1. ENDOCARDIUM - thin internal layer lining membrane of the heart and its valves 2. MYOCARDIUM - thick middle layer composed of cardiac muscle 4. EPICARDIUM - thin external layer (mesothelium)formed by the visceral layer of the serous pericardium

Module 6: Cardiovascular Flashcards by Mary Rose Carvajal

fibroserousmembrane that covers the heart and beginning of its great vessels; closed sac
functions:
a. restrict excessive movement of the heart
b. serve as a lubricated container

pericardium

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Two Layers of Pericardium

A. Fibrous Pericardium
B. Serous Pericardium
*Visceral Layer
*Parietal Layer

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fibrous part; tough external layer
stabilizes the heart and prevents it from overdilating
fuses superiorly with tunica adventitia of the great vessels and pretracheallayer of deep cervical fascia attached to the posterior part of the sternum by the STERNOPERICARDIAL
LIGAMENT
bound posteriorly by loose connective tissue to structures in the posterior mediastinum

FIBROUS PERICARDIUM

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The continuity of the fibrous pericardium with the central tendon of the diaphragm constitutes the __

pericardiacophrenic ligament

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composed mainly of mesotheliumthat lines the internal surface of the fibrous pericardium and external surface of the heart
has 2 layers:
A. Parietal Layer
B. Visceral Layer

SEROUS PERICARDIUM

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serous membrane that lines the internal surface
of the fibrous pericardium
this layer is reflected onto the heart at the great vessels (pulmonary trunk, aorta, SVC and IVC) and becomes the visceral layer

PARIETAL LAYER OF SEROUS PERICARDIUM

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layer reflected by the parietal layer to the heart
at the great vessels
makes up the epicardium
continuous with parietal layer:
*where the aorta and pulmonary trunk leave the heart
*where the SVC, IVC and pulmonary veins enter the heart

VISCERAL LAYER OF SEROUS PERICARDIUM

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potential space between the parietal and visceral
layers of serous pericardium contains a thin film of fluid
enabling the heart to move and beat in a frictionless
environment
30-50 ml.of thin, clear fluid in pericardial sac

PERICARDIAL CAVITY

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a finger can be passed through the transverse
pericardial sinus posterior to the aorta and pulmonary trunk and anterior to the SVC and superior to the atria of the heart
important when performing coronary artery bypass
grafting

TRANSVERSE SINUS

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pocket-like recess in the pericardial cavity posterior
to the base of the heart
bounded laterally by the pericardial reflections surrounding the pulmonary veins and IVC; posteriorly by the pericardium
blind sac (cul-de-sac)

OBLIQUE SINUS

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PERICARDIUM: ARTERIAL SUPPLY

pericardiacophrenic artery (main supply)
musculophrenic artery
bronchial, esophageal artery
superior phrenic artery
coronary artery (visceral layer of serous pericardium only)

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PERICARDIUM: VENOUS DRAINAGE

pericardiacophrenic vein

* which drains to the brachiocephalic vein

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PERICARDIUM: NERVE SUPPLY

PHRENIC NERVE (primary source of sensory fibers) supplies the:

a. fibrous pericardium
b. parietal layer of the serous pericardium

SYMPATHETIC TRUNKS AND VAGUS NERVE supply the:

a. visceral layer of the serous pericardium
* the function of the vagus is uncertain; the sympathetic trunks are vasomotor

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inflammation of the pericardium
roughened pericardium
(+) chest pain
(+) pericardial friction rub
(+) pericardial effusion

PERICARDITIS

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heart compression secondary to stab or gunshot wounds
extensive pericardial effusion does not allow full expansion of the heart limiting the amt. of blood the heart can receive, reducing cardiac output
(+) pericardial effusion
(+) hemopericardium
(+) pneumopericardium

CARDIAC TAMPONADE

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drainage of fluid from pericardial cavity
wide bore needle inserted to left 5thor 6th ICS near the sternum
cardiac tamponade relief

PERICARDIOCENTESIS

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How big is the heart?

