Cardiopulm anatomy (camtasi + class)

Question 1

What are the 4 chambers of the heart?

Answer 1

2 chambers to pump blood to lungs: R atria/ventricle

2 chambers to pump blood to body: L atria/ventricle

Question 2

Why is left side muscle mass so much thicker?

Answer 2

Arterial pressure on left is higher so it has to push against more pressure than the right side so it has more mass.

Question 3

What is the skeleton of the heart?

Answer 3

Consists of annuli fibrosi: four firmly connected, fibrous connective tissue rings (2 “coronets’; 2 rings)

Rigid attachment for:
myocardial fiber bundles; Pulmonary, aortic, and atrioventricular valves

Separates myocardial fibers of atria from those of ventricles

Question 4

What are the external features of the heart?

Answer 4

Base, apex, diaphragmatic surface, sternocostal surface

Question 5

What forms the base, apex, diaphragmatic surface, and sternocostal surface?

Answer 5

Base: Posterior aspect of heart
Formed largely by the left atrium (about in the mid line) along with a narrow portion of the right atrium.
Apex: Blunt descending projection formed by left the ventricle
Diaphragmatic surface: formed largely by the left ventricle along with narrow portion of the right ventricle.
Sternocostal surface: composed largely of the right atrium and right ventricle along with narrow portion of the left ventricle

Question 6

What are parts of the right atrium?

Answer 6

auricle, crista terminalis, fossa ovalis, opening of coronary sinus, valve of IVC, SVC, IVC, right AV valve

Question 7

What are characteristics of the auricle?

Answer 7

Corresponds to primitive atrium of embryonic heart; contains pectinate muscles

Question 8

What are characteristics of the crista terminalis?

Answer 8

Junction of rough pectinate muscles vs smooth interior of the sinus venarum

Superior end marks location of sinoatrial node

Question 9

What are characteristics of fossa ovalis?

Answer 9

Fossa ovalis (oval depression): Marks site of the embryonic foramen ovale through which blood passes from right atrium to left atrium before birth

Question 10

What are characteristics of opening of coronary sinus?

Answer 10

Opening of coronary sinus: Site of venous blood that has passed through the cardiac muscle

Question 11

What does valve of IVC, SVC, IVC, and AV valve do?

Answer 11

Valve: In embryonic heart, directs blood from inferior vena cava through foramen ovale and into left atrium (also call eustachian valve)
SVC: Large superior opening in the sinus venarum that brings poorly oxygenated blood from head and upper limbs
IVC: Large inferior opening in the sinus venarum that brings poorly (low) oxygenated blood abdomen and lower limb
Right AV valve:
Site of blood flow out of right atrium

Question 12

What are the cusps of the tricuspid valve?

Answer 12

Anterior, posterior, septal

Question 13

What can be found in the right ventricle?

Answer 13

Cusps of the tricuspid valve: anterior, posterior and septal cusps (leaves) of the AV valve

Papillary muscles: anterior (largest), posterior (smallest), and septal in right ventricle; according to location of their bases off the walls of the ventricle

Chordae tendineae: fibrous strands connecting papillary muscles to cusps (normally 2) of atrioventricular valves

Pulmonary valve

Question 14

What is the role of the papillary muscles?

Answer 14

Muscles and chorda tendineae attached to AV valve cusps.
Contract during systole
Prevents blood from regurgitation back into atria
May rupture

Question 15

What are characteristics of left atria?

Answer 15

Pulmonary veins: 2 right and 2 left pulmonary veins carry oxygenated blood into the left atrium
Smooth-walled part: derived from incorporation of pulmonary veins
Fossa ovale: slight depression in the interatrial wall
Left AV valve: Blood exits into the left ventricle through the mitral valve

Question 16

What are characteristics of mitral valve?

Answer 16

Has anterior and posterior cusps

Closes at beginning of systole (part of lub sound)

Question 17

What is mitral valve prolapse?

Answer 17

Everts into the left atrium when the left ventricle contracts during systole.

Although relatively common and often benign, it may produce chest pain, shortness of breath, and cardiac arrhythmia.

Question 18

What type of prolapse is more common?

Answer 18

Mitral valve (systemic) prolapse is more common than tricuspid valve (pulmonary) prolapse
Reason: Left ventricle contracts at higher pressure

Question 19

What are characteristics of left ventricle?

Answer 19

Wall 2 to 3 times thicker than right ventricle
Mitral valve cusps: anterior and posterior cusps (leaves) of the AV valve
Papillary muscles: only ant and post papillary muscles
Chordae tendineae: fibrous strands connecting papillary muscles to each cusps of the mitral valve
Aortic valve: allows blood to exit the left ventricle past the 3 semilunar cusps of the aortic valve leading to the ascending aorta

Question 20

What are characteristics of the pulmonary valve?

