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Cardiovascular > Anatomy > Flashcards

Anatomy Flashcards

1
Q

what are bronchopulmonary lymph nodes also known as

A

hilar lymph nodes

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2
Q

what is the path of the phrenic nerves

A

from C3-C5 descends across the lateral borders of the pericardium to the diaphragm

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3
Q

describe the positions of the phernic and vagus nerves in relation to the hilum

A

Phernic nerve anterior to hilum

Vagus nerve posterior to hilum

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4
Q

what internally lines the fibrous pericardium

A

lined internally by parietal serous pericardium

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5
Q

what covers the anterior surface of the heart

A

epicardium

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6
Q

what does the epicardium secrete

A

pericardial fluid lubricant

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7
Q

where is the pericardial cavity

A

located between the 2 layers of the serous pericardium

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8
Q

what is haemopericardium and what does it lead to

A

when pericardial cavity fills with blood, increasing pressure around heart and can prevent contraction = cardiac tamponade

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9
Q

what does the pericardial cavity contain

A

pericardial fluid

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10
Q

what is pericardiocentesis

A

drainage of fluid from the pericardial cavity

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11
Q

where is the needle inserted in a pericardiocentesis

A

into ‘bare area of pericardium’ via infrasternal angle and directed superoposteriorly, aspirating continuously

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12
Q

where is the bare area of the pericardium

A

below the sternal angle and costal cartilages

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13
Q

describe the transverse pericardial sinus

A

a space within the pericardial cavity, posterosuperiorly, lies posterior to the ascending aorta and pulmonary trunk

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14
Q

what vessels are enclosed within the pericardium

A

the most proximal segments of the ascending aorta and pulmonary trunk

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15
Q

how does the pericardium close around the ascending aorta and pulmonary trunk

A

blends with their adventitia

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16
Q

why is the transverse pericardial sinus clinically important

A

cardiac surgeons use this sinus to identify and isolate the great vessels in order to commence cardiopulmonary bypass (for open heart surgery)

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17
Q

where does a surgeons finger emerge from the TPS

A

anterior to the SVC

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18
Q

what are the three surfaces of the heart

A

anterior (sternocostal) surface, base (posterior) surface, inferior (diaphragmatic) surface

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19
Q

what are the borders of the heart

A

right and left (lateral)

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20
Q

what surface of the heart is in contact with the diaphragm

A

inferior

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21
Q

what vessel of the heart cannot be visualised anteriorly

A

left atrium

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22
Q

where can the apex beat normally be felt

A

5th left intercostal space in the midclavicular line (mitral area)

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23
Q

what does cardiac enlargement do to the heart what what is it AKA

A

cardiomegaly- often shifts the apex beat to the left

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24
Q

what does the coronary groove indicate

A

surface marking for the tricuspid valve (boundary between right atrium and right ventricle)

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25
Q

what does the anterior interventricular groove indicate

A

the boundary between the 2 ventricles

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26
Q

what combines to form the brachiocephalic veins

A

right and left internal jugular and subclavian veins

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27
Q

what combines t for the SVC

A

brachiocephalic veins

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28
Q

what is the right auricle

A

(ear like structure) extension of the right atrium

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29
Q

what is the left auricle

A

extension of the left atrium

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30
Q

where does the right coronary artery travel

A

within the coronary groove

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31
Q

what is the coronary sinus

A

short venous conduit which receives deoxygenated blood from most of the cardiac veins

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32
Q

where does the coronary sinus drain into

A

right atrium

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33
Q

where does the coronary sinus travel

A

within the atrioventricular groove posteriorly

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34
Q

what does the posterior interventricular groove contain

A

posterior interventricular artery (branch of right coronary artery) and posterior interventricular vein

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35
Q

what does the posterior interventricular groove indicate

A

the boundary between the 2 ventricles

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36
Q

what is the first branch off the aorta

A

coronary arteries

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37
Q

what connects the left and right coronary arteries

A

anastomoses

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38
Q

what is the septum between the 2 atria called and indicated by on the surface

A

interatrial septum- interatrial groove

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39
Q

what is the septum between the 2 ventricles called and indicated by on the surface

