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ESA 3 - Respiratory > Session 1.2h - Gray's Anatomy for Students - Thorax - Regional anatomy - Mediastinum (Images and Clinical) > Flashcards

Session 1.2h - Gray's Anatomy for Students - Thorax - Regional anatomy - Mediastinum (Images and Clinical) Flashcards

https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780702051319000031?scrollTo=%23hl0002407 (206 cards)

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1
Q

Fig. 3.51

Label and caption the image (label the vertebrae).

A
  • Superior thoracic aperture
  • Sternal angle
  • Sternum
  • Diaphragm
  • TI - TXII labelled

Lateral view of the mediastinum.

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2
Q

Fig. 3.50

Label and caption the image.

A
  • Right pleural cavity
  • Mediastinum
  • Left pleural cavity

Cross-section of the thorax showing the position of the mediastinum.

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3
Q

Fig. 3.52

Label and caption the image (including the vertebrae).

A
  • Sternal angle
  • Superior mediastinum
  • Anterior mediastinum
  • Inferior mediastinum
  • Middle mediastinum
  • Posterior mediastinum
    Vertebrae TI - TXII labelled

Subdivisions of the mediastinum.

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4
Q

Fig. 3.53

Label and caption the image.

A
  • Junction between fibrous pericardium and adventitia of great vessels
  • Visceral layer of serous pericardium (epicardium)
  • Pericardial cavity
  • Parietal layer of serous pericardium
  • Fibrous pericardium

Sagittal section of the pericardium

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5
Q

Fig. 3.54

Label and caption the image.

A
  • Trachea
  • Left common carotid artery
  • LEFT PHRENIC NERVE
  • LEFT PERICARDIACOPHRENIC VESSELS
  • Pericardium
  • RIGHT PERICARDIACOPHRENIC VESSELS
  • Diaphragm
  • RIGHT PHRENIC NERVE
  • Superior vena cava

Phrenic nerves and pericardiacophrenic vessels.

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6
Q

Fig. 3.55

Label and caption the image

A
  • Superior vena cava
  • Ascending aorta
  • TRANSVERSE PERICARDIAL SINUS (separates arteries from veins)
  • Branch of right pulmonary artery
  • Right pulmonary veins
  • Inferior vena cava
  • THORACIC AORTA
  • Cut end of pericardium
  • OBLIQUE PERICARDIAL SINUS (formed by reflection onto the pulmonary veins of heart)
  • Left pulmonary veins
  • Left pulmonary artery
  • Arch of aorta

Posterior portion of pericardial sac showing reflections of serous pericardium.

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7
Q

(IN THE CLINIC: Pericarditis)

What is pericarditis?

A

An inflammatory condition of the pericardium.

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8
Q

(IN THE CLINIC: Pericarditis)

What can cause pericarditis?

A

Common causes are:

  • viral infections
  • bacterial infections
  • systemic illnesses (e.g., chronic renal failure)
  • after myocardial infarction
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9
Q

(IN THE CLINIC: Pericarditis)

Why must pericarditis be distinguished from myocardial infarction?

A

Because the treatment and prognosis are quite different.

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10
Q

(IN THE CLINIC: Pericarditis)

What are symptoms of pericarditis?

A

As in patients with myocardial infarction, patients with pericarditis complain of “continuous central chest pain that may radiate to one or both arms”.

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11
Q

(IN THE CLINIC: Pericarditis)

How can pain from pericarditis be relieved?

A

By sitting forward

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12
Q

(IN THE CLINIC: Pericarditis)

What is a differential between myocardial infarction and pericarditis?

A

Unlike myocardial infarction, the pain from pericarditis may be relieved by sitting forward.

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13
Q

(IN THE CLINIC: Pericarditis)

What can be done to help differentiate between pericarditis and MI?

A

An electrocardiogram (ECG).

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14
Q

(IN THE CLINIC: Pericardial effusion)

How much fluid is normally present between the visceral and parietal layers of the serous pericardium?

A

Normally, only a tiny amount of fluid

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15
Q

(IN THE CLINIC: Pericardial effusion)

What is a pericardial effusion?

A

When in certain situations, the pericardial cavity is filled with excess fluid.

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16
Q

(IN THE CLINIC: Pericardial effusion)

What can pericardial effusion lead to?

