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SURGERY II > Cardiac Surgery > Flashcards

Cardiac Surgery Flashcards

(100 cards)

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1
Q

3 Surfaces of the Heart

A
  1. Sternocostal (Anterior)
  2. Diaphragmatic (Inferior)
  3. Base (Posterior)

• It also has an apex, which is directed downward, forward, and to
the left.

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2
Q

Borders of the Heart

A
  1. Right Border – formed by right atrium.
  2. Left Border – left auricle; and below, by the left ventricle.
  3. Lower/ Inferior Border – formed mainly by right ventricle but
    also by the right atrium; the apex is formed by the left ventricle.
  4. Upper/ Superior Border – right and left atrium and the great
    vessels.
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3
Q

Blood Flow

A

Superior and Inferior Vena Cava -> Right Atrium -> Tricuspid Valve
-> Right Ventricle -> Pulmonary Valve -> Pulmonary Arteries (2
arteries) -> Lungs (Oxygenation) -> Pulmonary Veins (4 veins) ->
Left Atrium -> Bicuspid/ Mitral Valve -> Left Ventricle -> Aortic
Valve -> Aorta

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4
Q

2 Atrioventricular Valves

A

Bicuspid/ Mitral and Tricuspid Valve.

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5
Q

Tricuspid Valve – 3 cusps:

A

anterior, septal and inferior/posterior

cusps.

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6
Q

Mitral Valve – 2 cusps:

A

anterior and posterior.

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7
Q

2 Semilunar Valves –

A

Pulmonary and Aortic Valve.

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8
Q

Pulmonary Valve – 3 cusps:

A 
1 posterior (left cusp), 2 anterior
(anterior and right cusps).
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9
Q

Aortic Valve: 3 cusps:

A

1 situated in the anterior wall (right cusp),
2 located at posterior wall (left and posterior cusps). Behind
each cusp, the aortic wall bulges to form an aortic sinus.

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10
Q

Aortic Sinus/ Sinus of Valsalva –

A

anterior aortic sinus gives origin
to the right coronary artery, and the left posterior sinus give
origin to the left coronary artery.

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11
Q

Drains most of the blood from the heart wall. It opens into the right atrium between the inferior vena cava and
atrioventricular orifice. Guarded by a rudimentary, nonfunctioning valve.

A

Coronary Sinus

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12
Q

The remnant of a thin fibrous sheet that covered the foramen ovale during fetal development.

A

Fossa Ovalis

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13
Q

Projecting ridges that gives the ventricular

wall a sponge-like appearance.

A

Trabeculae Carnae

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14
Q

3 Types of Trabeculae Carnae

A
  1. Papillary Muscles, which project inward, being attached by their bases to the walls; their apices are connected by fibrous
    chords (Chordae Tendineae) to the cusps of the valves.
  2. Moderator Band, crosses the ventricular cavity from the septal to the anterior wall. It conveys the right branch of the AV bundle.
  3. Prominent Ridges
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15
Q

Conducting System of the Heart

A

Sinoatrial Node -> Atrioventricular Node -> Atrioventricular Bundle (Bundle of His) -> Right and Left Terminal Branches ->
Subendocardial Plexus of Purkinje Fibers.

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16
Q

Located in the wall of the right atrium in the upper part of the sulcus terminalis just to the right of the opening of the superior vena cava.

A

Sinoatrial Node/ SA Node

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17
Q

Strategically placed on the

lower part of the atrial septum just above the attachment of the septal cusps of the tricuspid valve.

A

Atrioventricular Node/ AV Node

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18
Q

Only pathway of cardiac muscle that connects the myocardium of the atria and the myocardium of the ventricles and is thus the only route along which the cardiac impulse can travel from the atria to the ventricles.

A

Atrioventricular Bundle/ Bundle of His

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19
Q

3 Internodal Conduction Pathways

A
  1. Anterior Internodal Pathway (Bachmann’s Bundle)
  2. Middle Internodal Pathway (Wenckebach)
  3. Posterior Internodal Pathway (Thorel)
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20
Q

Arises from the anterior aortic sinus of the ascending aorta and runs forward between the pulmonary trunk and the right auricle.

A

Right Coronary Artery

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21
Q

Right Coronary Artery Branches

A
  1. Right Conus Artery
  2. Anterior Ventricular Branches
  3. Posterior Ventricular Branches
  4. Posterior Interventricular (Descending) Artery
  5. Atrial Branches
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22
Q

Supplies the anterior surface of the pulmonary conus (infundibulum of the right ventricle) and the upper part of the anterior wall of the right ventricle.

