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CVS > A01 - Topography of the Heart and Great Vessels > Flashcards

A01 - Topography of the Heart and Great Vessels Flashcards

1
Q

List the vessels that enter the right atrium.

A

1 - Superior vena cava.

2 - Inferior vena cava.

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2
Q

What is an auricle?

What is their purpose?

A
  • Wrinkled pouch-like structures on the anterior surfaces of each atrium.
  • Their purpose is to increase the capacity of the atria.
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3
Q

Which structures form the left and right borders of the heart from an anterior view?

A
  • The left border is formed by the right atrium.

- The right border is formed inferiorly by the left ventricle and superiorly by the left auricle.

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4
Q

List the vessels that enter the left atrium.

A
  • The superior pulmonary vein.

- The inferior pulmonary vein.

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5
Q

Which structures form the diaphragmatic border of the heart?

A
  • 2/3 of the border is formed of the left ventricle.

- 1/3 of the border is formed of the right ventricle.

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6
Q

Which structure forms the base of the heart?

A

The left atrium.

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7
Q

What is the name of the membranous partition in which the heart and pericardium lie?

A

The mediastinum.

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8
Q

What is the pericardium?

A
  • A fibrous sac which provides a serous parietal and serous visceral pericardial membrane.
  • These membranes are separated by a
    very small space known as the pericardial cavity.
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9
Q

What is adventitia?

A

The outermost layer of a vessel wall.

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10
Q

What is the pulmonary trunk?

A

A major vessel that originates from the right ventricle and branches into the right and left pulmonary arteries.

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11
Q

With which structure does the fibrous pericardium fuse?

A
  • Superiorly: The adventitia of the aorta, superior vena cava and pulmonary trunk.
  • Inferiorly: The central tendon of the diaphragm.
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12
Q

What is the transverse pericardial sinus?

A
  • A passage within the pericardial sac posterior to the pulmonary trunk and aorta and anterior to the upper left atrium.
  • A means of communication between the left and right pericardial sac.
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13
Q

What is the fibrous pericardium?

A
  • The outer supportive layer of connective tissue that is immediately superficial to the parietal pericardium.
  • Resists overexpansion of the heart to maintain high pressure.
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14
Q

What is contained within the pericardial cavity?

A

A thin layer of serous fluid.

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15
Q

Describe the innervation of each of the layers of pericardium.

A
  • The fibrous layer and parietal layer of serous pericardium are innervated by the phrenic nerves (C3-5).
  • The visceral layer of serous pericardium is innervated by branches of sympathetic trunks and the vagus nerve.
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16
Q

What is an aortic sinus?

A
  • One of the three dilations of the ascending aorta.

- There is one anterior sinus, one left posterior sinus and one right right posterior sinus.

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17
Q

What is a valve cusp?

A

One of the triangular segments of a valve which opens and closes with the flow of blood.

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18
Q

List the cusps of the aortic valve.

A

1 - Right coronary cusp.

2 - Left coronary cusp.

3 - Non-coronary cusp.

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19
Q

Which structure gives rise to the coronary arteries?

A

The aortic sinuses.

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20
Q

List the branches of the right coronary artery.

A

1 - Right marginal artery.

2 - Posterior interventricular descending artery.

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21
Q

List the branches of the left coronary artery.

A

1 - Circumflex artery.

2 - Left anterior (interventricular) descending artery (LAD).

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22
Q

List the structures that are supplied by the right coronary artery.

A

1 - Right atrium.

2 - Right ventricle.

3 - Bottom portion of both ventricles.

4 - Back of the interventricular septum.

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23
Q

List the structures that are supplied by the left coronary artery.

A

1 - Left atrium (circumflex).

2 - Side and back of the left ventricle (circumflex).

3 - Front and bottom of the left ventricle (LAD).

4 - Front of the interventricular septum (LAD).

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24
Q

List the sulci of the heart.

A

Those that separate atria from ventricles:

  • Left and right coronary (or atrioventricular) sulci.

Those that separate ventricles from ventricles:

  • Anterior and posterior interventricular (or longitudinal) sulci.
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25
Q

What is the apex of the heart?

A

The confluence of the left and inferior borders of the heart.

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26
Q

Describe the course of the great cardiac / left coronary vein.

A
  • Runs in the anterior interventricular (longitudinal) sulcus.
  • Curves around the heart to become the coronary sinus, which is joined by other venous tributaries.
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27
Q

List the venous tributaries that form the coronary sinus.

A

1 - Posterior cardiac vein.

2 - Middle cardiac vein.

3 - Small cardiac vein.

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28
Q

Into which structure does the coronary sinus empty?

A

The right atrium.

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29
Q

List the stages of embryological development of the heart.

A

1 - The primitive heart, the heart tube, first develops around the middle of the third week after fertilization.

2 - Contractions of the heart are evident at day 22.

3 - There is unidirectional flow of blood through the heart by day 28.

4 - During weeks 4 and 5 of development, the single heart tube is divided into four chambers.

