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Flashcards in Heart Deck (30):
1

HEART
- females: 230-280g
- males: 280-340g
- The base is formed by the __________.
- The apex is formed by the __________ at the ____ ICS left _________ line.

HEART
- females: 230-280g
- males: 280-340g
- The base is formed by the left atrium.
- The apex is formed by the left ventricle at the 5th ICS left midclavicular line.

2

SURFACES of the HEART
Anterior / sternocostal - ____
Left / pulmonary - ____
Inferior / diaphragmatic - both ventricles, mainly ____

BORDERS of the HEART
Superior - R and L auricles; inferior border of the _____ left costal cartilage to the superior border of the _____ right costal cartilage
Right - RA; ____ right costal cartilage to the _____ right costal cartilage
Inferior - RV; inferior end of the right border to the _________
Left - LV; line connecting the left ends of superior and inferior borders

SURFACES of the HEART
Anterior / sternocostal - RV
Left / pulmonary - LV
Inferior / diaphragmatic - both ventricles, mainly LV

BORDERS of the HEART
Superior - R and L auricles; inferior border of the 2nd left costal cartilage to the superior border of the 3rd right costal cartilage
Right - RA; 3rd right costal cartilage to the 6th right costal cartilage
Inferior - RV; inferior end of the right border to the apex beat
Left - LV; line connecting the left ends of superior and inferior borders

3

HEART VALVES
Surface Anatomy
- tricuspid - behind right half of sternum (_____ ICS)
- _________ - behind the left half of the sternum
- _________ - behind medial end of 3rd left costal cartilage
- _________ - behind left half of the sternum
Auscultatory Areas
- _________ - 2nd R ICS
- _________ - 2nd L ICS
- _________ - lower end of sternum
- _________ - 5th ICS L MCL

HEART VALVES
Surface Anatomy
- tricuspid - behind right half of sternum (4th ICS)
- mitral - behind the left half of the sternum
- pulmonic - behind medial end of 3rd left costal cartilage
- aortic - behind left half of the sternum
Auscultatory Areas
- aortic - 2nd R ICS
- pulmonic - 2nd L ICS
- tricuspid - lower end of sternum
- mitral - 5th ICS L MCL

4

ARTERIAL SUPPLY of the Heart
The coronaries from the ascending aorta
- R coronary
---- __________ interventricular
---- __________
---- SA nodal artery
---- AV nodal artery
- L coronary
---- __________ interventricular
---- __________
--------- left marginal artery
--------- SA nodal artery

ARTERIAL SUPPLY of the Heart
The coronaries from the ascending aorta
- R coronary
---- posterior interventricular
---- marginal
---- SA nodal artery
---- AV nodal artery
- L coronary
---- anterior interventricular
---- circumflex
--------- left marginal artery
--------- SA nodal artery

MNEMONIC: LARP (left anterior, right posterior)

5

VENOUS DRAINAGE of the Heart
_______________ which drains into the RA
Tributaries:
- great cardiac vein
- small cardiac vein - accompanied by the ___________ branch of the RCA
- middle cardiac vein - accompanied by __________________ artery from RCA
Anterior cardiac vein - opens directly to the RA
Venae cordis minimae - opens directly to the RA

VENOUS DRAINAGE of the Heart
Coronary sinus which drains into the RA
Tributaries:
- great cardiac vein
- small cardiac veins - accompanied by the marginal branch of the RCA
- middle cardiac vein - accompanied by posterior interventricular artery from RCA
Anterior cardiac vein - opens directly to the RA
Venae cordis minimae - opens directly to the RA

6

The right atrium directly receives blood from 5 veins:

SVC, IVC
coronary sinus,
anterior cardiac vein
venae cordis minimae

7

A 19 y/o came to the ET and his angiogram exhibited that he was bleeding from a vein that is accompanied by the posterior interventricular artery. Which of the following veins is most likely ruptured?
A. Great cardiac vein
B. Middle cardiac vein
C. Anterior cardiac vein
D. Small cardiac vein

B. Middle cardiac vein

8

What artery/arteries supply the following structures?
1) LA, LV - ____________ branch of the L coronary artery
2) antero-superior 2/3 of interventricular septum and apex - ________________________ branch of the L coronary artery
3) RV - (2)
4) RA - _________