A

Cardiac tamponade

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17
Q

(IN THE CLINIC: Pericardial effusion)

Why can pericardial effusion lead to cardiac tamponade?

A

Because the fibrous pericardium is a “relatively fixed” structure that cannot expand easily, a rapid accumulation of excess fluid within the pericardial sac compresses the heart (cardiac tamponade), resulting in biventricular failure.

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18
Q

(IN THE CLINIC: Pericardial effusion)

What is cardiac tamponade?

A

Excess fluid within the pericardial sac compressing the heart

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19
Q

(IN THE CLINIC: Pericardial effusion)

What can cardiac tamponade lead to?

A

Biventricular failure

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20
Q

(IN THE CLINIC: Pericardial effusion)

How can we treat pericardial effusions?

A

Removing the fluid with a needle inserted into the pericardial sac can relieve the symptoms.

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21
Q

(IN THE CLINIC: Constrictive pericarditis)

What is constrictive pericarditis?

A

Abnormal thickening of the pericardial sac

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22
Q

(IN THE CLINIC: Constrictive pericarditis)

What can happen in constrictive pericarditis?

A

Abnormal thickening of the pericardial sac can compress the heart, impairing heart function and resulting in heart failure.

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23
Q

(IN THE CLINIC: Constrictive pericarditis)

How is constrictive pericarditis diagnosed?

A

By inspecting the jugular venous pulse in the neck.

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24
Q

(IN THE CLINIC: Constrictive pericarditis)

What happens to the JVP in normal individuals?

