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CardioPulm > Karen Tong Lecture > Flashcards

Karen Tong Lecture Flashcards

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1
Q

Inferior Mediastinum

A

Anterior:

middle: heart
posterior: descending aorta, esophagus, vagus nerve

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2
Q

What envelops the heart

A

Fibrous pericardium: continuous with central tendon of diaphragm, prevent heart from overfilling

Parietal pericardium: inside fibrous

Visceral serous pericardium: inside parietal

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3
Q

pericardial cavity

A

filled with fluid that allows heart to pump without friction

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4
Q

what supplies blood to pericardium

A

pericardiacophrenic artery

pericardiacophrenic vein

phrenic nerve: only does sensory

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5
Q

Too much fluid in heart

A

causes: hemopericardium
pneumopericardium

treatments:
pericardiocentesis
emergency thoracotomy

“cardiac tamponade”

cute compression of the heart caused by a rapid accumulation of fluid or blood in the pericardial cavity from wounds to the heart or pericardial effusion

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6
Q

Start of diastole

A

aortic and pulmonic valves close

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7
Q

Oval Fossa

A

Septum between two atria

Sinus venarum: smooth wall

Pectinate muscle: rough wall

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8
Q

Crista Terminalis

A

separates smooth wall and rough wall

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9
Q

papillary muscles correspond to cusps

A

anterior papillary muscle: anterior cusp

posterior papillary muscle: posterior cusp

septal papillary muscle: septal cusp

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10
Q

pulmonary trunk

A

spaces behind cusps are trunks

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11
Q

Right Coronary A

A

supplies RA, most of RV, part of LV and IV septum, SA node and AV node

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12
Q

branches of right coronary A

A

sinuatrial nodal a

conus branch of right coronary A

atrial branch of right coronary A

Right marginal A

Atrioventricular Nodal A

Posterior Interventicular A

Right Posterolateral A

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13
Q

left coronary artery

A

Supplies LA, most of LV, part of RV, most of IVS, SA node

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14
Q

branches of left coronary artery

A

Anterior interventricular A

  • Lateral A
  • conus branch of left coronary Artery

Circumflex A

  • left marginal A
  • posterior left ventricular A
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15
Q

Small cardiac vein

A

runs with right marginal artery, dumps into coronary sinus

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16
Q

Great cardiac vein

A

runs with anterior inerventricular artery, before dumping into coronary sinus

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17
Q

Heart dominance

A

if it comes off RCA, right dominant

if it comes off LCA, left dominant

Codominance is possible

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18
Q

MI

A

Sudden occlusion of major artery by embolus

myocardium becomes infarcted, necrosis

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19
Q

Most common sites of MI:

A

Anterior IV, RCA, circumflex branch of LCA

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20
Q

Treatment of MI

A

coronary bypass graft, coronary angioplasty

pain is not relieved by rest

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21
Q

Coronary atherosclerosis

A

most common cause of ischemic heart disease

lipid deposits in coronary arteries

insufficient blood supply can lead to MI

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22
Q

Angina Pectoris

A

Pain that originates in the heart and produces a strangling pain of the
chest.

Angina Pectoris literally means strangling pain of the chest. The main is usually the
result of narrow or obstructed coronary arteries that produces ischemia of the myocardium

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23
Q

SA Node

A

“Pacemaker”, control heartrate

in junction of SVC and RA near sulcus terminalis
“in right atrium”

initiates and regulates impulses

supplied by SA nodal Artery

Stimulated by sympathetics and inhibited by parasympathetics

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24
Q

AV node, the gatekeeper

A

in interatrial septum near opening of coronary sinus

-lies in septal wall of right atrium, receives stimulus from SA node, sends it to AV bundle

