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Semester 1 Year 2 > Heart: Internal Structure and Surface Anatomy > Flashcards

Heart: Internal Structure and Surface Anatomy Flashcards

1
Q

What pressures do each side of the heart pump blood into their respective circulations?

A

Pulmonary - 12 – 16 mmHg

Systemic - 70 – 120 mmHg

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2
Q

Name all the surfaces of the heart

A 
Anterior (sternocostal)
Left Pulmonary
Right Pulmonary
Base
Diaphragmatic (inferior) surface
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3
Q

What structures make up the sternocostal (anterior) surface of the heart?

A

✓ Right ventricle
✓ Right atrium
✓ Left ventricle

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4
Q

What structures make up the diaphragmatic (inferior) surface of the heart?

A

✓ Left ventricle ✓ Right ventricle

✓ Separated from the base of heart by coronary sinus

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5
Q

What structures make up the right pulmonary surface of the heart?

A

✓ Right atrium

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6
Q

What structures make up the left pulmonary surface of the heart?

A

✓ Left ventricle (cardiac impression in the left lung)

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7
Q

Describe the location of the apex of the heart

A

✓ Left 5th intercostal space and 8-10 cm left of midline

✓ More superior and lateral in children

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8
Q

What structures make up the base of the heart?

A

✓ Composed primarily of left atrium and pulmonary veins, small portion of right atrium.
✓ Fixed posteriorly to the pericardium, at the level of T6(5)-T9(8) vertebrae

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9
Q

Name the margins of the heart

A

Obtuse - superior to apex

Inferior (acute) - medial to apex

Right margin - right atrium

Left margin - left ventricle and left auricle

Inferior margin - Right ventricle + left ventricle

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10
Q

What are the external suci?

A 
✓ Coronary sulcus
− Separates atria from ventricles
− Right coronary artery
− Left circumflex artery 
− Coronary sinus

✓ Anterior interventricular sulcus
– Anterior interventricular artery
– Great cardiac vein [Anterior interventricular vein]
– Right of the apex

✓ Posterior interventricular sulcus
– Posterior interventricular artery
– Middle cardiac vein [Posterior interventricular vein]

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11
Q

Name all the septa of the heart bitch

A

✓ Interatrial (IA) septum
✓ Interventricular (IV) septum
✓ Atrioventricular (AV) septum

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12
Q

Name all the septa AND chambers of the heart

A 
✓ Interatrial (IA) septum
✓ Interventricular (IV) septum
✓ Atrioventricular (AV) septum
✓ Right (RA) and left (LA) atria
✓ Right (RV) and left (LV) ventricles
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13
Q

What separates the right atrium form the right auricle?

A

✓ Internally, crista terminalis is a muscular ridge that separates right atrium from right auricle
✓ Sulcus terminalis externally

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14
Q

Describe the fossa ovalis

A 
✓ Fossa ovalis
− On the right side of IA septum
− Site of foramen ovale in foetus
− Margin is limbus fossae ovali
The fossa ovalis is the remnant of a thin fibrous sheet that covered the foramen ovale between the right and left atrium during fetal development
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15
Q

Describe the various openings into the right atrium

A 
✓ Opening of SVC
− Deep to the joint between right
3rd costal cartilage and sternum
− No valve
− Intervenous tubercle
✓ Opening of IVC
− Valve of inferior vena cava
✓ Opening of coronary sinus
− Valve of coronary sinus
prevent regurgitation of blood
✓ Openings of smallest cardiac veins
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16
Q

Describe the right auricle

A

Rough surface, formed by pectinate muscles

− Provide some power of contraction without significantly thickening the cardiac wall

17
Q

Describe the structure of the right ventricle

A

✓ Walls of RV have numerous irregular muscular ridges called Trabeculae carnea
✓ Sits on central tendon of diaphragm
✓ Wall thickness 3-4 mm.
✓Morphologically there are 3 types of muscles on right ventricle wall
1. Trabeculacarnea
2. Septomarginal trabecula
3. Papillary muscles

18
Q

What is the outflow tract of the right ventricle?

A

Outflow tract is Infundibulum [conus arteriosus] where the pulmonary trunk arises
− Blood flows upwards, backwards and to the left
− Surface of Infundibulum is smooth.

19
Q

Discuss the septomarginal trabecula and papillary muscles found in the right ventricle

A

Septomarginaltrabecula
− Bridge between IV septum and anterior papillary muscle
− Only in RV
− Carries right bundle branch of AV bundle of cardiac conduction system

Papillary muscles
− Three muscles (usually!)
− Named relative to their position
− Fibrous chords called Chorda tendinea run between their apex and free edges of tricuspid valve cusps
− Contract before ventricular contraction

20
Q

Discuss the chorda tendinea of the right ventricle

A

✓Chorda tendinea prevent evertion of cusps→regurgitation of blood into the atria during ventricular systole
✓Chorda tendinea from one papillary muscle attach to more than one cusp

21
Q

Discuss the tricuspid valve

A

✓ Closes right AV orifice
✓ Consists of 3 cusps (anterior,
posterior and septal)
✓ Base of each cusp attached to right fibrous ring (anulus fibrosus)
✓ Blood flows forwards and medially through this valve

