L2 - Heart & Mediastinum Flashcards by Rawan Alkhateeb

Where is the Sternal Angle located?

Attaches at the 2nd rib and in between T4 and T5

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The pericardial sac is located where in reference to the lungs and diaphragm?

The pericardial sac is between the lungs and superior to the diaphragm

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Where is the phrenic nerve located?

Anterior to the Lung Hillium and in between the pericardium and lungs

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The mediastinum has four divisions, what are they?

Superior, Anterior, Middle, and Posterior.

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What are the contents of the Superior Mediastinum? Whats the Mnemonic?

Mnemonic: LETS TAT

Thymus

Arch of Aorta

SVC

Trachea

Esophagus

Thoracic Duct

Left Recurrent Laryngeal Nerve

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What are the contents of the anterior Mediastinum

Thymus (before we become adults its thymus then as we grow it becomes fat)

Fat and connective tissue

Lymph nodes

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What are the contents of the middle mediastinum?

Pericardium

Phrenic Nerve

Heart

Roots of the Great Vessels

Arch of the Azygous Vein

Main Bronchi

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What is the middle mediastinum bound by?

The middle mediastinum is bound

Superiorly by the

Transverse thoracic plane (sternal angle to T 4,5)

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What are the contents of the Posterior Mediastinum? Mnemonic?

Mnemonic: DATE

Descending Aorta

Azygous and Hemiazygous Vein

Thoracic Duct

Esophagus

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The veins on the body of the wall are?

what do they do and where do they drain into?

Hemiazygos and Accessory Hemiazygos Vein → Azygos Vein → SVC

They drain on the body wall

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External Chest Wall has locations such as the APEX, BASE, and Valve sounds

Where are they?

Aortic Valve, Pulmonary Valve are at the top

Aortic Valve → Medial side (right) of the sternum

Pulmonary Valve → Left side of the sternum

Apex → Within the Fifth intercostal space

Mitral Valve → Lower left lateral side

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What does the Pericardium attach to?

Pericardium attaches to the Diaphragm

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Which of these are NOT located in the middle mediastinum (inferior)?

A. Phrenic Nerves

B. Pericardium

C. Azygos Veins

D. Arch of Azygos

E. Roots of Great Vessels

F. Main Bronchi

C. Azygos Veins

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The development of the Pericardium of the heart : Outside to inside

Outside to Inside:

Fibrous Pericardium

Serous Pericardium

Parietal Pericardium

(Pleural Cavity b/n)

Visceral Pericardium

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If you remove the parietal pericardium: You see ?

If you remove the parietal pericardium:

You see the main coronary vessels

Right ventricle makes up the majority of the anterior portion of the heart

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SVC and IVC drain into what atrium?

Right Atrium

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Pulmonary Veins drain into what atrium?

Left Atrium

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Transverse Sinus

Transverse Sinus:

Stick finger over the SVC and behind pulmonary trunk

Your finger is running what used to be was the venous end and arterial end of the heart tube

You do that surgically sometimes if someone is bleeding too much and squeeze your thumb there to pinch off the bleeding

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Transverse Sinus is Posterior to?

Transverse Sinus is Anterior to?

Posterior: Aorta and Pulmonary Trunk

Anterior: SVC

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What are the borders of the Oblique Sinus ?

Borders:

Pulmonary Veins

IVC

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All the major veins of the heart drains into the ?

Coronoary Sinus

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When all the major veins drain into the Coronary Sinus, what does the coronary sinus drain into?

The Right Atrium

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Which view of the heart can you see the Coronary Sinus on?

Posterior

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Base of the heart has how many pulmonary arteries and pulmonary veins?

2 Pulmonary Arteries

4 Pulmonary Veins

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Circulation of the Heart to the Lungs. What kind of blood goes to the lungs?

Deoxygenated → SVC, IVC & CS → RA →Tricuspid Valve → RV → Pulmonary Trunk → Pulmonary Arteries (2) → Lungs

Circulation of the Heart from the lungs. What kind of blood comes from the lungs?

oxygenated → Lungs → Pulmonary Veins (4)→ LA→ Bicuspid Valve → LV → Aorta

The pulmonary arteries and veins carry deoxygenated and oxygenated blood, respectively.