The normal heart weighs averages:
250-300 grams in females
300-350 grams in males

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HOW DOES THE HEART WORK?

suction and pressure pump

- propels blood to all parts of the body

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complex framework of dense collagen forming:
4 fibrous rings
right and left fibrous trigone
membranous parts of interatrial, interventricular septa
keeps the orifices of the AV and semilunar valves patent
provides attachment for the leaflets and cusps
provides attachment for the myocardium
forms an electrical insulator

FIBROUS SKELETON

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formed by the inferolateral part of the left ventricle
lies posterior to the left 5th ICS; approx. 9 cm from the median plane
motionless throughout the cardiac cycle
apex beat

APEX OF THE HEART

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opposite the apex
posterior aspect of the heart
formed mainly by the left atrium and partially by the right atrium
faces posteriorly toward the bodies of vertebrae T6-T9
extends superiorly to the bifurcation of the pulmonary trunk and inferiorly to the coronary sulcus
receives the pulmonary veins, SVC and IVC

BASE OF THE HEART

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FOUR SURFACES OF THE HEART

STERNOCOSTAL SURFACE (Anterior)
- formed mainly by the right ventricle
DIAPHRAGMATIC SURFACE (Inferior)
- formed mainly by the left ventricle,partly by the right ventricle
- related to the central tendon of diaphragm
RIGHT PULMONARY SURFACE
- formed mainly by the right atrium
LEFT PULMONARY SURFACE
- formed mainly by the left ventricle
- forms the cardiac impression of the left lung

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FOUR BORDERS OF THE HEART

RIGHT BORDER - formed by the right atrium extending between the SVC and IVC
INFERIOR BORDER - formed mainly by the right ventricle and slightly by the left ventricle
LEFT BORDER - formed mainly by the left ventricle and slightly by the left auricle
SUPERIOR BORDER - formed by the right and left atria and auricles
- ascending aorta and pulmonary trunk emerge from this border and the SVC enters its right side
- forms the inferior boundary of the transverse pericardial sinus

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LAYERS OF THE HEART

ENDOCARDIUM - thin internal layer lining membrane of the heart and its valves
MYOCARDIUM - thick middle layer composed of cardiac muscle
EPICARDIUM - thin external layer (mesothelium)formed by the visceral layer of the serous pericardium

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- receiving chamber | - are demarcated from the ventricles by the coronary sulcusor atrioventriculargroove

atria

- Forms the right border of the heart | - Receives venous blood from the: SVC, IV and Coronary Sinus

Right Atrium

(Right Atrium) - ear-like conical muscular pouch - increases the capacity of the atrium; add on room

RIGHT AURICLE

(Right Atrium) - forms the muscular anterior wall - resemble teeth of a comb

PECTINATE MUSCLES

(Right Atrium) - smooth, thin-walled, posterior part where the SVC, IVC and coronary sinus open up

SINUS VENARUM

(Right Atrium) - vertical ridge separating the smooth and rough parts of the atrium - its equivalent externally is the Sulcus Terminalis (Terminal Groove)

CRISTA TERMINALIS

(Right Atrium) - short venous trunk bet. the right AV orifice and IVC orifice receives most of the cardiac veins

OPENING OF CORONARY SINUS

(Right Atrium) - separates the right from the left atria - contains the Fossa Ovalis which is a remnant of the Foramen Ovale

INTERATRIAL SEPTUM

- incomplete closure of the foramen ovale - left to right shunt causing enlargement of the right atrium and ventricle and dilatation of the pulmonary - trunk surgical repair

ATRIAL SEPTAL DEFECT

(Right Atrium) - the opening where poorly oxygenated blood from the right atrium is discharged into the right ventricle

RIGHT ATRIOVENTRICULAR ORIFICE

(Right Ventricle) - guards the right AV orifice - the valve is made of 3 cusps: ANTERIOR CUSP, POSTERIOR CUSP, SEPTAL CUSP - tendinous cords are attached to the free edges of the cusps

TRICUSPID VALVE

(Right Ventricle) - conical muscular projections attached to the ventricular wall and connected to the cusps of the tricuspid valve via the Chordae Tendinae - 3 __ in the right ventricle: anterior, posterior, septal

PAPILLARY MUSCLES

(Right Ventricle) - irregular muscular elevations - give the ventricular wall a sponge-like appearance - composed of three types a. Papillary Muscles b. Moderator Band c. Prominent Ridges

TRABECULAE CARNAE

(Right Ventricle) - also known as septomarginal trabecula - muscular bundle from the inferior part of the IVS to the base of the anterior papillary muscle - carries part of the right branch of the AV bundle to the anterior papillary muscle

