CVS anatomy- anatomy of chest pain Flashcards Preview

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Flashcards in CVS anatomy- anatomy of chest pain Deck (33)
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1
Q

How does the autonomic innervation of the heart reach the heart?

A

Via the cardiac plexus

2
Q

Where do visceral afferent fibres from the heart go?

A

Pain fibres travel to the spinal cord alongside sympathetic fibres
Visceral reflex afferents (e.g. from baroreceptors) travel mainly in the vagus nerve (some in CN IX)

3
Q

What are the different cervical sympathetic ganglia?

A

Superior, middle and inferior

4
Q

At which level of the spinal cord do the sympathetic fibres leave?

A

T1- L2/3 (thoracolumbar)

5
Q

What are the sympathetic nerves to the heart and lungs transmitted in?

A

The cardiopulmonary splanchnic nerves

6
Q

Is sympathetic innervation of the heart unilateral or bilateral?

A

Bilateral (but predominantly left sided)

7
Q

How do sympathetic signals from the CNS reach the heart?

A

They travel inferiorly within spinal cord tracts
They exit the spinal cord in one of the T1- 5 spinal nerves (thoracolumbar nerves), then they travel superiorly in the sympathetic chain and synapse at another ganglion.
The post synaptic fibres are transmitted to the heart in the cardiopulmonary splanchnic nerves (post synaptic fibres from the cervical and upper thoracic sympathetic chains)

8
Q

What does the cardiac plexus contain?

A

Sympathetic nerves
Parasympathetic nerves
Visceral afferents

9
Q

How do parasympathetic signals reach the heart?

A

In cranial nerve X (the vagus nerve)

It carries presynaptic fibres which synapse in the walls of the heart.

10
Q

Which nerve fibres to/from the heart travel in the cardiopulmonary splanchnic nerves?

A

Post synaptic cardiac sympathetic efferent

Visceral afferent

11
Q

Where do action potentials from body sensation arrive in the brain?
What are these signals called?

A

The postcenetral gyrus of the parietal lobe

Somatosensory

12
Q

Where do action potentials that cause a conscious skeletal muscle contraction originate from in the brain?
What are these signals called?

A

The precentral gyrus of the frontal lobe

Somatomotor

13
Q

Describe how the pain in shingles (herpes zoster) comes about

A

Reactivation of dormant virus in posterior root ganglion
• Pain can be felt anywhere in that dermatome
• Pain precedes blisters
• Patient with shingles developing in T4/T5 dermatome may present with central chest pain

14
Q

Where does the left phrenic nerve pass in relation to the lung hilum?

A

Anterior to it

15
Q

What is the remnant of the ductus arteriosus connecting the pulmonary trunk to the aorta?

A

Ligamentum artereosum

16
Q

What is radiating pain?

A
The PAIN is felt BOTH at the actual site of the pathology AND 
ALSO radiating (spreading away from there)
17
Q

Where does pain radiate to from a somatic structure?

A

Along the affected dermatome

18
Q

Where does pain from the heart radiate to?

A

the dermatomes supplied by the spinal cord levels at which the cardiac visceral afferents enter the sympathetic chain/spinal cord i.e. BILATERALLY to cervical and upper thoracic dermatomes.

19
Q

Describe visceral radiating pain

A

it is “visceral” in nature i.e. although it is felt in a dermatomal pattern, it is still dull, aching and poorly localised in nature

20
Q

What is referred pain?

A

the sensation of pain is “felt” ONLY at a site remote from the actual area of injury or disease
• Otherwise very similar principle to radiating pain

21
Q

What causes referred pain?

A

Due to afferent (sensory) fibres from soma and afferent
(sensory) fibres from viscera (visceral afferents) entering
the spinal cord at the same levels
• The brain chooses to believe that the pain signals coming from the organ, are actually coming from the
soma

22
Q

Describe cardiac referred pain

A

in CARDIAC referred pain the brain chooses to believethe pain signals are coming from the upper limbs (especially the left upper limb) or from the back, neck (or jaw).

23
Q

What is a right dominant pattern of coronary artery supply?

A

When the posterior interventricular artery is a branch of the right coronary artery

24
Q

What is left dominant pattern of coronary artery supply?

A

When the posterior interventricular artery is a branch of the left coronary artery

25
Q

What is an extreme right dominant pattern of coronary arterial supply?

A

When all of the branches except the LAD come from the right coronary artery.

26
Q

What are common sites of narrowing/occlusion due to atherosclerosis in the coronary arteries?

A
  1. The anterior interventricular branch of the LCA
  2. The right coronary artery
  3. The circumflex branch of the LCA
  4. The left main stem coronary artery
27
Q

Where are grafts anastamosed in coronary artery bypass grafting?

A

They are anastamosed proximally to the ascending aorta and to the coronary artery distal to the narrowing

28
Q

What is the blood supply to the SA node in 60% of patients?

A

A branch from the right coronary artery near its origin

29
Q

What is the blood supply to the AV node in 80% of patients?

A

A branch from the right coronary artery near the origin of the posterior interventricular artery.

30
Q

What is the arterial blood supply of the interventricular septum?

A

The LAD and the posterior interventricular artery

31
Q

What can result when parts of the conducting system of the heart are affected by ischaemia of the coronary arteries?

A

Arrhythmia

32
Q

What is the result of AV node damage?

A

Complete heart block

33
Q

What is the result of bundle branch damage?

A

Bundle branch block