5 - Septa develop to separate the atria from ventricles, and also to separate the right and left atria and
right and left ventricles.

6 - In the between the atria, the foramen ovale develops as a valve to prevent the backflow of blood from the left to the right atrium.

7 - The interventricular septum gradually closes off the ventricles, but blood flow between right and left ventricles occurs until the end of week 7 of embryonic development.

8 - Whilst the four chambers of the heart are forming, a major embryonic artery known as the truncus arteriosus will separate into the aorta and pulmonary trunk. The valves of the heart will also develop during this time at their respective sites.

30
Q

Which vein supplies oxygenated blood to the foetus?

A

The umbilical vein.

31
Q

Describe the course of blood entering through the umbilical vein.

A
  • Half passes through the liver via the portal sinus.

- Half bypasses the liver via the ductus venosus, allowing the blood to enter the inferior vena cava.

32
Q

Describe the course of blood that flows through the foramen ovale.

A

From the right atrium, bypassing the lungs and entering the left atrium.

33
Q

What is the ductus arteriosus?

A

A vessel in the developing fetus connecting the trunk of the pulmonary artery to the proximal descending aorta.

34
Q

Describe the course of blood that flows through the ductus arteriosus.

A

From the right ventricle, bypassing the lungs and entering the descending aorta.

35
Q

What proportion of foetal cardiac output goes to the lungs?

A

5-10%.

36
Q

Describe the course of blood that flows through the descending aorta in a foetus.

A
  • Half passes into the umbilical arteries, returning to the placenta for reoxygenation.
  • Half supplies the viscera and lower trunk and limbs.
37
Q

What happens to the ductus venosus, ductus arteriosus, foramen ovale and placental vessels by birth?

A

By birth, they are nonfunctional, however remain present as ligamentous structures or depressions.

38
Q

What is the fossa ovalis?

A

The remnant of the foramen ovale which can be seen as a depression in the interatrial septum in adults.

39
Q

Describe the sympathetic innervation of the heart, commenting on the origin and distribution of the nerves that supply it.

A
  • Both sympathetic and parasympathetic nerves originate in the cardioregulatory centre of the medulla.
  • The sympathetic fibres synapse with preganglionic fibres the sympathetic trunk, which arise in the lateral horn of the upper segments of the thoracic cord (T1-4/5).
  • Sympathetic preganglionics synapse with their postganglionic counterparts in sympathetic ganglia of the cervical and upper thoracic cord (T1-4/5).
  • Sympathetic postganglionics travel bilaterally to the cardiac plexus as superior, middle and lower cardiac nerves.
40
Q

Describe the parasympathetic innervation of the heart, commenting on the origin and distribution of the nerves that supply it.

A
  • Both sympathetic and parasympathetic nerves originate in the cardioregulatory centre of the medulla.
  • The vagus nerves exit the medulla as long preganglionic fibers, and superior and inferior cardiac branches synapse with short postganglionic fibers within the cardiac plexus or walls of the atria.
41
Q

Which sensory unit is responsible for the sensation and regulation of heart activity?

A

The nucleus tractus solitarius (NTS).

42
Q

What are the two main components of the cardiac plexus?

Where is each component found?

A
  • Superficial part: Inferior the aortic arch, and between the aortic arch and pulmonary trunk.
  • Deep part: Between the aortic arch and the tracheal bifurcation.
43
Q

List the effects of stimulation of the parasympathetic innervation of the heart.

A

1 - Decreases heart rate.

2 - Reduces force of contraction.

3 - Constricts the coronary arteries.

44
Q

List the effects of stimulation of the sympathetic innervation of the heart.

A

1 - Increases heart rate.

2 - Increases force of contraction.

45
Q

Describe the organisation of visceral afferents arising from the heart.

A
  • Afferents are also a component of the cardiac plexus.
  • Afferents are either associated with vagal cardiac nerves or sympathetic cardiac nerves.
  • Afferents associated with vagal cardiac nerves return to the vagus nerve.
  • Afferents associated with sympathetic cardiac nerves return to either the cervical or thoracic sympathetic trunk
  • If afferents return to the cervical sympathetic trunk, they descend to the thoracic region, where they join the afferents from the thoracic sympathetic trunk.
46
Q

What is the functional difference between afferents associated with vagal cardiac nerves and afferents associated with sympathetic cardiac nerves?

A
  • Afferents associated with vagal cardiac nerves sense alterations in blood pressure and blood chemistry.
  • Afferents associated with sympathetic cardiac nerves conduct pain sensation from the heart, which is detected as tissue-damaging events (i.e., cardiac ischemia).
47
Q

List the nerves / branches that contribute to the superficial part of the cardiac plexus.

A

1 - The superior cardiac nerves of the cervical sympathetic trunk.

2 - The inferior cardiac branch of the left vagus nerve.

48
Q

List the nerves / branches that contribute to the deep part of the cardiac plexus.

A

1 - Cardiac nerves of the cervical sympathetic trunk.

2 - Cardiac branches of the vagus nerves.

