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Circulatory System Flashcards

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1
Q

Label the sternum and thoracic skeleton

A 
Sternum:
Manubrium
Body
Manubriosternal joint
Xiphoid process

Thoracic Skeleton:
Clavicle
Scapula
Sternum
True ribs (1-7)
False ribs (8-10)
Floating ribs (11, 12)
Costal cartilages
Thoracic vertebrae
Diaphragm
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2
Q

The chest cavity is divided into…

A

Median partition - mediastinum

Lateral pleura & lungs

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3
Q

The mediastinum extends to…

A

Root of neck above
Diaphragm below
Sternum anteriorly
Vertebral column Posteriorly

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4
Q

What are the subdivisions of the mediastinum?

A

Superior, inferior, anterior, middle and posterior

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5
Q

What is the pericardium?

A

Pericardium is a fibro-serous sac that encloses the heart and the roots of the great vessels
The heart lies within the pericardium in the mediastinum

Functions to;
restrict excessive movements of the heart as a whole
serve as a lubricated container in which the different parts of the heart can contract

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6
Q

What is fibrous pericardium?

A

Strong, fibrous layer
Firmly attached below to the central tendon of the diaphragm
Fuses with outer coats of great blood vessels that pass through it
Attached in front to sternum by sternopericardial ligaments

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7
Q

What is serious pericardium?

A 
Two layers
Parietal lines the fibrous pericardium
Visceral closely covers heart (epicardium)
Space between called pericardial cavity
Contains pericardial fluid; lubricant
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8
Q

Why is LV thicker than RV?

A

Greater force required to pump blood through the body than to the lungs, so muscular wall of left ventricle is thicker than the right

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9
Q

What separates the four heart chambers?

A

Inter-atrial, interventricular and atrioventricular septa separate the four chambers of the heart

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10
Q

Label the heart structure

A

SVC- superior vena cava

IVC- inferior vena cava

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11
Q

What are the features of the right atrium?

A

Forms right border of heart
Receives blood through the SVC, IVC and coronary sinus
Coronary sinus returns blood from the walls of the heart itself

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12
Q

Label the right atrium

A 
Crisla terminalis
Musculi pectinati
Fossa ovale
Atroventricular orifice
Right auricle
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13
Q

What are the features of the right ventricle?

A

Blood entering from right atrium moves in a horizontal and anterior direction
Outflow tract: pulmonary trunk
Pulmonary trunk closed by pulmonary valve–3 semilunar cusps

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14
Q

Label the right ventricle

A

Chordae tendinae
Tricuspid valve
Trabeculae carnae (including papillary muscles)

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15
Q

What are the features of the left atrium?

A

Forms most of base of heart
Blood enters X4 pulmonary veins
Anterior half is continuous with left auricle–No equivalent to the crista terminalis

Depression on interatrial septum is the valve of the foramen ovale
Blood moves into left ventricle via atrioventricular orifice–Guarded by the mitral valve

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16
Q

Label the left atrium

A

Left auricle
4 pulmonary veins
Foramen ovale
Mitral valve

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17
Q

What are the features of the left ventricle? Label the structure

A

Blood flows into the aortic vestibule
Guarded by the aortic valve
Similar in structure to pulmonary valve
As blood recoils after ventricular contraction, and fills the aortic sinuses formed by the cusps, it is forced into coronary arteries

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18
Q

What is the cardiac silhouette?

A

Cardiac silhouette refers to the outline of the heart as seen on frontal and lateral chest radiographs

The size and shape of the cardiac silhouette provide useful clues for underlying disease

From the frontal projection, the cardiac silhouette can be divided into right and left borders:

the right border is formed by the right atrium
the superior vena cava entering superiorly and the inferior vena cava often seen at its lower margin

the left border is formed by the left ventricle and left atrial appendage/auricle
the pulmonary artery, aortopulmonary window and aortic notch extend superiorly

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19
Q

Describe the pulmonary trunk

A

Arises slightly anterior to aortic orifice
Ascends posteriorly and to the left, lying anterior and to left of ascending aorta

Divides into left and right
Left: inferior to aortic arch
Right: posterior to ascending aorta and SVC

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20
Q

What are the features of the aorta?

A

Ascending within pericardial sac
Enters superior mediastinum = arch

Arch lies behind manubrium sterni, in front of trachea
Arches upwards and backwards
Becomes continuous with descending aorta

Aortic arch branches:
Brachiocephalic trunk (divides into right subclavian and right common carotid
Left common carotid
Left subclavian

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21
Q

What are the two parts of the vena cava?

A

Superior Vena Cava
Inferior half within pericardial sac

Inferior Vena Cava
Passes through diaphragm at T8 and enters fibrous pericardium

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22
Q

What are auscultation points and what can you hear from them?

