External and Internal Heart

Question 1

What is the CVS made up of?

Answer 1

Heart - pump, blood vessels and lymphatics

Question 2

What are the 2 main circulations of the CVS?

Answer 2

Pulmonary and Systemic
Also can include the hepatic portal circulation for lymphatic system

Question 3

What area of the mediastinum does the heart lie?

Answer 3

Middle mediastinum

Question 4

Explain the mediastinum

Answer 4

Between the left and right pleura
It extends from the sternum in front of the vertebral column behind and contains all the thoracic structures except lungs and pleura

Question 5

What are the anterior anatomical relations of the heart?

Answer 5

Sternum and costal cartridges of ribs 4-7
T4 sternal angle

Question 6

What are the posterior, lateral and inferior anatomical relations of the heart?

Answer 6

Posterior - oesophagus and descending aorta
Lateral - Pleura and phrenic nerve
Inferior - Central tendon of diaphragm

Question 7

Explain the heart borders

Answer 7

Right border is RA
Left border is LV
Superior border is auricles and great vessels
Inferior border us RA, RV and LV

Question 8

What is the anterior/ sternocostal surface?

Answer 8

1/3 of RA and 2/3 RV and LV

Question 9

What is the inferior (diaphragmatic) surface?

Answer 9

RV and LV

Question 10

What is the posterior surface (base)?

Answer 10

LA

Question 11

Where does the heart lie anteriorly compared to vertebrae?

Answer 11

T5-T8

Question 12

Where is the apex of the heart?

Answer 12

5th left intercostal space - midclavicular line
LV

Question 13

What is the border of the heart anteriorly compared to ribs?

Answer 13

Upper right cc rib 3
Upper left rib 2
Lower right cc rib 6
Apex

Question 14

What is the pericardium made up of?

Answer 14

2 pericardia - fibrous and serous

Question 15

Explain the fibrous layer of pericardium

Answer 15

Dense connective tissue sac
Outermost layer

Question 16

Explain the serous layers of the pericardium?

Answer 16

Outer parietal layer and inner visceral layer (epicardium)

Question 17

Describe the pericardial cavity

Answer 17

Between parietal and visceral layers and filled with fluid

Question 18

What branches does the right coronary artery give off?

Answer 18

Right marginal artery
Posterior intraventricular artery

Question 19

What branches does the left coronary artery give off?

Answer 19

Left anterior descending artery
Circumflex artery

Question 20

What are the anastomoses of the coronary arteries?

Answer 20

Anterior and posterior descending
Circumflex and right coronary artery

Question 21

What are the 2 major sulci that contain the branches of coronary arteries?

Answer 21

Atrioventricular sulcus
Interventricular sulcus

Question 22

Where does right coronary artery supply?

Answer 22

Supplies the right atrium and right ventricle

Question 23

Where does the right marginal artery supply?

Answer 23

Right ventricle and apex

Question 24

Where does left marginal artery supply?

Answer 24

Left ventricle

Question 25

Where does the left anterior descending artery supply?

Answer 25

Right ventricle, left ventricle and interventricular septum

Question 26

Where does right marginal artery supply?

Answer 26

Left atrium and left ventricle

Question 27

What are the main veins of the heart wall?

Answer 27

Great cardiac vein Middle cardiac vein Small cardiac vein All drain to coronary sinus which lies beside circumflex artery

Question 28

Where does the coronary sinus drain to?

Answer 28

Right atrium Anterior cardiac veins drain directly into RA

Question 29

What are the nerves to the heart?

Answer 29

Phrenic nerve Vegus nerve Sympathetic nerve

Question 30

What is the intrinsic and extrinsic innervation of the heart?

Answer 30

Intrinsic - purkinje cells in SA node Extrinsic - external autonomic nerves

Question 31

What does the phrenic nerve innervate?

Answer 31

Innervates the fibrous pericardium and parietal layer of serous pericardium Carries pain sensation

Question 32

What does the vegus nerve innervate?

Answer 32

Is parasympathetic Innervates the heart myocardium and visceral layer of serous pericardium

Question 33

Where do sympathetic nerves innervate?

Answer 33

T1-4 Innervate myocardium and visceral layer of serous myocardium - referred pain to inner surface of upper arm

Question 34

What can be seen of the heart on a normal CXR?

Answer 34

Aortic arch RA, RV and LV - apex of the heart

Question 35

How are chambers positioned on transverse plane?

Answer 35

RV most anterior LA most posterior RA on most right and LV on most left

Question 36

What are the main features of the right atrium?

Answer 36

Openings for IVC, SVC and coronary sinus Interatrial septum Fossa ovalis in interatrial septum Musculi pectinate Tricuspid valve

Question 37

What are the main features of the right ventricle/

Answer 37

3 papillary muscles with chordae tendineae for the tricuspid valve Trabeculae carneae, modulator band, opening for pulmonary trunk Intrerventricular septum

Question 38

What is the function of the trabeculae carneae?

Answer 38

Prevent suction that would occur with a flat surface and thus impair the hearts ability to pump efficiently

Question 39

What are the main features of the left atrium?

Answer 39

Openings for pulmonary veins and Mitral (bicuspid) valve Smooth walled, small chamber Posterior superior against oesophagus Forms the posterior surface of the heart

Question 40

What are the main features of the left ventricle?

Answer 40

2 papillary muscles and chordae tendineae Trabeculae carneae Opening for the aorta, interventricular septum Walls x3 thicker than left Forms the apex of the heart

Question 41

What is the intrinsic innervation of the heart?

Answer 41

Signals arise in SA node which stimulate atrium to contract and travels to AV node After delay, then conducted to bundle of His and left and right bundles of branches to endocardium then ventricles then epicardium

Question 42

What is the extrinsic innervation of the heat?

Answer 42

Vagus and sympathetic nerves T1-4 via cardiac plexuses

Question 43

Where is the point of auscultation for mitral valve?

Answer 43

5th intercostal space, midclavicular line - apex beat

Question 44

Where is the point of auscultation for the tricuspid valve?

Answer 44

4th left intercostal space on lower left of sternum

Question 45

Where is the point of auscultation for the pulmonary valve?

Answer 45

2nd left intercostal space on left of upper sternum

Question 46

Where is the point of auscultation for the aortic valve?

Answer 46

2nd right intercostal space on the right of upper sternum