A

It drops on inspiration

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25
(IN THE CLINIC: Constrictive pericarditis) What happens to the JVP in patients with constrictive pericarditis?
In normal individuals, the JVP drops on inspiration. In patients with constrictive pericarditis, the reverse happens (Kussmaul's sign).
26
(IN THE CLINIC: Constrictive pericarditis) What is Kussmaul's sign?
A paradoxical rise in JVP on inspiration (it should normally drop), or a failure in the appropriate fall on inspiration.
27
(IN THE CLINIC: Constrictive pericarditis) What is a differential of constrictive pericarditis?
JVP on inspiration (Kussmaul's sign)
28
(IN THE CLINIC: Constrictive pericarditis) What is Kussmaul's sign indicative of?
It is normally the differential associated with constrictive pericarditis. It is usually indicative of limited right ventricular filling due to right heart dysfunction.
29
(IN THE CLINIC: Constrictive pericarditis) How is constrictive pericarditis normally treated?
Treatment often involves surgical opening of the pericardial sac.
30
Fig. 3.56 Label and caption this schematic illustration of the heart.
- Anterior surface - Base - Right pulmonary surface - Diaphragmatic surface - Inferior (acute) margin - Apex - Obtuse margin - Left pulmonary surface Schematic illustration of the heart showing orientation, surfaces and margins.
31
Fig. 3.57 Label and caption the image.
- Left pulmonary artery - Left superior pulmonary vein - LEFT ATRIUM - Left inferior pulmonary vein - Coronary sinus - Left ventricle - Apex - Right ventricle - INFERIOR VENA CAVA - Sulcus terminalis - RIGHT ATRIUM - Right pulmonary veins - Right pulmonary artery - SUPERIOR VENA CAVA - Arch of aorta Base of the heart.
32
Fig. 3.58 Label and caption the image.
- Superior vena cava - Ascending aorta - Right coronary artery - RIGHT ATRIUM - RIGHT VENTRICLE - Small cardiac vein - Inferior vena cava - Inferior margin - Apex - Obtuse margin - LEFT VENTRICLE - Anterior interventricular groove - Great cardiac vein - Anterior interventricular branch of left coronary artery - Left auricle - Pulmonary trunk - Arch of aorta Anterior surface of the heart.
33
Fig. 3.59 Label and caption the image.
- Left pulmonary artery - Left pulmonary veins - Left atrium - Coronary sinus - LEFT VENTRICLE - Posterior interventricular branch of right coronary artery - Apex - Posterior interventricular groove - Middle cardiac vein - RIGHT VENTRICLE - Marginal branch of right coronary artery - Inferior vena cava - Right atrium - Right pulmonary veins - Right pulmonary artery - Superior vena cava - Arch of aorta Diaphragmatic surface of the heart.
34
Fig. 3.60A Label and caption the radiograph.
- Arch of aorta - Pulmonary trunk - Right atrium - Superior vena cava - Left ventricle - Apex of heart Chest radiograph. A. Standard posteroanterior view of the chest.
35
Fig. 3.60B Label and caption the radiograph.
- Right ventricle - Left atrium Chest radiograph. B. Standard lateral view of the heart.
36
Fig. 3.61A Label and caption the image.
- CORONARY SULCUS - Right coronary artery - Small cardiac vein - Great cardiac vein - ANTERIOR INTERVENTRICULAR SULCUS - Anterior interventricular branch of left coronary artery Sulci of the heart. A. Anterior surface of the heart.
37
Fig. 3.61B Label and caption the image.
- Great cardiac vein - Circumflex branch of left coronary artery - CORONARY SULCUS - Coronary sinus - Middle cardiac vein - Posterior interventricular branch of right coronary artery - POSTERIOR INTERVENTRICULAR SULCUS - Right coronary artery - Small cardiac vein Sulci of the heart. B. Diaphragmatic surface and base of the heart.
38
Fig. 3.62A Label and caption this diagram.
``` GENERAL BODY Inferior vena cava (Deoxygenated blood) - Right ventricle - Valve RIGHT PUMP - Right atrium Pulmonary arteries (Deoxygenated blood) LUNGS Pulmonary veins (Oxygenated blood) - Left ventricle LEFT PUMP - Left atrium Aorta (Oxygenated blood) [GENERAL BODY] Superior vena cava (Deoxygenated blood) ``` A. The heart has two pumps.
39
Fig. 3.62B Label and caption this image.
- Right ventricle - Right atrium - Left ventricle - Left atrium - Thoracic aorta B. Magnetic resonance image of midthorax showing all four chambers and septa.
40
Fig. 3.63 Label and caption this image.
- Superior vena cava - Limbus of fossa ovalis - CRISTA TERMINALIS - MUSCULI PECTINATI - Fossa ovalis - Inferior vena cava - VALVE OF INFERIOR VENA CAVA - VALVES OF CORONARY SINUS - OPENING OF CORONARY SINUS - Right ventricle - Right auricle - Arch of aorta Internal view of right atrium.
41
Fig. 3.64 Label and caption the image.
- Superior vena cava - Right auricle - Right atrium - Tricuspid valve == Anterior cusp == Septal cusp == Posterior cusp - CHORDAE TENDINEAE - ANTERIOR PAPILLARY MUSCLE - TRABECULAE CARNEAE - POSTERIOR PAPILLARY MUSCLE - SEPTOMARGINAL TRABECULA - SEPTAL PAPILLARY MUSCLE - CONUS ARTERIOSUS - Pulmonary valve == Anterior semilunar cusp == Right semilunar cusp == Left semilunar cusp - Left auricle - Pulmonary trunk - Arch of aorta Internal view of the right ventricle.
