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CARDIO > Anatomy of the heart > Flashcards

Anatomy of the heart Flashcards

1
Q

where is the pericardium and the heart located

A

middle mediastinum

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2
Q

what does the hilum (root) of the lung contain

A 
pulmonary artery
main bronchus
pulmonary vein 
pulmonary lymphatic vessels, brochopulmoanary lymph nodes
pulmonary nerves (visceral afferents)
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3
Q

what is the pericardium

A

tough fibrous sac enclosing the heart

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4
Q

what nerves descend across the lateral borders of the pericardium

A

phrenic nerves

keep diaphragm alive

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5
Q

what is the main motor nerve supply to the diaphragm

A

phrenic nerves

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6
Q

what are the 3 layers of the pericardium

A

fibrous pericardium (outermost)
parietal serous pericardium (in contact with fibrous pericardium)
visceral serous pericardium (in contact with heart)

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7
Q

what is the function of the space between the parietal and visceral serous pericardium

A

filled with fluid acts as lubricant to allow smooth muscle contraction

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8
Q

what is the anterior surface of the heart covered by

A

epicardium - secretes pericardial fluid lubricant

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9
Q

what is another name for the visceral serous pleura

A

epicardium

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10
Q

what is haemopericardium and what condition can it cause

A

pericardial cavity fills with blood

pressure around the heart prevents cardiac contraction = CARDIAC TAMPONADE

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11
Q

how do you treat haemopericardium

A

pericardiocentesis - drain fluid (blood from the pericardial cavity)

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12
Q

where is the needle inserted in pericardiocentesis

A

via infrasternal angle and directed superposteriorly (not through lungs!)

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13
Q

what is the transverse pericardial sinus

A

space in pericardial cavity poserosuperiorly

lies posterior to the ascending aorta and pulmonary trunk

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14
Q

why is the transverse pericardial sinus so vital

A

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

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15
Q

where is the transverse pericardial sinus located

A

behind aorta and pulmonary trunk but infront of SVC

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16
Q

what are the 3 clinically important surface of the heart

A

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

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17
Q

what are the 4 clinically important surfaces of the heart

A

right (mostly right atrium)
left (mostly left ventricle)
inferior (mostly right ventricle)
superior (mostly great vessels)

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18
Q

where is the apex located

A

most lateral and inferior part of the heart

5th intercostal space mid clavicular line

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19
Q

where does cardiomegaly shift the apex beat to

A

left

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20
Q

what are the 3 branches from right to left of the aortic arch

A

1) brachiocephalic trunk (branches into right subclavian artery and right common carotid artery)
2) left common carotid artery
3) left subclavian artery

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21
Q

what does the SVC branch off into

A 
right BCV (right subclavian and right IJV)
left BCV
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22
Q

what nerve lies anterior to the lung root

A

phrenic nerve

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23
Q

what nerve lies posterior to the lung root

A

vagus nerve

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24
Q

what is the extension of the right atria called

A

right auricle

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25
Q

how does blood leave the right ventricle

A

via pulmonary trunk which branches into right pulmonary arteries (superior and inferior) and left pulmonary arteries (superior and inferior)

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26
Q

what are the 3 parts of the aorta

A

ascending
arch
descending

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27
Q

what does the coronary groove indicated

A

surface marking of tricuspid valve

boundary between right atrium and right ventricle

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28
Q

what does the anterior inter ventricular groove indicate

A

boundary between the 2 ventricles

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29
Q

what artery does the coronary groove contain

A

right coronary artery

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30
Q

what artery does the anterior inter ventricular groove contain

A

branch of the left coronary artery

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31
Q

what chamber covers most of the area of the back of the heart

A

left atrium

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32
Q

what does the inter-atrial groove indicate

A

boundary between 2 atria

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33
Q

what does the posterior inter-ventricular groove indicate

A

boundary between 2 ventricles on diaphragmatic surface of the heart

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34
Q

what does the posterior inter-ventricular groove contain

A

an artery and a vein

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35
Q

what vein is responsible for draining venous blood from the intercostal spaces into the SVC

