Anatomy Flashcards
(107 cards)
1
Q
Sinus of Valsalva
A
The dilated portion of the aorta which faces the valve leaf
2
Q
Mitral Valve Leaflets
A
Two
Anterior and Posterior
3
Q
Which surface of the heart does the left phrenic nerve pass over?
A
The pericardium of the left ventricle, along the lateral border
4
Q
What is the innermost layer of the pericardium?
A
Epicardium (i.e. visceral pericardium)
5
Q
How much fluid would usually be found within the pericardium?
A
50 ml of clear, straw-coloured fluid
6
Q
Intra-Pericrdial Pressure
A
Usually either negative or zero
7
Q
Cardiac Tamponade
A
Result of increased pericardial pressure
Prevents heart contraction
8
Q
Name the condition in which the pericardial cavity feels with blood?
A
Haemopericardium
9
Q
Where is the needle inserted or pericardiocentesis?
A
Via infrasternal angle, and directed superoposteriorly, aspirating continuously
10
Q
Where does the Transverse Pericardial Sinus lie?
A
Posterior to the ascending aorta and pulmonary trunk
11
Q
What is the fibrous pericardium?
A
The tough external layer lined with serous pericardium
12
Q
What is the parietal serous pericardium?
A
In contact with the fibrous pericardium
Reflects onto the heart at the great vessels, becoming the visceral serous pericardium
13
Q
What is the visceral serous pericardium?
A
In contact with the heart
AKA, epicardium
Secretes pericardial fluid lubricant
14
Q
What is the pericardial cavity?
A
Potential space between the two layers of serous pericardium
Normally contains a thin layer of fluid
15
Q
What is the purpose of the fluid in the pericardial cavity?
A
Enables the heart to move and beat in a frictionless environment
16
Q
What are the three clinically important surfaces of the heart and which areas of the heart are they mainly formed by?
A
Anterior (sternocostal) = right ventricle
Base (posterior) = left atrium
Inferior (diaphragmatic) = mostly left ventricle, partly right
17
Q
What are the heart borders and which areas of the heart are they formed by?
A
Right border = right atrium
Left (lateral ) border = left ventricle, some of left atrium
18
Q
Where is the apex usually located?
A
5th intercostal space, midclavicular line
19
Q
What covers the great vessels of the heart?
A
Proximal part = pericardium
Distal parts = adventitia
20
Q
What is the coronary groove a surface marking for, and what vessel sits in it?
A
Tricuspid valve
Right coronary artery
21
Q
What is the anterior interventricular groove a surface marking for, and what vessel sits in it?
A
The boundary between the two ventricles (interventrciular septum)
LAD/anterior interventricular artery
22
Q
Which arteries arise from the ascending aorta?
A
Right and left coronary arteries
23
Q
Which arteries branch of the arch of the aorta?
A
Brachiocephalic trunk
Left common carotid artery
Left subclavian artery
24
Q
What does the brachiocephalic trunk branch into?
A
Right common carotid artery
Right subclavian artery
25
What is the posterior interventricular groove a surface marking for, and which vessel sits in it?
The boundary between the two ventricles (interventricular septum) on the diaphragmatic side
Posterior interventricular artery (and vein)
26
What is the intertribal groove a surface marking for?
The boundary between the atria
27
What is the coronary sinus, what is its function and where does it sit?
A short venous conduit
receives deoxygenated blood from most of the cardiac veins, and drains into the right atrium
Sits in the posterior atrioventricular groove
28
How many pulmonary veins are there?
Two right
| Two left
29
Where do the coronary arteries sit in the layers of the heart?
Just deep to the epicardium, usually embedded in adipose tissue
30
Which vessels come off of the right coronary artery?
Right marginal artery
| Posterior interventricular artery
31
What are the branches of the left coronary artery, and which vessels come off from these?
Circumflex artery = Left marginal artery
| LAD/anterior interventricular artery = left (diagonal) branch
32
What is the septum?
An internal wall of the heart, dividing it into a left and right side
33
What are the two parts of the septum?
Interatrial septum = Between the atria
| interventricular septum = Between the two ventricles
34
What two kinds of septa defects can occur?
Atrial septal defect
| Ventricular septal defect
35
What life threatening problem can occur as a result of a sept defect
Mixing of arterial and venous blood in the heart
| This reduces the oxygen content of systemic arterial blood in the aorta (hypoxaemia)
36
Which vessels open into the right atrium?
SVC
IVC
Coronary Sinus
37
What lines the right atrium?
Crista terminalis (a vertical ridge)
38
What is the oval fossa and where would you find it?
