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Thorax > The Pericardium, Heart Surface and Coronary Arteries > Flashcards

The Pericardium, Heart Surface and Coronary Arteries Flashcards

1
Q

what circulation does the right pump give

A

pulmonary circulation

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2
Q

what type of circulation does the left pump do

A

systemic and coronary circulation

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3
Q

pericardium function

A

Shock absorber (cardiac seatbelt), prevents over expansion when blood increases and limits heart movements

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4
Q

describe fibrous layer of pericardium

A
  • Outermost layer
  • Irregular dense CT with much collagen
  • Serves to anchor heart to diaphragm, sternum and the great vessels
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5
Q

two layers of pericardium

A
  • fibrous
  • serous
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6
Q

describe two layers of serous pericardium

A
  1. Parietal layer attached to fibrous pericardium
  2. Visceral layer attached to surface of the heart and aorta, pulmonary trunk, vena cavae (epicardium)
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7
Q

what is the pericardial cavity

A
  • cavity between two layers of pericardium
  • filled with serous pericardial fluid
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8
Q

pericarial cavity function

A

lubrication prevents friction as the heart beats

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9
Q

what is pericarditis

A

inflammation of the pericardium

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10
Q

where is the transverse pericardial sinus

A
  • Anterior to the superior vena cava and posterior to the ascending aorta and pulmonary trunk
  • Therefore it separates the arterial vessels (Aorta, Pulmonary Trunk) and the venous vessels (Superior Vena Cava, Pulmonary Veins)
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11
Q

where is the oblique pericardial sinus

A

Bounded by the lines of reflection of the serous pericardium onto the
inferior vena cava and the left and right pulmonary veins

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12
Q

where is the oblique pericardial sinus

A

Bounded by the lines of reflection of the serous pericardium onto the
inferior vena cava and the left and right pulmonary veins

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13
Q

what is cardiac tamponade

A
  • The relatively inextensible fibrous pericardium can cause pericardial effusion (increased fluid) in the pericardial cavity
  • There is an increase in pressure.
  • The chambers can become compressed, thus compromising cardiac output.
  • Can lead to Haemopericardium (blood in the pericardium) and pericarditis
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14
Q

causes of pericarditis

A
  • acute
  • chronic
  • cardiac tamponade
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15
Q

arterial supply of pericardium

A
  • Internal thoracic – gives off musculophrenic and pericardiophrenic branches
  • Descending thoracic aorta - gives off bronchial, oesophageal and superior phrenic arteries
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16
Q

venous drainage of pericardium

A

Venous drainage to azygous system

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17
Q

nervous supply of pericardium

A
  • Phrenic nerve to fibrous and serous pericardium
  • Vagus and sympathetic trunks to visceral pericardium (insensitive to pain)
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18
Q

nervous supply of pericardium

A
  • Phrenic nerve to fibrous and serous pericardium
  • Vagus and sympathetic trunks to visceral pericardium (insensitive to pain)
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19
Q

layers of the heart wall

A
  • epicardium
  • myocardium
  • endocardium
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20
Q

epicardium

A
  • Visceral layer of pericardium
  • Adipose and fibroelastic tissues
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21
Q

myocardium

A
  • Muscle
  • Double helical orientation of the cardiac muscle fibres
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22
Q

endocardium

A
  • Endothelial cells
  • Smooth lining also covering valves
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23
Q

myocarditis

A
  • Infection of myocardium often caused by viral infection
  • Need for biopsy
  • Mild disease, chest pain to heart failure, or sudden death
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24
Q

infective endocarditis

A
  • Bacterial infection
  • Affects valves, septum, chordae tendinae
  • Most common cardiovascular infection worldwide
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25
Q

what is the fibrous skeleton

A

Framework of dense collagen forming four fibrous rings (annuli fibrosi) that surround the orifices of the valves 2 rings and 2 cononets

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26
Q

three functions of the fibrous skeleton

A
  • Prevent over distension of valves
  • Serve as attachments of leaflets and cusps
  • Provide electrical insulation from atria and ventricles
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27
Q

sulci

A

Grooves on surface of heart containing coronary blood vessels and fat

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28
Q

coronary sulcus

A

Encircles heart and marks the boundary between the atria and the ventricle

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29
Q

anterior interventricular sulcus

A

Marks the boundary between the ventricles anteriorly

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30
Q

posterior interventricular sulcus

A

Marks the boundary between the ventricles posteriorly

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31
Q

how is dominance of the coronary arterial system defined

A

by which artery gives rise to the posterior interventricular (IV) branch (posterior descending artery)