MODERATOR BAND

(Right Ventricle) - made up of muscular and membranous parts - partition between the right and left ventricle

INTERVENTRICULAR SEPTUM

- incomplete closure of the ventricular septum - most common site is the membranous part - size of defect is 1-25mm. - left to right shunt - large shunt may lead to pulmonary hypertension resulting to cardiac failure - 50% of small muscular VSDs close spontaneously

VENTRICULAR SEPTAL DEFECT

(Right Ventricle) - separates the ridged muscular wall of the inflow part from the smooth wall of the outflow part - deflects the incoming flow into the main cavity of the ventricle and the outgoing flow into the conus arteriosus toward the pulmonary orifice

SUPRAVENTRICULAR CREST

(Right Ventricle) - arterial cone which leads into the pulmonary trunk

CONUS ARTERIOSUS (Infundibulum)

(Right Ventricle) - guards the pulmonary orifice - located at the level of the 3rd costal cartilage - consists of 3 semilunar cusps: anterior cusp, right cusp, left cusp

PULMONARY VALVE

- approx. 5 cm. long and 3 cm. wide - divides into right and left pulmonary arteries - conduct poorly oxygenated blood to the lungs for oxygenation

PULMONARY TRUNK

- forms most of the base or posterior surface of the heart | - slightly thicker wall than the right atrium

LEFT ATRIUM

(Left Atrium) - two superior and two inferior pulmonary veins entering the smooth posterior wall

PULMONARY VEINS

(Left Atrium) - forms the superior part of the left border of the heart - smaller muscular auricle containing pectinate muscles

LEFT AURICLE

(Left Atrium) - smaller pectinate muscles larger smooth walled part

PECTINATE MUSCLES

(Left Atrium) - semilunar depression in the interatrial septum - the surrounding ridge is the valve of the oval fossa

FLOOR OF FOSSA OVALIS

(Left Ventricle) - opening through which the left atrium discharges the oxygenated blood into the left ventricle - surrounded by the mitral valve

LEFT ATRIOVENTRICULAR ORIFICE

- benign neoplasm or tumor - 90% located in atrium - size is from 1 cm. to 10 cm. can present as a hard globular mass or a soft gelatinous appearance - (+) fever and malaise - surgical removal is curative

MYXOMA

- forms the apex of the heart, nearly all its left surface and border and most of the diaphragmatic surface - performs more work than the right ventricle because of the higher arterial pressure in the systemic circulation - walls are two to three times thick - has a longer and narrower conical cavity than the right

LEFTVENTRICLE

(Left Ventricle) - located posterior to the sternum at the level of the 4th costal cartilage - resembles a bishop’s miter - anterior and posterior cusps - papillary muscles and their tendinous cords support the mitral valve, - allowing the cusps to resist the pressure developed during contractions (pumping) of the left ventricle. - The cords become taut just before and during systole, preventing the cusps from being forced into the left atrium

MITRAL VALVE

- ballooning of mitral valve leaflets (floppy) which extends back into the left atrium during systole - leaflets are enlarged, thick and rubbery

MITRAL VALVE PROLAPSE/INSUFFICIENCY

(Left Ventricle) - larger than those of the right ventricle * *note: no moderator band on the left ventricle

PAPILLARY MUSCLES (anterior and posterior)

(Left Ventricle) - finer; more numerous

TRABECULA CARNAE

(Left Ventricle) - smooth-walled supero-anterior outflow part that leads to the aortic valve and aortic orifice

AORTIC VESTIBULE

(Left Ventricle) - blood leaves the left ventricle through the aortic orifice located at the upper right and posterior part

AORTIC ORIFICE

(Left Ventricle) - located posterior to the left side of the sternum at the level of the 3rd ICS - no tendinous cords - semilunar cusps: 1. right cusp 2. left cusp 3. posterior cusp

AORTIC VALVE

ATRIOVENTRICULAR VS SEMILUNAR VALVES

AV CUSPS - (+) Tendinous cords - Larger in area - Greater force exerted SEMILUNAR CUSPS - (-) Tendinous cords - Smaller in area - Less force exerted - Cusps project into artery - Thickened edge-lunule - Thickened apex-nodule

- most frequent valve abnormality - degenerative calcification - 10% rheumatic fever - resulting to left ventricular hypertrophy

