Dr. Seiden - Lecture 1 - Anatomy of the Heart

Question 1

Interventricular sulcus

Answer 1

Seperates left and right ventricle. Great cardiac vein and anterior interventricular artery (LAD) run here.

Question 2

Tricuspid valve

Mitral valve

Answer 2

Tricuspid - atrioventricular valve on the right side

Mitral - atrioventricular valve on the left side

Question 3

Pulmonic valve

Aortic valve

Answer 3

Pulmonic - outflow valve on the right side

Aortic - outflow valve on the left side

Question 4

When are the AV valves open/closed and when are the outflow valves open/closed?

Answer 4

AV valves are open during diastole and closed during systole.
Outflow valves are closed during diastole and open during systole.

Question 5

What is diastole and what is systole?

Answer 5

Diastole is when the ventricle is contracting and systole is when the ventricle is relaxing.

Question 6

Portions of the aortic and pulmonic valves

Answer 6

A - Right, Left, Posterior

P - Right, Left, Anterior

Question 7

Semilunar nodules

Answer 7

the corner portion of the semilunar valves are called the semilunar nodule. When the valve closes, they fit into each other to close the valve

Question 8

Portions of the mitral and tricuspid valves

Answer 8

Mitral - Anterior and Posterior

Tricuspid - Anterior, Posterior, Septal

Question 9

Normal auscultation points

Answer 9

Aortic Valve - right second intercostal space because the aortic valce is between left ventricle and ascending aorta. We want scope over ascending aorta. Aorta is on the right so you want to be over the right side.
Tricuspid valve - Valve between right atrium and right ventricle. So you want to place your stethoscope over the right ventricle (downstream). Don’t put it over the sternum, but rather over the intercostal space. We pick the 5th (as opposed to 3rd and 4th) intercostal space because the heart is tilted forward so we can hear the lower parts better.
Mitral valve - 5th intercostal space at the midclavicular line. You want to be in the left ventricle, downstream). We pick 5th as opposed to 4th and 3rd because the heart is tilted forward.
Pulmonic valve - second intercostal space on the left between pulmonic trunk and right ventricle. You want to go downstream

Question 10

stenosis

incompetence

Answer 10

stenosis - narrowing of an opening in a valve.

incompetence - a valve doesn’t close as it should so we have regurgitation.

Question 11

AV Valve Murmers

Answer 11

Stenosis - Diastolic murmer - Lub-Dub-Pshh

Insufficiency - Systolic murmer - Lub-Psh-Dub

Question 12

Outflow Valve Murmers

Answer 12

Stenosis - Systolic murmur - Lub-Psh-Dub

Insufficiency - Diastolic murmur - Lub-Dub-Psh

Question 13

Auscultation Points for murmurs

Answer 13

Slide 18

Question 14

Pectinate Muscle

Answer 14

Rough wall

Question 15

Crista Termanlis

Answer 15

ridge separating rough and smooth wall

Question 16

Fossa Ovalis

- Limbus of fossa ovalis

Answer 16

Oval depression on right atrial side of right atrium.

- Limbbus - sharp upper border of fossa ovalis

Question 17

Trabeluae Carnae

Answer 17

Same thing as pectinate muscle that we saw earlier.

Question 18

Chorda tendinae

Answer 18

attach to the papillary muscles. Tips of papillary muscles to edges of the cusps. Do not pull on the valves. The opening and closing of the tricuspid valve is purely based on pressure between the two ventricles. But if the pressure in the second valve gets too high then it would go from open to closed to open. But because we have the chordae tendinae, it tethers it so that it can’t go passed closed

Question 19

Blood Supply to the heart?

Answer 19

Right and left coronary arteries coming off of the ascending aorta

Question 20

Right coronary artery

Answer 20

leaves ascending aorta and ngoes straight to the coronary sulcus (atrioventricular sulcus). It supplies the right atrium and right ventricle. It gives off a branch callrd the SA Nodal Artery. It then continues to give off a branch called the marginl artery. leaves ascending aorta and ngoes straight to the coronary sulcus (atrioventricular sulcus). It supplies the right atrium and right ventricle. It gives off a branch callrd the SA Nodal Artery. It then continues to give off a branch called the marginl artery.

Question 21

Right Dominance vs. Left dominance

Answer 21

Right Dominance is when the posterior inerventricular artery comes off of the right coronary artery. Left Dominance is when the Posterior interventricular Artery comes off of the Left coronary artery.

Question 22

Left Coronary Artery

Answer 22

coems off of left side of ascending aorta. very short. Once it gets past the pulmonary trunk it ends and divides into two branches. The first branch is the left circumflex artery, which goes around to the posteior part of the heart, makes a U-turn and enters the coronary sulcus. The second branch is the anterior interventricular antery, which supplies the two ventricles.

