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Structures (ASV) > Lecture 22: Heart Gross Anatomy > Flashcards

Lecture 22: Heart Gross Anatomy Flashcards

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1
Q

Mediastinum

A

Space between the pleural cavities

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2
Q

Phrenic nerve: Fiber type, roots, trajectory

A

GSE; C3, 4, 5; Through middle mediastinum, to the diaphragm

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3
Q

What vessels supply the diaphragm and pericardium?

A

Pericardiacophrenic arteries and veins

Artery is a branch of the internal thoracic artery

Vein drains into internal thoracic vein

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4
Q

What are the sacs of the pericardium?

A

There are 2:

  1. Outer fibrous sac (composed of fibrous pericaridum)
  2. Inner serous sac (composed of serous pericardium, with parietal and visceral layers, with a pericardial cavity in between)
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5
Q

components of inner serous sac

A

Serous pericardium of the 2 pericardium sacs; composed of an outer parietal layer, middle pericardial cavity, and inner visceral layer, which is aka epicaridum

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6
Q

What’s another name for the visceral layer of the pericardium’s inner serous sac?

A

Epicardium

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7
Q

3 layers of the wall of the heart

A

epicardium, myocardium (cardiac muscle), endocardium

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8
Q

What are sulci, where do you see them, what are they composed of?

A

A component of the epicardium that are grooves of adipose tissue on the surface of the heart (aka FAT!)

Demarcate the chambers of the heart on the heart’s surface

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9
Q

What do the (anterior/posterior) coronary sulci (sing: sulcus) demarcate?

A

2 atria from 2 ventricles

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10
Q

What do the anterior/posterior interventricular sulci (sing: sulcus) demarcate?

A

Right ventricle from Left ventricle

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11
Q

What are the coronary arteries/veins embedded?

A

In the adipose tissue of the sulci

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12
Q

What do coronary arteries do?

A

Supply myocardium with oxygen; their occlusion results in a heart attack

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13
Q

Major branches of the Right Coronary Artery

A
  1. Sinuatrial nodal branch (supplies the SA node)
  2. Marginal branch
  3. Atrioventricular nodal artery (supplies the AV node)
  4. Posterior interventricular branch
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14
Q

Major branches of the Left Coronary Artery

A
  1. Anterior interventricular branch (aka LAD, Left anterior descending artery)
  2. Circumflex branch
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15
Q

What is the first branch of the aorta?

A

Coronary arteries

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16
Q

What does left anterior descending artery (LAD) run along?

A

Anterior interventricular sulcus

It is known as the Interventricular branch, the Widow Maker because where heart attacks occur most often

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17
Q

Location/path of the Right coronary artery

A

Originates from right aortic sinus of the ascending aorta; descends in the coronary sulcus between RA and RV

Travels in the coronary sulcus to reach posterior surface of the heart; there it anastomoses with circumflex branch of left coronary artery

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18
Q

What runs within the coronary sulcus?

A

Right coronary artery, small cardiac vein, coronary sinus, circumflex branch of the left coronary artery

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19
Q

What is the right atrial branch?

A

Branch of the RCA

Supplies the SA node

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20
Q

Where does sinuatrial nodal branch supply come from?

A

60% from Right coronary artery; 40% from Left coronary artery

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21
Q

Atrioventricular nodal artery supply?

A

Branch of the posterior interventricular branch of the RCA; 80% supply to AV nodal artery from the RCA, 20% from the LCA

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22
Q

Wheres does the LAD run?

A

Anterior interoventricular sulcus

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23
Q

What does the Right coronary artery supply?

A

Right atrium
Right ventricle
Posterior part of the Left ventricle
Posterior part of the interventricular sulcus

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24
Q

What does the Left coronary artery supply?

