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Cardiovascular > Anatomy 2 > Flashcards

Anatomy 2 Flashcards

1
Q

What does autonomic innervation consist of? What are visceral afferent nerves associated with the heart? (2)

A

* Sympathetic nerves and parasympathetic nerves

* Pain fibres that travel to spinal cord alongside sympathetic fibres
* Visceral reflex afferents (baroreceptors) that travel in vagus nerve to CNS

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2
Q

How does nervous stimulation reach the heart?

A

Via cardiac plexus

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3
Q

What are ganglions? Where are they found in sympathetic NS?

A

* Nerve cell bodies associated with CNS but located OUTSIDE CNS (contain synapse between presynaptic neurone and postsynaptic neurone)
* Bulges in sympathetic chain are sympathetic ganglia

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4
Q

What are presynaptic/preganglionic SYMPATHETIC fibres? Postgnaglionic?

A

* Connects between CNS and ganglion
* Connects between ganglion and organ

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5
Q

What is the neurotransmitter in sympathetic presynaptic nerve terminals? Sympathetic post synaptic nerve terminals?

A

* Acetylcholine
* Noradrenaline

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6
Q

Explain the travel of pre-synaptic sympathetic fibres from the brain (3)

A

* Travel inferiorly within spinal cord
* Exit spinal cord at level of T1-L2 spinal nerves (thoracolumbar outflow) then do one of the following 5 options…

* go into ganglion of that level & synapse
* travel SUPERIORLY the sympathetic chain to another ganglion & synapse
* travel INFERIORLY in sympathetic chain to another ganglion & synapse
* pass straight through sympathetic chain ganglion without synapsing then enter abdominopelvic splanchnic nerves and synapse in one of the prevertebral ganglia of the abdomen (e.g. celiac ganglion)
* pass straight to adrenal medulla without synapsing as an abdominopelvic splanchnic nerve (directly stimulating adrenaline release)

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7
Q

What are cardiopulmonary splanchnic nerves? What spinal nerves do they include? Where do post-synaptic nerves synapse with pre-synaptic nerves?

A

* Sympathetic nerves supplying heart and lungs
* T1 - T5
* In sympathetic chain ganglia

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8
Q

What sympathetic innervation will a midline organ like the heart have?

A

Bilateral sympathetic innervation (predominantly left sided for heart)

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9
Q

What are abdominopelvic splanchnic nerves? What spinal nerves do they include? Where do post-synaptic nerves synapse with pre-synaptic nerves?

A

* Sympathetic nerves supplying liver, pancreas, stomach, kidney, intestines and reproductive system
* T6 - L2
* Synapse in pre vertebral ganglia of the abdomen

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10
Q

Where are cardiopulmonary splanchnic nerves usually located in the heart?

A

Behind great vessels of the heart

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11
Q

What do cardiopulmonary splanchnic nerves feed into in the heart via? What nerves comprise this?

A

* Cardiac plexus - made up of sympathetic fibres, parasympathetic fibres and visceral afferent fibres

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12
Q

Are visceral afferent fibres delivered to cardiac plexus?

A

No, they are relayed back to CNS

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13
Q

What is the neurotransmitter of presynaptic fibre in parasympathetic NS? Postsynaptic fibre?

A

* Acetylcholine
* Aceytlcholine

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14
Q

Where are parasympathetic ganglia located? Where is the parasympathetic ganglia of the heart?

A

* They are isolated - not within chains
* On the wall of the heart

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15
Q

Why will post-synaptic parasympathetic nerve fibre supplying heart be very short?

A

* Ganglia is on surface of heart wall so post-synaptic fibre does not have to travel far for innervation of heart

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16
Q

What do parasympathetic nerves leave the spinal cord within? Therefore, what are the pelvic splanchnic nerves?

A

* Cranial nerves 3, 7, 9 and 10 and sacral spinal nerves (craniosacral outflow)
* PARAsympathetic

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17
Q

What is vagal tone with regards to the heart?