A

azygous vein

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36
Q

what arteries supply the epicardium and myocardium with its own oxygenated blood

A

coronary arteries

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37
Q

what is the prominent venous drain in the atrioventricular groove posteriorly that receives deoxygenated blood from most cardiac veins

A

coronary sinus

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38
Q

where do coronary vessels lie

A

deep to epicardium embedded in adipose tissue

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39
Q

what is the first branch of the aorta

A

coronary arteries which arise from the ascending aorta

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40
Q

what are the 2 branches of the right coronary artery

A

right marginal artery

posterior inter ventricular artery

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41
Q

what are the 4 branches of the left (main stem coronary artery)

A

Circumflex artery
left anterior descending (anterior interventricular artery)
left marginal artery
diagonal branch

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42
Q

what chamber does the coronary sinus drain into

A

right atrium

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43
Q

what separates the hearts left and right side

A

septum

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44
Q

what is the 2 parts of the septum

A

interatrial septum

interventricular septum

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45
Q

what is an atrial septal defect

A

hole in the intertribal septum

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46
Q

what is a ventricular septal defect

A

hole in inter ventricular septum

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47
Q

what does a septal defect result in

A

mixing of arterial and venous blood in the heart so results in hypoxaemia

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48
Q

what are the 3 openings in the right atrium

A

opening of the coronary sinus
opening of the SVC
opening of the IVC

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49
Q

where do the coronary arteries origionate

A

ascending aorta

right and left aortic sinuses

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50
Q

what is the name of the depression In the right atrium

A

oval fossa

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51
Q

what separates the muscle bands of the auricle wall and the smooth atrial muscle

A

crista terminalis

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52
Q

what are the 4 heart valve

A

tricuspid valve
mitral (bicuspid) valve
aortic valve
pulmonary valve

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53
Q

what are the 3 cups of the tricuspid valve

A

anterior
posterior
septal

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54
Q

what valves create the first heart sound (LUB)

A

tricuspid

mitral

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55
Q

what allows valves to close and resist opening to high pressure

A

tendinous cords

papillary muscle

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56
Q

what cardiac muscle attach to the chamber walls

A

papillary muscles

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57
Q

what valves create the second heart sound

A

pulmonary valve

aortic valves

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58
Q

describe the structure of pulmonary and aortic valves

A

pockets act to catch blood when it starts to reflux when the pockets fill valve closes

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59
Q

what are the cusps of the mitral valve

A

anterior and posterior

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60
Q

what is the function of the moderator band (septomarginal trabecular) in the ventricles

A

carries fibres of the right bundle branch to the papillary muscle of the anterior cusps - ensures all the cusps of the valve close at the same time

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61
Q

what is the function of the fibrous cardiac skeleton

A

facilitates electrical conduction by acting as an insulator

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62
Q

artery can be mobilised from its attachment to the sternum, sectioned inferiorly and anastomosed to a coronary artery, distal to an occlusion (in coronary artery bypass grafting). what is the artery

A

the inter thoracic artery

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63
Q

what lies above the aortic valves

A

the Ostia of left and right coronary arteries

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64
Q

what is the crux of the heart

A

junction of all 4 chambers

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65
Q

where do the sympathetic and parasympathetic nerves reach the heart

A

at the cardiac plexus

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66
Q

what are the 2 types of visceral afferent nerves

A
  • pain fibres travel to spinal cord alongside sympathetic fibres
  • visceral reflex afferent from baroreceptors
67
Q

what do the visceral reflex afferent from baroreceptors travel in

A

vagus nerve CNX

68
Q

how do sympathetic nerve fibres get from CNS to Organ

A

Impulse travels from CNS along presynaptic fibre to the sympathetic chain where they ganglion is and then synapse with the post synaptic fibre which carries impulse to the organ

69
Q

where is the ganglion of sympathetic nerve fibres

A

in the sympathetic chain

70
Q

what is the neurotransmitter of the sympathetic presynaptic neurone

A

acetylcholine

71
Q

what is the neurotransmitter of the sympathetic postsynaptic neurone

A

noradreneline

72
Q

where do the sympathetic presynaptic fibres exit the spinal cord and what happens next