Embryological remnant of a foramen which connected the two atria
Right atrium
Remnants of the valve may be seen in the left atrium
39
What are the openings in the left atrium for?
Bilateral drainage of the superior and inferior pulmonary veins
40
Where is the tricuspid valve located?
Between right atrium and ventricle
41
What is the anatomy of the tricuspid valve?
Anterior, posterior and septal cusps
Cusps connected to tendinous cord, which are attached to the walls of the right ventricle via papillary muscles
in an oblique section of the heart, it is associated with the right posterior fibrous ring
42
Where is the pulmonary valve located?
Between the right ventricle and pulmonary artery
43
What is the anatomy of the pulmonary valve?
Anterior, right and left cusps
| In an oblique section of the heart, it is associated to the most posterior fibrous ring
44
Where is the mitral valve located?
Between the left atrium and ventricle
45
What is the anatomy of the mitral valve?
Anterior and posterior cusps
Cusps connected to tendinous cords, which are attached to the walls of the left ventricle via papillary muscles
In an oblique section of the heart, it is associated with the left anterior fibrous ring
46
Where is the aortic valve located?
Between the left ventricle and aorta
47
What is the anatomy of the aortic valve?
Posterior, right and left cusps with sinuses (spaces) in between
In an oblique section of the heart, it is associated to the middle most fibrous ring
48
Where would you find the moderator band of the tricuspid valve, and what is its function?
Right ventricle
| Carries fibres of the right bundle branch to the papillary muscle of the anterior cusp
49
What are the walls of the left ventricle like?
2-3x thicker than those of the right ventricle
50
What are the papillary muscles in the left ventricle like?
Bigger than those in the right
51
What two types of nervous innervation exist in the heart?
Autonomic - sympathetic and parasympathetic
| Viceral Afferents - Pain fibres and visceral reflex afferents
52
How do sympathetics get from CNS to the organs?
CNS -> Presynaptic fibre -(acetylcholine)-> Sympathetic chain ganglion -> Postsynaptic fibre -(noradrenaline)-> Heart
53
Where do the presynpatic sympathetic fibres leave the spinal cord on their way to the heart?
In one of T1-L2/3 spinal nerves
54
What do the presynpatic sympathetic fibres do once they have left the spinal cord?
1 - Go into the ganglion of that level and synapse
2 - Travel superiorly in the sympathetic chain to another ganglion and synapse
3 - Travel inferiorly in the sympathetic chain to another ganglion and synapse
55
How do postsynaptic sympathetic fibres reach the heart?
Via the cardiopulmonary splanchnic nerves (T1-T5 and cervical ganglia)
There is bilateral sympathetic innervation of the heart
56
Which nerve fibres are contained within the cardiac plexus?
Sympathetic
Parasympathetic
Visceral afferents
57
How do parasympathetics get from the CNS to the organs?
CNS -> Presynaptic fibre -(acetylcholine)-> Parasympathetic ganglion -> Postsynaptic fibre -(acetylcholine)-> Organ
58
Where do the presynpatic parasympathetic fibres leave the brain on their way to the heart?
CNX (vagus nerve)
59
What do the presynpatic parasympathetic fibres do once they have left the brain?
Travel with vagus nerve
Synapse onto postsynaptic neurones
These have very short axons as ganglia are located within the heart walls
60
What do the cardiac visceral afferent nerves travel in?
Cardiopulmonary splanchnic nerves (alongside sympathetic nerves)
61
What do the visceral reflex afferents travel in?
CNX (vagus nerve)
62
Where are visceral afferent nerve ending located within the heart?
```
Inner aortic arch
Pulmonary trunk
Around the SA node
Outflow tracks from both ventricles
Papillary muscles
Vena Cava
```
63
Where re chemoreceptor nerve endings located within the heart?
Root of the aorta
| IV septum
64
What is pain?
Stimulation of sensory receptor
| Afferent AP reaches the brain
65
Nature of somatic chest pain
Sharp, stabbing, well localised
66
Nature of visceral chest pain
Dull, aching, nauseating, poorly localised
67
What is radiating pain?
Pain felt in centre of chest and spreading elsewhere
68
What is referred pain?
Pain only felt at a site remote from the area of tissue damage in the chest
69
What is the pain pathway for somatic central chest pain to the brain?
Skin mechanoreceptors stimulated in T5 dermatome
AP propagated centrally
Passes through anterior ramus, T5 spinal nerve, T5 posterior roots/rootlets
Crosses the spinal cord
Sensation reaches consciousness at cerebral cortex
70
In which part of the brain are somatic sensory APs brought to consciousness?