A

interventricular septum- interventricular groove

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40
Q

what can an atrial or ventricular septal defect cause

A

hypoxaemia due to mixing of atrial and venous blood

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41
Q

what does the mixing of arterial and venous blood do

A

reduces the oxygen content of systemic arterial blood in the aorta

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42
Q

what does the crista terminalis separate

A

rough and smooth textures

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43
Q

where is the tricuspid valve

A

between right atrium and right ventricle

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44
Q

where is the pulmonary valve

A

between the right ventricle and pulmonary trunk

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45
Q

where is the mitral (bicupsid) valve

A

between the left atrium and left ventricle

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46
Q

where is the aortic valve

A

between the left ventricle and the aorta

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47
Q

describe the pulmonary valve

A

has anterior right and left cusps

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48
Q

describe the aortic valve

A

has right, left and posterior cusps and sinuses (spaces within cusps)

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49
Q

describe the tricuspid valve

A

has anterior, posterior anf septal cusps

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50
Q

describe the mitral valve

A

has anterior and posteroir cusps

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51
Q

what attached the valve leaflets to papillary muscles

A

tendinous chords

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52
Q

what causes the first heart sound

A

mitral and tricuspid valves closing closing

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53
Q

what causes the second heart sound

A

the closure of the aortic and pulmonary valves

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54
Q

what are the sinuses within the aortic valves for

A

the coronary arteries

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55
Q

what are semilunar valves

A

cusps look like half moons; pulmonary and aortic

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56
Q

what are leaflet valves

A

have valve leaflets held down with teninous chords which attach to papillary muscles, prevent reflux, mitral and tricuspid

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57
Q

what does the fibrous skeleton do to the valves

A

provides them with stability

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58
Q

what does a moderator band do

A

carries fibres of right bundle branch to the papillary muscle of the anterior cusp (shortcut for electrical activity to make sure all cusps contract and close tricuspid at same time

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59
Q

what is a foetal remnant that can be seen in the right atrium

A

foramen ovale

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60
Q

where do you auscultate for the aortic valve

A

2nd right ICS sternal edge

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61
Q

where do you auscultate for the pulmonary valve

A

2nd left ICS sternal edge

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62
Q

where do you auscultate for the tricuspid valve

A

4th left ICS sternal edge (lower left sternal edge)

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63
Q

where do you auscultate for the mitral valve

A

5th left ICS midclavicular line

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64
Q

describe diastole

A

blood returns via vena cave to RA and pulmonary veins to LA
Tricuspid & mitral valves open so blood drains into RV & LV
Impulse originates at SA node and spreads across atria
Atrial contraction completes ventricular filling

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65
Q

describe systole

A

Impulse spreads across ventricles
Ventricles begin to contract – once pressure in ventricles > pressure in atria tricuspid & mitral valves snap shut
Ventricles continue to contract – once pressure in ventricles > pressure in PT & aorta pulmonary and aortic valves forced open and blood ejected into great arteries
Impulse spreads across ventricles
Ventricles begin to contract – once pressure in ventricles > pressure in atria tricuspid & mitral valves snap shut
Ventricles continue to contract – once pressure in ventricles > pressure in PT & aorta pulmonary and aortic valves forced open and blood ejected into great arteries

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66
Q

how does autonomic innervation and visceral afferent nerves reach the heart

A

via cardiac plexus

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67
Q

what are the two components of the visceral afferent nerves

A

pain fibres travel to spinal cord alongside sympathetic nerves

(visceral) reflex afferents (e.g. from baroreceptors) travel mainly in the vagus nerve (some in CN XI)

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68
Q

what do pain fibres travel to the spinal cord in

A

cardiopulmonary splanchnic nerves and cardiopulmonary plexus

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69
Q

where is the cardiac plexus located

A

behind the great vessels of the heart

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70
Q

what connects the CNS to the ganglion (synapse)

A

presynaptic fibre/ preganglionic fibre

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71
Q

what connect the ganglion to the organ

A

postsynaptic fibre

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72
Q

what is a ganglion

A

collection of nerve cell bodies outside the CNS

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73
Q

what are the neurotransmitters of the sympathetic ganglion and post synaptic fibres

A

ganglion=acetyl choline

PSF= noradrenaline

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74
Q

how do sympathetic signals leave the CNS

A
  1. travel inferiorly within spinal cord tracts and then…

2. exit the spinal cord in one of T1-L2/3 spinal nerves (thoracolumbar)