3 - Recurrent laryngeal branch of the vagus nerve.

49
Q

How does the path of the left recurrent laryngeal nerve differ from that of the right?

A
  • The recurrent laryngeal nerves branch off the vagus, the left at the aortic arch, and the right at the right subclavian artery.
  • The left recurrent laryngeal nerve passes in front of the arch, and then wraps underneath and behind it.
50
Q

Why might cardiothoracic surgery affect a patient’s phonation?

A

Injury to the recurrent laryngeal nerves would impair function of the intrinsic laryngeal muscles.

51
Q

What is the ligamentum arteriosum?

A

A ligament that is the remnant of the ductus arteriosus.

52
Q

Where is pain originating from the heart referred to?

A

In the jaw, left shoulder and left arm.

53
Q

What is angina pectoris?

A

Pain due to coronary artery disease.

54
Q

What can cause a blue baby syndrome?

A
  • Most commonly nitrates:

After a baby drinks formula made with nitrate-rich water, the body converts the nitrates into nitrites. These nitrites bind to the hemoglobin in the body, forming methemoglobin, which is unable to carry oxygen.

  • Sometimes congenital heart abnormalities.
55
Q

How do the auricles differ visually from atria on the inside?

A

The walls of the auricles are covered by ridges called pectinate muscles, which fan out from the folds like the “teeth of a comb.”

56
Q

What is the role of the papillary muscles attached to valve cusps?

A

They attach to the mitral and tricuspid valves and contract to prevent inversion of these valves on systole.

57
Q

What are chordae tendineae and what is their function?

A

They are fibrous cords of connective tissue that connect the papillary muscles to the tricuspid valve and the bicuspid valve in the heart.

58
Q

List the valves of the heart.

A
  • The two atrioventricular valves, the mitral valve (bicuspid valve), and the tricuspid valve, which are between the atria and ventricles.
  • The two semilunar valves, the aortic valve and the pulmonary valve, which are in the arteries leaving the heart.
59
Q

Where is the catheter normally inserted for an angiogram?

A

In the femoral vein.

60
Q

Give an example of a typical contrast medium for angiograms.

A

Iodine.

61
Q

List the components of the mediastinum.

A

1 - Superior mediastinum.

2 - Anterior inferior mediastinum.

3 - Middle inferior mediastinum.

4 - Posterior inferior mediastinum.

62
Q

List the contents of the superior mediastinum.

A

1 - Oesophagus.

2 - Trachea.

3 - Thymus.

4 - Phrenic nerve.

5 - Vagus nerve.

6 - Left recurrent laryngeal nerve.

7 - Superior vena cava.

8 - Brachiocephalic veins.

9 - Aortic arch.

10 - Thoracic duct.

63
Q

List the contents of the anterior inferior mediastinum.

A

1 - Remnants of the thymus.

2 - Lymph nodes.

64
Q

List the contents of the middle inferior mediastinum.

A

1 - Phrenic nerve.

2 - Heart.

3 - Pericardium.

4 - Ascending aorta.

5 - Pulmonary trunk.

6 - Superior vena cava.

65
Q

List the contents of the posterior inferior mediastinum.

A

1 - Oesophagus.

2 - Thoracic aorta.

3 - Azygos veins.

4 - Hemiazygos veins.

5 - Thoracic duct.

6 - Vagus nerve.

7 - Osophageal plexus.

8 - Greater, lesser and least splanchnic nerves.

66
Q

What is the sternal angle of Louis, and what is its significance?

A
  • The synarthrotic joint formed by the articulation of the manubrium and the body of the sternum.

1 - The point at which the costal cartilages of rib two articulate with the sternum.

2 - The level of the T4-T5 intervertebral disc

3 - The level of the transverse thoracic plane which divides the mediastinum into the superior and inferior mediastinum.

4 - It overlies the aortic arch on the left and the superior vena cava on the right.

5 - The bifurcation of the trachea and pulmonary trunk.

67
Q

List the boundaries of the superior mediastinum.

A

For all compartments:

  • Posteriorly: Thoracic spine.
  • Anteriorly: Sternum and costal cartilages.
  • Laterally: Mediastinal pleura.

For superior:

  • First rib to T4.
68
Q

List the boundaries of the anterior inferior mediastinum.

A

For all compartments:

  • Posteriorly: Thoracic spine.
  • Anteriorly: Sternum and costal cartilages.
  • Laterally: Mediastinal pleura.

For anterior inferior:

  • T4-T9.
69
Q

List the boundaries of the middle inferior mediastinum.

A

For all compartments:

  • Posteriorly: Thoracic spine.
  • Anteriorly: Sternum and costal cartilages.
  • Laterally: Mediastinal pleura.

For middle inferior:

  • T4-T9.
70
Q

List the boundaries of the posterior inferior mediastinum.

A

For all compartments:

  • Posteriorly: Thoracic spine.
  • Anteriorly: Sternum and costal cartilages.
  • Laterally: Mediastinal pleura.

For posterior inferior:

  • T4-T12.

CVS (18 decks)

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