42
Fig. 3.65 Label and caption the image
- Nodule - Pulmonary sinus - Pulmonary sinus - Nodule - Lunule - Left - Anterior - Right Semilunar cusps Posterior view of the pulmonary valve.
43
Fig. 3.66A Label and caption the image.
- Arch of aorta - LEFT AURICLE - Pulmonary arteries - PULMONARY VEINS - VALVE OF FORAMEN OVALE - Left atrium - Mitral valve - Left ventricle Left atrium. A. Internal view.
44
Fig. 3.66B Label and caption the image.
- Ascending aorta - Right pulmonary vein - Oesophagus - Right ventricle - Left atrium - Left pulmonary vein - Thoracic aorta Left atrium. B. Axial computed tomography image showing the pulmonary veins entering the left atrium.
45
Fig. 3.67 Label and caption the image.
- Arch of aorta - MITRAL VALVE ANTERIOR CUSP - CHORDAE TENDINEAE - ANTERIOR PAPILLARY MUSCLE - TRABECULAE CARNEAE - POSTERIOR PAPILLARY MUSCLE - MITRAL VALVE POSTERIOR CUSP - Coronary sinus - Left atrium - Pulmonary veins - Pulmonary arteries Internal view of the left ventricle.
46
Fig. 3.68 Label and caption the image.
- Nodule - Aortic sinus - Opening for right coronary artery - Aortic sinus - Lunule - Nodule - Left coronary artery - Right coronary artery - Right - Posterior - Left Semilunar cusps Anterior view of the aortic valve.
47
(IN THE CLINIC: Valve disease) What are the types of valve problems?
Two basic types: - Incompetence - Stenosis
48
(IN THE CLINIC: Valve disease) What does the term 'incompetence' mean in relation to valve problems?
Insufficiency
49
(IN THE CLINIC: Valve disease) What does incompetence (insufficiency) of valve problems arise from?
Incompetence, which results from poorly functioning valves
50
(IN THE CLINIC: Valve disease) What is stenosis of a valve?
A narrowing of the orifice
51
(IN THE CLINIC: Valve disease) What causes stenosis of a valve?
Stenosis, a narrowing of the orifice, caused by the valve's inability to open fully.
52
(IN THE CLINIC: Valve disease) What valve problem is present in mitral valve disease?
MITRAL VALVE DISEASE is usually a mixed pattern of stenosis and incompetence, one of which usually predominates.
53
(IN THE CLINIC: Valve disease) What do stenosis and incompetence of a valve lead to?
A poorly functioning valve and subsequent heart changes
54
(IN THE CLINIC: Valve disease) What heart changes occur in mitral valve disease?
- Left ventricular hypertrophy - Increased pulmonary venous pressure - Pulmonary oedema - Enlargement (dilation) and hypertrophy of the left atrium
55
(IN THE CLINIC: Valve disease) What happens to the left ventricle in mitral valve disease?
Left ventricular hypertrophy (this is appreciably less marked in patients with mitral stenosis)
56
(IN THE CLINIC: Valve disease) What happens to the left atrium in mitral valve disease?
Enlargement (dilation) and hypertrophy
57
(IN THE CLINIC: Valve disease) What happens to the pulmonary venous pressure in mitral valve disease?
Increases
58
(IN THE CLINIC: Valve disease) What is pulmonary oedema?
Fluid accumulation in the tissue and air spaces of the lungs
59
(IN THE CLINIC: Valve disease) What is mitral valve disease?
When the mitral valve does not close properly, leading to regurgitation (blood flowing back to the left atrium) or stenosis (valve narrowing).
60
(IN THE CLINIC: Valve disease) What are two types of aortic valve disease?
- Aortic stenosis | - Aortic regurgitation (backflow)
61
(IN THE CLINIC: Valve disease) What can aortic valve disease produce?
Both aortic stenosis and aortic regurgitation (backflow) can produce marked heart failure.
62
(IN THE CLINIC: Valve disease) What does valve disease in the right side of the heart affect?
The tricuspid or pulmonary valve
63
(IN THE CLINIC: Valve disease) What is valve disease in the right side of the heart most likely caused by?
Infection
64
(IN THE CLINIC: Valve disease) What does valve disease in the right side mean for the heart?
The resulting valve dysfunction produces abnormal pressure changes in the right atrium and right ventricle
65
(IN THE CLINIC: Valve disease) What can valve disease in the right side of the heart induce?
Cardiac failure
66
Fig. 3.69 Label and caption the image.
Anterior, Posterior, Left, Right labelled - Fibrous ring of pulmonary valve (Ant, Lt, Rt) - Fibrous ring of aortic valve (Lt, Rt, Post) - Right atrioventricular ring (Ant, Post, Septal) - Left atrioventricular ring (Ant, Post) - Left fibrous trigone - Right fibrous trigone - Atrioventricular bundle Cardiac skeleton (atria removed)
67
Fig. 3.70A Label and caption the image.
- Ascending aorta - Coronary sulcus - Marginal branches - POSTERIOR INTERVENTRICULAR BRANCHES - Apex - ANTERIOR INTERVENTRICULAR BRANCHES - Marginal branches Cardiac vasculature. A. Anterior view.