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75
Q

what are the 3 most likely options for a sympathetic signal once it leaves the CNS

A

go into the ganglion of that level & synapse

travel superiorly in the sympathetic chain to another ganglion & synapse

travel inferiorly in the sympathetic chain to another ganglion & synapse

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76
Q

what do the cardiopulmonary splanchnic nerves supply

A

sympathetic nerves to heart and lung from spinal cord

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77
Q

what type of innervation will a midline organ (e.g. the heart) have

A

bilateral sympathetic innervation

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78
Q

what three types of nerve fibres make up the cardiac plexus and where do they come from?

A

sympathetic fibres from the cardiopulmonary splanchnic nerves

parasympathetic fibres from the vagus

visceral afferent fibres (pain fibres ect)

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79
Q

what are the neurotransmitters for the ganglion and post synaptic fibres of the para system

A

both acetylcholine

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80
Q

what are para posr sympathetic fibres very short in the innervation of the heart

A

as ganglion on heart wall so PGF dont have to travel very far

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81
Q

how do Parasympathetic Signals Reach the Organs

A

via Cranial Nerves III, VII, IX & X

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82
Q

what is CN III

A

oculomotor nerve

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83
Q

what is CN VII

A

facial nerve

84
Q

what is CN IX

A

glossopharyngeal nerve

85
Q

what is CN X

A

vagal nerve

86
Q

describe the nerve fibres within the CN X nerve

A

presynaptic parasympathetic fibres in vagus nerve then synapse onto postsynaptic neurones
(with short axons in ganglia within the walls of the organs of the chest & upper abdomen e.g. heart, lungs)

87
Q

what does the vagus nerve supply

A

heart and other thoracic organs

88
Q

what spinal nerves do para also travel in

A

sacral spinal

89
Q

what reflex afferents are in the vagus nerve

A

aortic arch baroreceptor reflex afferents in vagus nerve

90
Q

what are the somatic causes of pain in the central chest and what is it like

A 
Muscular
Joint
Bony
Intervertebral disc
(Fibrous) pericardial
nerve

typically sharp, stabbing and well localised

91
Q

what are the potential visceral causes for central chest pain and what is it like

A

Heart & Great vessels
Trachea
Oesophagus
Abdominal viscerae

typically more dull, aching, nauseating, poorly localised

92
Q

describe radiating pain

A

Pain felt in centre of chest AND felt spreading from there

  • Upper limbs
  • Back
  • Neck
93
Q

describe referred pain

A

Pain ONLY felt at site remote from area of tissue damage in the chest

  • Upper limbs
  • Back
  • Neck
94
Q

where does sensation reach consciousness

A

cerebral cortex

95
Q

what is stimulate in dermatomes to produce sensations

A

skin mechanoreceptors

96
Q

describe the path of pain

A

sensor- AP propagated centrally- crosses spinal chord- CNS (e.g. Anterior ramus, spinal nevre posterior root, crosses side of spinal chord and then comes into contact with cerebral cortex)

97
Q

why is somatic pain well localised

A

due to precisely (somatotopically) organised pathways from periphery and projections to cortex

98
Q

what is the somatosensory part of the brain and what does it do

A

postcentral gyrus of parietal lobe- APs arriving here bring body wall (somatic) sensations into “consciousness”

99
Q

what is the somatomotor part of the brain and what does it do

A

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

100
Q

what are sources of sharp, somatic central chest pain

A

herpes zoster (shingles), muscle joint and bone, parietal pleura and fibrous pericardium

101
Q

what could cause dull, visceral central chest pain

A 
trachea- tracheitis 
aorta- ruptured aneurysm of aortic arch
abdominal viscerae- infections
oesophagus-oesophagitis 
heart- angina and MI
102
Q

what sub division of the mediastinum are the great vessels in

A

superior

103
Q

where does the phrenic nerve run in relation to the hilar

A

anterior

104
Q

where is the vagus nerve always found on the RHS

A

on surface of the trachea, passing posterior to the root of the lung then follows the oesophagus to the diaphragm

105
Q

what does the azygous vein drain into

A

SVC

106
Q

what is the path of the vagus nerve on the left hand side

A

crossing left side of aortic arch heading posterior to the lung hilum towards the oesophagus

