Heart

Question 1

Boundary of the heart

Answer 1

a) 3 cc, 1cm from sternal border
b) 6 cc, 1cm from sternal border
c) 5 ICS to apex beat at MC line
d) 2 ICS 2.5 cm from sternal border

Question 2

Living anatomy - where is the nipple found in males and prepubertal females?

Answer 2

4th ICS lateral to midclavicular line

Question 3

Base of breast in females?

Answer 3

between 2nd and 6th ribs

Question 4

Pericardium layers

Answer 4

Fibrous
Serous
patieral + viscreal

Question 5

Clinical relevance of the transverse pericardial sinus

Answer 5

It can be used to identify and subsequently ligate (to tie off) the arteries of the heart during coronary artery bypass grafting.

When the pericardium is opened anteriorly, a finger is placed in the transverse sinus to separate the arteries from the veins. A hand placed under the apex of the heart and moved superiorly enters the oblique pericardial sinus

Question 6

Location of the transverse pericardial sinus

Answer 6

Posterior to the ascending aorta and pulmonary trunk.
Anterior to the superior vena cava.
Superior to the left atrium.

Question 7

What structures does the transverse pericardial sinus surround?

Answer 7

Aorta, pulmonary trunk (anteriorly)

Question 8

What structures does the oblique pericardial sinus surround?

Answer 8

SVC, IVC, pulmonary veins

Question 9

Location of the oblique pericardial sinus

Answer 9

Posterior to left atrium

Question 10

Where are the valves located behind the sternum?

Answer 10

Pulmonary - 3CC
Aortic - 3ICS
Tricuspid-4ICS
Mitral - 4CC

Question 11

Where would you auscultate for the pulmonary valve?

Answer 11

2 ICS LEFT

Question 12

Where would you auscultate for the aortic valve?

Answer 12

2 ICS RIGHT

Question 13

Where would you auscultate for the tricuspid valve?

Answer 13

5 costo sternal border RIGHT

Question 14

Where would you auscultate for the mitral valve?

Answer 14

5 ICS at apex beat - LEFT

Question 15

From which 3 vessels an blood enter the heart?

Answer 15

SVC, IVC, coronary sinus

Question 16

What is the fossa ovalis?

Answer 16

embryological remnant of the foramen ovale, which in the foetus allowed oxygenated blood from the IVC (oxygenated from the mother) to pass directly to the left atrium and bypass the nonfunctional lungs

Question 17

what are crista terminalis in the R and L atria?

Answer 17

R smooth muscular ridge beginning at the roof of the right atrium and extending down to the anterior lip of the IVC. It separates the right atrium into 2 spaces

L no crista terminalis-no distinct structure that separates the halves

Question 18

Which are the three cusps of the tricuspid vale?

Answer 18

Anterior
Septal
Posterior

Question 19

Where are papillary muscles attached to? (2)

Answer 19

Chordae tendinae and traberculae carneae

Question 20

Which are the three cusps of the pulmonary vale?

Answer 20

Left
Right
Anterior semilunar cusps

Question 21

How does the pulmonary valve work?

Answer 21

After ventricular contraction, the recoil of the blood fills these sinuses and forces the cusps closed, preventing backflow into the right ventricle

Question 22

What is the function of the chordae tendinae and papillary muscles during ventricular contraction?

Answer 22

Keep the valve closed

Chordae tendinae - cusps have these projections which attach to papillary muscles within the ventricle wall

Papillary muscles - contract and pull on the chordae tendinae, this prevents eversion of the tricuspid valve cusps

Question 23

Where is the foramen ovale found?

Answer 23

depression in the interatrial septum of the L atrium. During development this is open to allow blood flow from R–> L ventricle

Question 24

Which are the two halves of the left atrium?

Answer 24

Posterior half - inflow portion which receives blood from the 4 pulmonary veins

Anterior half-continuous with the left auricle

Question 25

Which are the three cusps of the mitral vale?

Answer 25

anterior + posterior

Question 26

Which are the three cusps of the aortic vale?

Answer 26

Right Left Posterior semilunar cusps

Question 27

Where do the right and left coronary arteries originate from?

Answer 27

Aortic sinuses

Question 28

What are sulci?

Answer 28

Internal partitions separating the chambers of the heart that are reflected as grooves (sulci) on the surface of the heart

Question 29

Which are the two types of sulci?

