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CVS Flashcards

1
Q

Where does the mediastinum lie?

A

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

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2
Q

Where does the superior mediastinum occur?

A

T4

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3
Q

What structures are found in the superior mediastinum?

A 
SVC
Brachiocephalic v.
Arch of aorta
Vagus 
Phrenic nerve 
Trachea 
Oesophagus
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4
Q

What structures are found in the anterior mediastinum?

A 
Sternopericardial ligament (anchors pericardium to sternum)
Remnants of thymus gland which becomes fibrous and fatty after puberty
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5
Q

What structures are found in the middle mediastinum?

A

Heart
Ascending aorta
SVC

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6
Q

What structures are found in the posterior mediastinum?

A

Oesophagus
Thoracic aorta
Azygous and hemiazygous veins

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7
Q

What structure makes the base of the heart?

A

LA (T6-9)

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8
Q

What are the 4 surfaces of the heart?

A

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

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9
Q

What are the 4 borders of the heart?

A

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

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10
Q

What level is the heart located?

A

T5-8

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11
Q

How does the position of heart change with height?

A

Taller - more vertical

Smaller - more transversely placed

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12
Q

Describe layers to the pericardium

A

Fibrous outer layer

Serous inner layer: parietal, pericardial cavity, serous)

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13
Q

Describe endocarium

A

Simple squamous epithelium on BM adhered to connective tissue

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14
Q

Describe epicardium

A

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

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15
Q

Name the semi-lunar valves

A

Aortic and pulmonary (3 cusps)

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16
Q

Is mitral valve bicuspid or tricuspid?

A

Bicuspid

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17
Q

What is the annulus fibrosis?

A

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

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18
Q

What is the function of the chord tendineae?

A

Tendons that connect papillary muscles to valve cusps

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19
Q

What is the function of the papillary muscles?

A

Prevents inversion of valve

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20
Q

What is the function of the annulus fibrosis?

A

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

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21
Q

What is the function of the coronary arteries?

A

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

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22
Q

Where do the coronary arteries arise from?

A

Aortic sinuses at the proximal part of the ascending

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23
Q

What does the RCA divide into further?

A

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

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24
Q

What does the LCA divide into further?

A

Circumflex

Anterior IV branch (LAD)

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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.

Anatomy T2 (2 decks)

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