A

Continuous background APs in CNX to slow heart rate

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18
Q

Where is somatic chest pain felt? How is the pain described?

A

* Muscular, joint, bones, intervertebral disc, (Fibrous) pericardium, nerves
* Sharp, stabbing, well-localised

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19
Q

Where is visceral chest pain felt? How is the pain described?

A

* Heart and great vessels, trachea, oesophagus, abdominal viscera
* Dull, aching, nauseating, poorly localised

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20
Q

What is radiating pain with regards to central chest pain? Referred pain?

A

* Pain felt in centre of the chest AND felt spreading from there (e.g. upper limbs, back, neck)
* Pain ONLY felt at site remote from area of tissue damage in the chest (e.g. upper limbs, back, neck)

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21
Q

Explain how sensation would reach consciousness in a person who has been prodded on their RIGHT anterior side (4)

A

* Skin mechanoreceptors stimulated, AP fired
* AP will pass through anterior ramus then spinal nerve, then posterior roots and rootlets, then spinal cord
* Impulse will enter right side of spinal cord but will synapse and cross to left side before ascending to the brain
* Sensation reaches consciousness in cerebral cortex

22
Q

Where do sensations reach consciousness? What does spinal nerve impulse travels in depend on?

A

* Cerebral cortex
* The dermatome that was stimulated e.g. T5 will travel to T5 spinal cord segment

23
Q

Where is the somatosensory cortex located? What do APs ARRIVING here cause?

A

* Postcentral gyrus of parietal lobe (posterior to central sulcus)
* APs arriving here bring somatic (body wall) sensations into consciousness

24
Q

Where is the somatomotor cortex located? What do APs ORIGINATING here cause?

A

* Precentral gyrus of frontal lobe
* APs originating here bring about contractions of body wall (somatic) skeletal muscle

25
Q

What separates the frontal and parietal lobes?

A

Central sulcus

26
Q

What does sensory homunculus show? Motor homunculus?

A

* Shows areas where APs arrive from different body parts to reach consciousness
* Shows areas where APs for different body parts arise

27
Q

What are sharp (somatic) sources of central chest pain?

A

* Herpes Zoster (“shingles”)
* Muscle, bone and joint (slipped disc, dislocated costochondral joint, inflammation)
* Parietal pleura and fibrous pericardium (e.g. pleurisy, pericarditis) - they are SOMATIC structures even though they line viscera

28
Q

What are dull (visceral) central chest pain sources? (5)

A

* Trachea (tracheitis)
* Oesophagus (oesophagitis)
* Heart (angina + MI)
* Abdominal viscera (gastritis, cholecystitis, pancreatitis, hepatitis)
* Aorta (ruptured aneurysm of aortic arch)

29
Q

Name labelled structures on right side of mediastinum (pic)

A

A - Inferior vena cava
B - Oesophagus
C - Azygous vein
D - Right abdominopelvic splanchnic nerves
E - right sympathetic chain
F - right vagus nerve
G - oesophagus
H - trachea
I - superior vena cava
J - lung hilum
K - right phrenic nerve

30
Q

Where does right vagus nerve descend in the thorax? Left vagus nerve?

A

* Found on surface of trachea, passes posterior to root of lung and follows oesophagus down into abdomen
* Crosses aorta, passes posterior to root of lung and follows oesophagus down into abdomen

31
Q

How can you differentiate between phrenic nerve and vagus nerve?

A

* Phrenic nerve - anterior to root of lung
* Vagus nerve - posterior to root of lung

32
Q

Name labelled structures on left side of mediastinum (pic)

A

A - Left phrenic nerve
B - ligmentum arteriosum
C - recurrent laryngeal branch of left vagus nerve
D - thoracic duct
E - left vagus nerve
F - arch of aorta
G - left sympathetic chain
H - thoracic aorta
I - lung hilum
J - left abdominopelvic nerves
K - oesophagus

33
Q

What is ligamentum arteriosum?