68
Fig. 3.70B Label and caption the image.
Anterior, Posterior, Left, Right - Aortic sinuses - Right atrioventricular opening - CORONARY SULCUS - CORONARY SINUS Cardiac vasculature. B. Superior view (atria removed).
69
Fig. 3.71A Label and caption the image.
- SINU-ATRIAL NODAL BRANCH OF RIGHT CORONARY ARTERY - RIGHT CORONARY ARTERY - Right atrium - Right ventricle - RIGHT MARGINAL BRANCH OF RIGHT CORONARY ARTERY - POSTERIOR INTERVENTRICULAR BRANCH OF RIGHT CORONARY ARTERY - DIAGONAL BRANCH OF ANTERIOR INTERVENTRICULAR BRANCH - Left ventricle - ANTERIOR INTERVENTRICULAR BRANCH OF LEFT CORONARY ARTERY - LEFT MARGINAL BRANCH OF CIRCUMFLEX BRANCH - CIRCUMFLEX BRANCH OF LEFT CORONARY ARTERY - Left auricle - LEFT CORONARY ARTERY A. Anterior view of coronary arterial system. Right dominant coronary artery.
70
Fig. 3.71B Label and caption the image.
- Right coronary artery - Right marginal branch - Posterior interventricular branch Left anterior oblique view of right coronary artery.
71
Fig. 3.71C Label and caption the image.
- Circumflex branch - Anterior interventricular branch - Left marginal branch Right anterior oblique view of left coronary artery.
72
Fig. 3.72 Label and caption the image.
- SINU-ATRIAL NODAL BRANCH OF LEFT CORONARY ARTERY - Right coronary artery - Right marginal branch of right coronary artery - POSTERIOR INTERVENTRICULAR BRANCH OF CIRCUMFLEX BRANCH OF LEFT CORONARY ARTERY - Diagonal branch of anterior interventricular branch - Anterior interventricular branch of left coronary artery - Left marginal branch of circumflex branch - Circumflex branch of left coronary artery - Left coronary artery Left dominant coronary artery
73
(IN THE CLINIC: Clinical terminology for coronary arteries) How are the coronary vessels named?
In practice, physicians use alternative names for the coronary vessels.
74
(IN THE CLINIC: Clinical terminology for coronary arteries) What is the short left coronary artery referred to as?
The LEFT MAIN STEM VESSEL
75
(IN THE CLINIC: Clinical terminology for coronary arteries) What is the left main stem vessel?
The short left coronary artery
76
(IN THE CLINIC: Clinical terminology for coronary arteries) Which coronary artery is shorter?
The left coronary artery
77
(IN THE CLINIC: Clinical terminology for coronary arteries) Where does the anterior interventricular artery arise from?
It is a primary branch of the left coronary artery
78
(IN THE CLINIC: Clinical terminology for coronary arteries) What is another name for the anterior interventricular artery?
The LEFT ANTERIOR DESCENDING ARTERY (LAD)
79
(IN THE CLINIC: Clinical terminology for coronary arteries) What is another name for the left anterior descending artery (LAD)?
Anterior interventricular artery
80
(IN THE CLINIC: Clinical terminology for coronary arteries) What is the terminal branch of the right coronary artery?
The posterior interventricular artery
81
(IN THE CLINIC: Clinical terminology for coronary arteries) What is the posterior interventricular artery sometimes known as?
The POSTERIOR DESCENDING ARTERY (PDA)
82
(IN THE CLINIC: Clinical terminology for coronary arteries) What is the posterior descending artery otherwise known as?
The posterior interventricular artery
83
(IN THE CLINIC: Heart attack) When does a heart attack occur?
When the perfusion to the myocardium is insufficient to meet the metabolic needs of the tissue.
84
(IN THE CLINIC: Heart attack) What does a heart attack lead to?
Irreversible tissue damage.
85
(IN THE CLINIC: Heart attack) What is the most common cause of a heart attack?
Total occlusion of a major coronary artery
86
(IN THE CLINIC: Heart attack) What causes occlusion of a major coronary artery?
Usually due to atherosclerosis
87
(IN THE CLINIC: Heart attack) What does atherosclerosis of a major coronary artery lead to?
Occlusion of it, leading to inadequate oxygenation of an area of myocardium and cell death (Fig. 3.73).
88
(IN THE CLINIC: Heart attack) What does atherosclerosis eventually cause?
Cell death.
89
(IN THE CLINIC: Heart attack) What is the severity of coronary artery disease related to?
- Size and location of the artery involved - Whether or not the blockage is complete - Any collateral vessels to provide perfusion to the territory from other vessels
90
(IN THE CLINIC: Heart attack) What can patients develop from coronary artery disease?
Depending on the severity, patients can develop pain (angina) or a myocardial infarction (MI).
91
(IN THE CLINIC: Heart attack) Fig. 3.73A Caption the image.
Axial maximum intensity projection (MIP) CT image through the heart. Normal anterior interventricular (left anterior descending artery).
92
(IN THE CLINIC: Heart attack) Fig. 3.73B Label and caption the image.
- Anterior interventricular artery Axial maximum intensity projection (MIP) CT image through the heart. Stenotic (calcified) anterior interventricular (left anterior descending) artery.