A

Left atrium
Left ventricle
Variable amount of Right ventricle
Most of the interventricular sulcus

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25
Right coronary artery dominance
Normal distribution pattern of the coronary arteries means a right dominant coronary artery (supplies to 70% of heart) because the posterior interventricular branch arises from the RCA, and it supplies much of the posterior wall of the LV
26
Left coronary artery dominance
Normally, LCA supplies only 15% of the heart In hearts with left dominant coronary artery, posterior interventricular branch arises from enlarged circumflex branch --> supplies most of posterior wall of LV
27
What do coronary arteries do?
Supply myocardium with oxygen
28
What do cardiac veins do?
Remove metabolic waste products from the metabolic activity of the myocardium
29
What are the branches of the cardiac veins of the heart?
1. Coronary sinus 2. Great cardiac vein 3. Middle cardiac vein 4. Small cardiac vein 5. Anterior cardiac vein 6. Venae cordis minimae
30
What cardiac vein(s) drain into the coronary sinus / RA?
Great cardiac vein Middle cardiac vein Small cardiac vein
31
What cardiac vein(s) drain into the RA?
Anterior cardiac vein
32
What cardiac vein(s) drain into the RA chamber?
Venae cordis minimae
33
Companion vessel for LAD?
Great cardiac vein
34
What is the pericardial cavity?
POTENTIAL SPACE! between the parietal seroues and visceral serous layers of the pericardium
35
When do the coronary arteries fill with blood?
Diastoli
36
Where does the coronary sinus drain to?
RA
37
Paths of cardiac veins
Listed from R to L/smallest to biggest: Small cardiac vein (runs w/ R branch of RCA) Middle cardiac vein (runs w/ posterior interventricular branch of LCA/RCA) Great cardiac vein (runs w/ anterior interventricular a. and then circumflex branch of LCA)
38
Where does great cardiac vein begin?
Coronary sinus (posterior side of heart)
39
Where does middle cardiac vein begin?
Bottom of coronary sulcus
40
What do arteries give off?
arterioles and then capillaries
41
Do all arteries end in capillaries?
no
42
Do arteries/their branches sometimes anastomose?
yes
43
What forms the basis for collateral circulation?
Arterial anastomoses, which allow for collateral circulation if narrowing/occlusion of artery
44
Examples of arteries with anastomoses
1. Posterior intercostal arteries anastomose w/ anterior intercostal arteries 2. Superior epigastric arteries anastomose with inferior epigastric arteries
45
What are end-arteries?
Vessels without anastomoses; their occlusion results in necrosis of the tissue supplied by the occluded vessel
46
Example of end-arteries?
Central artery of the Retina; branches of the coronary arteries
47
Do coronary arteries have anastomoses?
Yes, but usually insufficient to provide adequate collateral circulation. Anastomoses occur: 1. between interventricular branch of RCA and circumflex branch of LCA 2. between posterior interventricular branch of RCA and LAD See anastomoses in the interventricular sulci
48
Why are coronary arteries called "functional end-arteries?
Because they are end-arteries ONLY in terms of physiology; NOT in terms of anatomy (since they do anastomose)
49
What does coronary occlusion lead to?
myocardial infarction/necrosis of the myocardium, aka heart attack
50
What does coronary insufficiency lead to?
myocardial ischemia, aka angina pectoris (cardiac pain; chest pain)
51
3 most common locations of coronary occlusion
Proximal end of RCA Proximal end of LAD Proximal end of circumflex branch of RCA
52
Where might cardiac pain be felt?
Pain arising from T1-T5 dermatomes Typical: substernal; upper left chest; medial aspect of left upper extremity Atypical: shoulder; neck; jaw; ear Less common: both sides/right side of these areas Uncommon: back between scapulae
53
What does MAK call the heart?
A muscular pump An electrical organ An endocrine gland Has its own blood supply
54
Thickness of heart walls?
Related to workload/pressure flow of heart chambers LV: thickest RV: moderate Atria: thinnest
55
Myocardium made of?
Cardiac muscle
56
Histo composition of epicardium?
Thickest epicardium along sulcus Single layer of squamous cells along mesothelium; produces pericardial fluid, which invades pericardial cavity Mostly is fat, elastic fiber Also have lymphatic vessels, nerves
