Anterior Mediastinum, Pericardial Cavity, Heart and Coronary Vessels

Question 1

Where in the anterior mediastinum?

Answer 1

Posterior to the manubrium and anterior to the pericardial sac

Question 2

What is in the anterior mediastinum?

Answer 2

Thymus Gland?

Question 3

Where is the middle mediastinum?

Answer 3

Between T4 (Angle of Louis) and the Diaphragm

Question 4

What is in the middle mediastinum?

Answer 4

1. Pericardium
2. Heart
3. Roots of the Great Vessels

Question 5

What is in the posterior mediastinum?

Answer 5

1. Great arteries and vein(s)
2. Oesophagus
3. Trachea
4. Phrenic and Vagus Nerves
5. Sympathetic Chain
6. Thoracic Duct

Question 6

What is Pericardium?

Answer 6

The membrane enclosing the heart

Question 7

What are the layers of Pericardium?

Answer 7

1. Fibrous Pericardium

2. Serous Pericardium, which splits into Parietal and Visceral Pericardium

Question 8

What does the Fibrous Pericardium attach to?

Answer 8

1. Great Vessels
2. Central Tendon of Diaphragm
3. Sternum (Sternopericardial ligament)
4. Parietal Layer of Serous Pericardium

Question 9

Where is the pericardial cavity?

Answer 9

Between the visceral and parietal layers of the serous pericardium

Question 10

What is the function of the pericardial cavity?

Answer 10

Contains fluid that facilitates the gliding movement caused by the beating of the heart

Question 11

What are the Pericardial Sinuses?

Answer 11

1. Transverse Sinus (Separates the Great Arteries and Great Veins)
2. Oblique Sinus

Question 12

What are the Pericardial Arteries?

Answer 12

1. Branches of the internal thoracic artery
2. Pericardocophrenic
3. Musculophrenic
4. Inferior Phrenic
5. Thoracic Aorta

Question 13

What are the Pericardial Veins?

Answer 13

1. Internal Thoracic Veins
2. Superior Phrenic Veins
   They all drain into the Azygous System

Question 14

What are the Pericardial Nerves?

Answer 14

1. Sympathetic Trunks
2. Vagus Nerve
3. Phrenic Nerves

Question 15

What are the clinical conditions of the Pericardium?

Answer 15

1. Pericarditis
2. Pericardial Effusion
3. Constrictive Pericarditis
4. Cardiac Temponade–> Pericardial effusion leading to compression of the heart

Question 16

What are the 3 layers of the Heart wall?

Answer 16

1. Endocardium –> Innermost
2. Myocardium–> Composed of Cardiac Muscle
3. Epicardium–> Outermost, formed by the visceral layer of the pericardium

Question 17

What is the right border of the heart?

Answer 17

The right atrium

Question 18

What is the inferior/diaphragmatic border of the heart?

Answer 18

Apex of the heart, 2/3 Left ventricle, 1/3 Right ventricle

Question 19

What is the left border of the heart?

Answer 19

The left ventricle

Question 20

What are the chambers of the heart?

Answer 20

1. Right Atrium
2. Right Ventricle
3. Left Atrium
4. Left Ventricle

Question 21

What is at level T4?

Answer 21

1. Angle of Louis
2. Bifurcation of the Trachea
3. Bifurcation of the Pulmonary Trunk
4. Origin and End of the Aortic Arch
5. Azygous Termination
6. Ligamentus Arteriosum

Question 22

What is the Ligamentus Arteriosum and what is its significance in embryology?

Answer 22

Used to be the ductus arteriosus, joining the left pulmonary artery and arch of aorta–> allows metal circulation to bypass lungs

Question 23

What are the 4 heart valves?

Answer 23

1. Mitral
2. Tricuspid
3. Pulmonary
4. Aortic

Question 24

What are the cusps of the 4 valves?

Answer 24

1. Mitral–> Anterior and Posterior
2. Tricuspid–> Anterior, Posterior and Septal
3. Pulmonary–> Posterior, Left Anterior and Right Anterior
4. Aortic–> Anterior, Left Posterior and Right Posterior

Question 25

What is the surface anatomy of the 4 valves?

Answer 25

1. Aortic--> Retrosternal, 3rd Rib 2. Pulmonary--> Retrosternal, 3rd Intercostal Space 3. Mitral--> Retrosternal, 4th Rib 4. Tricuspid--> Retrosternal, 4th Intercostal Space

Question 26

Where would you auscultate the 4 heart valves?

Answer 26

1. Aortic--> 2nd Intercostal Space, Right side 2. Pulmonary--> 2nd Intercostal Space, Left side 3. Mitral--> 5th Intercostal Space, left side along the mid-clavicular line 4. Tricuspid--> 4th Intercostal Space, Left side

Question 27

Where is the Apex beat?

Answer 27

The apex beat is the lowest, most lateral space on the chest where we can feel the heart beat. It is at the 5th Intercostal Space, left side along the mid-clavicular line

Question 28

Where does the Right Coronary Artery originate from?

Answer 28

The sinus in the anterior cusp of the aorta

Question 29

Where does the Left Coronary Artery originate from?

Answer 29

The sinus in the left posterior cusp of the aorta

Question 30

What are the branches of the Right Coronary Artery?

Answer 30

Marginal Branch and the Posterior Interventricular Branch

Question 31

What are the branches of the Left Coronary Artery?

Answer 31

1. Left Anterior Descending (LAD) branch 2. Circumflex Branch (which joins up with the Posterior Interventricular Branch of the right coronary artery) 3. Diagonal Branch (branching off LAD)

Question 32

What does the Right Coronary Artery supply? (7 things)

Answer 32

1. Both atria 2. Right Ventricle 3. Interatrial Septum 4. Posterior part of interventricular septum 5. Part of posterior left ventricle 6. SA Node (60%) 7. AV node (90%)

Question 33

What does the Left Coronary Artery Supply?

Answer 33

1. Both atria 2. Anterior part of left ventricle 3. Anterior part of interventricular septum 4. Part of adjacent right ventricle

Question 34

What are the Coronary Veins?

Answer 34

1. Great Cardiac Vein 2. Small Cardiac Vein 3. Middle Cardiac Vein 4. Anterior Cardiac Veins 5. Thebesian Veins

Question 35

Where do the Great, Small and Middle Cardiac Veins drain into?

Answer 35

The Coronary Sinus

Question 36

Where do the Anterior Cardiac Veins drain into?

Answer 36

Directly into right atrium

Question 37

Where do the Thebesian Veins drain into?

Answer 37

Directly into the atria and the ventricles

Question 38

What is an example of an abnormal apex beat?

Answer 38

Dextrocardia--> Apex beat is on the right side of the heart