A

Right Conus Artery

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23
Q

2 or 3 in numbers and supplies the anterior surface of the right ventricle. The
marginal branch is the largest and runs along the lower margin of the costal surface to reach the apex.

A

Anterior Ventricular Branches

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24
Q

2 or 3 in numbers and supply the diaphragmatic surface of the right ventricle.

A

Posterior Ventricular Branches

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25
Runs toward the apex in the posterior interventricular groove. It supplies branches to the posterior part of the ventricular septum but not to the apical part, which receives its supply from the anterior interventricular branch of the left coronary artery.
Posterior Interventricular (Descending) Artery
26
supplies the anterior and lateral surfaces of the right atrium. One branch supplies the posterior surface of both the right and left atria.
Atrial Branches
27
Arises from the left posterior aortic sinus of the ascending aorta and passes forward between the pulmonary trunk and the left auricle.
Left Coronary Artery
28
Left Coronary Artery Branches
1. Anterior Interventricular (Descending) Branch | 2. Circumflex Artery
29
May arise directly from the trunk of the left | coronary artery.
Left Diagonal Artery (Branch of Ant. Interventricular Branch)
30
Supplies the pulmonary conus.
Left Conus Artery (Branch of Ant. Interventricular Branch)
31
Winds around the left margin of the heart | in the atrioventricular groove.
Circumflex Artery
32
Supplies the left margin of the left ventricle down to the apex.
Left Marginal Artery (Branch of Circumflex Artery)
33
Descends behind the septal cusp of the tricuspid valve to reach the inferior border of the membranous part of the ventricular septum.
Atrioventricular bundle
34
It usually divides into two branches (anterior and posterior), which eventually become continuous with the fibers of the Purkinje plexus of the left ventricle.
Left bundle branch (LBB)
35
Passes down on the right side of the ventricular septum to reach the moderator band, where it crosses to the anterior wall of the right ventricle. Here, it becomes continuous with the fibers of the Purkinje plexus.
Right bundle branch (RBB)
36
Pierces the septum and passes down on its left side beneath the endocardium. It usually divides into two branches (anterior and posterior), which eventually become continuous with the fibers of the Purkinje plexus of the left ventricle.
Left bundle branch (LBB)
37
Leaves the anterior end of the SA node and passes anterior to the superior vena caval opening.
Anterior Internodal Pathway (Bachmann’s Bundle)
38
Descends on the atrial septum and ends in the AV node.
Anterior Internodal Pathway (Bachmann’s Bundle)
39
Leaves the posterior end of the SA node and passes posterior to the superior vena caval opening.
Middle Internodal Pathway (Wenckebach)
40
Descends on the atrial septum to the AV node.
Middle Internodal Pathway (Wenckebach)
41
Leaves the posterior part of the SA node and descends through the crista terminalis and the valve of the inferior vena cava to the AV node.
Posterior Internodal Pathway (Thorel)
42
Arterial Supply of the Heart
Provided by the right and left coronary arteries, which arise from the ascending aorta immediately above the aortic valve.
43
Coronary arteries and their major branches are distributed over the surface of the heart, lying within _______ connective tissue.
subepicardial
44
Descends almost vertically in the right atrioventricular groove, and at the inferior border of the heart it continues posteriorly along the atrioventricular groove to anastomose with the left coronary artery in the posterior interventricular groove.
Right Coronary Artery
45
Usually larger than the right coronary artery, supplies the major part of the heart, including the greater part of the left atrium, left ventricle, and ventricular septum.
Left Coronary Artery
46
The left coronary artery enters the atrioventricular groove and divides into:
an anterior interventricular branch and a circumflex branch.
47
Runs downward in the anterior interventricular groove to the apex of the heart. Usually, it passes around the apex of the heart to enter the posterior interventricular groove and anastomoses with the terminal branches of the right coronary artery.
Anterior Interventricular (Descending) Branch
48
Supplies the right and left ventricles with numerous branches that also supply the anterior part of the ventricular septum.
Anterior Interventricular (Descending) Branch
49
Supply the left ventricle.
Anterior ventricular and posterior ventricular branches
50
Supply the left atrium.
Atrial branches
51
Right Coronary Artery
Right Coronary Artery -> descend on right AV groove to supply right ventricle -> branches to anterior RV and terminate to right posterolateral and the right posterior descending collaterals with circumflex