107
Q

where is the thoracic duct

A

left side of upper oesophagus

108
Q

from what side of mediastinum can the aorta be visualised

A

left hand side

109
Q

what creates the recurrent layrngeal nerve

A

branch of left vagus nerve that cross the trachea

110
Q

what part of the aorta lies in the posterior mediastinum

A

thoracic aorta

111
Q

describe the path of visceral afferent APs

A

pass bilaterally to thalamus & hypothalamus then diffuse areas of the cortex

112
Q

alongside what do visceral pain afferents travel alongside going to the organs

A

alongside the sympathetic (motor)

113
Q

where do visceral pain afferents from the heart enter the spinal chord

A

via posterior roots in the cervical ganglia and T1-T5

114
Q

how does the route visceral afferents lead to radiating chest pain

A

as Route visceral afferents take from heart via neck & upper thoracic regions of trunk/cord leads to radiating and referred pain from the heart – due to lack of precision in route taken by visceral afferents to the spinal cord

(cant decide between visceral or somatic as they synapse at ganglion in same place)

115
Q

where do somatic sensory neurons enter the spinal chord in relation to visceral afferents

A

in same place (via posterior roots)

116
Q

if pain is originating in a somatic structure the radiation of pain is where

A

along the affected dermatome(s)

117
Q

if pain is originating from the heart where is the radiating pain and why

A

radiation is to the dermatomes supplied by the spinal cord levels at which the cardiac visceral afferents enter the sympathetic chain/spinal cord i.e. BILATERALLY to cervical and upper thoracic dermatomes

118
Q

what is referred pain

A

the sensation of pain is “felt” ONLY at a site remote from the actual area of injury or disease

119
Q

what causes referred 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

120
Q

what is a heart attack

A

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

121
Q

what are the types of MI

A

according to which SURFACE of the heart has been affected, e.g.:
Anterior MI
Inferior MI
Anterolateral MI

122
Q

where do the coronary arteries arise from

A

right and left aortic sinuses of the ascending aorta

123
Q

what are common sites for coronary atheroscleorosis (narrowing and occlusion especially)
(4 in order of likely hood)

A

anterior interventricular branch (LAD) of LCA

RCA

circumflex branch of LCA

left (main stem) coronary artery

124
Q

what is triple vessel disease

A

narrowing or occlusion in three coronary arteries, treated by triple bypass

125
Q

where are coronary artery grafts anastomosed proximally

A

to the ascending aorta

126
Q

where are coronary artery grafts anastomosed distally

A

to coronary artery distal to narrowing

127
Q

what are three commonly used grafts

A

radial artery/internal thoracic (mammary) artery; great saphenous vein

128
Q

what artery is grafted in pedicle and what does this mean

A

internal thoracic artery graft (by pedicle meaning a segment not cut from vessel but instead the distal end of the vessel is anastomosed distal to the narrowing leaving the proximal end in situ and receiving blood as normal via the subclavain artery

129
Q

what happens if the blood supply to the conducting system of the heart is reduced= tissue damaged by ischaemia

A

arrhythmia

130
Q

what blood supply feeds the SA node

A

RCA nears in origin

131
Q

what blood supple feeds the AV node

A

RCA near origin of PIV artery (posterior interventricular artery)

132
Q

what supplies blood to the interventricular septum

A

dual supply;

LAD (left anterior descending) or anterior interventricular artery

and

posterior interventricular artery

133
Q

what happens is the blood supply to the interventricular septum is compromised

A

arrhythmias

134
Q

what is right and left co dominance

A

territory supplied by left and right coronary arteries

right-dominant pattern in ~70%; in up to 35% LCA is dominant and in approx. 20% there exists a co-dominance : i.e. both supply branches that run in the posterior interventricular groove)

135
Q

which coronary artery gives rise to the posterior interventricular artery

A

right CA

136
Q

what is dysphagia

A

difficulty swallowing

137
Q

what is the mediastinum

A

area between the lungs

138
Q

what divides the superior and inferior mediastinum

A

sternal angle (in between t4 and t5)