A

T1-L2
THORACOLUMBAR OUTPUT
then either: 1) go into the ganglion of that level and synapse 2) travel superiorly in sympathetic chain to another ganglion and synapse or 3) travel inferiorly in sympathetic chain to another ganglion and synapse

73
Q

what name is given to the sympathetic post synaptic fibres that travel to heart and lungs

A

cardiopulmonary splanchnic nerves

74
Q

where do cardiopulmonary splanchnic nerves travel to

A

they travel from their synapse in the sympathetic chain to the cardiac plexus

75
Q

what fibres travel to the cardiac plexus

A

sympathetic fibres
parasympathetic fibres
visceral afferent fibres

76
Q

how do parasympathetic signals travel from the CNS to the Organ

A

Excitation will travel from CNS along the presynaptic fibre to the parasympathetic ganglion synapse on the surface of the heart then along the postsynaptic fibre to the organ

77
Q

where is the parasympathetic ganglion synapse located

A

on the organ eg on the heart hence why postganglionic fibres are short and pre ganglionic fibres are long

78
Q

what is the parasympathetic presynaptic neurotransmitter

A

acetylcholine

79
Q

what is the parasympathetic post synaptic neurotransmitter

A

acetylcholine

80
Q

what nerves carry the presynaptic parasympathetic fibres to the heart where the synapse is

A

Vagus nerves

81
Q

are pelvic splanchnic nerves sympathetic or parasympathetic

A

parasympathetic

82
Q

are abdominopelvic splanchnic nerves sympathetic or parasymapathetic

A

sympathetic

83
Q

what type of spinal outflow do parasympathetic nerves show

A

Craniosacral

84
Q

I have a sharp stabbing pain that is well localised. What type of pain is this

A

Somatic: muscular, joint, bony, intervertebral disc, fibrous pericardial, nerve

85
Q

I have a dull aching nauseating pain that is poorly localised. What is causing my pain?

A

Visceral (organ): heart/great vessels, trachea, oesophagus, abdominal viscerae

86
Q

what is radiating pain and where does it typically radiate to

A

somatic pain in centre of chest which also spreads outwards to upper limbs, back or neck along affected dermatome

87
Q

what is referred pain and where is it typically felt

A

pain ONLY at site remote from area of tissue damage in chest: upper limbs, back and neck

88
Q

what are the 5 different types of chest pain

A
  • somatic
  • visceral (organ)
  • radiating
  • referred
  • acute vs chronic
89
Q

if you are painfully prodded in T5 dermatome where will sensitisation reach conciousness

A

cerebral cortex

90
Q

what anatomical feature separates the frontal and parietal lobe

A

central sulcus

91
Q

what is the somatosensory region of the brain where APs arrive from the body wall and consciousness of pain is registered

A

Postcentral gyrus of parietal lobe

92
Q

what is the somatomotor region of the brain where APs originate to bring about contraction of the body wall skeletal muscle

A

precentral gyrus of frontal lobe

93
Q

what is the sensory homunculus

A

area of cerebral cortex where sensitisation from different body wall structures reach consciousness

94
Q

give examples of sharp (somatic) central chest pain sources

A 
Herpes Zoster (shingles)
bone, muscle, joint
parietal pleura and fibrous pericardium
95
Q

describe the pain associated with shingles (Herpes Zoster)

A

reactivation of dormant virus in posterior root ganglia
pain anywhere in dermatome
pain preceeds blisters

96
Q

what presentation does shingles have in the T4/5 dermatome

A

central chest pain

97
Q

what bone/joint/muscle pain can be felt as central chest pain

A

pectoralis or intercostal strain
dislocated costochondral joint
costovertebral joint inflammation
slipped thoracic intervertebral disc

98
Q

what type of pain is associated with pleurisy and pericarditis

A

sharp stabbing central chest pain
well localised
somatic

99
Q

where are dull visceral central chest pain sources

A 
tracheal
aorta (ruptured aneurysm of aortic arch)
heart (angina/MI)
abdominal visceral (gastritis, pancreatitis, hepatitis) 
oesophagitis
100
Q

what are the 4 subdivisions of the mediastinum

A

Superior mediastinum = above sternal angle
anterior = sternum
middle = heart and diaphragm
posterior = vertebral column and posterior of heart

