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Flashcards in CVS Deck (86):
1

Where does the mediastinum lie?

Inferior surface of the diaphragm to the superior thoracic aperture, and from the sternum and costal cartilages anteriorly to the thoracic vertebra posteriorly

2

Where does the superior mediastinum occur?

T4

3

What structures are found in the superior mediastinum?

SVC
Brachiocephalic v.
Arch of aorta
Vagus
Phrenic nerve
Trachea
Oesophagus

4

What structures are found in the anterior mediastinum?

Sternopericardial ligament (anchors pericardium to sternum)
Remnants of thymus gland which becomes fibrous and fatty after puberty

5

What structures are found in the middle mediastinum?

Heart
Ascending aorta
SVC

6

What structures are found in the posterior mediastinum?

Oesophagus
Thoracic aorta
Azygous and hemiazygous veins

7

What structure makes the base of the heart?

LA (T6-9)

8

What are the 4 surfaces of the heart?

Anterior - sternocostal
Inferior - diaphragmatic
Left - LV
Right - RA

9

What are the 4 borders of the heart?

Right: RV
Inferior: mainly RV and partly LV
Left: LV
Superior: RA and LA

10

What level is the heart located?

T5-8

11

How does the position of heart change with height?

Taller - more vertical
Smaller - more transversely placed

12

Describe layers to the pericardium

Fibrous outer layer
Serous inner layer: parietal, pericardial cavity, serous)

13

Describe endocarium

Simple squamous epithelium on BM adhered to connective tissue

14

Describe epicardium

Connective tissue, BM and simple squamous epithelium
Contains branches of the coronary arteries
Forms the serous visceral layer

15

Name the semi-lunar valves

Aortic and pulmonary (3 cusps)

16

Is mitral valve bicuspid or tricuspid?

Bicuspid

17

What is the annulus fibrosis?

A fibrous structural support for the heart chamber - supports the atrioventricular septum
Composed of dense connective tissue

18

What is the function of the chord tendineae?

Tendons that connect papillary muscles to valve cusps

19

What is the function of the papillary muscles?

Prevents inversion of valve

20

What is the function of the annulus fibrosis?

Keeps all valves open, preventing tears and back flow
Acts as an electrical insulator by preventing electrical impulses through atria and ventricles, so delaying contraction, to allow ventricles to fill up

21

What is the function of the coronary arteries?

Supply the myocardium and epicardium and are located deep in the epicardium, embedded in fat

22

Where do the coronary arteries arise from?

Aortic sinuses at the proximal part of the ascending

23

What does the RCA divide into further?

Sino-atrial (SA) nodal branch - SA node
R marginal branch - R of heart
AV nodal branch - AV node
Posterior IV branch - both ventricles

24

What does the LCA divide into further?

Circumflex
Anterior IV branch (LAD)

25

What are the two main sulci of the heart?

Coronary sulcus - between atria and ventricles
Interventricular sulcus - between ventricles

26

Where do the cardiac veins drain into?

Coronary sinus - a wide venous channel on the posterior side of the heart which feeds into the RA

27

What are the cardiac veins and what coronary aa. do they lie along?

Great cardiac vv. - LAD
Middle cardiac vv. - posterior descending aa.
Small cardiac vv. - R marginal aa.

28

At what level does the aortic arch lie?

T4

29

At what level is the bifurcation of abdominal aorta?

L4

30

At what level is the bifurcation of common iliac aa.?

L5

31

What are the 3 arteries that branch of the arch of the aorta?

Brachiocephalic trunk
L common carotid aa.
L subclavian aa.

32

What are the arteries that branch off the descending aorta?

Bronchial aa.
Oesophageal aa.
Pericardial aa.
Posterior IC aa. (only one indentifiable on wet specimen)

33

What are the tributaries of the SVC

L and R braciocephalic vv.
Azygous vv.

(Internal jugular vv. + subclavian vv. -> brachiocephalic vv.)

34

What is the function of the azygous vein?

Drain blood from the posterior IC veins to the SVC and found immediately to the right of the thoracic aorta

35

What are the hemiazygous veins?

Drain L IC veins and then drain into the azygous vein at T8/9

36

Where do the structures in the neuromuscular bundle arise from?

Larger structures that run vertically along the anterior and posterior chest wall

37

What drains into the azygous vein?

Posterior IC veins and hemiazygous vein

38

What arises from the descending aorta?

Posterior chest wall IC arteries

39

Where do the intercostal nerves arise from?

Ventral ramus of spinal nerves

40

What drains into the internal thoracic vein?

The anterior IC veins and then it drains into the bachiocephalic vein

41

What does the internal thoracic artery give rise to?

Branches off of the subclavian artery and gives rise to the anterior IC arteries

42

Where is the thoracic duct located?

Drains the posterior chest wall
Located on the vertebral lies between the azygous vein and the descending thoracic aorta on the R of the posterior thoracic wall

43

Where does the thoracic duct commence?

L1 as the cisterna chyli

44

Where does the thoracic duct drain into?

Medial end of L subclavian vein

45

What is the R upper quadrant drained by?

R lymphatic duct - which drains into the medial end of the R subclavian vein

46

What are the 5 different planes in the superior mediastinum (anterior to posterior)?

Glandular plane
Venous plane
Arterial-nervous plane
Visceral plane
Lymphatic plane

47

What is found in the glandular plane of the superior mediastinum?

Remnants of the thymus gland

48

What is found in the venous plane of the superior mediastinum?