Answer 20

Right, left, anterior
Forced closed by pressure and elastic recoil in pulmonary trunk during relaxation of right ventricle
Part of S2 dub sound at end of systole

Question 21

What are characteristics of aortic valve?

Answer 21

Right, left, posterior
Right and left coronary arteries open into right and left aortic sinuses
Blood flows into coronary arteries after valves have closed as result of elastic recoil of aorta and great vessels
Part of S2 sound

Question 22

What are the layers of the pericardium?

Answer 22

Serous pericardium (parietal and visceral): secretes fluid, 20-30 ml
Fibrous pericardium: tough, fibrous outer portion; fuses with diaphragm adventitia of great arteries and veins, inelastic
Visceral pericardium: layer surrounding and attached to heart

Question 23

What is the pericardial blood supply?

Answer 23

Pericardiophrenic artery and vein: phrenic nerve on external surface

Phrenic nerve: innervates pericardium, carry afferents from pericardium

Question 24

What is pericardial friction rub?

Answer 24

If the serous layer of the pericardium becomes rough, typically secondarily due to viral infections, then friction and vibrations (sounds) may occur with each cardiac cycle.
Pericaridal rub may sound like squeaky leather and may be widespread.

Question 25

When is blood flow to coronary arteries greatest? Why?

Answer 25

Greatest during diastole because there is blood pooling from the aorta and the back flow will automatically go into the coronary arteries

Question 26

What are landmarks/characteristics of cardiac venous system?

Answer 26

Coronary sinus: Direct continuation of great cardiac vein, Lies in posterior part of coronary sulcus and opens into right atrium, Receives all cardiac veins except anterior cardiac veins and smallest cardiac veins Great cardiac vein: lies beside anterior interventricular artery. Middle cardiac vein: lies next to posterior interventricular artery. Small cardiac vein: runs along acute margin of right ventricle, paralleling right marginal artery. Anterior cardiac veins: comprise two (or three) small veins that drain sternocostal surface of right ventricle directly into right atrium. Most numerous in right atrium

Question 27

What makes up the S1 heart sound?

Answer 27

Right AV/Tricuspid (ant, post, septal cusps) Allows blood to flow from atrium to ventricle during diastole Closes at beginning of systole Shuts so there is no back flow

Question 28

Explain the lub dub of the heart sounds.

Answer 28

``` First sound ("lub"): coincides with closure of AV valves at start of systole Second sound ("dub"): produced by closure of aortic and pulmonary valves at end of systole ```

Question 29

What are bronchopulmonary segments?

Answer 29

Include bronchi, pulmonary arteries, with pulmonary veins draining segment near by. Can be surgically removed while leaving rest of lung intact Important for postural drainage

Question 30

What are the bronchial arteries and veins?

Answer 30

The bronchi have small arteries that supply oxygenated blood to the bronchial tree. 2 on the left come off the descending aorta 1 on the right comes off the 3rd posterior intercostal artery

Question 31

What are characteristics of the lungs?

Answer 31

Organs of respiration for oxygenation and removal of CO2. Each have own pleural cavity They are light, spongy, elastic organs that change in size with each breath Collapse (due to elastic fibers) just as chest wall tends to retain normal shape (keeps them inflated). The elasticity of the lung is counter balanced by the muscles and structural elements of the thoracic cage and the negative pressure in the pleural space.

Question 32

What is a pneumothorax? symptoms?

Answer 32

Result of traumatic injury to wall of lung. Infection causing hole in lung which allows air to be pulled into the pleural space Air (or gas) is in pleural cavity Elasticity of lung causes it collapse on itself towards the hilum Symptoms: chest pain, respiratory distress, and tachycardia

Question 33

What is a hemothorax?

Answer 33

accumulation of blood in pleural space | Typically caused by injury to an intercostal vessel versus laceration of parenchema

Question 34

What is hydrothorax?

Answer 34

Excessive accumulation of fluid, other than blood within the pleural space. CHF Infection of lung

Question 35

What are clinical manifestations of pneumothorax?

Answer 35

Lung collapse from trauma: MVA, GSW, penetration of object

Question 36

What are clinical manifestations of atelectasis?

Answer 36

Collapse, compression (hydrothorax), obstruction (tumor)

Question 37

What will imaging show for atelectasis?

Answer 37

X-ray will show opaque area. Lung collapse x-ray will show: elevation of hemi diaphragm on affected side, shift of mediastinum toward affected side, decreased in size of rib interspaces over affected hemi diaphragm

Question 38

What is treatment for atelectasis?

Answer 38

breathing techniques, spirometry, airway clearance