Heart and Pericardium

Question 1

What are the three layers of the pericardium

Answer 1

Fibrous, Parietal (Serous), Visceral (Serous)

Question 2

Is the pericardium continuous with the great vessels and if so what is the structure called?

Answer 2

The fibrous pericardium is as the tunica adventita

Question 3

Sources of innervation to the pericardium and which parts each innervates

Answer 3

Phrenic nerves (fibrous and parietal pericardium, sense pain), Fibers from Sympathetic Trunks (muscle and vessels)

Question 4

Arterial supplies to the pericardium and where each comes from

Answer 4

Pericardiophrenic and Musculophrenic arteries (from Internal Thoracic Artery), Coronary Arteries (from Aorta), Bronchial, Esophageal, and Superior Phrenic Arteries (from Descending Aorta)

Question 5

What are pericarditis, pericardial effusion, and cardiac tamponade respectively?

Answer 5

Inflammation of pericardium, excess fluid in pericardium, and squeezing (excess pressure on) heart

Question 6

Where is the bare area of pericardium?

Answer 6

Between the xiphoid process and left costal margin

Question 7

List the great vessels in order from inferiormost to superiormost

Answer 7

Pulmonary veins, Pulmonary Arteries, Arch of Aorta, Superiormost portion of Superior Vena Cava (where brachiocephalic veins meet)

Question 8

What is the intersection of the pulmonary arteries called?

Answer 8

The pulmonary trunk

Question 9

What connects the pulmonary trunk to the arch of the aorta

Answer 9

Ligamentum Arteriosum

Question 10

Which artery is known as the widowmaker and why?

Answer 10

The Left Anterior Descending (LAD, aka Anterior IV Artery), because stenosis is common and serious here

Question 11

Name the coronary arteries and the branches of each

Answer 11

Left Coronary Artery (Anterior IV artery or LAD, Circumflex branch), Right Coronary Artery (Right Marginal Branch, Posterior IV artery)

Question 12

What empties into the coronary sinus?

Answer 12

Venous blood from the great, middle, and small cardiac veins

Question 13

What are the two pericardial sinuses?

Answer 13

The transverse and oblique pericardial sinuses

Question 14

Describe the locations of the two pericardial sinuses

Answer 14

The transverse is just inferior to the pulmonary trunk and just superior to pulmonary veins. The oblique is medial and posterior to pulmonary veins (behind the left atrium)

Question 15

List the structures behind the pericardium moving posteriorly

Answer 15

Lungs, descending aorta, esophagus

Question 16

Crista terminalis

Answer 16

A muscular ridge separating smooth right atrium from rough right atrium

Question 17

Give the internal features of the right atrium from anterior to posterior

Answer 17

Musculi pectinati (on anterior wall), Cristi terminalis, Smooth Right Atrium, Fossa Ovalis (on interatrial septum)

Question 18

What three major vessels drain into the right atrium?

Answer 18

Superior Vena Cava, Inferior Vena Cava, Coronary Sinus

Question 19

What does blood flow out of the RV through?

Answer 19

The conus arteriosus (infundibulum) through pulmonary valve into pulmonary arteries

Question 20

What large muscular structure in the RV is not present in the LV and what is it?

Answer 20

The septomarginal band. It is the largest of the trabeculae carnae (bridgelike network of cardiac muscle) which runs from IV septum to anterior papillary muscles and carries much of right bundle branch

Question 21

What do the papillary muscles do and what are the names of the papillary muscles in each ventricle?

Answer 21

Hold AV valves closed tight during ventricle contraction, Anterior, Posterior and Septal in RV, and Anterior, Posterior in LV

Question 22

What attaches papillary muscles to the cusps of the valves

Answer 22

Chordae Tendinae (heartstrings)

Question 23

What are the four heart valves and what junction does each guard?

Answer 23

Tricuspid valve (Right AV), Pulmonary (Right Ventricle to Pulmonary Trunk), Mitral (Left AV), Aortic (Left Ventricle to Aorta)

Question 24

What are the cusps of the aortic valve called and which one is unique from the other two?

Answer 24

Left, Right, and Posterior. The sinus of the posterior does not associate with a coronary artery

Question 25

What are the parts of the IV septum and which is thinner and smaller?

Answer 25

Membranous (thinner and smaller upper part) and Muscular (lower part)

Question 26

What are the three cusps of the pulmonary valve?

Answer 26

Left, Right, Anterior

Question 27

What are the sinuses of valsalva and what is their significance?

Answer 27

Dilated areas behind the cusps of the aortic valve. The left and right sinuses of valsalva give rise to the LCA and RCA

Question 28

What are the four functions of the fibrous skeleton of the heart?

Answer 28

Prevent overdistention of valve orafices, Attachment for valve cusps, Attachment for myocardial fibers, Electrical insulator

Question 29

Major parts of the conducting system of the heart in order of conduction

Answer 29

SA node, AV node, AV bundle of His (in membranous IV septum), Right and Left Bundle Branches (at intersection of membranous and muscular IV septum)

Question 30

Give the intercostal space where each heart valve should be auscultated

Answer 30

Aortic (2nd RICS), Pulmonic (2nd LICS), Tricuspid (4th LICS), Mitral (5th LICS)

Question 31

Acronym for sites of heart valve auscultation

Answer 31

APT-M

Question 32

Why are heart valve sounds not auscultated directly on top of that valves location?

Answer 32

Because the sound travels with the blood flowing in that vessel

Question 33

Give the presentation, significance, and two causes of heart murmurs

Answer 33

Longer duration than heart sounds, clinical significance varies widely, and caused by stenosis (obstruction) or regurgitation (valve fails to close)

Question 34

Where do afferent neurons from the heart enter the spinal cord?

Answer 34

From T1 through T4 or T5 (hence the referral of cardiac pain to dermatones of those areas)

Question 35

What is the external barrier between the muscular and smooth portions of the RA?

Answer 35

Sulcus terminalis