Cardiovascular Anatomy - Week 5 Flashcards
(164 cards)
1
Q
What is a portal vein or circulation?
Give two examples.
A
Veins that have capillaries at both ends.
hepatic portal system (large scale)
pituitary portal system (microscopic)
2
Q
What is the mediastinum? What does it lie between?
A
- Central compartment of the thoracic cavity
- covered on each side by the mediastinal pleura and contains all the thoracic viscera and structures, except the lungs
- extends from the superior thoracic aperture to the diaphragm inferiorly
3
Q
What are the four divisions of the mediastinum? What are the boundaries of each?
A
Superior mediastinum - between thoracic aperture, horizontal transverse thoracic plane that passes through the sternal angle anteriorly and the IV disc fo the T4-T5 vertebrae posteriorly.
Inferior mediastinum - between transverse thoracic plane passing through the sternal angle and the IV disc of the T4-T5 vertebrae and the diaphragm. It is further divided into the anterior, middle, and posterior mediastinum
Anterior mediastinum - within inferior mediastinum and anterior to the heart/pericardial sac
Middle Medistinum - within inferior mediastinum and within the pericardial sac (heart)
Posterior Mediastinum
4
Q
What are the contents of the superior mediastinum?
A
.
5
Q
What are the contents of the inferior mediastinum?
A
.
6
Q
What are the contents of the middle mediastinum?
A
.
7
Q
What are the contents of the posterior mediastinum?
A
.
8
Q
What is the name for the sac which contains the heart?
A
.
9
Q
What are the two layers of the pericardium?
A
.
10
Q
What two layers does the parietal layer of the paricardium consist of?
A
.
11
Q
What is the epicardium?
A
.
12
Q
What is the function of the serious lining in the pericardium?
A
.
13
Q
Where does blood entering the right atrium come from?
A
.
14
Q
Where does blood entering the left atrium come from?
A
.
15
Q
Where does blood entering the right atrium come from?
A
.
16
Q
What comprises the most anterior (sternocostal) aspect of the heart?
A
Right ventricle
17
Q
What makes up the posterior aspect of the heart?
A
Left atrium
18
Q
Heart embryiology
A
Watch Kaplan video and make cards on it
19
Q
What are the normal thicknesses of the right and left ventricles?
A
.
20
Q
What is the name of the groove that separates the two atria and two ventricles?
A
The atrio-ventricular groove (AV groove)
21
Q
What lies in the anterior part of the AV groove?
What lies in the posterior part of the AV groove?
A
.
22
Q
Left coronary artery. Origin? Path? What doe it divide into? What does it supply?
A
.
23
Q
Left circumflex artery. Origin? Path? What does it divide into? What does it supply?
A
.
24
Q
Left anterior interventricular artery. What is this also known as? Origin? Path? What does it divide into? What does it supply?
A
.
25
```
Right coronary artery.
Origin?
Path?
What does it divide into?
What does it supply?
```
.
26
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The posterior descending (interventricular) artery.
Origin?
Path?
What does it divide into?
What does it supply?
```
.
27
What are the branches of the LAD called?
Diagonal branches.
28
What are the branches of the left circumflex and right coronary artery called?
Marginal branches.
29
Diagonal branches.
Origin?
Path?
What does it supply?
.
30
What do the coronary veins dump into?
Coronary sinus.
31
Coronary Sinus.
Origin?
Path?
What does it dump into?
.
| Runs along the AV groove posteriorly.
32
Does the coronary circulation fill during systole or diastole?
Diastole.
33
The superior vena cava carries blood from where to where?
From the upper half of the body to the right atrium.
34
The inferior vena cava carries blood from where to where?
From the lower half of the body to the right atrium.
35
The coronary sinus carries blood from where to where?
From the coronary veins to the right atrium.
36
Where does the pulmonary trunk begin and what does it divide into?