AORTIC VALVE STENOSIS

- commences at the left ventricle - divided into 4 parts a. ascending aorta b. arch of the aorta c. descending aorta d. abdominal aorta

AORTA

- arise from the base of the left ventricle; begins at the aortic orifice - 2 inches long - 2 branches 1. Right coronary artery 2. Left coronary artery

ASCENDING AORTA AORTA

- continuation of the ascending AORTA - 3 branches: 1. BRACHIOCEPHALIC ARTERY 2. LEFT COMMON CAROTID ARTERY 3. LEFT SUBCLAVIAN ARTERY (remember your abcs)

ARCH OF THE AORTA

- continuous with the arch of the aorta | - enters the abdomen and becomes continuous with the abdominal aorta

DESCENDING AORTA

- arises from the right aortic sinus - runs in the coronary groove - gives off the ff. branches 1. sinuatrial nodal branch 2. right marginal branch 3. atrioventricular nodal br. 4. posterior interventricular branch

RIGHT CORONARY ARTERY

- originates from the right coronary artery | - supplies the SA node and pulmonary trunk

SINUATRIAL NODAL BRANCH

- originates from the right coronary artery | - supplies the apex of the heart and the right ventricle

RT. MARGINAL ARTERY

- originates from the right coronary artery | - supplies the atrioventricular node

ATRIOVENTRICULAR NODAL BRANCH

- originates from the right coronary artery - supplies the right and left ventricle and posterior third of the IVS - anastomoses with the anterior interventricular artery

POSTERIOR INTERVENTRICULAR ARTERY

The right coronary supplies the following:

- right atrium - most of the right ventricle - part of the left ventricle (diaphragmatic surface) - SA node (60% of people) - AV node (80% of people)

- arises from the left aortic sinus runs in the coronary groove - divides into two branches: a. Left anterior descending or anterior interventricular branch - lateral diagonal branch b. Circumflex branch - left marginal artery

LEFT CORONARY ARTERY

(left coronary artery) - originates from the left coronary artery - supplies the right and left ventricles and anterior 2/3 of IVS

LEFT ANTERIOR DESCENDING OR ANTERIOR INTERVENTRICULAR ARTERY

(left coronary artery) - originates from the left coronary artery - supplies the left atrium and left ventricle anastomoses with the right coronary artery

CIRCUMFLEX ARTERY

(left coronary artery) - arises from the circumflex artery - supplies the left ventricle

LEFT MARGINAL ARTERY

What does the left coronary artery supply?

- The left atrium and most of the left ventricle and most of the IVS - Part of the right ventricle, AV bundle and SA Node (40%)

- lipid accumulations on internal wall of coronary arteries - early adulthood - (+) stenosis of lumina

CORONARY ATHEROSCLEROSIS

- pain originating from heart tightness in thorax and deep to sternum - 15 sec. to 15 min duration ischemia of myocardium - caused by narrowed and hardened coronary arteries - relieved by rest and intake of nitroglycerin

ANGINAPECTORIS

- occlusion of a major artery by an embolus - (+) infarction and necrosis of affected area - 3 common sites of occlusion 1. LAD (40-50%) 2. RCA (30-40%) 3. Circumflex (15-20%)

MYOCARDIAL INFARCTION

- pass a catheter with small inflatable balloon into the obstructed coronary artery - balloon is inflated flattening the atherosclerotic plaque - complications include: reoccurence and clot formation

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

- segment of artery and vein connected to the ascending aorta or proximal part of coronary artery and then to the coronary artery distal to the stenosis - great saphenous vein is usually harvested because a) diameter equal to coronary arteries b) easily dissected c) lengthy portions

CORONARY ARTERY BYPASS GRAFT

(VENOUS DRAINAGE) - main vein of the heart - runs from the left to right in the posterior part of the coronary sulcus - the oblique vein of the left atrium and great cardiac vein form the coronary sinus

CORONARY SINUS

Coronary Sinus receives the following veins:

a. great cardiac vein b. middle cardiac vein c. small cardiac veins d. left posterior ventricular vein e. left marginal vein

(Venous Drainage) - main tributary of the coronary sinus - drains most of the left atrium and ventricle, IVS and AV bundle

GREAT CARDIAC VEIN

(Venous Drainage) - accompanies the post. interventricular artery - drains most of the areas supplied by the right coronary artery - empties in the coronary sinus

