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CardioPulm > 11.21 C > Flashcards

11.21 C Flashcards

1
Q

The two main divisions of the pericardium are what?

A

fibrous on the outside and serous on the inside

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2
Q

The serous pericardium has what two layers?

A

parietal on the outside and visceral on the inside

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3
Q

Where on the heart does the pericardium attach?

A

above the heart, actually fusing with the adventitia of the great vessels

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4
Q

In addition to the great vessels, the pericardium attaches to what?

A

the diaphragm

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5
Q

What is the normal volume of liquid in the pericardial sac?

A

20 mL

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6
Q

The pericardial fluid is produced by what?

A

the visceral pericardium

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7
Q

The pericardial fluid most resembles what other fluid?

A

an ultrafiltrate of plasma

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8
Q

What are the two pericardial sinuses?

A

the transverse pericardial and the oblique pericardial sinuses

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9
Q

Where is the transverse pericardial sinus located?

A
  • anterior to the superior vena cava and posterior to the aorta and pulmonary trunk
  • it’s where you hold the heart while removing it from a cadaver
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10
Q

Where is the oblique pericardial sinus located?

A

it is the most dependent (lowest) portion of the pericardial sac in a patient lying on their back

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11
Q

Leaking bypasses are likely to result in excess fluid where?

A

in the oblique pericardial sinus

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12
Q

Cardiac tamponade does what to stroke volume?

A

it prevents the chambers from fully expanding, thus limiting diastole and stroke volume

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13
Q

Classic indications of cardiac tamponade are what?

A
  • jugular venous distension
  • distant heart sounds
  • hypotension with dyspnea
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14
Q

How is a pericardiocentesis performed?

A
  • 18G needle placed just left of the Xiphoid process

- angle at 45 degrees and pointed towards medial edge of the left scapula

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15
Q

Pericarditis refers to inflammation of what?

A

the pericardial sac lining

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16
Q

What are three causes of pericarditis?

A
  • bacterial
  • viral
  • malignancy
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17
Q

What are the three ways in which acute pericarditis can be classified?

A
  • fibrous (usually viral)
  • purulent (usually bacterial)
  • hemorrhagic (blood)
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18
Q

Describe the pain associated with acute pericarditis.

A
  • remains substernal
  • possible referral to back and shoulders but not down left arm
  • worsens upon lying down or when inhaling deeply
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19
Q

Pericardial friction rub is highly specific for what?

A

acute pericarditis

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20
Q

Describe the sound generated by a pericardial friction rub.

A
  • squeaky leather or a scratchy sound

- becomes louder with forced expiration

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21
Q

Most of the blood to and from the pericardium travels via what vessels?

A

the pericardiophrenic artery and vein

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22
Q

The pericardiophrenic artery supplies what?

A

the pericardium

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23
Q

The pericardiophrenic artery runs alongside what other structure?

A

the phrenic nerve

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24
Q

The pericardium is innervated via what?

A

the phrenic nerve, which carries motor efferents and sensory afferents

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25
Q

What is the base of the heart?

A
  • opposite the apex, it is the posterior surface near the top
  • formed largely by the left atrium
  • sort of back and to the right
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26
Q

What is the apex of the heart?

A

the most inferior portion of the heart formed by the left ventricle

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27
Q

What is the diaphragmatic surface of the heart?

A
  • the inferior surface

- formed largely by the left ventricle

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28
Q

What is the sternocostal surface of the heart?

A
  • the anterior surface

- formed largely by the right atrium and right ventricle

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29
Q

What is the obtuse margin of the heart?

A

the rounded left margin of the heart

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30
Q

What is the acute margin of the heart?

A
  • inferior border

- divides the sternocostal and diaphragmatic surfaces

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31
Q

What are the three margins of the heart?

A
  • obtuse (left)
  • right
  • inferior
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32
Q

What is the coronary sulcus?

A

the dividing line between the atria and ventricles

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33
Q

The skeleton of the heart is made up of what?

A

fibrous connective tissue

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34
Q

Half of aortic valve insufficiencies are due to what?

A

aortic root dilatation (fibrous skeleton stretching)

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35
Q

What is the sinus venarum?

A

smooth part of the atrial wall

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36
Q

What are pectinate muscles?

A

the rough part of the atrial wall

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37
Q

Where is the oval fossa located?

A

in the right atrium

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38
Q

What is the crista terminalis?

A

the point where pectinate muscles end and the sinus venarum (smooth wall) begins

39
Q

What is the coronary sinus?

A

a channel that collects blood from the coronary veins and delivers it to the right atrium

40
Q

Where is the SA node located?

A

at the superior end of the crista terminalis

41
Q

The fossa ovalis marks the site of what?

A

the embryonic foramen ovale through which blood passes from right atrium to left atrium

42
Q

What is the eustachian valve?

A

the valve of the inferior vena cava which in the embryonic heart directs blood from the inferior vena cava through the foramen ovale and into the left atrium

43
Q

What is the right atrioventricular orifice?

A

the site of blood flow out of the right atrium and into the right ventricle

44
Q

The smooth wall of the left atrium is derived from what?

A

incorporation of the pulmonary veins

45
Q

The rough wall of the left atrium is derived from what?

A

the embryonic atrium

46
Q

What are papillary muscles?

A
  • found in the ventricles

- they attach to the cusps of the mitral and tricuspid valves and contract to prevent prolapse

47
Q

What are chorda tendineae?

A

fibrous strands connecting papillary muscles to the cusps of the atrioventricular valves

48
Q

The tricuspid valve regulates what?

A

the flow of blood between the right atrium and ventricle

49
Q

The mitral valve regulates what?