It begins from the right ventricle and divides into the right and left pulmonary arteries to the lungs.
37
Where does the aorta begin?
Left ventricle.
38
Where do the coronary arteries arise?
.
39
How many pulmonary veins are there normally? Into which chamber do they flow?
.
40
What causes the wall of the right ventricle to be thicker than usual?
.
41
What are the names of the ear-like tabs of the atria on each side?
.
42
What are the different opening by which the right atrium receives deoxygenated blood?
How many openings are there?
.
43
What is the wall that separates the two atria called?
The interatrial septum.
44
What is the oval depression that lies in the interatrial septum?
The fossa ovalis.
45
What is the fossa ovalis? What structure did it arise from in the foetus?
Foramen ovale.
46
What would a defect or aperature in the fossa ovalis be called?
Atrial septal defect (ASD)
47
What is an atrial septal defect (ASD)?
.
48
What are the muscular ridges in the internal atria called?
Musculi pectinati, or pectinate muscles.
49
What are the musculi pectinati or pectinate muscles?
.
50
What are th emuscular ridges of the ventricles called?
Trebeculae carneae.
51
What are trebeculae carneae?
.
52
What is the mitral valve? How many cusps does it have?
Valve between the left atrium and left ventricle.
2 cusps. Also known as the bicuspid valve.
53
What is the valve between the left atrium and left ventricle called?
Mitral or bicuspid valve.
54
What is the valve between the right atrium and right ventricle called?
Tricuspid valve.
55
What is the tricuspid valve? How many cusps does it have?
The valve between the right atrium and right ventricle.
56
What prevents the atrioventricular valves from blowing backwards?
The chordae tendineae.
57
What are the chordae tendineae? What are they connected to?
Tendinous cords that limit the backwards movement of the atrioventricular valves. They are connected to pillars of cardiac muscle called papillary muscles.
58
What are the papillary muscles?
.
59
Looking from above the heart, which outflow is most anterior?
.
60
What is the configuration of the pulmonary and aortic valves, looking from above?
.
61
What are the coronary ostia?
.
62
Where do the corinary ostia come from? Which of the aortic valvve leaflets/cusps are the related to?
.
63
What are the different aortic valve leaflets called?
.
64
Sinoatrial (SA) node.
| How would you identify it on a gross specimen?
The sinoatrial node is the main pacemaker node of the heart.
Near junction of the superior vena cava and the right atrium.
Position often markerd by the artery to the SA node.
65
Where does the artery to the SA node come from?
Either the left circumflex or the right coronary artery, sometimes both.
66
Atrioventricular (AV) node.
| How would you identify it on a gross specimen?
Start of the bi-ventricular conducting system.
Situatied near the inferior edge of the interatrial septum, near the opening of the coronary sinus.
67
Right and left bundle branches
Pass from the AV node and bundle of his down either side of the muscular interventricular septum.
68
What is the moderator band called? Where is it?
Septomarginal trabecula.
Passed from the lower part of the IV septum across the RV to the anterior papillary muscle of the RV.
69
What is the ductus arteriosus? How does blood flow through it?
The ductus arteriosus is a short but wide connection between the root of the left pulmonary artery (right after the min pulmonary artery divides into the left and right pulmonary arteries) and the underside of the aortic arch.
Before birth, this allows blood from the right ventricle to bypass the lungs and flow back into the systemic circulation.
At birth, the lungs expand, decreasing pulmonary resistance, and blood flows into the pulmonary circulation. The ductus ateriosus becomes redundant and soon closes down, leaving the ligamentum arteriosusm as a remnant betwen the pulmonary artery and the aorta.
70
What is the ligamentaum ateriosus?
The remnant from the ductus arteriosus. It's an important landmark in heart surgery.
71
What is patent ductus arteriosus (PDA)? What type of shunt does it usually create?
A condition when the ductus arteriosus does not close properly after birth.
