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Flashcards in Anatomy Deck (83):

Name the coronary arteries

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Describe the branching of the coronary arteries

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Name the vessels on the back of the heart

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What runs across the lateral aspect of the pericardium?

Phrenic n.


What are the layers of the pericardium?

  • 1) Fibrous pericardium
  • 2) Serous pericardium, made up of:
    • Parietal serous pericardium
    • Visceral serous pericardium (aka epicardium)



Pericardial cavity fills with blood and the pressure around the heart can prevent cardiac contraction (“cardiac tamponade”)


Where is the needle inserted for a pericardiocentesis?

Infrasternal angle and directed superoposteriorly to 'bare area' where there is no lung tissue

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Transverse pericardial sinus

A posterosuperior space in the pericardium behind the ascending aorta and pulmonary trunk. Used in surgery to isolate the great vessels

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What forms the right, left and inferior borders of the heart?

Right: RA

Left: LV

Inferior: RV


Where would you find the apex beat?

5th left intercostal space in midclavicular line


Coronary groove/sulcus

Surface marking for the tricuspid valve (boundary between RA and RV). Also holds the right coronary arteries.

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What is the coronary sinus and where is it?

The venous drainage of the myocardium itself which drains back into the RA. Found in the posterior atrioventricular groove

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Where is the right coronary artery found?

Coronary groove/sulcus behind right auricle


Where is the left coronary artery found?

Left atrioventricular groove between pulmonary trunk and left auricle


What is the consequences of a septal defect?

Arterial and venous blood mixes which reduces the oxygen content of systemic arterial blood in the aorta- leading to hypoxaemia


Crista Terminalis

Smooth muscular ridge in superior portion of right atrium that divides musculi pectinati and the right atrial appendage from smooth surface of right atrium

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Where do the coronary arteries arise from?

The aortic valve has sinus (spaces) to allow blood to pass into the coronary arteries. The coronary arteries arise from the right and left aortic sinuses respectively

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How are the leaflets of the valves attached?

Attach to cardiac muscle via papillary muscles which attach to the leaflets via tendinous cords


Moderator band

Spans between the interventricular septum and the anterior wall of the right ventricle acting as a bridge. It has an important conductive function, containing the right bundle branches.

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Aortic area

2nd intercostal space on the right sternal edge


Pulmonary area

2nd intercostal space on the left sternal edge


Tricuspid area

4th intercostal space on the left sterna edge


Mitral area

5th intercostal space in the mid clavicular line


What is the boundary of the superior and inferior mediastinum?

Sternal angle at the level of T4/5

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Anterior mediastinum

Found between the sternum and the fibrous pericardium. In the adult this is mostly adipose tissue, in children it contains the thymus gland


What is found in the posterior mediastinum?

Bifurcating trachea, thoracic duct, thoracic aorta, oesophagus, sympathetic chains, azygous v. and neuromuscular bundle (vagus nerve branches)


What is found in the middle mediastinum?

Pericardium, heart and the proximal part of the great vessels


Where does the azygous vein run and what does it drain?

Anterior surface of the vertebral bodies behind the oesophagus then arches over the root of the lung. Drains the intercostal veins to the SVC


What are the 2 main lymphatic drainage points?

Thoracic duct to left venous angle, and right thoracic duct to right venous angle

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What does the right thoracic duct drain?

Right upper limb, thorax, head and neck


What is the pathway of the thoracic duct.

Extends from the abdomen to the neck when it enters the internal jugular vein.

1) It begins are either a plexus/dilation called the cistern chyli

2) passes through the aortic opening of the diaphragm

3) ascends in the posterior mediastinum between the aorta and azygous vein.

4) then goes behind subclavian, enters the neck and ends in the left internal jugular


Which lymph nodes drain the lungs?

1) Hilar (aka bronchopulmonary) lymph nodes around the bronchus 2) Tracheobronchial nodes at the bifurcation of the trachea

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What is the pathway of the vagus nerve?