A

Embryological remnant of ductus arteriosus

34
Q

Where is thoracic duct located?

A

Left side of upper oesophagus

35
Q

Name labelled structures on posterior mediastinum (pic)

A

A - thoracic duct
B - sympathetic chains
C - azygous vein
D - Vagus nerves
E - aorta (only thoracic aorta lies in posterior mediastinum)
F - trachea and 2 main bronchi
G - Oesophagus

36
Q

Where do visceral afferents of chest organs come from?

A

* Cardiopulmonary splanchnic nerves (T1 - T5 and cervical ganglia)

37
Q

How do visceral afferents travel from cardiopulmonary splanchnic nerves (from the heart) to cerebral cortex? (2)

A

* Travel alongside sympathetic nerves except at spinal cord where they enter via posterior roots like somatic sensory nerves
* Ascend to thalamus and hypothalamus then to the cortex

38
Q

What leads to radiating//referred pain from the heart?

A

Lack of precision in route taken by visceral afferents to the spinal cord

39
Q

Where does pain radiate if it originates in somatic structure? If pain is from heart?

A

* Along affected dermatomes
* dermatomes supplied by spinal cord levels that the cardiac visceral afferents enter the sympathetic chain/spinal cord i.e. BILATERALLY to cervical and upper thoracic dermatomes

40
Q

If visceral pain from heart can radiate to dermatomes (i.e. soma) does that mean the pain is sharp, stabbing, well-localised?

A

Nope, it is still dull, aching an poorly localised

41
Q

What causes referred pain (detail)? (2) Where is pain referred in cardiac pain?

A

* Due to afferent (sensory) fibres from soma and afferent (sensory) fibres from viscera (visceral afferents) entering the spinal cord at the same levels
* The brain chooses to believe that the pain signals coming from the organ are actually coming from the soma
* in CARDIAC referred pain the brain chooses to believe the pain signals are coming from the upper limbs (especially the left upper limb) or from the back, neck (or jaw)

42
Q

What is an MI?

A

irreversible death (necrosis) of part of the myocardium due to occlusion of it’s arterial blood supply

43
Q

What is the type of MI described clinically according to? What are these?

A

According to which SURFACE of the heart has been affected

* Anterior MI
* Inferior MI
* Anterolateral MI
(surfaces supplied by right coronary artery and left coronary artery)

44
Q

Which areas of the heart are supplied by which coronary arteries? What determines the severity of an MI?

A

* Right dominant pattern in 70% of patents, however left dominant in 15% and there can also be unusual extreme right dominant pattern
* depending on arterial pattern, effect of occlusion will vary from small MI to potentially massive MI

45
Q

What are common sites of narrowing/occlusion in coronary atherosclerosis?

A

1 - anterior inter ventricular branch (LAD) of LCA
2 - RCA
3 - circumflex branch of LCA
4 - left (main) coronary artery

(1 = most common, 4 = least common)

46
Q

What is triple vessel disease in atherosclerosis? What is the treatment?

A

* RCA, LAD, and circumflex branch of LCA affected
* Treated by triple bypass

47
Q

What is coronary artery bypass grafting (CABG)? What are common grafts?

A

* Grafts are anastomosed proximally to ascending aorta and distally to occlusion/narrowing so it is BYPASSED
* Radial artery, internal thoracic artery, great saphenous vein

48
Q

What is different about the way the internal thoracic artery is grafted?

A

A segment is not cut from the vessel but instead the distal end of the vessel is anastomosed distal to the narrowing, leaving proximal end in situ and receiving blood as normal via subclavian artery

49
Q

What happens if conducting tissue is damaged by ischaemia?

A

Arrythmia

50
Q

What is the blood supply of the inter ventricular septum?

A

* LAD/ anterior interventricular artery
* Posterior interventricular artery (dual supply from right an left coronary arteries)

51
Q

What is the blood supply to conducting system of the heart?

A

Right coronary artery

Cardiovascular (28 decks)

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