It creates a shunt between the right and left heart circulations, allowing oxygenated blood (higher pressure) to flow into the pulmonary circuit (lower pressure) back into the lungs.
This is known as a left to right shunt.
http://en.wikipedia.org/wiki/Patent_ductus_arteriosus
72
What is the aortic root?
A fibrous ring inside which sits the aortic valve.
73
What are the different sections of the aorta? Starting from the aortic root.
Ascending aorta, the aortic arch, and the descending aorta.
74
What is the ascending aorta? Where is it located (surface anatomy reference)?
What is it's path?
What are the branches of the ascending aorta?
The ascending aorta extends from the aortic root, pasing upwards and slightly to the right behind the pulmonary trunk.
It's located just behind the sternal angle.
The only banches from the ascending aorta are the coronary arteries, arising from the left and right coronary sinuses.
75
What are the coronary sinuses?
They are the slightly bulging parts of the aortic wall at its root, just above the leaflets of the aortic valve.
There are three coronary sinuses. The left, right, and posterior.
See page 90 in Essential Clinical Anatomy, inconsistent with page 95. Clear this up.
76
Which coronary sinus does not have a coronary artery coming out of it?
Posterior sinus..
77
What are the branches of the ascending aorta?
The only branches of the ascending aorta are the right and left coronary arteries.
78
Carries the origins of the great vessels: namely the bachiocephalic trunk or artery, the left common carotid artery, and the left subclavian artery.
The arch of the aorta
79
What are the three great vessels branching off of the arch of the aorta from right-side of body to left side of body.
1) bachiocephalic artery or trunk
2) left common carotid
3) left subclavian
80
Describe the path of the arch of the aorta.
After passing to the left of the trachea, it passes backwards in a sagittal plane.
81
What is the nerve that passing down the lateral aspect of the arch of the aorta?
What is the branch that arises alongside the aortic arch and then turns back under the arch and ascends in the mediastinum next to the oesophagus, reaching the larynx?
1) left vegas nerve
| 2) left recurrent laryngeal nerve
82
Where is the left recurrent nerve at risk during thoracis surgery?
When it wraps under the aorta, just after it branches off the left vegas nerve.
83
Where does the descending aorta begin?
After the take off off of the subclavian artery.
84
What is the section of the aorta called between the takeoff of the left subclavian artery and the diaphragm? How about after the diaphragm?
1) thoracic aorta
| 2) abdominal aorta
85
What extends from the pulmonary artery to the underside of the aortic arch? What is it a remnant of?
The ligamentus arteriosum is a remnant of the ductus arteriosus.
86
What "pulls" the recurrent nerve down into the chest on the left side during embryological development?
The ductus arteriosus (now ligamentum arteriosum).
87
Durying embryological development, what pulls the right recurrent nerve down?
The subclavian artery (p102 in ECA)
88
Why do we have a left sided aorta in most cases, while the brachiocephalic trunk is th eremnant of the right aortic arch.
Review the development of the aorta from the double aortic arches that supply the gill clefts (brachial clefts and arches) in the embryo
89
What is the slight constriction of the aorta just distal to the origin of the left subclavian artery?
What is this area important and what is the name of the condition in which there is a large constriction?
The isthmus.
A severe constriction may occur here during development, known as a coartation of the aorta.
90
Identify the bachiocephalic trunk. What does it branch into?
right subclavian artery to the upper limb and the right common carotid to the head and neck.
91
Identify the left common carotid artery
.
92
identify the right subclavian artery
.
93
Identify the superior vena cava (SVC)
.
94
What is the name of the vessel that drains the upper part of the body.
Describe the branching the occurs before blood gets to the superior vena cava.
right and left subclavian veins come together to form the superior vena cava.
On each side, the jugular and subclavian veins form the brachiocephalic veins.
95
Identify the inferior vena cava.
.
96
What is the vessel that drains mainly the lower part of the body.