MIDDLE CARDIAC VEIN

(Venous Drainage) - accompanies the right marginal branch of the RCA drains most of the areas - supplied by the right coronary artery

SMALL CARDIAC VEIN

(Venous Drainage) - usually enter directly into the right atrium

ANTERIOR CARDIAC VEIN

- generates and transmits the impulses that produce the coordinated contractions of the cardiac cycle - consists of nodal tissue that initiates the heartbeat and coordinates contractions of the four heart chambers - highly specialized conducting fibersfor conducting them rapidly to the different areas of the heart

CONDUCTING SYSTEM

SA NODE >> AV NODE >> LEFT AND RIGHT BUNDLE BRANCHES >> PURKINJE FIBERS

- located at the junction of the SVC and Right Atrium - pacemaker of the heart - gives off an impulse of 70 times per minute - supplied by the sinuatrial nodal artery

SINUATRIAL NODE

- located at the postero-inferior region of the interatrial septum - near the opening of the coronary sinus - transmit the signal to the ventricles via the AV bundle - supplied by the atrioventricular nodal artery

ATRIOVENTRICULAR NODE

- AV bundle divides into __ at the junction of the muscular and membranous - parts of the septum right and left bundles ramify into subendocardial branches or purkinje fibers

RIGHT AND LEFT BUNDLES

(PURKINJE FIBERS) - stimulate the muscle of the IVS, anterior papillary muscle through the moderator band and the wall of the right ventricle

right purkinje fibers

(PURKINJE FIBERS) - stimulate the IVS, anterior and posterior papillary muscles and the wall of the left ventricle

left purkinje fibers

Sympathetic

- increases the heart rate - increases the force of contraction - increases blood flow to the coronary arteries - increases impulse conduction

Parasympathetic

- slows the heart rate - reduces the force of contraction - constricts the coronary arteries - decreases atrial contractility

Vascular System

Cardiovascular system - Heart - Blood vessels - Blood Lymphatic system - Lymphatic organs and vessels - Lymph

- most permeable (and more permeable in some parts than others) - Especially in liver, spleen and red marrow (so cells can enter and leave circulation) - Blood flow can vary to different parts of the body, too

Capillaries

- Wide, leaky capillaries found in some organs - Usually fenestrated - Have large diameters - Intercellular clefts are wide open - Occur in bone marrow, liver, spleen and lymphoid tissue

Sinusoids

Pulmonary circulation

From Right ventricle -> pulmonary artery -> lungs -> pulmonary vein -> Left atrium

Systemic circulation

from Left ventricle -> aorta -> body -> Right atrium

Aorta

- Thoracic Ascending Arch Descending Abdominal - Anterior Visceral - Lateral Visceral - Lateral Abdominal - Terminal branches

Thoracic Aorta

1. Ascending Aorta - Right / Left coronaries 2. Arch of Aorta - Brachiocephalic - Left common carotid - Left subclavian 3. Descending Aorta - Bronchial - Mediastinal - Esophageal - Posterior intercostal - Pericardial - Subcostal

ABDOMINAL AORTA

1. Anterior Visceral - Celiac - Superior Mesenteric - Inferior Mesenteric 2. Lateral Visceral - Suprarenal - Renal - Gonadal 3. Lateral Abdominal - Inferior Phrenic - Lumbar 4. Terminal branches - Common iliac - Median Sacral

Common Carotid

1. External Carotid - Superior thyroid - Asc. Pharyngeal - Lingual - Facial - Occipital - Posterior Auricular - Superficial Temporal - Maxillary 2. Internal Carotid

- Divisible into 3 parts by Scalenous anterior 1. First Part - Vertebral - Thyrocervical - Internal Thoracic 2. Second part - Costocervical 3. Third part

SUBCLAVIAN

- Divisible into 3 parts by Pectoralis Minor 1. First Part - Highest thoracic 2. Second Part - Thoracoacromial - Lateral thoracic 3. Third Part - Subscapular - Ant/Post Circumplex - Humeral

Axillary

Arteries of the arm

- Brachial - Radial / Ulnar - Palmar arch

Circle of Willis

1. Internal carotid - Opthalmic - Posterior Communicating - Anterior Cerebral - Middle Cerebral 2. Vertebral

Celiac artery – T12

1. Left Gastric 2. Splenic - Left Gastroepiploic - Short Gastric 3. Hepatic - Right Gastric - R/L Hepatic - Gastroduodenal - Right Gastroepiploic - Sup.Pancreaticoduodenal