101
Q

how can the vagus nerve be found on from the right side of the mediastinum

A

on lateral aspect of trachea goes over oesophagus and through diaphragm

102
Q

what lies behind the oesophagus and arches over the top of the lung into the SVC

A

azygous vein

103
Q

what is another name for the descending aorta

A

thoracic aorta

104
Q

how can the left vagus nerve be found

A

courses over aortic arch

105
Q

how can the recurrent laryngeal branch of the left vagus be found

A

it hooks under ligaments arteriosum

106
Q

what is the ligamentum arteriosum

A

remnant ductus arterioles connecting PT to arch of aorta

107
Q

where does the thoracic duct lie posteriorly

A

between azygous and oesophagus

DUCK between 2 GOOSE (azygoose and oesophagoose)

108
Q

where do visceral afferent action potentials pass

A

bilaterally to the thalamus and hypothalamus then diffuse areas of the cortex

109
Q

what do visceral (pain) afferents travel alongside

A

sympathetic motor nerves to organs except enter via posterior roots as do somatic sensory fibres from body wall this is what causes confusion as to where pain comes from

110
Q

how do pain signals travel from the organs to the brain

A

via visceral pain afferents

111
Q

at what spinal cord level do the visceral afferent enter the sympathetic trunk and spinal cord from the heart

A

cervical ganglia and T1-T5 spinal nerves)

112
Q

what is visceral radiating pain

A

pain is still dull in nature at organ although felt in dermatome pattern

113
Q

How does radiating pain arise if from the heart radiation is to the dermatome supplied by the spinal cord levels at which cardiac visceral afferents enter spine

A

bilaterally to cervical and upper thoracic dermatomes

114
Q

how does referred pain arise

A

due to afferent (sensory) fibres from soma and afferent sensory fibres from viscera (visceral afferens) entering the SPINAL CORD AT SAME LEVEL
brain chooses to belie the pain signal from the organ are coming from the soma

115
Q

define myocardial infarction

A

irreversible death (necrosis) of part of the myocardium due to occlusion of its arterial blood supply

116
Q

what are the 3 types of MI

A

Anterior MI
Inferior MI
Anteriolateral MI

117
Q

occlusions of what coronary arteries cause an anterior MI

A

Right coronary arter
left coronary artery
anterior inter ventricular artery

118
Q

where does the left coronary artery sit

A

in left atrioventricular groove between the pulmonary trunk and left auricle

119
Q

in most people what coronary arteries supply myocardium

A

right coronary arteries

120
Q

what are the 4 sites of coronary atherosclerosis

A
  1. anterior interventricualr branch of LCA
  2. Right Coronary Artery
  3. Circumflex branch of LCA
  4. Left (main stem coronary artery)
121
Q

what arteries are replaced in a triple bypass

A

Anterior Interventricular artery
RCA
circumflex artery

122
Q

where are Coronary Artery Bypass Grafts anastomosed

A

proximal to ascending aorta

123
Q

what arteries are usually used in CABG

A

radial artery
great saphenous vein
internal thoracic artery by pedicle

124
Q

what coronary arteries are linked with the conducting system of the heart (beside the SAN and AVN)

A

right coronary arteries

125
Q

how is the superior and inferior mediastinum

A

line from sternal angle (manubrium above and sternum below) goes to transverses thoracic plane between sternal angle and T4/5

126
Q

what is thoracic outlet syndrome

A

compression of vascular and brachial plexus of thoracic inlet bounded by ribs 1, T1 vertebra and jugular notch

127
Q

what does the diaphragm separate

A

thoracic and abdominal cavity

128
Q

what is contained in the anterior mediastinum (area betweens sternum and fibrous pericardium) of adult

A

adipose tissue

129
Q

what is contained in the anterior mediastinum (area betweens sternum and fibrous pericardium) of child