What are some of it's tributaries?
the inferior vena cava.
renal veins and the common iliac veins.
(as well as hepatic veins and many others.)
97
Why does the aorta pass behind the pulmonary artery?
Reference the embryological process.
When the interventricular septum forms, it creates a spiral, sending blood to the aorta "under" blood to the pulmonary arteries. When they partially untwist, the aorta is posterior to the pulmonary artery.
98
Atrial septal defect (ASD)
need to look this up on your own and understand how it is formed
99
Ventricular septal defect (VSD)
need to look this up on your own and understand how it is formed
100
Aortic or pulmonary stenosis
need to look this up on your own and understand how it is formed
101
Tetralogy of Fallot - what four components make up this syndrome?
need to look this up on your own and understand how it is formed
102
Transposition of the great vessels.
need to look this up on your own and understand how it is formed
103
Patent Ductus Arteriosus (PDA)
need to look this up on your own and understand how it is formed
104
In fetal circulation, how many shunts are there? In what direction, right to left or left to right?
Where are they?
Two, both are right-to-left shunts.
1) ductus arteriosus - shunts blood from the pulmonary trunk to the aorta
2) foramen ovale - shunts blood from the right atrium to the left atrium
105
Summarize fetal circulation starting with oxygenated blood returning from the placenta.
oxygenated blood from placenta --> umbilical vein --> right atrium --> ductus venosus --> inferior vena cava --> mixture of oxygenated blood and deoxygenated blood (from body) --> mixed blood --> right atrium --> foramen ovale --> left atrium --> left ventricle --> systemic circulation.
*note that most of the blood returning from the IVC bypasses the right atrium.
106
Summarize the path of fetal circulation starting with deoxygenated blood from the superior vena cava.
deoxygenated blood from brain, neck, upper limbs, body wall (azygos system) --> superior vena cava --> right atrium --> right ventricle --> pulmonary trunk --> small amount into collapsed lung, but most of the RV output takes a path of least residtance and is shunted through the ductus ateriosus into the aorta --> large percentage of blood in aorta then goes back to placenta where it becomes oxygenated blood.
107
How do the pressures in the right and left venticles of the fetus compare?
They are about the same. If anything, the pressure in the right ventricle is greater than that of the left venntricle, remember that blood passes throught eh ductus ateriosus into the aorta from the right ventricle.
The wall thicknessess of the embryonic/foetal ventricles are the same on both sides.
The right ventricle must pump blood against the resistance of both the pumonary sustem and the aortic systemic system.
108
How does foetal circulation change at birth?
Umbilical arteries are clamped, preventing blood flow to/from the placenta.
The lungs are expanded and become aerated, droping the pulmonary resistance and blood flow to the lungs increases.
The ductus arteriosus actively contracts, though the ductus can remain oipen for several hours or days. The direction of the shunt in the ductus arteriosus will reverse, becoming left to right, because the pulmonary pressure will be lower than the aortic pressure with the expanded lungs. It takes weeks for anatomical closure with ingrowth of fibrous tissue, resulting in the ligamentum arteriosusm.
The pressure in the left atrium increases because there is more blood flowing into it from the pulmonary veins. Thus the pressure increases and surpasses that of the right atrium, passively closes the valve structure of the foramen ovale. Full obliteration of the foramen can take weeks.
109
What is the "hole in the heart" condition?
This refers to a atrial-septal defect (ASD). Refers topatent foramen ovale, the one way fetal valve structure between the left and right atria. Usually, pressure is greater in the left atria than in the right atria so this condition isn't a big deal. However, later in life some patients with ASD may develop pulmonary hypertension, which which case it can cause flow across the atrial septum from right to left.
110
What is PDA?
PDA is a patend dustus arteriosus. Generally, the ductus arteriosus becomes the fibrous ligamentum arteriosum but in some cases the channel remains open. This is called patent arteriosus
111
What can you give an infant in order to prevent closure of the ductus arteriosus?