Question 23

Two sites of anastemoses in the heart

Answer 23

1) Between right and left coronary artery by way of the circumflex artery.
2) Anterior and posterior interventricular arteries.

Question 24

Great cardiac vein

Answer 24

Venous drainage - Great cardiac - sits in anterior interventricular sulcus on the anterior portion of the heart and runs parallel with the LAD. It then ascneds into the coronary sulcus, goes to the back of the heart in the coronary sulcus, it then expands to become what is called the coronary sinus

Question 25

Coronary Sinus

Answer 25

the great cardiac vein as well as the other cardiac veins such as the small cardiac and middle cardiac all flow into the coronary sinus. The coronary sinus then flows into right atrium.

Question 26

Anterior cardiac veins

Answer 26

Drain directly into the right atrium

Question 27

Least Cardiac Veins (Thebesian Veins)

Answer 27

drains directly into whatever chamber is underlying that vein. Therefore, usually you get your venous return going into the right atrium. But now we see that you also get some venous return going into the left atrium and left ventricle. Therefore, you get some deoxygenated blood getting into the left side of the heart, which makes it so that the blood in the pulmonary venous return isn't 100% oxygenated. The blood that is flowing into the right atrium is 100% saturated, and blood going into the left atrium is 100% saturated. The blood that is leaving the left ventricle is not 100% saturated, its like 95%.

Question 28

Pericardial Cavity - Visceral pericardium - parietal pericardium

Answer 28

heart is surrounded by the pericardial cavity, which is made up of the visceral layer and parietal layer. The visceral layer is on the inside, the parietal layer is on the outside.

Question 29

Fibrous peericardium

Answer 29

as opposed to the abdomen, we have a third layer here called the fibrous pericardium, which is fused to the parietal pericadium. Very tough collagenous layer. If you cut into it you would see the parietal pericardium. It doesn't stretch. If you get a rapid accumulation of fluid into the pericardial cavity, the cavity cant expand to accommodate this volume of fluid. So, it'll expand inward and compress the heart. This will impede filling of the heart. Called pericardial tamponade, which is fixed through a procedure called pericardiocentesis

Question 30

Transverse Sinus

Answer 30

If you slide your finger behind the pulmonary trunk, the finger would go behind the pulmonary trunk, behind the ascending aorta, submerge between ascending aorta and SVC. You would have the outflow vessels in front of the finger and the inflow vessels behind the finger.

Question 31

Oblique Sinus

Answer 31

if you pull the heart forward and slide your finger behidn the heart, you would be sliding up onto the left atrium, and as you contnue on the hand would pass between the left and right pulmonary veins, and you would end up in a blind ending sinus.

Question 32

Sinuatrial Node | - Fibrous skeleton

Answer 32

In cardiac cells, there is electrical communication between the cells. Whicheevr cells depolarizes fastest will dictate the rate of contractin of the heart. This is the Sinuatrial Node (SA Node) and act as a pacemaker. of the heart The only caveat is that the atrial muscle cells do not communicate with the ventricular cells. This is because there is a fibrous connective tissue called fibrous skeleton, which seperates the two. Therefore their rates are different. When it deolarizes, it hits all of the atrial cells, gets to the AV node. Once it gets to the AV node it slows down and eventually gets to the ventrical portion and then speeds up again. This occurs because we want contraction to occur at the same rate, not as the same time.

Question 33

AV Node

Answer 33

skeletal muscle. Only pathway to get electrical impulse to the AV bundle. The propagation is much slower than any other part of the pathway.

Question 34

AV Bundle (Bundle of His)

Answer 34

Bundle of His - goes from atrial septum to ventricular septum so that the two contract at a similar rate. Allows propogation from the AV node into the ventricular septum. It then splits into a left and right bundle branch. The right gives rise to the moderator band, which gives conducting fibers to the papillary muscles.

Question 35

Vagus nerve

Answer 35

cell bodies in the medulla. Parasympathetic supply. Will also have sensory fibers coming back to the heart. The postganglionic parasympathetics will have their cell bodies studded on the wall of the heart. Vagus has the cell bodies of the afferent in vagal ganglia. Sensory info here does not reach conscious levels, it is just cardiac reflexes.

Question 36

Sympathetic

Answer 36

comes from sympathetic chain ganglia. Cell bodies are in thoracic spinal cord. Also has sensory fibers coming back. sensory sympathetics have their cell bodies in dorsal root ganglia. The sensory fibers in the sympathetics that go back to the spinal levels carry sensory info that will reach conscious levels. This seneory info watches the myocardium of the heart to determine if the amount of O2 supplied to the cells is sufficient. So basically they monitor ischemia.

Question 37

Coronary Sulcus

Answer 37

Also called the atrioventricular sulcus because it separates the right atrium from the right ventricle.