1) On right side of trachea then moves to the oesophagus where it forms a plexus with R and L

2) Plexus follows oesophagus through the diaphragm


What is the main difference in the pathway of the vagus n and the phrenic n.?

Vagus n. sits posterior to the root of the lung, which the phrenic n. moves anteriorly


Ligamentum arteriosum

Remnant of the ductus arteriosum. Connects the pulmonary trunk and the arch of the aorta


What are the structures of the superior mediastinum from anterior to posterior?

1) Left brachiocephalic v. 2) Arch of the aorta 3) Trachea 4) Oesophagus 5) Thoracic duct


What are the nerves in the superior mediastinum from lateral to medial?

1) Phrenic n. 2) Vagus n. 3) Recurrent branches of the vagus


Central veins

Those large veins close enough to the heart such that the pressure within them is said to approximately reflect the pressure within the right atrium


What are the central veins in order of blood flow

Superiorly: 1) Internal jugular 2) Subclavian 3) Brachiocephalic 4) Superior vena cava

Inferiorly: 1) Femoral 2) Iliac 3) IVC


Double pulsation of the jugular

The right atrium against a closed tricuspid valve cause sa “double pulsation” (pressure wave) conducted in a retrograde direction into the central veins that can be observed in the internal jugular vein


What level should a normal JVP be in relation to the sternal angle at 45 degrees?

No more than 3cm

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Which nerve hooks under the ligament arteriosum under the arch of there aorta?

Left. recurrent laryngeal n.

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What is the pathway of the right recurrent laryngeal?

Hooks under the right subclavian and doesnt enter the chest

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Where does the phrenic n. originate from?

Combined anterior rami of cervical spinal nerves 3, 4 and 5


What is the function of the phrenic n.?

  • Somatic motor supply of the diaphragm.
  • Somatic sensory supply to:
    • mediastinal parietal pleura
    • fibrous pericardium
    • diaphragmatic parietal pleura
    • diaphragmatic parietal peritoneum


What nerves does the vagus nerve contain (what does it supply)?

  • Somatic sensory nerves for palate, laryngopahrynx and larynx.
  • Somatic motor nerves for pharynx and larynx.
  • Autonomic parasympathetic nerves for thoracic and abdominal organs.
  • Once the vagus has given off the recurrent laryngeals, it only has parasympathetic fibres


What are the recurrent laryngeal nerves?

Branches of the vagus which supply the pharynx and larynx


Where is the pulse for the bifurcation of the common carotids felt?

Anterior to the sternocleidomastoid muscle at the level of the superior border of the thyroid cartilage


Where are the peripheral pulses of the brachial arteries felt?

Medial to biceps brachii tendon in the cubital fossa


Where are the peripheral pulses of the radial arteries felt?

Lateral to tendon of flexor carpi radialis


Where are the peripheral pulses of the femoral arteries felt?

Mid inguinal point (hallway between ASIS and pubic symphysis)

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Where are the peripheral pulses of the popliteal arteries felt?

Inferior region of the popliteal fossa


Where are the peripheral pulses of the posterior tibial arteries felt?

Posterior to the middle malleolus of the tibia, between that and the achilles tendon


Where are the peripheral pulses of the dorsals pedis arteries felt?

Dorsum of the foot (lateral to the extensor halluces longs tendon over the 2/3rd cuneiform bones)


Which visceral afferent nerves supply the heart?

Pain fibres and visceral reflex nerves


How do visceral pain nerves get from the heart to the CNS?

  1. Fibres from diffuse endings around the heart wall travel to cervical ganglia of the sympathetic trunk  alongside sympathetic nerves in cardiopulmonary splanchnic nerves and cardiopulmonary plexus
  2. Enter spinal cord at posterior roots at T1-5 
  3. Then travel to thalamus and hypothalamus before diffuse areas of the cortex


How do visceral reflex afferents travel from the heart to the CNS?