True

The coronary circulation. Where do the coronary arteries originate from?

Coronary Arteries originate from the Aorta

What's another name for the Anterior Interventricular Artery?

Left Anterior Descending (LAD)

What's another name for the Posterior Interventricular Artery?

Posterior Descending Artery (PDA)

Right Coronary Artery Branches

_Right Coronary Artery_ → SA Nodal Branch Right Marginal Artery (Not Shown) Right Posterior Interventricular Artery

Left Coronary Artery Branches

Left Coronary Artery → Left Anterior Interventricular Artery Left Circumflex Artery Left Circumflex Artery → Left Marginal Artery (Not Shown)

The Typical Heart. What side is dominant? Which are of the heart receives the most circulation?

Left dominant | (Most circulation to the anterior)

On the anterior view of the heart we see the great cardiac vein. What does it run with?

Anterior Interventricular Artery (LAD)

On the anterior view of the heart, we see the Left Marginal Vein, what does it runs with?

Left Marginal Artery

On the posterior view of the heart. we see the right small cardiac vein what does it run with?

Right Coronary and Right Marginal Artery

On the posterior view of the heart, We see the middle cardiac vein what does it run with?

Posterior Interventricular Artery

On the posterior view of the heart. We see the left posterior ventricular veins what does it run with?

by itself! ( low yield)

Which vein runs with the left anterior interventricular artery?

Great Cardiac Vein Small Cardiac Vein Middle Cardiac Vein Left Marginal Vein

The right atrium is characterized by two kinds of textured areas. What are they and what are they divided by?

_The rough area of the atrium_ is due to the pectinate muscles and represents the primitive atrium _Division_: Crista Terminale _The smooth area_ is from absorption of part of the primitive vessels

Right Atrium is a chamber to which blood returns to the heart via and from the

The right atrium is the chamber to which _deoxygenated_ blood returns to the heart via the _superior and inferior vena cava_ and from the _coronary system through the coronary sinus_

SVC, IVC, and CS drain into?

SVC, IVC, and CS → RA → Tricuspid Valve → RV

The right atrium has a septal wall that contains the remnant of the foramen ovale and the indentation is termed?

Fossa Ovale

Fossa Ovale is?

Thin wall between the right and left atrium Where blood used to be shunted from the RA to the LA embryologically

Blood leaves the right atrium through to valve to enter the right ventricle.

Tricuspid valve

How many Papillary muscles attach to the Tricuspid valve via chordae tendinae?

When thinking of Tricuspid = think 3. Thus, three papillary muscles!

The 3 papillary muscles are important for the Right Ventricle, what are the other two main features?

Trabeculae carneae (the rough part of the wall) Moderator band - from the septum to the ANTERIOR papillary muscle

In systole what are the ventricles doing?

Contracting

In diastole what are the ventricles doing?

Relaxing

Imfundibulum Conus ?

Its the smooth area going up toward the pulmonary trunk from the RV

What is the name of the rough area in the RA?

Pectinate Muscles

What is the name of the rough area of the right ventricle?

Trabeculae Carneae

Left Atrium has mostly smoothed or rough walled chamber?

Smooth walled chamber

What vein system brings blood into the LA?

Pulmonary veins → oxygenated

BLOOD RETURNING FROM THE LUNGS ENTERS THE ATRIUM THROUGH THE VEINS THEN THROUGH THE VALVE TO THE LEFT VENTRICLE

1) Left Atrium 2) Pulmonary Veins 3) Mitral Valve

Does the Left Atrium and ventricle have a moderator band?

THE INTERIOR OF THE LEFT VENTRICLE IS CHARACTERIZED BY PAPILLARY MUSCLES.

