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1
Q

Layers of the Heart Wall

A

Epicardium
Myocardium
Endocardium

2
Q

Epicardium =

A

visceral layer of serous pericardium

3
Q

Endocardium =

A

lining the chambers (endothelium)

4
Q

Atrioventricular (AV) valves

A

Separate atria & ventricles

5
Q

Semilunar valves

A

Between ventricles & ejecting vessels

6
Q

Interatrial (IA) septum

A

Separates R & L atria

7
Q

Interventricular (IV) septum

A

Separates R & L ventricles

8
Q

Smooth wall portion

: Derived from

A

sinus venosus

9
Q

Auricle (roof)

rough with

A

Rough with pectinate mm.

10
Q

Crista terminalis

A

Vertical ridge separating smooth part from rough

11
Q

Fossa ovalis

Remnant of

A

foramen ovale in IA wall

12
Q

The right atrium will receive deoxygenated blood from

A

SVC, IVC, & coronary sinus. This deoxygenated blood will flow towards the AV orifice to get to the right ventricle.\

13
Q

Right AV Valve

A

Tricuspid valve
Anterior cusp
Septal cusp
Posterior cusp

14
Q

Right AV Valve: Anchored via

A

chordae tendineae to papillary mm.

15
Q

Interior wall – rough with Left Ventricle

A

trabeculae carneae

16
Q

Septomarginal trabecula (moderator band) – located Left Ventricle

A

medially; this structure makes up part of conduction system of heart

17
Q

Conus arteriosus (infundibulum) – funnel to

A

pulmonary trunk

18
Q

Pulmonary Valve

A

In pulmonary trunk

At apex of infundibulum

19
Q

Pulmonary valve consists of

A

Consists of 3 cusps
Left
Right
Anterior

20
Q

Auricle (roof) – rough with

A

pectinate mm.

21
Q

4 pulmonary vv. enter

A

atrium posteriorly

22
Q

Valve of foramen ovale – define

A

fossa ovalis in IA wall

23
Q

Left AV Valve

A

Bicuspid (mitral) valve
Anterior cusp
Posterior cusp

24
Q

Left AV Valve: Anchored via

A

chordae tendineae to papillary mm.

Anterior & posterior papillary mm control both cusps

25
Q

Left Ventricle: Interior wall – rough with

A

trabeculae carneae

26
Q

Left Ventricle: Aortic orifice – leads into

A

ascending aorta

27
Q

Left Ventricle:

no

A
moderator band
muscle wall (myocardium) is typically 3x thicker (normally ~ 1 to 1.5 cm thick)
28
Q

Aortic Valve

A

Consists of 3 cusps
Left
Right
Posterior

29
Q

The four valves of the heart (along with the myocardium) are attached to this

A

fibrous skeleton which is composed of dense collagen rings (4) & trigones

30
Q

The fibrous skeleton provides

A

attachment, support, & insulation

31
Q

Coronary arteries arise from

A

either side of the aortic sinuses

will give off multiple branches

32
Q

Most cardiac veins will drain into the

A
coronary sinus (located on the posterior of the heart)
	drains into right atrium
33
Q

Right Coronary Artery

A
Supplies
Right atrium
Right ventricle
Sinu-atrial node
Atrioventricular nodes
Interatrial septum
Portion left atrium
Posteroinferior 1/3 IV septum
Portion posterior part left ventricle
34
Q

Right coronary artery: Travels in

A

coronary sulcus around right side of heart

35
Q

Right coronary artery: Turns inferior to become

A

posterior interventricular a.

36
Q

Right coronary artery: Lies in the

A

posterior interventricular sulcus

37
Q

Right Coronary Artery Branches:

A

Ant. right atrial a.
-Sinu-atrial nodal a.

Right marginal
Posterior interventricular a.

38
Q

Right Coronary Artery: Right coronary a. travels in

A

coronary sulcus around right side of heart
Turns inferior to become posterior interventricular a.
Lies in the posterior interventricular sulcus

39
Q

Right Coronary Artery supplies

A

The right coronary artery supplies the right atrium and right ventricle, the sinu-atrial and atrioventricular nodes, the interatrial septum, a portion of the left atrium, the posteroinferior one third of the interventricular septum, and a portion of the posterior part of the left ventricle.

40
Q

Left Coronary Artery: supplies most of

A

Left atrium
Left ventricle
Interventricular septum,
Atrioventricular bundle and its branches

41
Q

Left coronary a (proper) actually

A

very short

Divides into anterior interventricular a. & circumflex aa.

42
Q

Left Coronary Artery Branches

A

Ant. interventricular a. (also called left ant. descending a. – LAD)
Circumflex a.
Left marginal a.

