6: heart and great vessels Flashcards Preview

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Flashcards in 6: heart and great vessels Deck (45):

where is apex of heart

midclavicular line, 5th intercostal space


where does lower border of heart cross midline

xiphisternal jxn


base of heart

consists of exit of great vessels at level of sternal angle


middle mediastinum

top is transverse thoracic plane, at sternal angle btween T4 and T5

consists of pericardial sac and contents; pericardiophrenic vessels, phrenic nerve


sole innervation of diaphragm

phrenic nerve, one on each side, passes along pericardial sac with pericardiophrenic vessels



middle part of thoracic cavity, DOES NOT CONTAIN LUNGS


pericardium layers

fibrous outside; on top of parietal layer, which is on top of serous fluid on top of visceral layer

visceral + parietal = serous pericardium


fibrous pericardium

tough. fused to central region of diaphragm. surrounds root of great vessels. phrenic nerve and pericardiophrenic vessels run in its wall


oblique pericardial sinus

related to INPUT of heart; IVC, SVC, pulmonary vein

when heart in situ and you can slide your hand behind it -- oblique


transverse pericardial sinus

related to OUTPUT of heart; finger behind aorta, pulmonary artery and in front of SVC

**surgical isolation of cardiac outflow for bypass


heart circulation, general

out to system through aorta; back through SVC, IVC, coronary sinus and anterior cardiac veins into RA

through tricuspid into RV

through pulmonary semilunar to pulmonary artery (deox) to lung and back through FOUR pulmonary veins to LA

through bicuspid to LV and through aortic SL to body


musculi pectinati

in RA and LA.
small muscular corrugations that pass from atrium proper into atrium appendage (AURICLE). creates turbulence.


crista terminalis

muscular ridge that runs vertically in RIGHT ATRIUM only, separates posterior smooth wall from anteriorally placed musculi pectinati


SA node

at jxn of crista terminales and SVC; pacemaker


valves INTO right atrium

valve of IVC and coronary sinus; sickle like flaps


fossa ovalis

in RA and also LA; remnant of foramen ovale, which let fetal blood go straight from right to left atrium


right AV opening

tricuspid valve (located in ventricle)


tricuspid valve cusps




chordae tendinae

tendinous cords in ventricles that attach valve cusps to muscls


papillary muscles

from ventricular wall; chordae tendinae attach them to valve cusps; they contract and tether to wall, keep valve closed to prevent backflow

attach to half of cusp

anterior pap m
septal (high on IV septum)


trabeculae carnae

BOTH ventricles; thick irregular muscle for turbulation


septomarginal trabecula = moderator band

trabecula carna that passes between interventricular septum and free wall of right ventricle at base of anterior papillary muscle; contains important conducting fibers that convey electrical impulses to apex of right ventricle and free wall


infundibulum AKA conus arteriosus

smooth walled part of right ventricle, inferior to exit of pulmonary artery;


pulmonary semilunar valve


RV to lungs

hold heart in hands and use probe to find anterior


left atrium

4 pulmonary veins

]musculi pectinati (only in small auricle)

bicuspid valve to LV
anterior and posterior cusp


bicuspid valve

anterior and posterior cusp


left ventricle

bicuspid valve

chordae tendinae
papillary muscles
(ant, post -- for bicuspid)
trabeculae carnae

**aortic semilunar valve has posterior, left and right --> coronary


right coronary artery branches

from aorta above right aortic SL valve cusp, goes to the right and down behind pulmonary artery and then in RIGHT ATRIOVENTRICULAR GROOVE

branches to right atrial branch and sinoatrial node

marginal branch at bottom

curves around to back and posterior interventricular branch (anastomoses with anterior from left)

terminal right coronary branch stays horizontal and anastomoses with circumflex branch from left, in left atrioventricular groove


left coronary artery

it exits aorta. posteriorly. superior to left aortic SL cusp. goes to left of pulmonary artery and immediately divides into...

circumflex; goes around back to meet terminal branch of right coronary artery in left atrioventricular groove

anterior interventricular artery: goes down front to back to anastomose with posterior interventricular artery


great veins - list them

great cardiac
middle cardiac
small cardiac
^^^all go into coronary sinus on back of heart
anterior cardiac veins -- from right ventricle right into right atrium


what does great cardiac follow

circumflex artery from left coronary.

begins in anterior interventricular sulcus, ascends to left atrioventricular sulcus and into coronary sinus


what does middle cardiac follow

posterior interventricular artery into coronary sinus


what does small cardiac vein follow

marginal artery. drains the right ventricle. goes in right atrioventricular groove with right coronary artery into coronary sinus


path of electric activity

SA node is in right atrium at jxn of crista terminales and SVC through walls of atria to AV node

AV node is at interatrial septum; superior to ostium of coronary sinus; location of origin of long conducting fibers (AV bundle)

AV bundle -- fibers go from AV node to interventricular septum and divide to left and right branches to go to each ventricle
****some fibers in right AV bundle go to right ventricular free wall through the MODERATOR band, which goes from interventricular septum to base of free right wall


what can provide artery to artery bypass

left internal thoracic artery graft

around blocked anterior interventricular artery


fetal circulation of oxygenated blood

umbilical vein is oxygenated and goes to:

inferior vena cava -- bypass liver via ductos venosus

to right atrium -- skips right ventricle and lungs with foramen ovale an dgoes to left atrium

then ventricle

then aorta to body


deoxygenated blood path fetal circulation

returns via IVC and SVC; so IVC is mix ox and deox

goes to right atrium; right ventricle; pulmonary trunk -- but not to lungs because they are not inflated and resist blood flow -- and leaves pulmonary via LIGAMENTUM ARTERIOSUM to enter aorta, which takes blood to placenta via umbilical arteries


bypass liver in fetus

ductus venosus


bypass lungs in fetus

foramen ovale (right and left atria)


fetal circulation, once oxygenated blood is expelled through aorta

a lot passes into carotid circulation which is returned to heart (deox) through SVC; blood from SVC primarily directed against atrioventricular orifice and into right ventricle; blood to pulmonary trunk (deflated lungs) is shunted to aorta via ductus arteriosus; systemic circulation -- and then returns to placenta


how does bloodo return to placenta

blood from aorta through systemic circulation: to common iliac, internal iliac, and the umbilical artery


ductus arteriosus

shunt from pulmonary trunk to aorta


5 main changes at birth:

1. lungs inflate = lost resistance, blood enters pulmonary arteries and goes to lungs

2. ductus arteriosus collapse --> LIGAMENTUM ARTERIOSUM

3. pulmonary veins now carry oxygenated blood to left atrium

4. rise in blood pressure in left atrium closes foramen ovale --> FOSSA OVALIS

5. sever umbilical cord; umbilical vein and ductus venosus collapse and become ligamentum teres and ligamentum venosus of liver
6. umbilical arter collapse from umbilical cord severing --> becomes medial umbilical fold in anterior abdominal wall


what do the following become at birth:

1. foramen ovale (RA to LA)
2. ductus arteriosis (pulm trunk to aorta)
3. umbilical artery
4. umbilical vein
5. ductus venosus (skip liver)

1. fossa ovalis
2. ligamentum arteriosus
3. medial umbilical fold of anterior abdominal wall
4. ligamentum teres
5. ligamentum venosus of liver


ligamentum arteriosum is landmark for what

left recurrent laryngeal