supplied by AV nodal a, mostly comes from right coronary artery

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25
right AV bundle
stimulates muscles of IVS, anterior papillary muscle through moderator band and RV wall
26
Fibrillation
rapid irregular uncoordinated contractions of cardiac muscle
27
Cardiac Plexus
Anterior to trachea, contributions from sympathetic and parasympathetic nerves
28
Sympathetic
T1-T4 Increased heart rate, impulse conduction, force of contraction increased blood flow through CA
29
Parasympathetic
Vagus nerve slows HR, reduces force of contraction constricts CA
30
chordae tendinae
attach cusps to valves
31
Sternal angle separates which two parts of the mediastinum?
superior and inferior mediastinum
32
Divisions of inferior mediastinum
anterior, middle and posterior mediastinum
33
location of anterior mediastinum
anterior to heart
34
middle mediastinum
is the heart
35
posterior mediastinum
posterior to the heart
36
which part of the heart receives blood from the body?
right side of the heart receives blood from superior and inferior vena cava, to be sent to lungs for oxygenation
37
which part of heart pumps oxygenated blood to body?
left side of heart receives oxygen rich blood from lungs, pumps it to rest of body
38
Systemic Circulation
Left Atrium past the Bicuspid Valve into the Left Ventricle out of the Heart past the Aortic Valve into the Aorta, through the arterial system, through the capillaries, though the venous system and back into the Heart through the Inferior and Superior Vena Cavae
39
Pulmonary Circulation
from the Superior and Inferior Vena Cavae into the Right Atrium past the Tricuspid Valve into the Right Ventricle out of the Heart past the Pulmonary Valve into the Pulmonary Trunk, through the Right and Left Lungs Back into the Heart through the Pulmonary Veins
40
Epicardium of heart
outermost layer; made up of Visceral Serous | Pericardium
41
Myocardium of heart
thick muscular layer made up of spiraling, | overlapping layers of Cardiac muscle
42
Myocardial Infarction
lack of blood flow to a specific area of the myocardium, usually the result of a blockage in a Coronary A. Coronary Atherosclerosis, or buildup of lipids on the internal walls of the Coronary arteries decreases the size of lumen of that vessel, increasing the likelihood of an embolus, or plug blocking a vessel off entirely
43
Endocardium
thin internal endothelial and subendothelial layer | lining the inside of the chambers of the Heart and valves
44
Fibrous Skeleton of the Heart
1.Produces attachment points for the Myocardium 2. Produces attachment points for the vales of the cuspid valves 3. Supports and strengthens Atrioventricular and Semilunar orifices 4. Provides an electrically insulated barrier between the Atria and the Ventricles
45
Apex
inferolateral part of the Left Ventricle, | formed by left ventricle, in left fifth intercostal space, used to auscultate mitral valve
46
Base
posterior portion, formed primarily by left atrium
47
Surfaces
1. Sternocostal (Right Ventricle) 2. Diaphragmatic (Right and Left Ventricles) 3. Pulmonary (Paired; Right Atrium and Left Ventricle, occupying the Cardiac Impression on both Lungs)
48
Borders
1. Right (Right Atrium) 2. Inferior (Right Ventricle) 3. Left (Left Ventricle) 4. Superior (Right and Left Atria and the exit point for the Aorta and Pulmonary Trunk)
49
Right Atrioventricular Groove
between the Right Atrium and | Right Ventricle, transmits the Right Coronary A
50
Left Atrioventricular Groove
between the Left Atrium and | Left Ventricle, houses the Coronary Sinus
51
Anterior Interventricular Groove
between Right and Left Ventricles on the anterior aspect of the Heart, transmits the Anterior Interventricular A. and Great Cardiac V
52
Posterior Interventricular Groove
between Right and Left Ventricles on the posterior aspect of the Heart, transmits the Posterior Interventricular A. and the Middle Cardiac V
53
Sulcus Terminalis
external vertical groove corresponding to | the internal Crista Terminalis
54
Ligamentum Arteriosum, what is it?
Travels from the superior aspect of the Pulmonary Trunk to the inferior concave border of the Aortic Arch. The Ligamentum Arteriosum is the adult remnant of the embryological Ductus Arteriosus which shunted blood from the Pulmonary Trunk to the Aorta to bypass the nonfunctional lungs.
55
What loops around the aortic arch and ligamentum arteriosum?