A

Cardiac auscultation enables heart sounds to be listened to using a stethoscope for cardiac assessment

Normal heart sounds (lub-dub) are produced by the closure of the valves during a contraction

Valve sounds travel through the surrounding structures of the thoracic wall

Placement of the stethoscope differs from the position of the valve being examined (downstream from flow of blood)

Palpation of the ribs is used to determine which level a stethoscope needs to be placed

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23
Q

What is it called if a heart sound differs due to turbulent blood flow?

A

Heart murmur

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24
Q

What are the 4 auscultation points?

A

Aortic valve: medial end of the 2nd right intercostal space

Pulmonary valve: medial end of the 2nd left intercostal space

Tricuspid valve: 4th intercostal space at the lower left sternal border

Mitral valve: 5th left intercostal space at the mid-clavicular line

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25
What are the three layers of the heart?
–Endocardium: inner most layer. Lines Cavities and heart valves –Myocardium: composed of cardiac muscle and responsible for contraction of the heart –Epicardium: outermost layer of the heart, formed by the visceral layer of the serous pericardium. It is composed of connective tissue and fat
26
Describe the endocardium
Structurally, the endocardium is comprised of loose connective tissue and simple squamous epithelial tissue Similar in its composition to the tunica intima which lines the inside of blood vessels Deep to the endocardium is the subendocardial tissue, which contains loose vascularized connective tissue Subendocardial tissue also contains nerves as well as Purkinje fibres In areas where the myocardium is thin (i.e. atria) the endocardium is relatively thicker In addition to lining the inside of the heart, the endocardium also regulates contractions and aids cardiac embryological development
27
Describe the myocardium
Like the muscular tunica media, the myocardium is the middle layer of the heart that contains a large quantity of muscle cells Cardiomyocytes are arranged in a branched, linear manner This layer is highly vascularized and the cardiomyocytes contain glycogen granules as an additional energy source
28
What connects cardiac myocytes?
Intercalated discs, forming cardiac syncytium to enable transmission of electrical impulses for contraction
29
Describe the epicardium
The pericardium is a fibrous double layered connective sheath that encases the heart within the mediastinum The visceral portion of the serous pericardium (that is in contact with the heart) is called the epicardium It is a mesothelium derivative that is rich in adipocytes and neurovascular tissue
30
Describe the cardiac skeleton
Collection of dense, fibrous tissue in the form of four rings which interconnect in a plane between the atria and ventricles Surround the AV orifices, aortic orifice and opening of pulmonary trunk Helps maintain integrity of openings and provides attachments for cusps Separates muscular wall of atria from ventricles, as well as electrically isolating the ventricles The AV bundle is the single connection between these two groups of myocardium
31
Cardiac skeleton
32
Tricuspid valve
33
Bicuspid (mitral) valve
34
Semilunar valve structure
35
Auscultation points
• Aortic valve: medial end of the 2nd right intercostal space • Pulmonary valve: medial end of the 2nd left intercostal space • Tricuspid valve: 4th intercostal space at the lower left sternal border • Mitral valve: 5th left intercostal space at the mid-clavicular line
36
What happens in regurgitation?
``` (leaky valve) • Retrograde flow of blood either from the ventricles, or in the case of the semilunar valves back into the ventricles from the outflow tracks ``` • Heart has to pump harder, potentially leading to pathological hypertrophy or heart failure • Causes include prolapse (valve leaflets bulge back into the atrium),damaged chordae tendineae, rheumatic fever
37
What happens in valve stenosis?
(narrowing of the valve) • Main causes are calcification, congenital defects and rheumatic fever • Heart must use more force to pump blood through the hardened valve leaflets • May lead to pathological hypertrophy of the heart chamber
38
What is atresia?
(congenital) • Valve doesn’t form properly • Often means there is a patent foramen ovale and ductus arteriosus, to allow blood to reach the lungs via an alternative route
39
Valve regurgitation may be a result of damage to which structure?
Chordae tendineae
40
How does the chordae tendineae attach to ventricular wall?
Papillary muscles
41
Common causes of valve regurgitation?
Congenital Stenosis Endocarditis Rheumatic fever
42
Describe the features of foetal circulation
Pulmonary circulation not functional in foetus bc oxygen delivered from placenta through umbilical vein and 2 umbilical arteries wrapped around it. Umbilical vein bypasses liver through Ductus Venosis and empties into right atrium of heart. Blood bypasses lungs through 1) Foramen Ovale (right to left side of heart) and blood from right ventricle pumped up through pulmonary trunk and passes through 2) Ductus Arteriosus into aorta. Ductus Arteriosus: Bypasses lungs just AFTER where 3 branches from aortic arch have branched off- distal to subclavian.
43
What arteries supply the heart and where do they arise from?
Coronary arteries • Two: right and left • Arise from aortic sinuses of the ascending aorta: small openings found within the aorta behind the left and right flaps of the aortic valve. • When the heart is relaxed, the back-flow of blood fills these valve pockets, therefore allowing blood to enter the coronary arteries.
