Applied Anatomy of Heart

Question 1

Cardiac plexus location

Answer 1

Anterior to bifurcation of trachea

Posterior to aortic arch

Question 2

Parasympathetic innervation pathway

Answer 2

Cardioinhibitory centre in medulla
Vagus Nerve
To SA + AV nodes

Question 3

Sympathetic innervation pathway

Answer 3

Cardioacceleratory centre in medulla
Preganglionic sympathetic neurones in thoracic spinal cord
Postganglionic sympathetic neurones to SA + SV node and to coronary vascular smooth muscle

Question 4

Cardiac Pain

Answer 4

Caused by ischaemia
General visceral afferent nerve fibres ascend to CNS through cardiac branches of sympathetic trunk
Pain referred

Question 5

Referred Cardiac Pain

Answer 5

T1-4
Medial arm + neck/jaw
To epigastrium T5-9
Because heart + skin share same pathway

Question 6

Anterior surface of heart

Answer 6

Right ventricle

Question 7

Base of heart

Answer 7

Left atrium

Question 8

Coronary Artery Dominance

Answer 8

70% right dominant
Defined by where posterior interventricular artery comes from- if from RCA, right dominant, if from Circumflex, left dominant

Question 9

LCA blood supply

Answer 9

Anterior 2/3rd heart

Question 10

RCA blood supply

Answer 10

Posterior 1/3rd heart

Question 11

SA node supply

Answer 11

60% RCA

Question 12

AV node supply

Answer 12

80% RCA

Question 13

Inferior part of heart ECG leads

Answer 13

II, III, aVF

Question 14

Septal part of heart ECG leads

Answer 14

V1, V2

Question 15

Anterior part of heart ECG leads

Answer 15

V3, V4

Question 16

Lateral part of heart ECG leads

Answer 16

I, aVL, V5, V6

Question 17

Mitral Valve Stenosis

Answer 17

Atrial Enlargement
Increased atrial pressure- pulmonary congestion (oedema)
Reduced ventricular filling- reduced CO
Can lead to atrial fibrillation due to atrial enlargement
Mainly rheumatic in origin- rare diastolic murmur

Question 18

Aortic Regurgitation

Answer 18

Backflow into LV during diastole
Chronic Vol Overload--> stretching + elongation myocardial fibres
LV dilatation
Congestive HF
Decreased CO output
Pre-load elevation
DIASTOLIC MURMUR

Question 19

Valvular Disease

Answer 19

Inflammation of valve
Fibrosis
Calcification
Stenosis (narrowing)
Regurgitation
Cusps fibrose + cordae tendinae soften

Question 20

Mitral regurgitation

Answer 20

Most common form valvular disease
Mitral valve doesn’t close properly- regurgitation of blood back into LA
SYSTOLIC MURMUR
Heard @ apex
Left atrial enlargement + LV eccentric hypertrophy
Pulmonary oedema + reduced CO

Question 21

Aortic Stenosis

Answer 21

LV generates increased pressure to overcome stenotic aortic valve blockage
LV hypertrophy- increased muscle mass to help
Hypertrophied myocardium has reduced compliance + decreased coronary blood flow reserve
Heard @ Right 2nd intercostal space

Question 22

Concentric Hypertrophy

Answer 22

PRESSURE OVERLOAD
Wall thickness increase
Compliance reduced (stiffy boi)–> vol. overload
Vent. filling compromised

Question 23

Eccentric Hypertrophy

Answer 23

VOLUME OVERLOAD
Chamber dilation 
- aortic + mitral regurgitation, systolic dysfunction, vol overload
Elevates O2 demand
Lowers mechanical efficacy

Question 24

S1

Answer 24

Lub

Mitral + tricuspid closing

Question 25

S2

Answer 25

Dub

Aortic + pulmonary closing

Question 26

Concentric Hypertrophy causes

Answer 26

Physiological- strength training

Pathological- hypertension, aortic constriction

Question 27

Eccentric Hypertrophy causes

Answer 27

Physiological- Endurance training e.g. swimming

Pathological- Valve disease

Question 28

Concentric Hypertrophy Remodelling

Answer 28

Sarcomeres added in parallel

Increase myocyte cell width

Question 29

Eccentric Hypertrophy Remodelling

Answer 29

Sarcomeres added in series

Increase myocyte cell length

Question 30

Remodelling issues

Answer 30

Myocyte ratio will outweigh capillary ratio
Insufficient angiogenesis- decreased blood supply
Increased fibrous tissue
Increase in resistance

Question 31

Bundle Branch Block

Answer 31

Impulses not conducted right
Different pathways used for depolarisation
Impulse travels through myocytes- QRS complex prolonged
Loss of Vent. synchrony
e.g. if RHS block, need to go first via LHS then RHS

Question 32

Pathological cardiac hypertrophy

Answer 32

Non reversible

Question 33

Physiological cardiac hypertrophy

Answer 33

Reversible