52
Left side of the heart
Left side of the heart -> Left Main Coronary Artery -> Left Anterior Descending (LAD) supply most ateroseptal to apex.
53
LAD septal branches with diagonal arteries which supplies | _______ aspects.
lateral
54
AV groove and the posterior aspect and branches to obtuse marginal arteries.
Circumflex
55
Narrowing of one or more coronary arteries.
CORONARY ARTERY DISEASE
56
Cause of coronary artery disease
Atherosclerotic Disease
57
Consequence of coronary artery disease
Limitation of myocardial blood flow
58
Pathophysiology of coronary artery disease
Increasing degrees of stenosis -> Limit reserve flow -> Reduce flow at rest -> May totally occlude the vessel.
59
Lesions of atherosclerosis
1. Fatty streak begins in childhood. 2. Lipid laden macrophages and T-lymphocytes with smooth muscle cells cause focal intimal thickening. 3. More smooth muscle cells and connective tissue form in the intima. 4. Eccentric fibrous plaque develops, which is white and elevated. 5. Lipid deposition in cells and connective tissue. 6. A luminal fibrous cap form. 7. Zone of necrotic tissue beneath the cellular area.
60
But if plaques are less than ___% stenosis, vessels will not have enough time to develop collaterals, once occlusions in myocardium sets then the distal portion to the stenosis will be infarcted.
50%
61
Probable cause of most unstable angina and acute myocardial infarction.
Rupture and thrombosis of a plaque
62
Acute ischemia commonly develops in vessels with?
Less than 50% stenosis.
63
Play a role I acute narrowing/occlusion
Platelet aggregation, vessel stenosis, and coronary spasm
64
The _____ are more often involved than the Circumflex.
LAD and RCA
65
___% of patients studied for symptoms will have significant stenosis in all 3 vessels.
40%
66
____% of patients with 1 completely occluded artery will have significant stenosis in at least one other artery.
95%
67
____% of patients with significant disease will have L main involvement.
10-20%
68
Severity of lesions and size of distal vessels may be underestimated.
Coronary Angiography
69
75% reduction in cross-section =
50% diameter reduction (moderate).
70
90% reduction in cross-section =
67% diameter reduction (severe).
71
Ejection fraction should be considered with _______, as the _______ can be normal even in severe LV dysfunction.
heart size
72
Gold standard
Coronary angiography
73
Depends on the amount of myocardium | devoid of scar.
Resting LV function
74
Reflects loss of coronary flow reserve, and | is typically depressed when compared to resting function.
Exercise LV function
75
Usually visually estimated on angiography | as ejection fraction.
Global LV function
76
Can also be evaluated by CASS score, which is the sum of five segmental scores.
Global LV function
77
Assessed by local wall motion or thickening during cardiac cycle. assessed by local wall motion or thickening during cardiac cycle.
Segmental LV wall function
78
“widower’s disease” decreased ejection fraction -> heart failure.
LAD
79
Denote more | rapid progression of coronary stenoses.
Young age, hyperlipidemia, and presence of PVD
80
As areas of ischemia become more extensive, ______ will fall during exercise testing.
global LV systolic function
81
_______ will increase from the decreased systolic function.
LVEDV
82
_________ also falls from inspired myocardial relaxation during early diastole.
LV diastolic function
83
All factors ultimately result in?
increased LVEDP
84
LV dysfunction at rest is usually from?
myocardial scarring
85
Myocardial stunning or _______ can cause resting LV dysfunction as well.
Myocardial stunning or hibernation
86
______ helps quantify the degree of reduction in flow reserve.
Graded exercise testing
87
Severe and persisting angina with EKG evidence of ischemia and minor CK-MB changes.
Unstable Angina
88
Severe class IV angina within _____ months of onset.
two months
89
Severe angina lasting more than 15min. occurring within 10 days of presentation.
Unstable Angina
90
Severe angina within 2 weeks of acute myocardial infarction.
Unstable Angina
91
Probable cause of unstable angina.
Plaque fissure and/or rupture
92
These patients have increase tendency to develop myocardial infection.
Unstable Angina
93
_______ is prone to cause acute MI.
Severe proximal LAD disease
94
____% of patients studied will have an acute MI within 5 years.
30%
95
Probability of acute MI is increase by?
Number of previous MIs | and number of vessels involved.
96
Thrombolytics have reduced current hospital mortality to less than _____%.
10%
97
Death usually the result of?
Acute cardiac failure or sudden ventricular arrhythmia
98
____% of patients have sudden death.
20%
99
10-year survival is about _____%.
60%
100
30% diameter loss =
50% cross sectional area loss

SURGERY II (2 decks)

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