43
Q

Ant. interventricular a. runs in

A

anterior IV sulcus

44
Q

Circumflex a. runs in

A

coronary sulcus
Gives off L marginal br. to supply lateral L ventricle
Circles around L side of heart

45
Q

The distribution pattern of the .

A

left coronary artery enables it to supply most of the left atrium and left ventricle, and most of the interventricular septum, including the atrioventricular bundle and its branches

46
Q

Frequently one coronary a. is more

A

dominant

This means that it gives off the posterior interventricular artery and supplies more of the heart.

47
Q

R coronary a. = dominant in

A

~65% of cases

crosses over to supply L ventricle posteriorly

48
Q

L coronary a. = dominant in

A

~15% of cases

crosses over to supply R ventricle posteriorly

49
Q

Balanced arterial pattern

A

~ 20% of cases

50
Q

Most vv of heart are tributaries to

A

coronary sinus
Lies in posterior portion of coronary sulcus
Opens into right atrium (between the IVC & AV orifice)

51
Q

Venous Drainage of Heart – Great Cardiac Vein: Travels with

A

anterior IV a. in anterior IV sulcus
Turns left to run in coronary sulcus superiorly
Travels with circumflex a. around left side of heart
Empties into coronary sinus posteriorly

52
Q

Venous Drainage of Heart – Middle Cardiac Vein: Travels with

A

posterior interventricular a. in posterior IV sulcus

Empties into coronary sinus superiorly

53
Q

Venous Drainage of Heart – Small Cardiac Vein

A

Travels with right marginal a. along lateral right ventricle
Turns right to run in coronary sulcus superiorly
Travels with right coronary a. around right side of heart
Empties into coronary sinus posteriorly

54
Q

Venous Drainage of Heart – Anterior Cardiac Veins: travels with

A

Travels with anterior right ventricular aa. along anterior right ventricle
Ascend toward right auricle empty directly into right atrium
Do NOT empty into coronary sinus

55
Q

Cardiac Catherization

A

A procedure used to diagnose and treat cardiovascular conditions. During cardiac catheterization, a long thin tube called a catheter is inserted in an artery or vein in the groin, neck or arm and threaded through blood vessels to the heart.

56
Q

Occlusion of major coronary artery, usually due to

A

atherosclerosis, leads to inadequate oxygenation of an area of myocardium and eventually cell death

57
Q

Great Saphenous v. – commonly used for

A

bypass grafts
Harvested from the anterior/medial region of the thigh or leg
Can be sutured into aorta & distal branch of a coronary a.
Must consider the arrangement of valves within the saphenous vein

Int. Thoracic a. & Radial a. may also be used

58
Q

Heart has its own

A

conduction system

59
Q

Heart Does not REQUIRE

A

CNS innervation to initiate heartbeat
With sufficient O2 & nutrition, heart will beat without CNS initiation
Normal ~70 beats per min

60
Q

Damage to Conduction System causes

A

cardiac arrhythmias

61
Q

Damage to AV node will cause

A

heart block

uncoordinated contraction

62
Q

Pacemaker may be inserted to control the

A
contractions
	Different types:
		single chamber
		dual chamber
		biventricular
63
Q

Placement of a Pacemaker

battery pack inserted

A

subcutaneously below clavicle
Electrode threaded down thru SVC to R atrium
Passed thru AV valve into R ventricle
Electrode terminal firmly fixed to trabeculae carneae
Placed in contact with endocardium of ventricular wall

64
Q

A chest x-ray can be very useful in detecting abnormalities in the

A

structure of the heart and great vessels.

This requires an understanding of the cardiac and vascular structure anatomy

65
Q

ANS does affect rate of

A

heartbeat

66
Q

Heart receives sympathetic innervation from

A

T1-T5

67
Q

Heart receives parasympathetic innervation from the

A

Vagus n. (CN X)

68
Q

Both sympathetic & parasympathetics contribute to both

A

superficial and deep cardiac plexuses of nerves

69
Q

Impulses initiated by

A

SA node travel to AV node

Propagation allow for atrial contraction

70
Q

Impulses then travel to

A

AV bundle & IV septum

71
Q

Bundle divides into

A

R & L bundle branches

72
Q

Purkinje fibers travel to

A

ventricles for contraction
also supply
papillary muscles

73
Q

The heart’s conduction system is formed

A

by specialized cardiac muscle cells that form nodes and by unidirectional conduction pathways that initiate and coordinate excitation and contraction of the myocardium
Consists of SA node, AV node & AV bundle, bundle branches & purkinje fibers

74
Q

The SA node is called the

A

“pacemaker” where the initiation of action potentials occurs

in crista terminalis between R atrium & SVC

75
Q

AV Node & Bundle

in

A

IA septum near coronary sinus opening

76
Q

Bundle branches course down the

A

IV septum (R&L)