What artery/arteries supply the following structures?
1) LA, LV - circumflex branch of the L coronary artery
2) antero-superior 2/3 of interventricular septum and apex - anterior interventricular branch of the L coronary artery
3) RV - anterior interventricular branch of L coronary artery, marginal branch of the R coronary artery
4) RA - right coronary artery

9

ANGINA PECTORIS
- Reduced blood flow because of narrowing of a coronary artery
- Substernal pain that may be referred over the ______ dermatomes
- ____ dermatome in the medial aspect of the left arm and forearm and may be felt over cervical dermatomes in the neck up to the level of the angle of the mandible
MYOCARDIAL INFARCTION
- Results from localized _________________ of cardiac muscle cells caused by prolonged ischemia
- __________________ artery - common site of an occlusion

ANGINA PECTORIS
- Reduced blood flow because of narrowing of a coronary artery
- Substernal pain that may be referred over the T1-5 dermatomes
- T1 dermatome in the medial aspect of the left arm and forearm and may be felt over cervical dermatomes in the neck up to the level of the angle of the mandible
MYOCARDIAL INFARCTION
- Results from localized avascular necrosis of cardiac muscle cells caused by prolonged ischemia
- anterior interventricular artery - common site of an occlusion

10

ELECTRICAL SYSTEM OF THE HEART
SA node - pacemaker; within atrial wall on the ____ side of its junction with ________
AV node - interatrial septum _________ to the opening of the _____________
AV bundle / Bundle of His - membranous
R/L bundle branches - muscular portion of the interventricular septum
Purkinje fibers

ELECTRICAL SYSTEM OF THE HEART
SA node - pacemaker; within atrial wall on the R side of its junction with SVC
AV node - interatrial septum superior to the opening of the coronary sinus
AV bundle / Bundle of His - membranous
R/L bundle branches - muscular portion of the interventricular septum
Purkinje fibers

11

PLACEMENT OF ECG LEADS
V1 - ____ ICS just to the right of sternum
V2 - ____ ICS just to the left of sternum
V3 - midway between V2 and V4
V4 - ____ ICS L ___L
V5 - ____ ICS L ___L
V6 - ____ ICS L ___L

PLACEMENT OF ECG LEADS
V1 - 4th ICS just to the right of sternum
V2 - 4th ICS just to the left of sternum
V3 - midway between V2 and V4
V4 - 5th ICS L MCL
V5 - 5th ICS L AAL
V6 - 5th ICS L MAL

12

ECG Findings -- Infarct Location -- Coronary Artery Lesion
II, III, avF -- ___________ wall -- _________ LAD
V1-V3 -- ___________ wall -- ________ LAD
V4-V6 -- __________ wall - __________
I, aVL, V1-V6 -- ____________ wall -- _________ LAD
V2-V4 -- ___________ -- __________ LAD

ECG Findings -- Infarct Location -- Coronary Artery Lesion
II, III, avF -- inferior wall -- distal LAD
V1-V3 -- anteroseptal wall -- distal LAD
V4-V6 -- posterolateral wall - circumflex
I, aVL, V1-V6 -- large anterior wall -- proximal LAD
V2-V4 -- anteroapical -- distal LAD

13

CHAMBERS OF THE HEART
Right Atrium
- internal wall
---- musculi pectinati - _________
---- sinus venarum - ________
- interatrial septum - with _________________ (oval depression; remnant of _____________; if persists after birth leads to ASD)

CHAMBERS OF THE HEART
Right Atrium
- internal wall
---- musculi pectinati - anterior
---- sinus venarum - posterior
- interatrial septum - with fossa ovalis (oval depression; remnant of foramen ovale; if persists after birth leads to ASD)

14

CHAMBERS OF THE HEART
_______________
- most anterior chamber
- internal surface with irregular muscular ridges called __________________ where ___________ muscles originate
- apices are connected by fibrous strands called ________________
- _______________ - modified trabeculae carnae that crosses the interventricular septum

CHAMBERS OF THE HEART
Right Ventricle
- most anterior chamber
- internal surface with irregular muscular ridges called trabeculae carnae where papillary muscles originate
- apices are connected by fibrous strands called chordae tendinae
- moderator band - modified trabeculae carnae that crosses the interventricular septum

15

Most posterior of the four heart chambers

Left atrium

16

CHAMBERS OF THE HEART
Left Ventricle
- conical cavity ________ than that of RV
- trabeculae carnae ________, more ___________ than those of RV
- papillary muscles ________ than those of RV

CHAMBERS OF THE HEART
Left Ventricle
- conical cavity longer than that of RV
- trabeculae carnae finer, more numerous than those of RV
- papillary muscles larger than those of RV

17

PRIMITIVE HEART
_________________ becomes partitioned to form the root of the aorta and pulmonary trunk.
____________ forms all of the R ventricle.
____________ forms the L ventricle.
____________ forms the L atrium.
Right horn of _____________ forms the R atrium; the left horn becomes the coronary sinus.