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32
Q

where do the coronary arteries branch off the aorta

A

above aortic semilunar valve

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33
Q

path of LCA

A

arises from left posterior aortic sinus and passes forward between the left auricle (anterior surface of atrium, purpose to increase volume when needed) and infundibulum (aka conus arteriosus, the pulmonary trunk arises here)

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34
Q

where does the LCA arise in 40% of people

A

the Sinoatrial (SA) nodal artery

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35
Q

where is the circumflex branch of LCA

A

in coronary sulcus, supplies left atrium and left ventricle – sometimes AV node (left dominant)

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36
Q

where is the anterior descending interventricular artery

A

interventricular groove

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37
Q

what branches does the LCA give off

A

conus branch and diagonal branch

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38
Q

what does the LCA supply

A

anterior 2/3 of interventricular septum (bundle of His), most of the left ventricle, and part of the right ventricle before anastomosing with right coronary

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39
Q

where does the RCA arise in 40% of people

A

the SA nodal artery

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40
Q

RCA path

A

located in ant aortic sinus travels between infundibulum of the right ventricle and the right auricle to Atrioventricular groove

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41
Q

what branches does the RCA give off

A
  • the right marginal branch in coronary sulcus, supplies right ventricle
  • posterior descending interventricular artery (in ~ 70%)
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42
Q

what does the RCA sipply

A

most of the right ventricle, the diaphragmatic surface of the left ventricle, interventricular septum and AV node - typically right dominant

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43
Q

what is right coronary artery dominance associated with

A

severity of Coronary Artery Disease

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44
Q

coronary veins

A
  • Posterior vein, oblique vein, middle and small cardiac veins drain to
    great cardiac vein which drains into coronary sinus on posterior
    surface of heart - continuation of great vein.
  • Coronary sinus empties into right atrium
  • Anterior vein drains directly into heart chambers
45
Q

describe right atrium

A
  • Posterior wall is smooth
  • Rest of wall is ridged by pectinate muscles
  • Small out pouching extension called the auricle
  • Receives blood from the superior and inferior vena cava and the coronary sinus
  • Fossa ovalis is a remnant of the embryonic inter-atrial circulation
  • Opens into the right ventricle - regulated by the tricuspid valve
46
Q

describe right ventricle

A
  • Separated from atrium by tricuspid valve
  • Inflow tract is rugged - Trabeculae carnae
  • Outflow tract is smooth
  • Outflow to pulmonary trunk is controlled by pulmonary valve
  • Pulmonary trunk splits into left and right pulmonary arteries (only arteries containing de-oxygenated blood)
47
Q

decribe tricuspid valve

A
  • Three cusps of connective tissue
  • Opened by contraction of papillary muscles pulling on chordae tendinae
  • Anterior, posterior and septal cusps
  • Attached to fibrous AV ring
48
Q

sulcus terminalis

A

between the superior vena cava and the auricle - produced by the crista terminalis on the lateral wall

49
Q

tendon of todaro

A

a tendinous structure connecting the valve of the inferior vena cava ostium to the central fibrous body

50
Q

what side of the heart is the triangle of koch

A

right

51
Q

components of triangle of koch

A
  • Ostium of coronary sinus posteriorly
  • Anterior septal leaflet commissure
  • Tendon of Todaro
52
Q

components of triangle of koch

A
  • Ostium of coronary sinus posteriorly
  • Anterior septal leaflet commissure
  • Tendon of Todaro
53
Q

apex of triangle of koch

A

AV node

54
Q

describe left atrium

A
  • Posterior wall is smooth
  • Anterior wall is also smooth
  • Small out pouching extension - auricle which has pectinate muscles
  • Receives blood from the four pulmonary veins
  • Opens into left ventricle - controlled by bicuspid valve
55
Q

describe pulmonary veins

A
  • four
  • Two from each lung
  • Only veins carrying oxygenated blood
56
Q

describe left ventricle

A
  • Separated from atrium by the bicuspid valve
  • Inflow tract is rugged - trabeculae carnae
  • Outflow tract is smooth
  • Wall of left ventricle is the thickest part of the heart
  • Outflow to the aorta is controlled by the aortic valve
  • Coronary arteries branch off the ascending aorta
57
Q