93
(IN THE CLINIC: Heart attack) Fig. 3.73C Label and caption the image.
- Anterior interventricular artery Vertical long axis multiplanar reformation (MRP) CT image through the heart. Normal anterior interventricular (left anterior descending) artery.
94
(IN THE CLINIC: Heart attack) Fig. 3.73D Caption the image.
Vertical long axis multiplanar reformation (MRP) CT image through the heart. Stenotic (calcified) anterior interventricular (left anterior descending) artery
95
(IN THE CLINIC: Heart attack) What is percutaneous coronary intervention (PCI)?
A technique in which long fine tube (a catheter) is inserted into the femoral artery in the thigh and passed through the external and common iliac arteries and into the abdominal aorta.
96
(IN THE CLINIC: Heart attack) Where is the catheter inserted in PCI?
In the femoral artery (thigh), or via radial (wrist) or brachial (elbow) arteries.
97
(IN THE CLINIC: Heart attack) What is the route of the catheter in a PCI?
- Femoral a. - External iliac a. - Common iliac a. - Abdominal aorta - Thoracic aorta - Origins of the coronary a.
98
(IN THE CLINIC: Heart attack) What is the procedure for a PCI?
1) Catheter inserted into femoral a. (or radial/brachial a.) 2) Follows course to coronary a. 3) Fine wire is passed into coronary a. in the catheter, to cross the stenosis 4) Fine balloon is passed over the wire and inflated at the level of the obstruction, thus widening it (angioplasty) 5) A fine wire mesh (stent) is
99
(IN THE CLINIC: Heart attack) Once the catheter has been inserted for a PCI, then what occurs?
A fine wire is then passed into the coronary artery
100
(IN THE CLINIC: Heart attack) What is the fine wire used for in a PCI?
To cross the stenosis
101
(IN THE CLINIC: Heart attack) Once the catheter and fine wire have been inserted into the patient, what is placed next in a PCI?
A fine balloon is then passed over the wire and may be inflated at the level of the obstruction, thus widening it; this is termed angioplasty.
102
(IN THE CLINIC: Heart attack) What is the fine balloon used for in a PCI?
To be inflated at the level of the obstruction, thus widening it.
103
(IN THE CLINIC: Heart attack) What is an angioplasty?
A term used to describe the minimally invasive procedure of widening a narrowed or obstructed artery.
104
(IN THE CLINIC: Heart attack) What is used to augment the angioplasty in a PCI?
Placement of a fine wire mesh (a stent) inside the obstruction to hold it open.
105
(IN THE CLINIC: Heart attack) What is used as a stent in a PCI?
A fine wire mesh
106
(IN THE CLINIC: Heart attack) What is the use of the stent in a PCI?
To augment the widening of the obstruction, holding it open.
107
(IN THE CLINIC: Heart attack) As well as a balloon angioplasty, what other types of percutaneous intervetions are there?
- Suction extraction of a coronary thrombus | - Rotary ablation of a plaque
108
(IN THE CLINIC: Heart attack) What is the most common procedure of a PCI?
Balloon angioplasty
109
(IN THE CLINIC: Heart attack) What is the first-line treatment for coronary artery disease?
Percutaneous coronary intervention - a non-surgical procedure used to treat narrowing of the coronary arteries
110
(IN THE CLINIC: Heart attack) What does percutaneous mean?
Made, done, or effected through the skin
111
(IN THE CLINIC: Heart attack) When is a coronary artery bypass graft (CABG) performed?
If coronary artery disease is too extensive to be treated by percutaneous intervention.
112
(IN THE CLINIC: Heart attack) If coronary artery disease is too extensive to be treated by percutaneous intervention, what treatment is performed next?
A coronary artery bypass graft
113
(IN THE CLINIC: Heart attack) What type of procedure is CABG?
Surgical
114
(IN THE CLINIC: Heart attack) What is the mechanism of CABG?
1) A blood vessel is taken from another part of your body e.g. leg (saphenous vein), chest (internal mammary artery), or arm (radial artery) to be harvested and used as a graft 2) These blood vessels are chosen because there is collateral supply to these areas to compensate for loss of these blood vessels after the operation 3) The number of blood vessels used will depend on the severity of disease 4) If you need 2, 3 or 4 grafts, this will be referred to as a double, triple or quadruple bypass. 5) The surgeon will perform a sternotomy to access your heart 6) The graft is used as a new route, to bypass the blocked sections of the coronary arteries https: //www.nhs.uk/conditions/coronary-artery-bypass-graft-cabg/what-happens/
115
(IN THE CLINIC: Heart attack) Which vessel is most commonly used in CABG to be harvested and used as a graft?
The great saphenous vein, in the lower limb (Gray's Anatomy for Students) The internal mammary artery, in your chest (NHS) - this is because this vessel doesn't narrow over time, unlike blood vessels taken from your leg or arm