Superior Mesenteric Artery – L1

- Inferior Pancreaticoduodenal - Middle Colic - Right Colic - Ileo-colic - Jejunal-Ileal

Inferior Mesenteric Artery – L3

- Left Colic - Sigmoid - Superior Rectal

COMMON ILIAC

1. Internal iliac 2. External iliac - Femoral - Popliteal - Ant / Post Tibial - Plantar arch

- must carry the same volume of blood as the arteries but at a lower pressure - have large and somewhat more irregular lumina and thin wall, hence relatively compressible by external forces. - Muscles in venous walls tend to be arrange in a loop near the point of drainage of the tributary to act as “sluice gate”. - Walls of large __ have elastic tissue to resist the pressure of right systole. - Many __ contain valves that permit proximal flow only

VENOUS SYSTEM

Pressure gradients between the periphery and the right side of the heart control the venous flow.

VENOUS HEMODYNAMICS

Pressure gradients are established by:

1. An arterial pressure of approximately 10mm Hg transmitted through the capillary bed to the venous side 2. The sucking bulb-syringe action of the heart during right ventricular diastole 3. The negative pressure, relative to atmospheric pressure, produced by the thoracic cage during inspiration. 4. The flow in the superficial veins, which can be occluded by application of mild pressure. 5. The contractile activity of the muscles of the extremities, which will milk the venous blood towards the heart.

Provide a rich anastomotic network in the dorsal subcutaneous space

SUPERFICIAL VEINS

Formed by a coalescene of the dorsal veins on the radial side of the hand. It winds from the posterior preaxial border of the forearm to lie along the ventral preaxial border.

CEPHALIC VEIN

Formed by the medial coalescence of the dorsal vein on the ulnar side of the hand. It ascends nearly to the cubital fossa along the dorsal postaxial border.

BASILIC VEIN

Accompany the radial and ulnar arteries as well as other tributaries.

DEEP VEINS (venae comitantes)

- Left and Right Internal jugular and subclavian veins - Unite at level of inferior border of 1st Right costal cartilage to form Superior Vena Cava - Tributaries: * Internal thoracic * Vertebral * Inferior thyroid * Superior intercostal

BRACHIOCEPHALIC VEIN

- Continuation of Sigmoid sinus - Tributaries: * Inferior petrosal sinus * Facial * Pharyngeal * Lingual * Superior thyroid * Middle thyroid

INTERNAL JUGULAR

- Superior and Inferior bulb * Bicuspid valve - resist backflow of blood from Right Atrium and Superior Vena Cava - Intracranial sinuses - sigmoid and inferior petrosal drain posterior cranial fossa and cavernous sinuses - Lymphatic drainage of Head and Neck - Removal in Radical Neck dissection - ACCESS FOR HEMODIALYSIS

INTERNAL JUGULAR

- Union of R / L brachiocephalic veins | - Ends at the level of the 3rd costal cartilage to enter the Right atrium

SUPERIOR VENA CAVA

- Veins on each side of vertebral column - Drain back and walls of thorax and abdomen - Connects SVC from IVC - Tributaries: * Intercostal vein * Mediastinal * Esophageal * Bronchial * Accessory hemiazygos - Hemiazygos

AZYGOS SYSTEM OF VEINS

- Ascends a the R side of inferior T( 8) vertebrae - lateral to thoracic duct - Lateral to descending Thoracic Aorta

Azygos

- Largest vein in body - Pierces diaphragm T8 - Crosses 8 vertebrae - ~2x length of abdominal Aorta

INFERIOR VENA CAVA (IVC)

INFERIOR VENA CAVA (IVC): Veins of Origin

- right and left common iliac | - Median sacral

TRIBUTARIES OF INFERIOR VENA CAVA

1. Anterior Visceral - R / L hepatic 2. Lateral Visceral - R suprarenal - R / L renal - R gonadal 3. Lateral Abdominal - Inferior phrenic - Lumbar

- Begins in the capillaries and subsequently form a large vein before breaking up into sinusoids. - The hepatic portal system, for example, drains most of the venous blood from the capillary beds of the intestinal tract to the sinusoid. - A system of vessels in which blood collected from intestinal capillaries passes through the portal vein and then through the liver capillary sinusoid before reaching to the inferior vena cava (systemic circulation )