describe bicuspid valve

A
  • Two cusps of connective tissue
  • Mitral valve
  • Anterior and posterior cusps
  • Attached to fibrous AV ring
  • Opened by contraction of papillary muscles pulling on chorda tendinae
58
Q

sympathetic innervation of the heart

A
  • Sympathetic system enhances activity – sympathetic trunk
  • Acts via release of norepinephrine and epinephrine
59
Q

parasympathetic innervation of the heart

A
  • The parasympathetic system inhibits activity - vagus nerve
  • Acts via acetlycholine
60
Q

parasympathetic innervation of the heart

A
  • The parasympathetic system inhibits activity - vagus nerve
  • Acts via acetlycholine
61
Q

what is the cardiac plexus

A

collection of parasympathetic and sympathetic nerve fibres (inferior aortic arch)

62
Q

sensory cardiac nerves

A
  • Afferent (sensory nerve fibres) accompany sympathetic nerves
  • Transmit visceral information to the CNS
63
Q

diastole

A

relaxation period - ventricles are relaxed and blood flows from atria to ventricles

64
Q

atrial systole

A

atria contract to fill ventricles

65
Q

atrial systole

A

atria contract to fill ventricles

66
Q

venticular systole

A

ventricles contract to push blood out of the heart

67
Q

how do signals travel through heart

A
  • SA node generated action potential which spreads through the atria, synchronising their contraction
  • SA node signal to the AV node is delayed ensuring time for the atria to drain into ventricles
  • AV node signal spreads through the ventricles via bundle of His and Purkinje fibres, ventricles then contract to expel blood
  • Nodes are autorhythmic - generate their own action potential
68
Q

how do signals travel through heart

A
  • SA node generated action potential which spreads through the atria, synchronising their contraction
  • SA node signal to the AV node is delayed ensuring time for the atria to drain into ventricles
  • AV node signal spreads through the ventricles via bundle of His and Purkinje fibres, ventricles then contract to expel blood
  • Nodes are autorhythmic - generate their own action potential
69
Q

valve disorders

A
  • genetic, bacterial infection
  • Incompetent valve - failure to completely close
  • Stenotic - narrowed opening
70
Q

valve disorders

A
  • genetic, bacterial infection
  • Incompetent valve - failure to completely close
  • Stenotic - narrowed opening
71
Q

heart disorders

A
  • Coronary artery disease (blockage of coronary arteries)
    • Angina pectoris
    • Myocardial infarction
  • Heart failure - weakening of heart muscle
  • Fibrillations - atrial and ventricular
  • Transposition of the great vessels
  • Septal defects
72
Q

bradycardia

A

when heart rate is too slow - less than 60bpm

73
Q

tachycardia

A

when heart rate is too fast - more than 100bpm

74
Q

1

A

ascending aorta

75
Q

2

A

superior vena cava

76
Q

3

A

right auricle

77
Q

4

A

right atrium

78
Q

5

A

inferior vena cava

79
Q

6

A

right coronary artery

80
Q

7

A

marginal artery

81
Q

8

A

right ventricle

82
Q

9

A

apex

83
Q

10

A

left ventricle

84
Q

11

A

anterior interventricular artery

85
Q

12

A

left auricle

86
Q

13

A

infundibulum

87
Q

14

A

pulmonary trunk

88
Q

15

A

ligmentum arteriosum

89
Q

16

A

arch of aorta

90
Q

1

A

right atrium

91
Q

2

A

inferior vena cava

92
Q

3

A

left atrium

93
Q

4

A

coronary sinus

94
Q

5

A

circumflex artery

95
Q

6

A

posterior interventricular artery and middle cardiac vein

96
Q

7

A

left ventricle

97
Q

8

A

right ventricle

98
Q

9

A

right coronary artery

99
Q

1

A

pulmonary trunk

100
Q

2

A

left auricle

101
Q

3

A

left ventricle

102
Q

4

A

coronary sinus

103
Q

5

A

left atrium (oblique sinus)

104
Q

6

A

inferior vena cava

105
Q

7

A

right atrium

106
Q

8

A

transverse sinus

107
Q

9

A

superior vena cava

108
Q

10

A

ascending aorta

Thorax (9 decks)

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