PRIMITIVE HEART
Truncus arteriosus becomes partitioned to form the root of the aorta and pulmonary trunk.
Bulbus cordis forms all of the R ventricle.
Primitive atrium forms the L ventricle.
Primitive atrium forms the L atrium.
Right horn of sinus venosus forms the R atrium; the left horn becomes the coronary sinus.

18

ATRIAL SEPTAL DEFECT
- most common form: patent ____________
- leads to hypertrophy of _________, __________, and __________

ATRIAL SEPTAL DEFECT
- most common form: patent foramen ovale
- leads to hypertrophy of RA, RV, and pulmonary trunk

19

_________________________
- the most common type of congenital heart disease
- more common in males
- Incomplete closure of the interventricular foramen results from failure of the __________________ part of the IV septum to develop.
- L to R shunting of blood increased blood flow to the lungs, causing ____________ hypertension

VENTRICULAR SEPTAL DEFECT
- the most common type of congenital heart disease
- more common in males
- Incomplete closure of the IV foramen results from failure of the membranous part of the IV septum to develop.
- L to R shunting of blood increased blood flow to the lungs, causing pulmonary hypertension

20

TRUNCUS ARTERIOSUS
- Persistent truncus arteriosus results from failure of the ________ ridges and _________________ septum to develop normally and divide the truncus arteriosus into aorta and pulmonary trunk.
- ______ is always present and the truncus arteriosus overrides it.

TRUNCUS ARTERIOSUS
- Persistent truncus arteriosus results from failure of the truncal ridges and aorticopulmonary septum to develop normally and divide the truncus arteriosus into aorta and pulmonary trunk
- VSD is always present and the truncus arteriosus overrides the VSD

21

_________________________
- most common cause of cyanotic heart disease
- aorta lies ________ and to the ________ of the pulmonary trunk and arises anteriorly from the morphological RV and the pulmonary trunk arises from the morphological LV
- associated with ______ and ______

TRANSPOSITION OF GREAT ARTERIES
- most common cause of cyanotic heart disease
- aorta lies anterior and to the right of the pulmonary trunk and arises anteriorly from the morphological RV and the pulmonary trunk arises from the morphological LV
- associated with ASD and VSD

22

The foramen ovale anatomically closes by the _____ month.

The foramen ovale anatomically closes by the 3rd month.

23

Ductus arteriosus
- begins to close immediately after birth and may be closed functionally within a few hours
- complete obliteration and fibrosis by _____ weeks into the ___________________

Ductus arteriosus
- begins to close immediately after birth and may be closed functionally within a few hours
- complete obliteration and fibrosis by 3-4 weeks into the ligamentum arteriosum

24

Ductus venosus
- conducts fetal oxygenated blood from the ___________ to the ______________ (bypasses liver)
- becomes the ______________ in the liver

Ductus venosus
- conducts fetal oxygenated blood from the umbilical vein to the IVC
- becomes the ligamentum venosum in the liver

25

Within a week of birth, the neonate's umbilical vein is completely obliterated and is replaced by a fibrous cord called the ________ ligament of the liver (also called _______________).

Within a week of birth, the neonate's umbilical vein is completely obliterated and is replaced by a fibrous cord called the round ligament of the liver (also called ligamentum teres hepatis).

L umbilical vein -> ligamnetum there's hepatis / round ligament of the liver

26

Proximal parts of the umbilical arteries persist as the ______________ arteries which supply the urinary bladder.

Umbilical arteries (distal) become the _________ umbilical ligaments.

The urachus becomes the _________ umbilical ligament.

Proximal parts of the umbilical arteries persist as the superior vesicular arteries which supply the urinary bladder.

Umbilical arteries (distal) become the medial umbilical ligaments.

