Heart Structures

Question 1

Pericardium

Answer 1

Sac of connective tissue that encloses the heart and forms the first wall of the great vessels

Question 2

Parts of pericardium

Answer 2

Pericardium is made of fibrous and serous pericardium. Serous pericardium has 2 parts: 1. Parietal layer - connected with the fibrous pericardium 2. Visceral layer - forming the inner layer of the pericardium tissue, touching the heart

Question 3

Coronal place

Answer 3

Head band across the head is the coronal plane

Question 4

Facts about fibrous pericardium

Answer 4

1. It is inelastic, but it can slowly grow to accomodate a growing heart 2. Fibrous pericardium fuses with the diaphragm 3. The heart hangs inside the lumen of the fibrous pericardium, it is 2 to 4 cm below the fibrous pericardium

Question 5

Pericardial fluid

Answer 5

1. Made by the visceral pericardium 2. It is essentially an ultra filtrate of plasma 3. About 20 ml of fluid 4. Function is to lubricate

Question 6

Transverse and oblique pericardial sinus

Answer 6

Transverse pericardial sinus is used to cut out heart in cadavers and doesnt have much clinical significance

Oblique pericardial sinus is where the fluids first accumulate when the cabbages are leaking in an open heart surgery. Ultrasound is done to check for accumulation of fluid

Question 7

Cardiac Tamponade

Answer 7

Accumulation of fluid in the pericardial cavity of the heart that can be due to for example a stab wound that cuts open the pericardial sac and the walls of the heart such that blood starts to leak into the pericardial cavity.

As a results the heart cannot dilate as much to take in blood and that can be life threatening.

Question 8

What is the clinical presentation of cardiac tamponade

Answer 8

1. Jugular venous distention due to elevated venous pressure
2. Distant heart sounds
3. Hypotension
4. Dyspnea

Question 9

How is cardiac tamponade treated

Answer 9

By performing pericardiocentesis

1. This process involved removing excessive fluid from the pericardial cavity with the help of a needle and a syringe
2. Performed with the aid of an ultrasound

Question 10

Paricarditis

Answer 10

1. Inflammation of the walls of the pericardial sac, can be due to infection or malignancy.
2. Acute pericarditis can be fibrous (viral), purulent (bacterial) or hemorrhagic (blood).
3. Pain reamains substernal
4. Clinically it is different from MI since the patients when they lay down or take deep breaths causes their heart to push against the wall of the pericardial sac which causes even more pain whereas in MI it relieves pain

Question 11

Pericardial friction rub

Answer 11

1. Highly characteristic of pericarditis
2. Friction and vibration occur due to the serous layer of the pericardium being rough
3. Sound is louder with EXPIRATION
4. Sounds like a squeaky rubber

Question 12

Anatomy of the pericardial sac and its associated structures

Answer 12

1. Blood comes from the pericardiophrenic artery
2. Innervations of the pericardial sac are from the phrenic nerve - “C3, 4, 5 keeps the diaphragm alive”

Question 13

Best places to hear the heart sounds

Answer 13

Question 14

Coronary suculus

Answer 14

Seperates atria from the ventricles

Question 15

Know where these structures are

There are 8

Answer 15

Base

Apex

Diaphragmatic surface

Sternocoastal surface

Obtuse margin

Acute margin

Right margin

Coronary suculus

Question 16

What is the pnemonic and its corresponding location on the patient’s chest

Answer 16

Question 17

Fibrous skeleton of the heart

Answer 17

It is only clinically relevant when the fiber stretches and the valve is no longer able to perform its function. It is called the heart valve failing - 50% of aortic valve insufficiency is due to the stretching of the fibrous skeleton of the heart