PORTAL SYSTEM

- Drains the abdominal part of the gut, spleen, pancreas, and gallbladder and is 8 cm.(3.2inches) long. - Formed by the union of the splenic vein and the superior mesenteric vein posterior to the neck of the pancreas.. - The inferior mesentric vein joins either splenic or the superior mesenteric vein, or the junction of these two veins

Portal Vein

- Receives the left gastric (or coronary) vein. - Carries deoxygenated blood containing nutrients - Carries twice as much blood as the hepatic artery and maintains a higher blood pressure than in the inferior vena cava. - Ascends behind the bile duct and hepatic artery within the free margin of the lesser omentum

Portal Vein

PORTAL VENOUS SYSTEM: TRIBUTARIES

- Superior mesenteric - Splenic - Inferior mesenteric - Left gastric - Paraumbilical

- accompanies the SMA on its right side in the root of the mesentery. - crosses the 3rd part of duodenum and the uncinate process of the pancreas and terminates posterior to the neck of the pancreas ny joing the splenic vein, thereby forming the portal vein

SUPERIOR MESENTERIC VEIN

- formed by the union of the tributaries from the spleen | - receives the short gastric, left gastroepiploic, and pancreatic veins.

SPLENIC VEIN

- formed by the union of the superior rectal and sigmoid veins. - receives the left colic vein.

INFERIOR MESENTERIC VEIN

- drains normally into the portal vein - has tributaries that anastomose with the esophageal vein of the Azygos system at the lower part of the esophagus and thereby enter systemic circulation

LEFT GASTRIC(CORONARY) VEIN

- found in the Falciform ligament usually closed, however, will dilate in portal hypertension

PARAUMBILICAL VEIN

- Permits direct transfer of the blood from arterial to venous channels, bypassing the capillary bed. - are widely distributed - usually occurs in organs whose functions are intermittent

ARTERIOVENOUS(AV)ANASTOMOSES

Occur between: - Left gastric and esophageal of the azygos system - Superior rectal and middle/inferior rectal - Paraumbilical & superficial epigastric of abdominal wall - Colic and retroperitoneal

PORTO-CAVAL ANASTOMOSES

- Results from thrombosis of the portal vein or liver cirrhosis - If dilated, results to: 1. esophageal varices 2. hemorrhoids 3. caput medusae

PORTAL HYPERTENSION

VENAE COMITANTES

- Common iliac - Ant / Post Tibial - Popliteal - Femoral - External iliac - Internal iliac

- Continuation of the popliteal vein proximal to adductor hiatus - Ascends through the adductor canal and lies posterolateral and theen posterior to femoral artery. - Enters the femoral sheath lateral to femoral canal and ends posterior to the inguinal ligament, where it becomes the external iliac vein

FEMORAL VEIN

- Formed by the junction of the venae comitantes of the anterior and posterior tibial arteries at the lower border of the popliteus muscle on the medial part of the politeal artery.

POPLITEAL VEIN

- Great Saphenous drains into Femoral - Small Saphenous drains into Popliteal - Accessory Saphenous

SAPHENOUS VEINS

- The principal superficial vein of the thigh. - It lies on the superficial fascia in the medial aspect of the legs and thigh, passing on the flexor side of the ankle, knee, and hip joint. - Contains about 8 valves in the thigh.

GREAT SAPHENOUS VEINS

TRIBUTARIES OF THE SAPHENOUS VEIN

PENETRATING VEINS. Communicate between the saphenous and the deep veins of the leg and thigh. SUPERFICIAL EPIGASTRIC VEIN, SUPERFICIAL CIRCUMFLEX ILIAC VEIN and the EXTERNAL PUDENDAL VEIN. Joins the saphenous vein in the femoral triangle.

- Starts as the lateral marginal vein along the lateral side of the dorsum of the foot. - The small saphenous vein passes posteriorly tp the lateral malleolus and ascends along the lateral aspect of the leg freely anastomosing with great saphenous vein. - It penetrates the crural fascia to eenter th popliteal fossa where it joins the popliteal vein - Contains about 12 valves.

SMALL SAPHENOUS VEIN

Module 6: Cardiovascular Flashcards

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