139
Q

what structures surround the thoracic inlet

A

ribs 1, T1 vertebra and jugular notch

140
Q

how is the mediastinum divided

A

superior, inferior; anterior, middle and posterior

141
Q

what is the anterior mediastinum between

A

sternum and the fibrous pericardium

142
Q

what gland in contained within the anterior mediastinum

A

thymus

143
Q

what is the role of the thymus is children and adults

A

children- produces T lymphocytes

adults- replaced with adipose tissue

144
Q

what is contained within the middle mediastinum

A

pericardium, heart, parts of the great vessels

145
Q

what great vessels attach to the heart and pass through the middle mediastinum

A 
inferior part of SVC,
superior part of IVC,
pulmonary trunk anf arteries,
pulmonary veins,
ascending aorta
146
Q

what is contained within the posterior mediastinum

A 
azygous vein,
vagus nerves,
2 main bronchi,
thoracic aorta,
oesophagus,
vagal trunks,
thoracic duct,
sympathetic chains/ trunks
147
Q

what is the role of the azygous vein

A

conveys blood from the intercostal veins to the SVC

148
Q

what is the role of the thoracic duct

A

carries lymph to the left venous angle

149
Q

what is the path of the vagal trunks

A

pass through the diaphragm with the oesophagus onto the stomach

150
Q

what part of the aorta lies within the posterior mediastinum

A

the thoracic part

151
Q

where does the trachea bifurcate

A

at the level of the sternal angle (so in the superior mediastinum)

152
Q

describe how and where the vagus nerves exist

A

as plexus within posterior mediastinum

153
Q

what nerves are the most lateral

A

sympathetic trunks

154
Q

what can rupture the azygous vein

A

chest trauma

155
Q

describe the path of the azygous vein

A

arches anteriorly, superior to the lung root to drain into the SVC

156
Q

where do the intercostal veins drain into

A

drain posteriorly into the analogous vein

157
Q

where is the azygous vein in relation to the lung root

A

posterior and superior to it

158
Q

when does the descending aorta become the abdominal aorta

A

after it passes through the diaphragm

159
Q

what part of the aorta do the carotids come from

A

ascending aorta

160
Q

what are the mediastinal branches of the aorta

A

coronary arteries,
brachiocephalic trunk- common carotids and left subclavian,
posterior intercostal ateries (one for each intercostal space),

branches from the thoracic aortas anterior surface;

  • bronchial arteries
  • oesophageal arteries
  • mediastinal arteries
  • pericardial arteries
  • phrenic arteries (for the diaphragm)
161
Q

where does the right subclavian artery come from

A

right brachiocephalic artery

162
Q

what is the role of the bronchial arteries

A

arterial blood for the lung tissue

163
Q

what is the aortic hiatus

A

opening in the diaphragm for the aorta

164
Q

what drains into the right venous angle

A

right lymphatic duct

165
Q

what drains into the left venous angle

A

thoracic duct

166
Q

what do the lymph vessels accompany

A

veins

167
Q

how does the lymph drain from the nodes

A

via the bronchopulmonary lymph nodes

168
Q

where are the bronchopulmonary lymph nodes

A

surround the main bronchus at the lung root

169
Q

how can pulmonary malignancies metastasise

A

via the lymphatics

170
Q

where are the tracheo-bronchial lymph nodes

A

around the bifurcation of the trachea

171
Q

what is the cisterna chyli

A

swollen start of thoracic duct in abdomen

172
Q

how does the oesophagus pass through the diaphragm

A

oesophageal hiatus

173
Q

where is the right vagus nerve in the mediastinum

A

sits on lateral surface of the trachea and passes posterior to the root of the lung

174
Q

the right phrenic nerve pass through the _____ with the _____ to supply the _____ from the ______ aspect

A

passes through the diaphragm with the IVC to supply the diaphragm from the inferior aspect

175
Q

where is the left vagus nerve in the mediastinum

A

closely associated with the aorta, lies on top of it then passes posterior to root of lung

176
Q

what is the ligamentum arteriosum

A

remnant of the ductus arteriosus

177
Q

where is the liganentum arteriosum

A

between the aortic arch and pulmonary trunk

178
Q

the right phrenic nerve pass through the _____ to supply the _____ from the ______ aspect