Postcentral gyrus of parietal lobe
71
Specific causes of somatic central chest pain
Herpes Zoster (shingles) deevloping in T4/5 dermatome
Pectoralis major or intercostal muscle strain
Dislocated costochondral joint
Costovertebral joint inflammation
Slipped thoracic intervertebral disc
Pleurisy
Pericarditis
72
Specific causes of visceral central chest pain
```
Angina
MI
Ruptured aneurysm of aortic arch
Oesophagitis
Tracheitis
Gastritis, cholecystitis, pancreatitis, hepatitis etc.
```
73
Where does somatic pain radiate to?
Along the affected dermatome
74
Where does visceral pain radiate to?
The dermatomes supplied by the spinal cord levels at which the cardiac vessel afferents enter the sympathetic chain/spinal cord
i.e. Bilaterally to cervical and upper thoracic dermatomes
75
How does referred pain work?
When afferent fibres from the soma and viscera enter the spinal cord at the same level, the brain chooses to believe that the pain signals coming from the organ are actually coming from the soma
76
Where does cardiac pain refer to?
Upper limbs (especially left upper limb)
Back
Neck
Jaw
77
Which blood vessels supply the SA node?
SA nodal branch from right coronary artery near its origin (~60% of patients)
AV nodal branch from right coronary artery near the origin of the posterior interventricular artery (~80% of patients)
78
Ischaemia of coronary arteries leading to AV node damage causes
Complete heart block
79
Ischaemia of the coronary arteries leading to bundle branch damage causes
Bundle branch block
80
What is the most common pattern of occlusion in MIs?
Right dominant pattern
81
What is the arterial blood supply of the interventicular septum?
Posterior interventicular artery
| Anterior interventricular artery
82
Which branches come off the thoracic aorta's anterior surface?
```
Bronchial arteries
Oesophageal arteries
Mediastinal arteries
Pericardial arteries
Phrenic arteries
```
83
What is the function of the azygous vein?
Drains posterior intercostal veins into the SVC
84
Which branches come off the thoracic aorta bilaterally?
Posterior intercostal arteries (one for each intercostal space)
85
Where does the vagus nerve sit in relation to the root of the lung?
Posterior
86
Where does the phrenic nerve sit in relation to the root of the lung?
Anterior
87
Which structure does the right recurrent laryngeal nerve look under?
Right subclavian artery
| Does NOT enter the chest
88
Which structure does the left recurrent laryngeal nerve hook under?
Arch of the aorta
| DOES enter the chest
89
Which spinal nerves make up the phrenic nerves?
Anterior rami of cervical spinal nerves 3,4 and 5
| 3,4 and 5 keep the diaphragm alive
90
Where does diaphragmatic pain radiate?
Shoulder tip
91
What kinds of nerve fibres do the phrenic nerves contain?
Somatic motor to diaphragm
Somatic sensory to mediastinal parietal pleura, fibrous pericardium, diaphragmatic parietal pleura, diaphragmatic parietal peritoneum
92
What kind of nerve fibres do the vagus nerve contain?
Somatic sensory for palate, laryngopharynx and larynx
Somatic motor nerves for pharynx and larynx
(ONLY UNTIL THE POINT THEY GIVE OFF THE RLNs)
Autonomic parasympathetics for thoracic and abdominal organs
93
Which nerves branch off of the vagus nerve?
Recurrent laryngeal nerves
| Supply pharynx and larynx
94
Which lymph nodes drain the bifurcation of the trachea?
Tracheobronchial lymph nodes
95
Where is the carotid pulse palpated?
Anterior to the sternocleidomastoid muscle at level of superior border of thyroid cartilage
96
Where is the brachial pulse palpated?
Medial to biceps brachii tendon in the cubital fossa
97
Where is the radial pulse palpated?
Lateral to tension of flexor carpi radialis
98
Where is the femoral artery palpated?
Inferior ot midpoint of inguinal ligament
99
Where is the popliteal pulse palpated?
Popliteal fossa (immediately posterior to knee joint)
100
Where is the posterior tibial pulse felt?
between the posterior border of the medial malleolus and the achilles tendon
101
Where is the dorsalis pedis pulse palpated?
Medial to tendon of extensor hallicus longus on the dorsum of the foot
102
Which lymph nodes drain the main bronchus at the lung root?
Bronchopulmonary lymph nodes
103
Where does the right lymphatic duct drain?
Right venous angle
104
Where does the thoracic duct drain?
Left venous angle
105
What causes the double pulsation of the JVP?
Atrial contraction then filling of the right atrium against a closed tricuspid valve conducted in retrograde into the central veins
106
Which side of the heart would you get arterial access?
To the left side
107
Which side of the heart would you get central venous access?
To the right side
