B3.085 - Intro to Anatomy of Heart

Question 1

What is the oblique pericardial sinus

Answer 1

lowest (most dependent) part of pericardial sac when a patient lies on ones back.
Blind pocket dorsal to left atrium formed by pericardial reflections surrounding pulmonary veins and s/i VC

Question 2

What is cardiac tamponade

Answer 2

compression of the heart due to rapid accumulation of fluid in the pericardial sac. Prevents chambers from expanding fully limiting stroke volume.

Question 3

What are classic indications of cardiac tamponade

Answer 3

Jugular venous distention
Distant heart sounds
Hypotension with dyspnea

Question 4

What is pericardiocentesis

Answer 4

Removal of excess fluid from pericardial sac with 18G spinal tap needle
Used to treat cardiac tamponade

Question 5

How is a pericardiocentesis done

Answer 5

With US, needle placed just left of xyphoid angled 45 degrees towards head while pointing towards medial edge of left scapula

Question 6

What is pericarditis

Answer 6

inflammation of the pericardial sac lining typically due to viral or bacterial infections

Question 7

What is a non infectious cause of pericarditis

Answer 7

malignancy

Question 8

Describe pain due to pericarditis

Answer 8

Remains substernal and worsens upon lying down or when inhaling deeply

Question 9

What is pericardial rub indicative of

Answer 9

acute pericaditis

Question 10

what is pericardial rub

Answer 10

if the serous layer of pericardium becomes rough it induces friction and vibrations

Question 11

What is S2 due to

Answer 11

closing of the aortic and pulmonary valves

Question 12

What is S1 due to

Answer 12

Closing of the atrioventricular valves

Question 13

What valves can you listen to on the body

Answer 13

A -Aortic
P - Pulmonary
T - Tricuspid
M - Mitral

Question 14

Where can you hear the aortic valve best

Answer 14

right of sternum at 2nd IC space

Question 15

Where can you hear Pulmonary valve best

Answer 15

left of sternum at 2nd IC space

Question 16

Where can you hear the tricuspid valve best

Answer 16

left of sternum at 5th IC space

Question 17

Where can you hear the mitral valve best

Answer 17

left side at 5th IC space at midclavicular line

Question 18

What is the clinical relevance of the fibrous skeleton of heart

Answer 18

if its stretched the heart valves often fail

Question 19

How do you close the left atrial appendage

Answer 19

Placing an implant designed to close off appendage

Question 20

What are papillary muscles

Answer 20

restrict valve cusp movement during ventricular systole to prevent blood from regurgitating back in

Question 21

What happens when papillary muscles rupture

Answer 21

sometimes in MI, leads to AV valve dysfunction or insufficiency. Regurgitation of blood is often a consequence

Question 22

How can regurgitation of a valve present clinically

Answer 22

as a diastolic murmur

Question 23

What is left ventricular hypertrophy produced by

Answer 23

chronic hypertension or aortic valve stenosis

Question 24

What does volume overloading cause

Answer 24

ventricular hypertrophy and chamber dilation

Question 25

What happens when the mitral valve everts into the left atrium when left ventricle contracts

Answer 25

mitral valve prolapse

Question 26

what can mitral valve prolapse cause

Answer 26

mitral valve regurgitation

Question 27

Why is mitral valve prolapse more common than tricuspid valve prolapse

Answer 27

the left ventricle contracts at higher pressure

Question 28

What can cause mitral valve regurgitation

Answer 28

rupture of chordae tendineae or papillary muscles

Question 29

how do the aorta and pumonary trunk end up in relation to eachothers position in the body

Answer 29

Aorta slightly posterior | pulmonary anterior

Question 30

what is the most common congenital abnormality

Answer 30

bicuspid aortic valve

Question 31

what are complications of a bicuspid aortic valve

Answer 31

more likely to cause aortic valve stenosis than a normal tricuspid aortic valve

Question 32

what is "right dominant distribution"

