Heart and Great Vessels pt. 2

Question 1

Location: Left, 3rd costal cartilage & rib
Auscultate: LSB 2nd ICS

Answer 1

Pulmonic Valve

Question 2

Location: Left, 3rd ICS
Auscultate: RSB 2nd ICS

Answer 2

Aortic Valve

Question 3

Location: Left 4th costal cartilage and rib
Auscultate: 5th ICS, MCL

Answer 3

Mitral Valve

Question 4

Location: Right, behind sternum, 4th ICS
Auscultate: LSB, 4th ICS

Answer 4

Tricuspid Valve

Question 5

Located on the right side of the heart and pulmonary trunk & arteries
-Low resistance, low pressure system
-Normally 25/10 mmHg

Answer 5

Pulmonary Circulation

Question 6

Located on the left side of the heart and the Aorta.
-High resistance, high pressure system
-Normally <120/<80 mmHg

Answer 6

Systemic Circulation

Question 7

-Comes off of the Ascending Aorta, distal to the Right Aortic Valve Cusp
-Gives off the Right Marginal Artery and the Posterior Descending Artery
-Anterior Right Atrial Branch

Answer 7

Right Coronary Artery

Question 8

Artery that supplies the inferior aspect of the Right Ventricle.
-Branch of the RCA

Answer 8

Right Marginal Artery

Question 9

Artery that anastomeses with the Anterior Descending Artery as they curl around the apex.
-Branch of the RCA

Answer 9

Posterior Descending Artery

Question 10

-Comes off of the Ascending Aorta, distal to the Left Aortic Valve Cusp
-Branches into the Anterior Descending Artery (courses down to apex, gives off Diagonal Branch) and the Circumflex Artery (curves around the upper left side)

Answer 10

Left Coronary Artery

Question 11

Branch off of the Right Coronary Artery that gives off another branch, called the Branch to the Sinoatrial Node

Answer 11

Anterior Right Atrial Branch

Question 12

-Lateral Left Ventricular Branch
-Posterolateral Left Ventricular Branch
-Posterior Left Ventricular Branch

Answer 12

Branches of the Circumflex Artery

Question 13

A physiologic shunt occurs because some veins dump blood into the LA and the LV.
-Slightly decreased SpO2, less than 100%
-Thebesian Veins empty into the LA/LV
-Also occurs due to some Bronchial veins anastomosing with Pulmonary Veins

Answer 13

Venous Admixture

Question 14

-Runs with the Anterior Descending Artery down the Inter-ventricular Sulcus.
-Loops around apex and anastomoses with the Middle Cardiac Vein running posteriorly.
-Winds around upper left hand border and then descends in a diagonal fashion.
-Joined by the Oblique vein of Marshall (drains the left atrium)

Answer 14

Great Cardiac Vein

Question 15

Occurs when the Great Cardiac Vein and the Oblique Vein of Marshall come together
-Drains into the RA, has a valve

Answer 15

Coronary Sinus

Question 16

Drain the upper portion of the RV and terminate in the RA by themselves (not via the Coronary Sinus)

Answer 16

Anterior Cardiac Veins

Question 17

Vein that drains the Left Atrium

Answer 17

Oblique Vein of Marshall

Question 18

Veins that run with the Right Marginal Artery. Loop around the edge of the RA, and works itself back up to connect with other veins, usually the Middle Cardiac Vein

Answer 18

Small Cardiac Vein

Question 19

Double layer membrane, inside hoods the heart very tightly (epicardium), then flips out and forms outside layer wrapped around great vessels at the top to suspend the heart in place.
-Visceral Layer: clings tightly to muscle of heart
-Outer layer: Parietal (Serous) and Fibrous
Between the two layers is a potential space called the Pericardial Cavity (Pericardial Space). Only contains a few mL of fluid.

Answer 19

Pericardium

Question 20

Supplies sensory and motor innervation to the pericardial sac.

Answer 20

Phrenic Nerves

Question 21

Supplied by the:
-Pericardiacophrenic Arteries (very tiny vessels that branch off of the Internal Thoracic Arteries and run with the Phrenic Nerve)
-Pericardial Arteries: small branches off of the Thoracic Aorta

Answer 21

Blood Supply to the Pericardial Sac

Question 22

Spinal Cord segments (T1-T4,T5) give off SNS preganglionics (WRC) to the Sympathetic Chain. Fibers go to Inferior, Middle, or Superior Cervical Ganglion. Ganglia give off postganglionics (GRC) that go to the heart

Answer 22

SNS Innervation to the heart

Question 23

Vagus nerve originates in the brain, goes to the heart where it ends just as it approaches the heart. The ganglion is right up against the wall of the myocardium. Gives off little tiny postganglionics (GRC)

Answer 23

PNS Innervation to the heart

Question 24

A mixing of PNS and SNS fibers that overlies the great vessels.

Answer 24

Cardiac Plexus

Question 25

Negative chronotropic effect (Slows heart down). Doesn’t eject as much blood

Answer 25

PNS Domination

Question 26

Positive chronotropic effect (increases HR). Increases the amount of blood ejected with each contraction (increases stroke volume)

Answer 26

SNS Domination

Question 27

Formed by the Subclavian Vein and Internal Jugular Vein
-Forms the SVC, which drains into the RA

Answer 27

Brachiocephalic Veins

Question 28

-Brachiocephalic Trunk (that divides into R Subclavian A. and R CC A.)
-Left CC Artery (blood to head/neck)
-Left Subclavian Artery (blood to upper limb)

Answer 28

Branches off of the Aortic Arch

Question 29

Exists in the fetal state, tying the aortic arch in with the left pulmonary artery.
-Lungs are collapsed in-utero and have high resistance to blood flow. In order to be pumped and circulated, blood flow takes another route.
-With birth, resistance in lungs goes way down, so this closes
-Not supposed to be present after birth.

Answer 29

Ductus Arteriosus

Question 30

A piece of scar tissue, remnant of the Ductus Arteriosus.
-After 2 weeks post-birth, DA is scarred over and gives a true anatomic closure.
-Prevents venous admixture from occurring
-Risk of damage to Recurrent Laryngeal Nerve with surgical repair as it runs right down by it

Answer 30

Ligamentum Arteriosum