116
(IN THE CLINIC: Heart attack) What is the purpose of the great saphenous vein in CABG?
It can be harvested and used as a graft
117
(IN THE CLINIC: Heart attack) Once a suitable vessel is chosen to be used as a graft for CABG, what occurs?
It is divided into several pieces, each of which is used to bypass blocked sections of the coronary arteries.
118
(IN THE CLINIC: Heart attack) Which vessels can be used as a graft in CABG?
``` The great saphenous vein (leg) The internal thoracic/mammary artery (chest) Radial arteries (arm) ```
119
(IN THE CLINIC: Common congenital heart defects) What are the most common abnormalities of the heart that occur during development?
Those produced by a defect in the atrial and ventricular septa
120
(IN THE CLINIC: Common congenital heart defects) Defects that occur in the atrial and ventricular septa are ...
The most common abnormalities that occur during development
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(IN THE CLINIC: Common congenital heart defects) What does a defect in the interatrial septum do?
Allows blood to pass from one side of the heart to the other from the chamber with the higher pressure
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(IN THE CLINIC: Common congenital heart defects) What problem allows blood to pass from one side of the atria to the other from the chamber with higher pressure?
A DEFECT IN THE INTERATRIAL SEPTUM
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(IN THE CLINIC: Common congenital heart defects) What is a cardiac shunt?
When blood passes abnormally from one side of the heart to the other from the chamber with the higher pressure; this is clinically referred to as a shunt.
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(IN THE CLINIC: Common congenital heart defects) What is the clinical term to describe blood passing abnormally from one side of the heart to the other?
This is clinically referred to as a SHUNT.
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(IN THE CLINIC: Common congenital heart defects) What is an atrial septal defect (ASD)?
When oxygenated blood flows from the left atrium (higher pressure) across the ASD into the right atrium (lower pressure).
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(IN THE CLINIC: Common congenital heart defects) What condition causes oxygenated blood to flow from the left atrium into the right atrium?
An ATRIAL SEPTAL DEFECT (ASD).
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(IN THE CLINIC: Common congenital heart defects) Which atria has the higher pressure?
Left (higher) | Right (lower)
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(IN THE CLINIC: Common congenital heart defects) What type of blood moves in an ASD?
Oxygenated blood from the left atrium, into the right atrium
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(IN THE CLINIC: Common congenital heart defects) What is the outcome for most patients with ASD?
Many patients with ASD are asymptomatic
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(IN THE CLINIC: Common congenital heart defects) What is the treatment for ASD?
Many patients are asymptomatic, but in some cases the ASD may need to be closed surgically or by endovascular devices
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(IN THE CLINIC: Common congenital heart defects) How can an ASD be closed?
- Surgery | - Endovascular devices
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(IN THE CLINIC: Common congenital heart defects) What are the complications of ASD?
Occasionally, increased blood flow into the right atrium over many years leads to - Right atrial hypertrophy - Right ventricular hypertrophy - Enlargement of the pulmonary trunk (resulting in pulmonary arterial hypertension)
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(IN THE CLINIC: Common congenital heart defects) Why can we get right-sided cardiac hypertrophy and enlargement of the pulmonary trunk in ASD?
Due to increased blood flow into the right atrium over many years
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(IN THE CLINIC: Common congenital heart defects) ASD may lead to hypertrophy of ____
The right atrium and ventricle
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(IN THE CLINIC: Common congenital heart defects) ASD may lead to enlargement of ___
The pulmonary trunk
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(IN THE CLINIC: Common congenital heart defects) Enlargement of the pulmonary trunk in ASD may result in ___?
Pulmonary arterial hypertension
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(IN THE CLINIC: Common congenital heart defects) Pulmonary arterial hypertension can be caused by ___?
Enlargement of the pulmonary trunk (such as in ASD, due to increased blood flow into the right atrium)