Two papillary muscles: Anterior and Posterior

Which statement is false? A. The RV has 3 papillary muscles (Anterior, Posterior, and Medial) B. The LV has 2 papillary muscles (Anterior and Posterior) C. The RA has Pectinate Muscles and Crista Terminale D. The Moderator Band attaches to the Posterior Papillary Muscle of the RV

D. The Moderator Band attaches to the Posterior Papillary Muscle of the RV Where does it really attach to? ANTERIOR

Why are the indicated areas not directly over the valves listened to?

Because that is where the blood is going Easier to see which valve is compromised

During diastole, the blood is moving from the to the through the (left) and (right)

During diastole, the blood is moving from the _atria_ to the _ventricles_ through the _mitral_ (left) and _tricuspid_ (right) _atrioventricular_

DIASTOLE THE OPENING OF THE VALVES IS DUE TO BETWEEN THE ATRIA AND VENTRICLES

THE OPENING OF THE VALVES IS DUE TO DIFFERENTIAL PRESSURE BETWEEN THE ATRIA AND VENTRICLES

THE CONTRACTION OF THE IS RESPONSIBLE FOR PUMPING ABOUT OF THE BLOOD INTO THE VENTRICLE THE REST MOVES DOWN THE PRESSURE GRADIENT WHEN THE VALVE OPENS

THE CONTRACTION OF THE **_ATRIA_** IS RESPONSIBLE FOR PUMPING ABOUT **_25_%** OF THE BLOOD INTO THE VENTRICLE THE REST MOVES DOWN THE PRESSURE GRADIENT WHEN THE VALVE OPENS

Blood moves from the atrium to the ventricles MOSTLY because of

pressure differential

PULMONARY AND AORTIC VALVES The aorta has a and the pulmonary a these are called ??

The aorta has a → posterior and the pulmonary → anterior SEMILUNAR VALVES

The mitral and tricuspid valves, also known as the

atrioventricular, or AV valves

During systole, in which the ventricles contract and force blood into the major vessels the valves are closed and the valves are open.

_Systole_ is the period in which the ventricles contract and force blood into the major vessels The AV valves are closed and the _SEMILUNAR_ valves are open

The shape of the are critical in the closing of these valves at the end of systole and the perfusion of the coronaries

semilunar valves

In diastole, the SV and AV are what?

_Diastole_: SV → closed AV → open

Tricuspid Valve → Chordae Tendineae →

Tricuspid Valve → Chordae Tendineae → - Anterior - Posterior - Medial Papillary Muscles

Bicuspid Valve → Chordae Tendineae →

Bicuspid Valve → Chordae Tendineae → Anterior and Posterior Papillary Muscles

The conduction of the depolarization of the cardiac muscle begins at the node, moves to the atrioventricular node

SA node

SA node is located near?

SVC

What is the conduction pathway?

SA → AV → Bundle Of His → R & L Bundle Branches

Some Branches off Aorta:

Coronary Bronchial Esophageal Posterior

What side does the dumping into the left subclavian vein occur on? and via what duct?

_Left Side:_ Thoracic Duct Dumps into → Left Subclavian Vein

What does the dumping into the right subclavian occur on and from what duct?

Right Side: Right Lymphatic Duct into → Right Subclavian Vein

Thoracic Splanchnic Nerves:

Thoracic Splanchnic Nerves: Sympathetic

Azygous Vein drains into the

SVC

Which vein drains the body wall?

Azygous Vein (muffly lecture Qs)

What is the main drainage for the lymphatic system?

Thoracic duct (muffly lecture Qs)

What is the sinoatrial node?

- Pacemaker of the heart - Important to properly pace the heart and make it contract appropriately at the right time - Contraction starts at the sinoatrial node then spread over atria

Foreman → Facet →

hole indentation

What is the purpose of the chordae tendineae and papillary muscles?

(Papillary muscles attached to the chordae tendineae) → They are there to keep the valves from prolapsing → They put tension on the chordae tendineae during systole → They put tension on it so the valves stay closed and don’t flap up

What is the structure that separates the smooth part of right atrium from the rough part of the right atrium?

crista terminalis

The heart grows

into the pericardium

Left Ventricle and Right Ventricle