A

left dome of the diaphragm

diaphragm

inferior aspect

179
Q

what is a role of the recurrent laryngeal branch of the left vagus nerve

A

allows us to talk

180
Q

what is the course of the left recurrent laryngeal branch of the left vagus nerve

A

left RLN originates from the left vagus nerve as it crosses the aortic arch. It then passes posteriorly under the arch and the ligamentum arteriosum then travels back up to larynx

181
Q

list the structures within the superior mediastinum from anterior to posterior

A

brachiocephalic veins and SVC, arch of aorta, trachea, oesophagus, thoracic duct

182
Q

list the structures within the superior mediastinum from lateral to medial

A

phrenic nerves, vagus nerves, recurrent laryngeal nerves

183
Q

the pressure inside which veins reflect the pressure in the right atrium

A

central veins

184
Q

what are the central veins

A

internal jugular, subclavian, brachiocephalic, superior vena cava, inferior vena cava illiac, femoral

185
Q

what causes the double pulsation in the JVP

A

atrial contraction and then filling of the right atrium against a closed tricuspid valve

186
Q

how high should the JVP be normally at 45 degrees

A

no more than 3cm above the sternal angle

187
Q

what does the right recurrent laryngeal nerve hook under

A

the right subclavian artery

188
Q

do either of the reccurent laryngeal nerves enter the chest

A

no

189
Q

what are the phrenic nerves made up of

A

combined anterior rami of the cervical spinal nerves 3, 4 and 5 ( keep the diaphragm alive)

190
Q

what does the phrenic supply somatic motor to

A

the diaphragm

191
Q

what does the phrenic supply somatic sensory to

A

mediastinal parietal pleura,
fibrous pericardium,
diaphragmatic parietal pleura,
diaphragmatic parietal peritoneum

192
Q

describe referred pain from the diaphragm

A

something (liver abscess/ inflammation) irritates parietal peritoneum lining the inferior surface of the diaphragm, which is supplied by the phrenic nerve (C3,4,5). The supraclavicular nerves (c3,4) supply the dermatomes over the “shoulder tip” and enter the spinal cord at the same levels as the phrenic nerve. Brain refers pain to skin over the shoulder tip

193
Q

what does the vagus nerves contain

A

somatic sensory nerves, somatic motor nerves, autonomic parasympathetic nerves

194
Q

what structures are supplied with the somatic sensory nerves within the vagus nerves

A

palate, laryngopharynx and larynx

195
Q

what structures are supplied with the somatic motor nerves within the vagus nerves

A

pharynx and larynx

196
Q

what structures are supplied with the autonomic parasympathetic nerves within the vagus nerves

A

thoracic and abdominal organs

197
Q

what do the vagus nerves contain after the recurrent laryngeal branches branch off

A

only parasympathetic fibres

198
Q

where do the anterior intercostal arteries come from

A

thoracic artery

199
Q

where do the posterior intercostal arteries come from

A

thoracic arota

200
Q

what is the superficial vein of the upper limb

A

cephalic vein

201
Q

where do the anterior intercostal veins drain into

A

thoracic vein

202
Q

where do the posterior intercostal veins drain into

A

azygous veins

203
Q

what is the peripheral pulse in the neck and where is it found

A

bifurcation of the common carotid- anterior to sternocleido-mastoid muscle at level of superior border of thyroid cartilage

204
Q

what peripheral pulses are in the upper limb and where are they found

A

brachial- medial to biceps brachii tendon in the cubital fossa

radial- lateral to tendon of flexor carpi radialis

205
Q

what peripheral pulses are in the lower limb and where are they found

A

femoral artery
-inferior to midpoint of inguinal ligament

popliteal artery
-in popliteal fossa (immediately posterior to knee joint)

posterior tibial artery
-between the posterior border of the medial malleolus & the achilles tendon

-dorsalis pedis artery (dorsal artery of the foot)
medial to tendon of extensor hallucis longus on the dorsum of the foot

206
Q

what are allows arterial access to the (left side) of the heart and their uses

A

radial artery (cannulation for ABP/ABG)

femoral artery (intravascular interventions)

subclavian artery (ccardiac pacing wire)

207
Q

what are allows venous access to the (right side) of the heart and their uses

A

inferior jugular vein (central line)

femoral vein (central line and intravascular interventions)

Cardiovascular (34 decks)

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