A

the flow of blood between the left atrium and ventricle

50
Q

What are the three cusps of the tricuspid valve?

A

anterior, posterior, septal

51
Q

What are trabeculae carneae?

A

irregular muscular elevations on the inner wall of the ventricles

52
Q

What is the septomarginal trabecula?

A
  • aka moderator band

- a trabecula carneae that conveys right branch of the atrioventricular bundle to the anterior papillary muscle

53
Q

What is the conus arteriosus?

A

the smooth-walled outflow tract of the right ventricle to the pulmonary trunk

54
Q

What is the supraventricular crest?

A

part of the right ventricle that separates the ventricle proper from the conus arteriosus

55
Q

What are the cusps of the mitral valve?

A

anterior and posterior (bicuspid)

56
Q

Papillary muscle rupture typically leads to what?

A

atriventricular valve dysfunction/insufficiency

57
Q

AV valve insufficiency is often the result of what?

A

papillary muscle rupture secondary to MI

58
Q

Left ventricular hypertrophy is most commonly the result of what two things?

A
  • chronic hypertension

- aortic valve stenosis

59
Q

What would cause left ventricular hypertrophy and chamber dilation?

A

volume overloading as a consequence of aortic or mitral valve regurgitation

60
Q

Which is more common, mitral or tricuspid valve prolapse?

A

mitral valve prolapse is more common given that the left ventricle contracts at higher pressure

61
Q

What are the symptoms of mitral valve regurgitation?

A
  • chest pain
  • cardiac arrhythmia
  • shortness of breath with activity or when lying flat
62
Q

What are the right and left aortic sinuses?

A

the spaces above the cusps of the leaves of the aortic valve

63
Q

After development, does the pulmonary or aortic valve end up more anterior?

A

the pulmonary valve does

64
Q

What is the posterior semilunar cusp?

A

the posterior cusp of the aortic valve

65
Q

When is blood flow into the coronary arteries greatest?

A

during diastole

66
Q

The coronary arteries extend from what other structure?

A

the right and left aortic sinuses

67
Q

The most common congenital heart anomaly is what?

A

a bicuspid aortic valve

68
Q

A bicuspid aortic valve is associated with what gene defect?

A

that of the Notch-1 gene

69
Q

A bicuspid aortic valve is most commonly ____ but may cause what other problems?

A
  • benign

- aortic valve stenosis

70
Q

Aortic valve stenosis can cause excessive turbulence which will in turn cause what?

A

ascending aortic aneurysm

71
Q

The right coronary artery supplies what?

A
  • right atrium
  • most of right ventricle
  • diaphragmatic surface of left ventricle
  • posterior 1/3 of AV septum
  • SA node in 60% of people
  • AV node in 80% of people
72
Q

The left coronary artery supplies what?

A
  • left atrium
  • most of left ventricle
  • anterior 2/3 of AV septum
  • SA node in 40% of people
  • AV node in 20% of people
73
Q

The right/left dominance of a heart is with regards to which side does what?

A

which coronary artery supplies the posterior interventricular artery

74
Q

In a right dominant heart, what is true?

A

the posterior interventricular artery arises from the right coronary artery

75
Q

What is a balanced heart?

A

one in which the posterior interventricular artery arises from both the left and right coronary arteries

76
Q

Is a left, right, or balanced heart most common?

A

a right dominant heart

77
Q

What is the most common coronary artery occlusion?

A

blockage in the left anterior descending branch

78
Q

What are the three most common coronary artery occlusions?

A
  • LAD near the origin
  • circumflex branch near the origin
  • right coronary artery near the origin
79
Q

How are anterior interventricular descending artery occlusions are usually bypassed?

A

using the internal thoracic artery which comes off the subclavian artery and attaching it to the LAD in a spot distal to the occlusion

80
Q

Which arteries and veins are most commonly grafted for coronary artery bypass?

A
  • radial artery (from arm)

- great saphenous vein (from leg)

81
Q

Most blood coronary blood returns to the heart through what vessels?

A
  • coronary sinus

- anterior cardiac veins

82
Q

Where is the SA node located?

A

at the superior point of the cristae terminaleus near the superior vena cava

83
Q

Where is the AV node located?

A

by the opening of the coronary sinus in the right atrium

84
Q

Why doesn’t the AP from the SA node travel directly from the atria into the ventricles?

A

because the tissue is discontinuous across the annuli fibrosi (fibrous skeleton)

85
Q

Blockage within the anterior interventricular artery may lead to what electrical disturbance?

A
  • blockage leads to ischemia
  • ischemia damages myocytes
  • conduction is interrupted
  • may lose ventricular contractions
86
Q

How is a pacemaker placed?

A

by threading the lead down the superior vena cava

87
Q

Pacemakers are generally planted in what two locations within the heart?

A
  • at the SA node

- at the apex in the right ventricle to replace the AV node

88
Q

What is the cardiac plexus?

A

a plexus of sympathetic, parasympathetic, and afferent nerve fibers

89
Q

Why does cardiac pain get referred?

A

because after traveling through the cervical spinal cord, they synapse in dorsal root ganglia of the upper thoracic spinal nerves (T5 to C4) along with other afferent nerves

90
Q

The cardiac plexus is a _____ autonomic nerve plexus.

A

mixed

91
Q

Parasympathetic innervation of the heart originates from where?

A

the vagus cranial nerve (X)

92
Q

Males typically experience what sort of pain when experiencing a heart attack?

A

they have very stereotypic pain which is substernal, radiating down the medial side of the left arm

93
Q

In contrast to men, women experience what sort of pain when experiencing a heart attack?

A

more localized pain

CardioPulm (31 decks)

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