Prostaglandin
112
Why might prostaglandin be given to an infant with a congential heart defect?
To keep the ductus arteriosus open so that the infant can remain alive until surgery.
113
What is one of the longer term morphologic changes that takes place in the heart after birth?
The ventricles, initially of equal or similar thickness, start to thicken at different rates. The left ventricle will become much thicker than the right, due to its increased resistance.
114
Understand the different layers of the pericardium.
.
115
Where does the transverse sinus of the pericardium pass?
Behind the outflow tracts (pulmonary and aortic) but in front of the inflow (SVC, left atrium)
116
Where does the oblique sinus of the pericardium pass?
p78-79 of ECA has a good description of it.
117
What are the two sections of the right atrium? What characterizes the wall in each? What divides the two?
There is the musculi pectinati (pectinate muscles) part and the smoother part.
The ridge separating the two is called the crista terminalis.
118
The curved line or ridge that separates the musculi pectinati and smooth area of the right atrium.
Crista Terminalis
119
What vessels open into the smooth part of the right atrium?
SVC, IVC, Coronary sinus
120
These veins drain blood from the myocardium directly into the chambers of the heart, primarily the right atrium.
Thebesian Veins or venae cordis minimae.
Aka the smallest veins in the heart
121
Anterior Spinal Artery
Runs down the front of the spinal cord and supplies the anterior segment, which is the main motor segment. Disruption of this blood supply can render a patient paraplegic.
122
Intercostal Arteries
Arteries that branch from the internal thoracic artery and pass between internal and innermost intercostal muscles.
123
Tendon of Todaro
Not visible to the visible eye and must be dissected out of the atrial wall.
It lies in the "edge" of the sinus septum, a fold like structure running between the coronary sinus and the orifice of the IVC.
The tendon runs towards the central fibrous body of the fibrous "skeleton" of the heart, and ends at the membranous portion of the septum, between the right atrium and the left ventricle (the AV septum)
124
Triangle of Koch; Why is it important?
Tendon of Todaro as one base, opposite point at attachment of septal leaflet of the tricuspid valve.
Coronary sinus lies immediately posterior to the triangle.
AV node is somewhere within the triangle.
125
The fibrous skeleton of the heart.
Fibrous or fibrocartilaginou tissue that surrounds the atrioventricular openings and the aortic and pulmonary arterial openings.
Continuous with the membranous part of the interventricular septum.
126
What do the muscles oft he atria and ventricles attach to?
The fibrous skeleton of the heart. Ventricle muscles attach on one side, atrial muscles on the other.
127
How are the muscles of the heart arranged?
Two different layers. A superficial spiral layer/sheet and a deeper constrictor group. The fibers of the two layers are perpendicular to one another.
The deeper layer contracts to squeeze the ventricle like a fist, while the superficial spiral layer contracts to twist the ventricle like wringing out a cloth.
128
Anomalous right subclavian artery origin. What is this condition called sometimes?
Variation int he great vessels.
The right subclavian artery arises from the aorta distal to the left subclavian artery.
In order to reach the right upper limb, the right subclavian must pass across the mediastinum behind the esophagus.
Dysphagia lusoria
129
Is you see a pulsative bulge when viewing the esophagus through an endoscope, what could it be?
Anomalous right subclavian artery or dyshagia lusoria - variation in vessel layout where the right subclavian branches off distally to the left subclavian from the aorta. It then passes behind the esophagus through the mediastinum in order to reach the right upper limb.
130
How are arteriograms of coronary arteries and any systemic arteries typically accessed?
Common femoral artery
131
How could a catheter be inserted into the pulmonary circulation?
Femoral vein --> IVC --> RA --> tricupid valve -> RV --> injection of dye directed directly into the mulmonary circulation for a pulmonary angiogram.