Brachiocephalic vv
SVC

49

What is found in the arterial-nervous plane of the superior mediastinum?

Branch of aorta
Vagus nn
Phrenic nn

50

What is found in the visceral plane of the superior mediastinum?

Trachea
Oesophagus

51

What is found in the lymphatic plane of the superior mediastinum?

Thoracic duct

52

What is the effect of innervation from the vagus nerve?

Part of the parasympathetic system to control heart rate and regulate breathing, however it has some sympathetic influence through peripheral chemoreceptors

53

Where are the vagus nerves situated?

L: anterior to aortic arch then behind L bronchus and to the oesophagus

R: behind R bronchus and oesophagus

Both enter abdomen through the oesophageal hiatus of the diaphragm

54

Where do the superficial veins in the upper limbs arise from?

The dorsal venous arch on the back of the hand

55

What superficial vein is most lateral in the upper limbs and what does it drain into?

Cephalic vein - drains into the axillary vv.

56

What superficial vein is most medial in the upper limbs and what does it drain into in the upper limbs?

Basilic vein - becomes continuous with the brachial vein (deep vein) and drains into axillary vv.

57

What vein connects the basilic and cephalic veins and where in the upper limbs?

Median cubital vein in the median cubital fossa

58

What is the term for deep veins lying alongside corresponding arteries?

Venae comitantes

59

Where does the subclavian aa. become axillary aa in the upper limbs?

Lateral border of the 1st rib

60

Where does the axillary aa. become the brachial aa. in the upper limbs?

Inferior border of the teres major muscle

61

What two arteries does the brachial artery give rise to in the upper limbs?

Radial (lateral) and ulnar (medial)

62

What do the names of the deep veins in the legs correspond to?

The name of the arteries

63

Where do the superficial veins of the lower limbs arise from?

The dorsal arch of the foot

64

What superficial vein runs up the lower limbs anteriorly to the medial malleous?

The long saphenous vein and drains into the femoral vv.

65

What superficial vein runs up the lower limbs posteriorly to the lateral malleous?

Short saphenous vein and drains into the popliteal vv

66

Describe the main arteries of the lower limb from top of led to feet

External iliac aa
Superficial femoral aa (and deep femoral aa)
Popliteal aa.
Anterior tibial aa and posterior tibial aa
Fibular aa (from post tibial aa)
Dorsalis pedis (from ant tibial aa)

67

What artery provides temporal and facial pulses?

Branches of external carotid

68

What artery provides common carotid pulses?

Common carotid aa from aortic arch

69

What artery provides brachial pulse?

Brachial aa from axially aa

70

What artery provides radial pulse?

Radia aa branch off of brachial aa

71

What artery provides femoral pulse?

Femoral aa

72

What artery provides dorsals pedis pulse?

Dorsalis pedis aa from the ant tibial aa

73

What makes up the anterior surface of the heart?

RV (most)
RA
LV

74

What are the main features of the RA?

Openings for the IVC, SVC coronary sinus
Fossa ovalis
Musculi pectinati
Tricuspid valve
Extending from anterograde-medial portion is the R auricle (RA appendage)

75

What are the main features of the RV?

Tricuspid valve: 3 valves, chordae tendineae, papillary muscles x3
Trabeculae carnae
Moderator band - connects the IV septum with the anterior wall
Opening for the pul. trunk
IV septum

76

What is the purpose of the papillary muscles?

Pull on the chord tendinae to prevent prolapse of the valve leaflet during ventricular systole

77

What are the main features of the LA?

Openings for the pul veins: L and R superior/inferior
Bicuspid (mitral) valve
Smooth walled, small chamber lying most posterior and superior against the oesophagus
Forms base of the heart

78

What are the main features of the LV?

Bicuspid (mitral) valve: 2 valve cusps and 2 pap muscles
Trabeculae Carneae
Opening for the aorta
Forms apex of the heart
Wall is x3 thicker than the R as it pumps blood around the body

79

What nerves innervate the heart wall?

Vagus nerve (parasympathetic) - visceral layer

Sympathetic fibres (T1-4) which synapse in the ganglionic chain and continue through the cardiac plexus at the trachea bifib (pain and sensory) - heart muscle and visceral

Phrenic nerve - fibrous and parietal layers

80

Describe innervation of SA and AV nodes

Motor fibres innervate and influence nodes of modified cardiac muscle cells that generate electrical pulse (pacemaker cells) - these are punkinje cells and their branches are the punkinje fibres

81

Where are the purkinje fibres located?

In the subendothelial surface and rapidly transmit AP from the AV node to the myocardium

82

What is the effect of parasympathetic innervation?

Reduces heart rate
Reduces force of contraction
Vasoconstriction of coronary arteries

83

What is the effect of sympathetic innervation?

Increases heart rate
Increases force of contraction

84

What is referred pain?

Pain that emanates from an organ/viscus but experienced somaticcaly

85

Give example of referred pain

Pain of Myocardial ischaemi is carried back to T1-4 by sympathetic afferent nerves that supply heart

Pain is also felt on the anterior chest and medial side of the L arm

86

What causes referred pain?

Dermatomes responsible for cutaneous innervation are supplied by the same spinal cord levels as visceral afferents of the heart

Dermatome T1 innervates medial side of the L arm as pain from heart usually left of the chest. The brain isn't used to receiving such strong signals from the heart, so it interprets them as pain in the chest and left arm.