22
Q

Discuss the pulmonary valve

A

✓ Consists of 3 semilunar cusps: anterior, right and left
✓ On their free edge, there is nodule of the semilunar cusp
✓ Each cusp forms a pulmonary sinus, which helps closure of pulmonary valves after systole

23
Q

Discuss the left atrium

A

✓ Forms most of the base of heart
✓ Four pulmonary veins carry
oxygenated blood from the lungs
− Pulmonary veins do not have valves
✓ Consists of Left auricle and left atrium
✓ Depressed area on the IA septum (falx septi) is caused by the fusion of valve of foramen ovale
− Not at the same level as foramen ovale

24
Q

Discuss the left ventricle

A

✓ Blood from the LA enters through left AV opening
✓ Blood flows anteriorly, towards the apex
✓ Thickest wall: 8-12 mm
✓ LV pressure: 70-120 mmHg
✓ Apex belongs to left ventricle
✓ Muscular ridges: Trabecula carnea
✓ Anterior and posterior papillary muscles

25
Q

Discuss the mitral (bicuspid) valve

A

✓ Left AV orifice is closed by mitral (bicuspid) valve
✓ Consists of 2 cusps: anterior and posterior
✓ Bases of the cusps are attached to left fibrous ring (anulus fibrosus)
✓ Chorda tendinea extend between their free margins and papillary muscles

26
Q

Discuss the aortic valve

A

✓ Aortic vestibule is the outflow tract of LV
✓ Blood in the LV is ejected into the aorta
✓ Blood flows upwards, backwards and to the right side through this valve
✓ Aortic orifice is closed by aortic valve ✓ Consists of 3 semilunar cusps: Right,
left, posterior
✓ Between the superior surface of the cusps and aortic wall are pocket-like aortic sinuses (sinus Valsalvae)
3 semi-lunar cusps at the apex of the aortic vestibule (right and left→coronary, posterior → non-coronary sinus)

27
Q

What does the structure of the aortic valve mean for the blood supply to the myocardium?

A

In diastole, the valve is closed, so blood goes to coronary arteries

28
Q

Describe the structure of the fibrous skeleton of the heart

A

✓ Heart has a structural support frame formed by a complex set of fibrous rings with connecting areas
✓ Provides a great amount of structural and functional support
✓ 4 fibrous rings (anulus fibrosus) around AV, aortic and pulmonary valves
✓ Between the four rings are two trigones (right and left) and the membranous portions of the IA, IV, and AV septa

29
Q

Describe the function of the skeleton of the heart

A

✓ Points of attachment for the cusps
✓ Maintains the patency and integrity of AV
and semilunar orifices
✓ Serves as origin/insertion for atrial and ventricular muscles
✓ Insulates the atria from the ventricles
− Allows independent atrial and
ventricular contraction
− Atrioventricular bundle of His should be the only conduction between them (arrhythmias)

30
Q

Describe the structure of the cardiac wall

A

✓ Endocardium: Thin layer of endothelium that lines the inner surface of the walls as well as the valves. Receives oxygen and nutrients directly from the chambers of the heart
✓ Myocardium
− Atrial musculature
− Ventricular musculature
− Muscles are arranged in spiral and circular bundles
− Originate and insert on fibrous skeleton
✓ Epicardium: Visceral layer of the serous pericardium

31
Q

What are the four corners of the heart?

A

✓ 1: Right 3rd costal cartilage – 2 cm right of the midline
✓ 2: Right 6th costal cartilage – 2 cm right of the midline
✓ 3: Left 5th costal cartilage – 7-9 cm left of the midline (apex cordis)
✓ 4: Left 2nd costal cartilage – 3 cm left of the midline

32
Q

Where are the valves of the heart located in relation to surface anatomy?

A

✓ Tricuspid valve: Behind the right half of the sternum, at the level of the 4th intercostal space
✓ Mitral valve: Posterior to the articulation between left 4th costal cartilage and the sternum
✓ Pulmonary valve: Posterior to the articulation between left 3rd costal cartilage and the sternum
✓ Aortic valve: Posterior to the sternum, at the level of the 3rd intercostal space

33
Q

How do the heart valves relate to cardiac auscultation?

A

They make the noises

✓ The valves open and close due to changes in blood pressure and cause “sounds” when they close
✓ Closure of AV valves causes 1st heart sound
✓ Closure of semilunar valves causes 2nd heart sound
✓ Rapid filling of the ventricle causes 3rd heart sound
✓ Sitting or recumbent position, inspiration, expiration, valsalva manoeuvre, exercise can cause changes in heart sounds

34
Q

Where is it best to auscultate to hear the tricuspid valve?

A

(HS1): Best heard just to the left of the lower part of the sternum near the 5th intercostal space

35
Q

Where is it best to auscultate to hear the mitral valve?

A

(HS1): Best heard over the apex of the heart in the left 5th intercostal space at the midclavicular line (apex cordis)

36
Q

Where is it best to auscultate to hear the aortic valve?

A

(HS2): Best heard over the medial end of the right 2nd intercostal space

37
Q

Where is it best to auscultate to hear the pulmonary valve?

A

(HS2): Best heard over the medial end of the left 2nd intercostal space

Semester 1 Year 2 (69 decks)

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