132
Read the clinical cases in Hankin's Clinical Anatomy book (pages 18-42)
The Big Picture Gross Anatomy pages 52-61, 72-75, Questions on 74 and 75, answers on page 76.
.
133
How are the two cusps of the mitral valve oriented?
There is a posterior and anterior cusp. There are also posterior and anterior papillary muscles.
134
In the mitral valve, which cusp is larger?
The area of the anterior cusp is approximately twice that of the posterior cusp.
135
Surface anatomy of the right atrioventricular (tricuspid) valve
slightly right of the midline, deep to the 4th and 5th intercostal space
136
Surface anatomy of the left atrioventricular (bicuspid) valve
just left of the midline, deep to the 4th costal cartillage
137
Surface anatomy of the pulmonary valve
just left of the midline at the level of the 3rd costal cartillage
138
Surface anatomy of the aortic valve
near the midline at the level of the 3rd intercostal space
139
Orthopnea
difficulty breathing and shortness of breath when lying down
140
paroxysmal
sudden onset of a symptom or disease
141
fibrillation
rapid contraction or twitching of muscle fibrils but not of the muscle as a whole
142
crackle
crackling noise heard with lung disease
143
hemoptysis
blood in sputum from airway hemorrhage
144
Signs and Symptoms:
- pulmonary hypertension
- dyspnea on exertion
- orthopnea
- acute pulmonary edema
- mitral valve murmur
- heart failure
- palpitations
- fatigue
Atrial Myxoma
- most commonly a primary tumor of the heart
- usually occurs in the left atrium
- the tumor may obstruct the mitral orifice or pulmonary venous orifices leading to pulmonary hypertension and decreased left ventricular output
- right ventricular hypertrophy frequently develops
145
Signs & Symptoms
- dyspnea
- fatigue
- palpitations
- one or more midsystolic clicks
- midsystolic clicks accentuated when patient is standing
Predisposing
- female 3:1
- thin
- thoracic skeletal deformities (scoliosis)
- heritable connective tissue diseases
Mitral Valve Prolapse
- typically asymptomatic
- prolapse --> stress on papillary muscles --> more regurgitation --> more stress
- leads to heart failure
146
Signs & Symptoms
- dyspnea on exertion
- paroxysmal noctural dyspnea
- orthopnea
- atrial fibrillation
- lung crackles
- hemoptysis
Examination
- systolic snap on auscultation
- biphasic P waves
Predisposing Factors
- history of rheumatic fever
- systemic lupus erythematosus
- female (3:1)
- congenital valve defect
Mitral Valve Stenosis
- narrowing of the mitral valve
- mitral valve is open for longer than usual and it closes with an abrupt snap
- said to protect the left ventricle, though output is reduced
- left atrium will have greater stress because it cannot empty, and it will become larger
- this stress leads to atrial fibrillation, which leads to pulmonary hypertension, edema, lung crackles, hemoptysis
147
What does the presence of S3 heart sound mean after age 40?
Suggests left sided heart failure.
148
What produces the S3 heart sound?
.
149
What is area of contact between each cusp called? Where it thickens in the middle, what is it called?
