit begins with deoxygenated blood returned from the body to the right atrium of the heart where it is pumped out from the right ventricle to the lun ...
.


Right atrial appendage

The right atrial appendage (lat: auricula atrii dextra) is located at the front upper surface of the right atrium. Looking from the front, the right atrial appendage appears wedge-shaped or triangular. Its base surrounds the superior vena cava.> The right atrial appendage is a pouch-like extension of the right atrium and is covered by a trabecula network of pectinate muscles. The interatrial septum separates the right atrium from the left atrium; this is marked by a depression in the right atrium – the fossa ovalis. The atria are depolarised by
calcium Calcium is a chemical element; it has symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar to it ...
.


Left atrium

The left atrium receives the oxygenated blood from the left and right pulmonary veins, which it pumps to the left ventricle (through the mitral valve (left atrioventricular valve) for pumping out through the
aorta The aorta ( ; : aortas or aortae) is the main and largest artery in the human body, originating from the Ventricle (heart), left ventricle of the heart, branching upwards immediately after, and extending down to the abdomen, where it splits at ...
for
systemic circulation In vertebrates, the circulatory system is a organ system, system of organs that includes the heart, blood vessels, and blood which is circulated throughout the body. It includes the cardiovascular system, or vascular system, that consists of ...
.


Left atrial appendage

High in the upper part of the left atrium is a muscular ear-shaped pouch – the left atrial appendage (LAA) (lat: auricula atrii sinistra), which has a tubular trabeculated structure. LAA anatomy as seen in a
CT scan A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...
is characterized as being in one of four groups: chicken wing (48%), cactus (30%), windsock (19%), and cauliflower(3%). Cauliflower is the morphology most often associated with embolism. The LAA appears to "function as a decompression chamber during left ventricular systole and during other periods when left atrial pressure is high". It also modulates intravascular volume by secreting natriuretic peptides, namely atrial natriuretic peptide (ANP), and brain natriuretic peptide (BNP) into the
coronary sinus The coronary sinus () is the largest vein of the heart. It drains over half of the deoxygenated blood from the heart muscle into the right atrium. It begins on the backside of the heart, in between the left atrium, and left ventricle; it begi ...
, where they enter into the blood circulation. The left atrial appendage can be seen on a standard posteroanterior X-ray, where the lower level of the left hilum becomes concave. It can also be seen clearly using transesophageal echocardiography. The left atrial appendage can serve as an approach for mitral valve surgery. The body of the left atrial appendage is anterior to the left atrium and parallel to the left pulmonary veins. The left pulmonary artery passes posterosuperiorly and is separated from the atrial appendage by the
transverse sinus The transverse sinuses (left and right lateral sinuses), within the human head, are two areas beneath the brain which allow blood to drain from the back of the head. They run laterally in a groove for transverse sinus, groove along the interior ...
. In
atrial fibrillation Atrial fibrillation (AF, AFib or A-fib) is an Heart arrhythmia, abnormal heart rhythm (arrhythmia) characterized by fibrillation, rapid and irregular beating of the Atrium (heart), atrial chambers of the heart. It often begins as short periods ...
, the left atrial appendage fibrillates rather than contracts resulting in blood stasis that predisposes to the formation of blood clots. Because of consequent
stroke Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...
risk, surgeons may choose to close it during open-heart surgery, using a left atrial appendage occlusion procedure.


Conduction system

The
sinoatrial node The sinoatrial node (also known as the sinuatrial node, SA node, sinus node or Keith–Flack node) is an ellipse, oval shaped region of special cardiac muscle in the upper back wall of the right atrium made up of Cell (biology), cells known as pa ...
(SA node) is located in the posterior aspect of the right atrium, next to the superior vena cava. This is a group of pacemaker cells which spontaneously depolarize to create an action potential. The cardiac action potential then spreads across both atria causing them to contract, forcing the blood they hold into their corresponding ventricles. The
atrioventricular node The atrioventricular node (AV node, or Aschoff-Tawara node) electrically connects the heart's atria and ventricles to coordinate beating in the top of the heart; it is part of the electrical conduction system of the heart. The AV node lies at the ...
(AV node) is another node in the cardiac conduction system. This is located between the atria and the ventricles.


Blood supply

The left atrium is supplied mainly by the left circumflex coronary artery, and its small branches. The oblique vein of the left atrium is partly responsible for venous drainage; it derives from the embryonic left superior vena cava.


Development

During
embryogenesis An embryo ( ) is the initial stage of development for a multicellular organism. In organisms that reproduce sexually, embryonic development is the part of the life cycle that begins just after fertilization of the female egg cell by the male ...
at about two weeks, a primitive atrium begins to be formed as one chamber, which over the following two weeks becomes divided by the septum primum into the left atrium and the right atrium. The interatrial septum has an opening in the right atrium, the foramen ovale, which provides access to the left atrium; this connects the two chambers, which is essential for fetal blood circulation. At birth, when the first breath is taken fetal blood flow is reversed to travel through the lungs. The foramen ovale is no longer needed and it closes to leave a depression (the fossa ovalis) in the atrial wall. In some cases, the foramen ovale fails to close. This abnormality is present in approximately 25% of the general population. This is known as a ''patent foramen ovale'', an atrial septal defect. It is mostly unproblematic, although it can be associated with paradoxical embolization and stroke. Within the fetal right atrium, blood from the inferior vena cava and the superior vena cava flow in separate streams to different locations in the heart; this has been reported to occur through the Coandă effect.