Travel mostly from baroreceptors in vagus nerve


Which neurotrasmitter occurs at the preganglionic fibres for sympathetic innervation of the heart?



Which neurotrasmitter occurs at the post ganglionic fibres for sympathetic innervation of the heart?



How do Postsynaptic sympathetic fibres reach the heart?

Cardiopulmonary splanchnic nerves arise from superior cervical ganglia, middle cervical ganglia, inferior cervical ganglia and ganglia of T1-L2/3


What fibres does the cardiac plexus at the posterior of the heart contain?

  • sympathetic fibres
  • parasympathetic fibres
  • visceral afferent fibres


Which nerve supplied the parasympathetic innervation of the heart?

CN X - vagus


Where are the parasympathetic ganglia for the heart?

Within the walls of the heart itself


Which part of the brain is responsible for perceiving pain?

Postcentral gyrus


Which part of the brain is responsible for the body's response to pain?

Pre-central gyrus 


What can cause somatic (localised) central chest pain?

  1. Herpes zoster "shingles" - Reactivation of dormant virus in posterior root ganglion. Pain can be felt anywhere in T4/5 dermatome and present as central chest pain
  2. Muscle/joint pain e.g. pec major, costochondral or costvertebral joint, slipped disc
  3. Pleurisy
  4. Pericarditis 


What can be the source of  visceral (dull) central chest pain?

  • Trachea (tracheitis)
  • Oesophagus (oesophagitis/GORD)
  • Aorta (ruptured AAA)
  • Heart (angino/MI)
  • Abdominal viscerae (gastritis, cholecystitis, pancreatitis)


What is the difference between radiating and referred pain?

Radiating pain is felt at both the source of the pain and the site it is radiating to, in reffered pain, pain is  felt ONLY at a site remote from the actual area of injury or disease


Why does pain with MI often radiate to the jae, neck and upper limb?

The sensory afferents for these areas send impulses to the same levels of the spinal cord (T1-4) . So the brain confused the pain from the heart as pain from other somatic areas of this dermatoem 


Coronary artery dominance

Dominant artery is the one which supplies the majority of the heart, most commonly is the right coronary artery which is dominant 


Which 4 sites of the coronary circulation are most commonly affected by atherosclerosis?

1) Anterior interventricular branch (LAD) of LCA (40-50%)

2. RCA (30-40%)

3. Circumflex branch of LCA (15-20%)

4) Left (main stem) coronary artery


Triple vessel disease = affected by 1-3


Which vessels are often used for CABG?

  • radial artery/internal thoracic (mammary) artery by pedicle
  • great saphenous vein
  • internal thoracic artery graft


What is the arterial supply to the SA node?

Branch of the right coronary artery near its origin called the SA nodal branch


Which artery supplies the AV node?

Branch of the right coronary artery  near the orogin of posterior interventricular a.  known as the AV nodal branch 


What happens if there is ischaemia of the blood supply to the nodal tissue?

  • Arrythmias.
  • AV node ischaemia = complete heart block.
  • Bundle branch ischaema = bundle branch block


Which coronary artery supplies the anterior interventricular septum and therefore the bundle branches?

Left Anterior Descending (aka anterior interventricular)


Which coronary artery supplies the posterior interventricular septum?

Posterior interventricular a. 


Cardiothoracic ratio (CTR)

the ratio of the maximum diameter of the heart divided by the maximum diameter of the thorax.


What is the normal cardiothoracic ratio?

The normal CTR should be less than or equal to 50%, as shown opposite. Note how the yellow diameter of the heart can be fitted more than twice into the thorax.

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What can cause the heart to seem falsely enlarged in CXR?

  • taken with AP projection
  • poorly inspired
  • rotated


What are the 2 types of angiography?

Catheter coronary angiography and non-invasive coronary angiography using CT


What is the most common contrast to use with imaging?

Iodine, or gadolinium with MRI


How much does the heart normally weigh?