mediastinum and heart exam 3 anatomy Flashcards
(93 cards)
1
Q
contents of superior mediastinum
A
svc, brachiocephalic veins, arch of aorta, thoracic duct, trachea, esophagus, thymus, vagus nerves, left recurrent laryngeal nerve, phrenic nerves
2
Q
what is the inferior mediastinum divided into?
A
anterior, middle, posterior
3
Q
contents of anterior mediastinum
A
thymus, lymph nodes, fat, connective tissue
4
Q
contents of middle mediastinum
A
heart, roots of great vessels, arch of azygos vein, main bronchi
5
Q
contents of posterior mediastinum
A
esophagus, thoracic aorta, azygos and hemi azygos veins, thoracic duct, vagus nerves, sympathetic trunks, splanchnic nerves
6
Q
where does bifercation of the trachea and thymus gland happen?
A
sternal angle
7
Q
what innervates the diaphragm?
A
phrenic nerves
8
Q
functions/characteristics of fibrous pericardium
A
tough, inelastic, limits filling capacity
9
Q
what is the fibrous pericardium attached to ?
A
attached to central tendon of diaphragm
10
Q
layers of serous pericardium
A
parietal and visceral layer
*visceral layer also called epicardium
11
Q
pericardial cavity
A
-potential space between parietal and visceral layers of serous pericardium
-serous fluid
12
Q
pericarditis
A
inflammation of the pericardial cavity
13
Q
cardiac tamponade
A
-accumulation of fluid in pericardial cavity and can compress heart
*if over 250 mL
14
Q
what can lead to cardiac tamponade?
A
gsw, seatbelt or airbag trauma, iv drug use, coronary rupture
15
Q
pericardiocentesis
A
relieves excess fluid in pericardium
16
Q
what are the 2 approaches to pericardiocentesis
A
- peristernal approach
2.paraxyphoid approach
17
Q
sympathetic trunks are in which part of the mediastinum?
A
posterior
18
Q
where is the base of the heart when standing?
A
xyphosternal angle
19
Q
borders of the heart
A
superior border- atria
left border- left ventricle
inferior border-right ventricle
right border-right atrium
20
Q
where is the apex of the heart located?
A
left ventricle
21
Q
what part of the heart is the base?
A
L atrium
22
Q
great vessels of the heart
A
internal jugular veins, subclavian veins, brachiocephalic veins, superior vena cava, IVC, ascending aorta, arch of aorta
23
Q
venous drainage superior to diaphragm
A
superior vena cava
24
Q
venous drainage inferior to diaphragm
A
inferior vena cava
25
what vertebral level is the arch of the aorta located at?
T4/T5
26
what arteries branch from brachiocephalic trunk?
right subclavian artery and right common carotid artery
27
what arteries branch from aorta?
brachiocephalic trunk, left common carotid artery, left subclavian artery
28
transverse pericardal sinus
During cardiac surgery, the transverse pericardial sinus allows a surgeon to isolate the pulmonary trunk and ascending aorta and apply a temporary ligature or clamp.
29
parasympathetic innervation of the heart
vagus nerve
30
vagus nerve innervation tract in heart
pregang cb- brain
pregang fibers- dissected vagus nn
postgang cb and fibers- walls of heart
31
right vagus nerve branches off what nerve?
right recurrent laryngeal nerve (in root of neck, deep to right subclavian artery)
32
left vagus nerve branches off what artery?
left current laryngeal nerve (in mediastinum, under arch of aorta, deep to ligamentum arteriosum)
33
what would you see in a pt with an aneurysm of the aortic arch?
chest pain, hoarseness, recurrent laryngeal referred pain, tachycardia
34
vagus nerve plexuses
cardiac plexus, left and right pulmonary plexuses, esophageal plexuses
35
sympathetic innervation of the heart
pregang cb- lateral horn
pregang fibers:
*ventral root, spinal nerve, ventral ramus, white ramus communicans, sympathetic trunk
post gang cb-paravertebral ganglia
post gang fibers- cardiac nerves
36
what happens when ventricular walls get too thick?
hypertrophy, decreased chamber size, systemic hypertension
37
what is the left ventricle thicker?
systemic circulation pumps blood to majority of body
38
what do the coronary arteries arise from?
the ascending aorta
39
what are the branches of the right coronary artery?
sinoatrial (SA) nodal branch, right marginal branch, posterior interventricular branch
40
what branch of the left coronary artery is nicknamed the 'widow maker'
anterior interventricular branch (LAD)
41
what are the branches of the left coronary artery (LCA)
anterior interventricular branch, circumflex branch, left marginal branch
42
what arteries can you use in a coronary bypass?
radial, internal thoracic, internal mammary artery
43
venous drainage of heart
coronary sinus
*great cardiac vein
*middle cardiac vein
*small cardiac vein
44
pt has ischemia in apex of heart, which vessel is likely affected?
LAD
45
what openings are in the right atrium?
openings of the IVC, SVC, and coronary sinus
46
tricuspid (right atrioventricular) valve
located in right ventricle, three cusps, opens passively during atrial contraction
47
what structures are in the right atrium?
-right auricle with pectinate muscles
-crista terminalis
-internal septum
-fossa ovalis
48
what structures are in the right ventricle?