Answer 32

posterior interventricular artery arising from the right coronary artery

Question 33

What is left dominant distribution

Answer 33

circumflex branch of LCA gives off posterior interventricular

Question 34

what is balanced distribution

Answer 34

when both right and left coronary arteries supply the posterior interventricular artery

Question 35

what are the top 3 sites of coronary artery blockage

Answer 35

1. Anterior descending 2. Base of right coronary artery 3. left circumflex branch

Question 36

what is CABG

Answer 36

coronary artery bypass graft

Question 37

how is CABG performed

Answer 37

distal end of internal thoracic artery is attached to the existing coronary artery distal to the blockage

Question 38

What are additional arteries and veins harvested for graft

Answer 38

radial artery | Great saphenous vein

Question 39

Where does most blood passed through the coronary arteries return ot venous circulatory system

Answer 39

``` coronary sinus (most) anterior cardiac veins (less) ```

Question 40

what is the SA node

Answer 40

initiates heartbeats

Question 41

Where is the SA node located

Answer 41

in the right atrial wall at superior end of sulcus terminalis near SVC

Question 42

what is the SA node stimulated by

Answer 42

sympathetic cardiac nerves

Question 43

What is the SA node decreased by

Answer 43

parasympathetic cardiac nerves

Question 44

what do ANF/ANP do

Answer 44

affect blood volume | ANP acts on kidney to increase sodium and water excretion to reduce blood volume

Question 45

where is the AV node located

Answer 45

inferior aspect of the intraatrial septum near the opening of the coronary sinus

Question 46

ischemia to what artery can fuck up SA and AV node

Answer 46

right coronary artery

Question 47

blockage of what artery can cause loss of ventricular contractions

Answer 47

LAD

Question 48

if pacemaker cells in ventricles are not stimulated by SA node what happens

Answer 48

spontaneous contraction at slower pace

Question 49

Where are pacemakers generally inserted

Answer 49

under the skin on anterior chest wall inferior to clavicle while leads are threaded through the venous system down SVC and over to site of SA

Question 50

sympathetic nerves that innervate heath have cell bodies where

Answer 50

in sympathetic chain ganglia from C4 down to T5

Question 51

What is ischemic pain caused by

Answer 51

inadequate blood flow is carried back to CNS through afferents that run with sympathetic nerves and enter synapse within the spinal cord at C4 to T5

Question 52

major signs of MI in women

Answer 52

``` chest pain or discomfort nausea, lightheadedness, tired pain in jaw, nack or back pain in arm or shoulder SOB ```

Question 53

What are signs of MI in men

Answer 53

chest pain or discomfort in arm or shoulder | SOB

Question 54

what is the basis of referred pain caused by

Answer 54

convergence of afferent nerves from both viscera and soma onto same dorsal horn neuron

Question 55

There is convergence of both somatic and visceral afferents onto nerves in same dorsal horn nerve in spical cord such that

Answer 55

heart pain may be perceived as chest or left arm pain

Question 56

What is a thymoma

Answer 56

tumors of the thymus

Question 57

The brachiocephalic veins are formed by union of what

Answer 57

subclavian and internal jugular veins

Question 58

What is the sternal angle

Answer 58

where the trachea bifurcates into the right and left main bronchus

Question 59

Where does the esophagus pass through the diapragm

Answer 59

esophageal hiatus at T10

Question 60

How do you remember the hiatuses

Answer 60

8- I - Inferior VC 10- Esophageal 12-Aortic I 8 10 Eggs At Noon

Question 61

Where does the phrenic nerve arise from

Answer 61

C3, C4, C5

Question 62

The phrenic nerve transmit referred pain from diaphragm, pericardium, abdominal cavity and mediastinal pleura back to what dermatones

Answer 62

C3, C4, C5 where they present as neck pain

Question 63

where can pain from the diaphragm be referred to

Answer 63

T7, 8, 9,10 anteriorly, and T11, 12 posteriorly or C3,C4, C5

Question 64

Which nerve is the vagus nerve

Answer 64

10th cranial