44
Right coronary artery: arises from? Descends where? Does it branch?
Arises from aorta and runs forward between pulmonary trunk and right auricle • Descends almost vertically in the right atrioventricular groove • At inferior border continues posteriorly to anastamose with left coronary artery • Offers a marginal branch and a posterior interventricular branch
45
Label the arteries
The right coronary artery (RCA) branches to form the right marginal artery (RMA) anteriorly In 80-85% of individuals, it also branches into the posterior interventricular artery (PIv) posteriorly.
46
Left coronary artery: arises from where?
Usually larger than right Arises from aorta and passes forward between the pulmonary trunk and left auricle
47
Left coronary artery: branches
``` The left coronary artery (LCA) initially branches to yield the left anterior descending (LAD), also called the anterior interventricular artery ``` ``` • The LCA also gives off the left marginal artery (LMA) and the left circumflex artery (Cx) ``` • In ~20-25% of individuals, the left circumflex artery contributes to the posterior interventricular artery (PIv)
48
Coronary artery distribution: RCA vs LCA
49
Coronary artery variation: | What is the most common presentation?
RIGHT DOMINANT artery
50
Right dominant artery variation
Posterior interventricular/descending artery (PDA) Supplies large portion of posterior wall of left ventricle
51
Left dominant branch variation
Posterior interventricular arises form the circumflex Additional variation in relation to SA and AV nodes - Normally supplied by RCA - Sometimes vessels from circumflex of LCA
52
Co-dominant variation
Indicator of left ventricular strength: Left dominance associated with worst prognosis
53
Coronary artery angiography utilises which peripheral vessel to inject die into the coronary vasculature?
Femoral or radial artery
54
Why is prognosis of people who are right dominant better than those who are left dominant?
In right coronary circulation, PDA (branching from RCA) serves as a collateral vessel to basal left anterior descending artery via septal perforators -> so patient with proximal left anterior descending coronary artery stenosis has benefit of possibly receiving supply from right coronary artery if they're right heart dominant So if someone has blockage on left side of heart, if PDA branching from right, because of collateral vessels that run from it there's a chance that there will be some supply to structures on left side through RCA So collateral circulation MAY be enough to bypass blockage in LAD to provide enough oxygenated blood so cardiac muscle can thrive and survive
55
Why is dominance important in cardiac surgery planning?
In coronary artery bypass grafting- surgeon must knew what vessels are suitable to receive distal anastomosis of venous graft. For occlusion of RCA or LCA the PDS might be chosen if suitable (depends on patency). Venous conduit is then sutured into a portion of RCA that is distal to occlusion
56
Aortic valve stenosis affects which chamber of the heart?
Left ventricle, can cause LV hypertrophy
57
Coronary sinus receives what 4 major tributaries?
• Great, middle, small and posterior cardiac veins • Anterior cardiac veins are very small, draining only the anterior portion of the right ventricle
58
Great cardiac vein
* Also known as the anterior interventricular vein * Largest tributary of the coronary sinus * Runs from apex to pass around the posterior surface of the heart * Gradually enlarges to ‘form’ the coronary sinus
59
Small cardiac vein
• Located on the anterior surface of the heart, in a groove between the right atrium and right ventricle • It travels within this groove onto the posterior surface of the heart, where it empties into the coronary sinus
60
Middle cardiac vein
• Also known as the posterior interventricular vein • Begins at the apex of the heart and ascends in the posterior interventricular groove to empty into the coronary sinus
61
Posterior cardiac vein
* Located on the posterior surface of the left ventricle | * It lies to the left of the middle cardiac vein and empties into the coronary sinus
62
Anterior and smallest cardiac vein: Arise from where and features?
Anterior cardiac veins - Small; arise on anterior surface of right ventricle - Cross coronary sulcus and enter anterior wall of right atrium Smallest cardiac veins (aka thebesian) -Valve-less -Drain directly into cardiac chambers; numerous in right atrium and ventricle  Occasionally associated with left atrium
63
What artery is most commonly occluded?
LAD is the most commonly occluded of the coronary arteries • Main supply to interventricular septum and the bundle branches of the conducting system • Infarction of the conduction system
64
What can happen if right coronary branches are occluded?
Right coronary branches supply SA and AV nodes; blockage can lead to conduction abnormalities
65
Angina vs MI
BOTH SYMPTOMS OF CORONARY ARTERY DISEASE ``` Angina • Ischaemia but falls short of necrosis • Stable: predictable; after exercise of exertion; pain eases after rest • Unstable: more severe; can happen during resting ``` MI • Complete block of an artery due to embolus • Usually result of atherosclerosis • Progressive blockage of a coronary artery can encourage collateral branching which can help in the event of an M.I.
66
CABG (coronary artery bypass graft)
Saphenous vein usually HARVESTED. without mercy Radial artery occasionally used Sometimes even internal thoracic artery if you're feeling spicy enough Method: site of complete occlusion due to plaque, so new vessel taken from aorta and taken downstream of occlusion to bypass blockage

Anatomy (13 decks)

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