lunule and nodule
150
Signs and Symptoms
- chronic, productive cough
- dyspnea
- Barrel Chest deformity in advanced stages
- right ventricular hypertrophy
Predispositions
- smoking
- cigarettes + marijuana
- environmental air pollutants
- occupational exposure to dust and chemical fumes
Chronic Obstructive Pulmonary Disease
- lung disease that diminishes the flow of air through the lungs
- often a combination of chronic bronchitis and emphysema --> chronic bronchitis is chronic inflammation that produces mucus; emphysema causes permanent damage to elastic tissue in the lung, resulting in loss of recoil
151
Sign & Symptoms
- lung congestion
- dyspnea
- edema in extremities
- tachycardia
- S3
- low left ejection fraction
EKG
- wide and deep Q wave
- deep S wave
- tall R wave
Predispositions
- cardiovascular disease
- prior heart attack
- hypertension
- history of tobacco, alcohol, illicit drug use
- arrhythmias
Congestive Heart Failure
- always progressive and result of prior damage to the myocardium
- often is the result of a combined effect os several diseases
- "failure" refers to inability of ventricles to ejejct the volume of blood necessary to adequately supply oxygen to organs and tissue
- systolic heart failure --> ventricle myocardium cannot contract with enough force
- diastolic heart failure --> myocardium does not relax enough for adequate filling
152
Signs & Symptoms
- dyspnea
- dizziness
- overall weakness
- peripheral edema
- murmurs
- palpitations
Predisposition
- rheumatic fever
- endocarditis
- heart attack
- hypertension
Valvular Disease
- one or more of valves not functioning properly
- divided into valvular insufficiency and valvular stenosis
Valvular Stenosis
- leaflets get rigid or fused, causing the opening to narrow
Valvular Insufficiency
- failure of the valve to close properly
- allows blood to leak across the valve when it should form a seal
153
What are the three layers of the pericardium?
Fibrous
- outermost
- thick
- opaque
- encases the heart and great vessels as they exit
- ascending aorta and pulmonary trunk are within the pericardium
- loses its identify as it blends with the adventitia of the great vessels
Serous Pericardium
- parietal layer and visceral layer (epicardium)
- coronary vessels course between the myocardium and the visceral layer of serous pericardium
Pericardial fluid
- exists within the space and reduces friction
154
What artery supplies the right atrium and the sinoatrial node?
Right sinu-atrial nodal (60%)
155
What artery supplies the right ventricle and apex?
Right marginal
156
What artery supplies the right and left ventricles, interventricular septum?
Right (67%) or Left (33%) Posterior interventricular
157
What artery supplies the atrioventricular node?
Atrioventricular nodal
158
What artery supplies the right and left venticles?
Left interventricular (left anterior descending)
159
What artery supplies the left ventricle and left atrium?
Left circumflex
160
What artery supplies the left atrum and sinoatrial node?
Left sinu-atrial nodal (40%)
161
What artery supplies the left ventricle?
Left marginal
162
Signs and Symptoms
- febrile
- substernal pain (dull or sharp), increased when recumbent, coughing, or sneezing
- tachycardia
- tachypnea
- pericardial rub heard on auscultation
EKG
- PR depression
- ST elevation
Predisposition
- recent viral infection, especially coxsackievirus
- recent myocardial infarction
- open coronary surgery
Acute Pericarditis
- inflammation of the serous pricardium
- can occur with or without pericardial effusion
- most common cause is a viral infection
- dull pain --> visceral serous pericardium involvement from visceral afferent fibers (sympathetic)
- sharp pain --> parietal serous pericardium involvement from somatic afferent nerve (phrenic)
163
Signs and Symptoms
- chest discomfort (aching, tightness, pressure, crushing)
- pain referred to arms, shoulder, neck, teeth, back
- dyspnea
- hyperhidrosis
- nausea and vomiting
- malaise or fatigue
- anxiety
- elevated serum troponin T and I
Predisposition
- male > female
- age (older)
- family history of heart disease
- African American, Mexican American, Native American
- smoking
- diet high in cholesterol/fat
- obesity
- stress
Myocardial Infarction
- region of the heart wall deprived of oxygen for a prolonged period and muscle cells die
- blockage frequently results from thrombus formation
164
Signs and Symptoms
- sharp thoracic wall pain
- pain aggravated by deep breathing, coughing, sneezing
- auscultation reveals pleural friction rub
- febrile
- tachypnea
Predisposition
- recent viral infection
- chest injury (rib fracture)
- pneumonia
- tuberculosis
Pleuritis
- inflammation of pleura
- may occur with or without effusion
- in young healthy adults its usually caused by coxsackievirus B
- chest pain is caused by inflamed pleural membranes rubbing against each other