The urachus becomes the median umbilical ligament.

27

PATENT DUCTUS ARTERIOSUS
- most common congenital anomaly associated with maternal ________ infection during early pregnancy
- more common in _________
- left _____ aortic arch - responsible for the origin of the PDA
- aortic blood is shunted to the pulmonary artery

PATENT DUCTUS ARTERIOSUS
- most common congenital anomaly associated with maternal rubella infection during early pregnancy
- more common in females
- left 6th aortic arch - responsible for the origin of the PDA
- aortic blood is shunted to the pulmonary artery

28

AORTIC ARCH DERIVATIVES
As the pharyngeal arches develop during the ____ week, they are supplied by arteries.
Six pairs of aortic arches usually develop:
- 1st pair - ___________ arteries
- 2nd pair - ___________ arteries
- 3rd pair
--- proximal parts: ___________ arteries
--- distal parts: ____________ arteries
- 4th pair
--- left: ____________
--- right: ____________
- 5th pair - none
- 6th pair
--- left: ______________ artery (proximal), _____________ (distal)
--- right: ______________ artery (proximal), distal part degenerates

AORTIC ARCH DERIVATIVES
As the pharyngeal arches develop during the 4th week, they are supplied by arteries.
Six pairs of aortic arches usually develop:
- 1st pair - maxillary arteries
- 2nd pair - stapedial (facial) arteries
- 3rd pair
--- proximal parts: common carotid arteries
--- distal parts: internal carotid arteries
- 4th pair
--- left: arch of the aorta
--- right: R subclavian artery
- 5th pair - none
- 6th pair
--- left: left pulmonary artery (proximal), ductus arteriosus (distal)
--- right: right pulmonary artery (proximal), distal part degenerates

29

DEVELOPMENT OF THE VENOUS SYSTEM
The venous drainage pattern of the embryo consists of the following paired veins
- Umbilical/___________/__________ veins - return blood from the placenta; involute after birth
- Vitelline/omphalomesenteric veins - returns blood from the splanchnopleura (yolk sac and gut derivatives); become the ________ system
- Cardinal veins - returns blood from the somatopleura; becomes the ________ system
- ____________ veins - carry well-oxygenated blood from the placenta to the sinus venosus (the right disappears at the end of embryonic period)
Ductus venosus develops within the ______, connects the umbilical vein with IVC.

DEVELOPMENT OF THE VENOUS SYSTEM
The venous drainage pattern of the embryo consists of the following paired veins
- Umbilical/placental/allantoic veins - return blood from the placenta; involute after birth
- Vitelline/omphalomesenteric veins - returns blood from the splanchnopleura (yolk sac and gut derivatives); become the portal system
- Cardinal veins - returns blood from the somatopleura; becomes the caval system
- Umbilical veins - carry well oxygenated blood from the placenta to the sinus venosus (the right disappears at the end of embryonic period)
Ductus venosus develops within the liver, connects the umbilical vein with IVC.

30

The __________ band (also known as septomarginal trabecula) is a muscular band of heart tissue found in the right ventricle of the heart. It is well-marked in sheep and some other animals, and frequently extends from the base of the anterior papillary muscle to the ventricular septum.
The moderator band is important because it carries part of the right bundle branch of the AV bundle of the conduction system of the heart to the anterior papillary muscle. This shortcut across the chamber of the ventricle seems to facilitate conduction time, allowing coordinated contraction of the anterior papillary muscle.
From its attachments it was thought to prevent overdistension of the ventricle, and was named the "moderator band".
The moderator band is often used by radiologists and obstetricians to more easily identify the right ventricle in prenatal ultrasound.

The moderator band (also known as septomarginal trabecula) is a muscular band of heart tissue found in the right ventricle of the heart. It is well-marked in sheep and some other animals, and frequently extends from the base of the anterior papillary muscle to the ventricular septum.
The moderator band is important because it carries part of the right bundle branch of the AV bundle of the conduction system of the heart to the anterior papillary muscle. This shortcut across the chamber of the ventricle seems to facilitate conduction time, allowing coordinated contraction of the anterior papillary muscle.
From its attachments it was thought to prevent overdistension of the ventricle, and was named the "moderator band".
The moderator band is often used by radiologists and obstetricians to more easily identify the right ventricle in prenatal ultrasound.