57
Composition of endocardium (facing atrium)?
Thicker than portion on ventricle Endo: covered by single layer of endothelium cells; beneath endo, have layer of subendothelial tissue- CT with collagen and elastic fibers, fibroblasts, and some SM cells Also have subendocarium
58
Composition of endocardium (facing ventricle)?
Thinner than portion on atrium Endo: covered by single layer of endothelium cells; beneath endo, have layer of subendothelial tissue- CT with collagen and elastic fibers, fibroblasts, and some SM cells Also have subendocarium layer
59
Myocardium made of
cardiac muscle cells, cardiac myoctyes or cardio cytes, contractile cells, myoendocrine cells (atrial myocytes), and conducting cells (nodal cells, bundle branches, purkinje fibers)
60
What are cardiac myocytes?
Contractile cells; endocrine cells that form exclusively in the atrium- not in the ventricle! Conduct impulses Made up cells of SA and AV nodes, bundle branches, and purkinje fibers
61
Direction of cardiac muscle fiber in myocardium
Spiral around ventricles and atria
62
Perimysium
separate cardiac myocytes into bundles/fascicles
63
How cardiac myocytes work?
Contract; leads to squeezing/twisting of ventricle to expel blood out of ventricle, wrings it out (like wet towel)
64
Fibers of cardiac myocytes?
Actin and myosin filaments
65
Intercalated disc
specialized intercellular junctions that draw together 2 cardiomyocytes
66
How many capillaries around each cardiac myocyte cell/why?
5 capillaries | b/c very metabolic/active tissue, need lots of blood supply, nutrients from capillaries
67
Lipofuscin pigment
Cardiac myocytes become yellow/brown pigment as age; are very long-lived cell
68
Can cardiac myocytes regenerate?
No
69
structure of intercalated disc
desmosome: 2 filaments that bind the 2 cardiac myocyte cells together fascia adherentes: actin filaments for contractility gap junction: lie on longitudinal portion; site of electrical and chemical transmission rapdily
70
extracellular matrix of heart structure
made of collagen fiber bundles, extends from extracellular matrix to myocardium basal lamina form weave surrounding cardiocytes; elastic fiber bundles wrap around them; collagen fibrils insert into basal lamina; collagen fiber bundles form collagen struts btwn neighboring cardiocytes
71
atrial monocytes
smaller than ventricular monocytes have granules which contain hormones have fewer transverse-tubules than ventricular myocytes
72
is the heart endocrine/exocrine organ?
endocrine because atrial myocytes synthesize atrial natriuretic peptide (ANP) - a peptide hormone that is stored in its granules
73
What is ANP/what does it do?
when atrial wall stretches, it's secreted by exocytosis into blood circulation blocks sodium resportion in renal tubules, thereby promoting sodium excretion and urine excretion
74
What conducts heart?
Cardiac muscle cells, NOT NERVOUS TISSUE!
75
What are cardiac muscle cells specialized for?
Initiating normal heart beat Conducting impulses rapidly through the heart Coordinating contraction of the 4 heart chambers
76
Components of heart's conducting system
SA node AV node AV bundle (Bundle of His) - right and left bundle branches Purkinje fibers (in subendocardium)
77
SA node location?
sulcus terminales cannot see it superficially located at landmark btwn entrance of SVC to RA
78
What does SA nodal artery supply?
RA and SA node
79
SA node characteristics
``` modified atrial monocytes small in size few myofibrils unorganized striations gap junctions and desmosomes irregular meshwork embedded in fibrous tissue autonomic nerves/blood vessels ```
80
purkinje fiber characteristics
``` in subendocardium stain pale b/c of glycogen large in size have fewer myofibrils lack t-tubules no typical ICD have desmosomes, gap junctions ```
81
Are there blood vessels w/in valve?
no
82
What are heart valves made of?
Leaflets of fibroelastic tissue, covered by endothelium continuous with that of the lining of the heart chambers and great vessels On ventricular side, dense plate of collagneous tissue, lamina fibrosa; toward atrial side, elastic fibers No blood vessels are present in the valves.

Structures (ASV) (30 decks)

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