The Left recurrent Laryngeal N. of the Vagus N. loops around the Aortic Arch and Ligamentum Arteriosum then ascends to the Larynx
56
Pericardiocentesis
Drainage of blood, fluid or pus from the pericardial sac. This is usually done to relieve cardiac tamponade
57
Pericardial Effusion
Inflammation of the pericardium can result in the accumulation of fluid or pus in the pericardial sac which can compress the heart. Heart compression is known as Cardiac Tamponade.
58
Pericarditis
Inflammation of the pericardium, which can make the pericardium rough and produce friction. This friction called a pericardial friction rub can be observed with a stethoscope. If left untreated the pericardium can calcify
59
Surgical Significance of the Transverse Pericardial Sinus
this space allows cardiac surgeons to access the area posterior to the aorta and pulmonary trunk to clamp or insert the tubes of a bypass machine into these large vessels
60
Cardiac Referred Pain
Ischemia stimulates visceral pain sensory fibers in the heart of the Autonomic Nervous system. These visceral sensory fibers often share a spinal ganglion with the somatic sensory fibers of areas such as the upper limb and superior lateral chest wall. Anginal pain is typically referred to the area innervated by the Left Medial Brachial Cutaneous nerve, the left substernal area, left pectoral area and medial aspect of the left upper limb are often involved in this variety of referred pain.
61
Ventricular Fibrillation
Rapid irregular twitching of the ventricles rendering the Heart unable to pump blood. An electric shock administered by electrodes can cease all cardiac movement (defibrillation), in the hopes that the Heart may begin beating regularly after a period of time
62
Atrial Fibrillation
Irregular twitching of the Atrial cardiac muscle fibers to which the ventricles respond at irregular intervals. Circulation usually remains satisfactory
63
Artificial Cardiac Pacemaker
Produces a regular electrical impulse that is carried to the Ventricles via electrodes which are inserted through a large vein to the Superior Vena Cava, into the Right Atrium past the Tricuspid Valve into the Endocardium of the Trabecula Carnae of the Right Ventricle
64
Ventricular Septal Defects
Due to the embryologically divergent tissues that make up the Interventricular Septum that structure is particularly susceptible to defects. All defects are clinically relevant as they allow the mixture of oxygen rich and oxygen depleted blood.
65
Cardiac Catheterization
Insertion of a catheter into the femoral vein which is then passed up to the Inferior Vena Cava allowing radiographic visualization of the Right Atrium, Right Ventricle, Pulmonary Trunk and Pulmonary arteries
66
Atrial Septal Defects
Typically involves an incomplete closure of the Foramen Ovale. It is estimated that 15-20% of adults have a small patency of their Foramen Ovale which is considered clinically insignificant. Larger openings in the Interatrial Septum can be clinically significant as they allow mixture of oxygen rich and oxygen depleted blood
67
Coronary Artery Bypass Graft
Obstruction of the coronary arteries may necessitate replacement of a segment of the coronary artery, this process is called a coronary artery bypass graft. The great saphenous vein is often used based on its comparable diameter to the coronary arteries, its easy of dissection from the lower limb and the fact that it offers lengthy portions without branching or valves. The radial artery is also used
68
Coronary Angioplasty
Insertion of a small balloon catheter into the lumen of the coronary artery. The balloon is inflated to flatten the obstructing plaque against the wall and increase the size of the lumen improving blood flow
69
Pulmonary Embolism
Obstruction of a Pulmonary A. by an embolus, such as a blood clot, fat globule or air bubble. The embolus usually passes from a vein through the right side of the heart into the Pulmonary arteries
70
middle cardiac vein
dump into coronary sinus, posterior interventricular artery
71
Right dominant heart
off right coronary artery, feeds posterior
72
Direction of cardiac conducting system
SA node to AV node to AV bundle to purkinje fibers
73
-IV Septum
origin of septal papillary muscle
74
Coronary Sulcus:
marks border between atria and ventricles

CardioPulm (10 decks)

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