-tricuspid valve
-trabeculae carnaea (aid in turbulent flow and create suction)
-papillary muscles (3)- helps close valves
-chordae tendineae
-interventricular septum
-septomarginal trabecula (moderator band)
49
describe the pulmonary valve during ventricular CONTRACTION
it is open!
when is relaxes we get small backflow that closes the valve during ventricular RELAXATION
50
what part of the heart are the openings of the pulmonary veins in?
left atrium
51
mitral (left atrioventricular) valve
-two cusps
-opens passively during atrial contraction
-in left ventricle
52
structures in the left ventricle
-trabeculae carneae
-papillary mm (2)
-chordae tendineae
-mitral valve
53
where does blood in aortic sinuses flow?
into coronary arteries
54
if chordae tendinae are pulled tight on tricuspid valve are they open or closed?
closed
55
postnatal circulation right side*be able to diagram this out
ivc/svc/coronary sinus
right atrium
right ventricle
pulmonary trunk/left and right pulmonary arteries
56
postnatal circulation left side
pulmonary veins
left atrium
left ventricle
ascending aorta/arch/thoracic aorta
57
fetal circulation
umbilical vein
ductus venosus
IVC
right atrium
58
what are the bypasses in the fetal heart?
foramen ovale (right to left atrium)
ductus arteriosus (pulmonary trunk to aorta)
59
which fetal chamber of the heart has an increased percentage of deoxygenated blood?
right atrium
60
what arteries are responsible for fetal circulation?
umbillical arteries
61
in postnatal circulation blood that has just traversed the pulmonary valve has just exited which chamber?
the right ventricle
62
during atrial contraction the pulmonary valve is...
closed
63
during ventricular contraction the aortic valve is...
open
64
during ventricular contraction the tricuspid valve is...
closed
65
what are adult remnants of fetal bypasses?
fossa ovalis
ligamentum arteriosis
66
conducting system of heart
SA node
AV node
AV bundle
67
SA (sinoatrial) node
junction SVC/right atrium
sympathetics stimulate and PS inhibit
68
AV (atrioventricular) node
interatrial septum
stimulated by atrial contraction
69
AV bundle
*under av node
interventricular septum
right and left bundles
*moderator band
70
location of esophagus
posterior to trachea
in super mediastinum
*lies to the right of thoracic aorta
*posterior to base of heart
71
where does the esophagus pass through in the diaphragm?
esophageal hiatus (T10)
72
where is the aortic hiatus located? (vertebral level)
T12
73
arteries branching off of thoracic aorta
-bronchial artery=oxygen rich blood to tissue of lungs
-esophageal artery=blood supply of esophagus
-posterior intercostal artery (VAN)
-subcostal artery
74
azygos system
*NO VALVES
SVC
AZYGOS VEIN
-what dumps into it:
rigth of midline, bronchial veins, esophageal veins, posterior intercostal veins, lumbar veins
75
What branches off of the ayzgos vein?
accessory hemiazygos vein
hemiazygos vein
76
what is the location of the thoracic duct?
lies on vertebral bodies (between azygos vein and esophagus)
77
sympathetic innervation of the abdominal organs
greater splanchnic nerve
lesser splanchnic nerve
least splanchnic nerve
78
sympathetic innervation abdominal organs tract
lateral horn> splanchnic nerves > prevertebral ganglia > organs
79
myocardial infarction
sudden occlusion of artery by embolus
most common cause- insufficiency due to coronary artery atherosclerosis
*atery atherosclerosis= lipid deposits in tunica intima of coronary arteries
80
coarctation of the aorta
arch or descending aorta has abnormal narrowing, or stenosis
81
atrial and ventricular septal defects
ASD- incomplete closure of foramen ovale
VSD- embryologic origin
82
1. The sternocostal surface of the heart is formed primarily by the anterior wall of which heart chamber?
Right ventricle
83
2. A patient involved in an automobile accident presents with a sharp object puncture of the middle of the sternum at about the level of the 4th or 5th costal cartilage. If the object also penetrated pericardium and heart wall, which heart chamber would most likely be damaged?
Right ventricle
84
3. Blockage of which of the following arteries would lead to ischemia of the apex of the heart?
Anterior interventricular (descending)
85
Which valves would be open during ventricular systole?
Aortic and pulmonary
86
Which statement is true of the right atrioventricular valve?
It is open during ventricular diastole
87
During fetal life and sometimes persisting into the adult there is an opening between the right and left atria; this opening is called the:
Foremen ovale
88
Which heart valve has leaflets described as "anterior, left and right"?
Pulmonary
89
The sound associated with tricuspid stenosis (narrowing) in a
40-year-old male would be best heard at which location on the anterior chest wall?
Left4-5th intercostal space near sternum
90
Blockage of blood flow in the proximal part of the anterior interventricular artery could deprive a large area of heart tissue of blood supply, unless a substantial retrograde flow into this artery develops via an important anastomosis with which other artery?
Posterior interventricular
91
Which structure does NOT lie in the coronary sulcus?
Right bronchial artery
92
15. Elevated systolic blood pressure in the right ventricle suggests stenosis of which valve?
Pulmonary
93
While attempting to suture the distal end of a coronary bypass onto the anterior interventricular artery, the surgeon accidentally passed the needle through the adjacent vein. Which vein was damaged?
Great cardiac vein