A

thymus gland producing T cells in prepubescent childhood

130
Q

what does the middle mediastinum contain

A 
pericardium
heart 
parts in great vessel: ascending aorta, pulmonary veins, inferior part of SVC
superior part of IVC
pulmonary trunk & pulmonary arteries
131
Q

what part of aorta is confined in the posterior mediastinum

A

descending

132
Q

what part of the aorta is in the superior medistinum

A

arch of aorta

133
Q

what structures are in the posterior medistinum

A 
oesophagus (behind trachea)
vagus nerve 
trachea + 2 main bronchi
thoracic duct 
azygous vein 
sympathetic chains
134
Q

where does the trachea bifurcate

A

level of sternal angle so is in superior mediastinum

135
Q

where do the vagal trunks from the vagal plexus pass through

A

diaphragm with the the oesophagus onto the stomach

136
Q

function of azygous vein

A

covneys blood from intercostal veins/intercostal space of chest wall to SVC
can be ruptured in trauma

137
Q

function of thoracic duct

A

carries lymph to left venous angle

138
Q

what does the azygous vein cross over

A

root of the lung posteriorly to drain into SVC

139
Q

4 parts of aorta

A

ascending
arch
thoracic
abdomina

140
Q

what does the aorta become after passing through the diaphragm

A

no longer thoracic aorta becomes abdominal aorta

141
Q

what is the aortic hiatus

A

opening in the diaphragm where thoracic artery becomes abdominal artery

142
Q

what are the 5 branches from the thoracic aorta

A 
bronchial arteries 
oesophageal arteries
mediastinal arteries
pericardial arteries
phrenic arteries
143
Q

what does the right lymphatic duct drain into

A

right venous angle

144
Q

what does the thoracic duct drain lymph into

A

left venous angle

much more drainage than right lymphatic drug drainage

145
Q

how does lymph drain from lungs

A

1) bronchopulmonary/hilar lymph nodes surround main bronchus, lymph drains here
2) lymph drain into tracheobrachial lymph nodes around the bifurcation of the trachea
3) lymph then either drain into right lymphatic duct or thoracic duct

146
Q

what makes up the left venous angle

A

internal jugular vein and subclavian vein which forms brachial cephalic vein

147
Q

how can pulmonary metastases spread

A

via lymphatics

148
Q

In some patients where does left inferior lobe drain into

A

right lymphatic duct (usually drains into thoracic duct)

149
Q

how can the thoracic duct be identified

A

by cisterns chyli: swollen start if thoracic duct in abdomen

150
Q

what does the right vagus nerve sit on

A

trachea passes posteror to lung root

151
Q

how can the left vagus nerve be identified

A

arches over the aorta, one branch that supplies larynx goes under ligamenum arteriosum (recurrent laryngeal branch of left vagus nerve)

152
Q

what is the ligament arteirosum

A

embryological structure, remnant ductus arteriosus

153
Q

what structures are located in superior mediastinum from anterior to posterior

A 
brachiocephalic veins (jugular vein + subclavian) + SVC
arch of aorta
trachea
oesophagus
thoracic duct
154
Q

what nerves are in the superior mediastinum from lateral to medial

A

phrenic nerves
vagus nerves
recurrent laryngeal nerves

155
Q

what are central veins

A

subclavian, brachiocephalic, internal jugular, SVC, IVC, iliac, femoral veins that have the same pressure as the right atrium

156
Q

what is the most lateral nerve

A

phrenic

157
Q

at 45 degrees what is the max the JVP should be

A

no more then 3cm superior to sternal angle (angle of Louis)

158
Q

where can the right recurrent laryngeal nerve be found

A

hook under right subclavian artery (NOT enter chest)

159
Q

where can the left recurrent laryngeal nerve be found

A

hooks under the arch of the aorta (does enter the chest)

160
Q

what is the phrenic nerve somatic sensory to

A

supplies somatic motor diaphragm
somatic sensory to: pericardium, mediastinal parietal pleura, diaphragmatic parietal pleura, diaphragmatic parietal peritoneum

161
Q

if a patient presents with right shoulder tip pain what structure can this be due to

A

diaphragm (due to shared nerves)

162
Q

if a patient presents with right shoulder tip pain what structure can this be due to

A

diaphragm (due to shared nerves)

163
Q

2 main nerves of superior mediastinum

A

phrenic and vagus nerve

CARDIO (14 decks)

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