Answer 29

Coronary - separating atria from ventricles | Atrioventricular - separating the ventricles from each other

Question 30

Right coronary artery + branches

Answer 30

Right coronary artery Sino-atrial nodal artery Right marginal artery Right posterior descending artery

Question 31

Left coronary artery + branches

Answer 31

Left coronary artery Circumflex branch of left coronary artery Left anterior descending artery

Question 32

``` Which arteries supply he posterior inferior anterior lateral parts of the heart? ```

Answer 32

posterior + inferior: PDA anterior: LAD lateral: circumflex

Question 33

Which structures do the right coronary artery and branches supply?

Answer 33

Right atrium + ventricle SAN, AVN posteroinferior 1/3 of interventricular septum some of the posterior part of the left ventricle

Question 34

Which structures do the left coronary artery and branches supply?

Answer 34

Left atrium + ventricle | Atrioventricular branches and bundles

Question 35

Which structures does the LAD supply?

Answer 35

anterior interventricular septum | left ventricle

Question 36

Which structures does the circumflex supply?

Answer 36

left atrium | posterolateral part of the left ventricle

Question 37

which branch arises from the left circumflex artery?

Answer 37

left marginal artery

Question 38

What are the main differences between right dominant coronary artery and left dominant coronary artery?

Answer 38

Sino-atrial nodal branch | Posterior descending artery

Question 39

What does severity of myocardial infarction depend on?

Answer 39

Size and location of artery Size of blockage Whether there are collateral blood vessels

Question 40

List 5 symptoms of MI

Answer 40

severe crushing chest pain sweating nausea pain radiating to arms (more commonly left)

Question 41

Where do the coronary veins drain?

Answer 41

Coronary sinus

Question 42

Which vein eventually forms the coronary sinus?

Answer 42

Great cardiac vein

Question 43

Which course of coronary arteries does the great cardiac vein follow?

Answer 43

LAD | circumflex

Question 44

Which course of coronary arteries does the middle cardiac vein follow?

Answer 44

posterior descending artery

Question 45

Which course of coronary arteries does the small cardiac vein follow?

Answer 45

right coronary artery

Question 46

Where do each of the cardiac veins drain from? +course

Answer 46

great and middle = from apex up the interventricular sulcus small=lower anterior end of the coronary sulcus + travels along the base of the heart posterior= posterior end of left ventricle

Question 47

Where do the small and posterior coronary arteries drain?

Answer 47

``` Small = drains at the distal end of the coronary sulcus Middle = drains directly in coronary sulcus or joins the great cardiac vein ```

Question 48

Course of phrenic nerve on the right vs on the left

Answer 48

Right: over aortic arch Left: Lateral to IVC

Question 49

Function of phrenic nerve

Answer 49

Sensory: diaphragm, mediastinal pleura, pericardium Motor: diaphragm

Question 50

Visceral efferents (motor) of vagus nerve

Answer 50

Visceral efferents to cardiac muscle, glands of gut & airways

Question 51

Visceral afferents (sensory) of vagus nerve

Answer 51

Visceral afferents relay normal physiological processes and reflexes to CNS. NOT pain

Question 52

Course of the vagus nerve

Answer 52

Arises from the medulla of the brainstem as cranial nerve 10 (CN X) Descends down the neck posterolateral to the common carotids Left vagus: crosses anterior to aortic arch and then posterior to left lung root Right vagus: passes posterior to right lung root Both vagus nerves form a plexus around the oesophagus and then turn into oesophageal/gastric nerves Left recurrent laryngeal nerve: Passes inferior and under the aortic arch and travels in a groove between the oesophagus and trachea to the neck Right recurrent laryngeal nerve: Passes under the right subclavian artery and travels upwards to the neck

Question 53

Parasympahetic innervation to the heart | Efferents vs afferents

Answer 53

Efferents: decrease heart rate, decrease contraction, constrict coronary arteries afferents: relay cardiac reflexes

Question 54

Sympathetic innervation to the heart | Efferents vs afferents

Answer 54

Efferents: increase heart rate, increase contraction Afferents: pain sensation from the heart

Question 55

Differences in afferent innervation of heart parasympthetic vs sympathetic

Answer 55

Parasympathetic: relays cardiac reflexes Sympathetic: relays cardiac pain