Function

In human physiology, the atria facilitate circulation primarily by allowing uninterrupted venous flow to the heart during ventricular systole. By being partially empty and distensible, atria prevent the interruption of venous flow to the heart that would occur during ventricular systole if the veins ended at the inlet valves of the heart. In normal physiologic states, the output of the heart is pulsatile, and the venous inflow to the heart is continuous and non-pulsatile. But without functioning atria, venous flow becomes pulsatile, and the overall circulation rate decreases significantly. Atria have four essential characteristics that cause them to promote continuous venous flow. (1) There are no atrial inlet valves to interrupt blood flow during atrial systole. (2) The atrial systole contractions are incomplete and thus do not contract to the extent that would block flow from the veins through the atria into the ventricles. During atrial systole, blood not only empties from the atria to the ventricles, but blood continues to flow uninterrupted from the
vein Veins () are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and feta ...
s right through the atria into the ventricles. (3) The atrial contractions must be gentle enough so that the force of contraction does not exert significant back pressure that would impede venous flow. (4) The "let go" of the atria must be timed so that they relax before the start of ventricular contraction, to be able to accept venous flow without interruption. By preventing the inertia of interrupted venous flow that would otherwise occur at each ventricular systole, atria allow approximately 75% more cardiac output than would otherwise occur. The fact that atrial contraction is 15% of the amount of the succeeding ventricular ejection has led to a misplaced emphasis on their role in pumping up the ventricles (the so-called "atrial kick"), whereas the key benefit of atria is in preventing circulatory inertia and allowing uninterrupted venous flow to the heart. Also of importance in maintaining the blood flow are the presence of atrial volume receptors. These are low-pressure baroreceptors in the atria, which send signals to the
hypothalamus The hypothalamus (: hypothalami; ) is a small part of the vertebrate brain that contains a number of nucleus (neuroanatomy), nuclei with a variety of functions. One of the most important functions is to link the nervous system to the endocrin ...
when a drop in atrial pressure (which indicates a drop in blood volume) is detected. This triggers a release of vasopressin.


Disorders


Atrial septal defect

In an adult, an atrial septal defect results in the flow of blood in the reverse direction – from the left atrium to the right – which reduces cardiac output, potentially causing cardiac failure, and in severe or untreated cases
cardiac arrest Cardiac arrest (also known as sudden cardiac arrest CA is when the heart suddenly and unexpectedly stops beating. When the heart stops beating, blood cannot properly Circulatory system, circulate around the body and the blood flow to the ...
and sudden death.


Left atrial appendage thrombosis

In patients with
atrial fibrillation Atrial fibrillation (AF, AFib or A-fib) is an Heart arrhythmia, abnormal heart rhythm (arrhythmia) characterized by fibrillation, rapid and irregular beating of the Atrium (heart), atrial chambers of the heart. It often begins as short periods ...
, mitral valve disease, and other conditions, blood clots have a tendency to form in the left atrial appendage. The clots may dislodge (forming emboli), which may lead to ischemic damage to the brain, kidneys, or other organs supplied by the systemic circulation. In those with uncontrollable atrial fibrillation, left atrial appendage occlusion may be performed at the time of any open-heart surgery to prevent future clot formation within the appendage.


Functional abnormalities

* Wolff–Parkinson–White syndrome *
Atrial fibrillation Atrial fibrillation (AF, AFib or A-fib) is an Heart arrhythmia, abnormal heart rhythm (arrhythmia) characterized by fibrillation, rapid and irregular beating of the Atrium (heart), atrial chambers of the heart. It often begins as short periods ...
* Atrial flutter * Atrial tachycardia * Sinus tachycardia * Multifocal atrial tachycardia – several types * Premature atrial contraction


Other animals

Many other animals, including mammals, also have four-chambered hearts, which have a similar function. Some animals (amphibians and reptiles) have a three-chambered heart, in which the blood from each atrium is mixed in the single ventricle before being pumped to the aorta. In these animals, the left atrium still serves the purpose of collecting blood from the pulmonary veins. In most
fish A fish (: fish or fishes) is an aquatic animal, aquatic, Anamniotes, anamniotic, gill-bearing vertebrate animal with swimming fish fin, fins and craniate, a hard skull, but lacking limb (anatomy), limbs with digit (anatomy), digits. Fish can ...
, the circulatory system is very simple: a two-chambered heart including one atrium and one ventricle. Among sharks, the heart consists of four parts arranged serially: blood flows into the most posterior part, the sinus venosus, and then to the atrium which moves it to the third part, the ventricle, before it reaches the conus anteriosus, which itself is connected to the ventral aorta. This is considered a primitive arrangement, and many vertebrates have condensed the atrium with the sinus venosus and the ventricle with the conus anteriosus. With the advent of lungs came a partitioning of the atrium into two parts divided by a septum. Among
frog A frog is any member of a diverse and largely semiaquatic group of short-bodied, tailless amphibian vertebrates composing the order (biology), order Anura (coming from the Ancient Greek , literally 'without tail'). Frog species with rough ski ...
s, the oxygenated and deoxygenated blood is mixed in the ventricle before being pumped out to the body's organs; in
turtle Turtles are reptiles of the order (biology), order Testudines, characterized by a special turtle shell, shell developed mainly from their ribs. Modern turtles are divided into two major groups, the Pleurodira (side necked turtles) and Crypt ...
s, the ventricle is almost entirely divided by a septum, but retains an opening through which some mixing of blood occurs. In birds, mammals, and some other reptiles (alligators in particular) the partitioning of both chambers is complete.


See also

* Atrial syncytium * Left atrial volume


References


External links

* {{DEFAULTSORT:Atrium (Heart) Cardiac anatomy de:Herz#Räume und Gefäße