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(IN THE CLINIC: Common congenital heart defects) A patient presenting with right atrial and right ventricular hypertrophy, enlargement of the pulmonary trunk, and pulmonary arterial hypertension is suggestive of what?
Increased blood flow into the right atrium, therefore an ATRIAL SEPTAL DEFECT (ASD).
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(IN THE CLINIC: Common congenital heart defects) What is the most common congenital heart defect?
A VENTRICULOSEPTAL DEFECT (VSD)
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(IN THE CLINIC: Common congenital heart defects) What is a ventriculoseptal defect (VSD)?
The most common of all congenital heart defects, that occurs in the ventricular septum
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(IN THE CLINIC: Common congenital heart defects) What is the most common location for a VSD lesion to occur?
Membranous portion of the septum
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(IN THE CLINIC: Common congenital heart defects) What does a VSD do?
Moves blood from the left ventricle (higher pressure) to the right ventricle (lower pressure).
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(IN THE CLINIC: Common congenital heart defects) Which ventricle has higher pressure?
Left (higher) | Right (lower)
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(IN THE CLINIC: Common congenital heart defects) What complications does VSD lead to?
- Right ventricular hypertrophy | - Pulmonary arterial hypertension
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(IN THE CLINIC: Common congenital heart defects) What can be hypertrophied in a VSD?
Right ventricle
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(IN THE CLINIC: Common congenital heart defects) Where might hypertension occur in a VSD?
Pulmonary arteries
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(IN THE CLINIC: Common congenital heart defects) If a patient presents with right ventricular hypertrophy and pulmonary arterial hypertension, what is this suggestive of?
Blood moving abnormally from the left ventricle to the right ventricle, such as in a VENTRICULOSEPTAL DEFECT (VSD).
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(IN THE CLINIC: Common congenital heart defects) What treatment is there for VSD?
If large enough and left untreated, VSDs can produce marked clinical problems that might require surgery.
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(IN THE CLINIC: Common congenital heart defects) When is surgery required for a VSD?
If it is large enough and left untreated, causing marked clinical problems.
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(IN THE CLINIC: Common congenital heart defects) What connects the left branch of the pulmonary artery to the inferior aspect of the aortic arch?
DUCTUS ARTERIOSUS
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(IN THE CLINIC: Common congenital heart defects) What is the ductus arteriosus?
A blood vessel which connects the left branch of the pulmonary artery to the inferior aspect of the aortic arch.
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(IN THE CLINIC: Common congenital heart defects) What normally happens to the ductus arteriosus?
It closes at birth
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(IN THE CLINIC: Common congenital heart defects) What happens if the ductus arteriosus does not close at birth?
The oxygenated blood in the aortic arch (higher pressure) passes into the left branch of the pulmonary artery (lower pressure)
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(IN THE CLINIC: Common congenital heart defects) Which has higher pressure - the aortic arch or the pulmonary artery?
``` Aortic arch (higher) Pulmonary artery (lower) ```
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(IN THE CLINIC: Common congenital heart defects) What blood travels in a patent ductus arteriosus?
Oxygenated blood, from the aortic arch to the pulmonary artery.
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(IN THE CLINIC: Common congenital heart defects) What does a patent ductus arteriosus produce?
Pulmonary hypertension
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(IN THE CLINIC: Common congenital heart defects) What can pulmonary hypertension be indicative of?
A congenital heart defect, such as: - ATRIAL SEPTAL DEFECT (ASD) - VENTRICULOSEPTAL DEFECT (VSD) - PATENT DUCTUS ARTERIOSUS (PDA)
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(IN THE CLINIC: Common congenital heart defects) What is the term used for a ductus arteriosus that does not close at birth?
PATENT or PERSISTENT DUCTUS ARTERIOSUS (PDA)
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(IN THE CLINIC: Common congenital heart defects) What is a patent/persistent ductus arteriosus (PDA)?
A DUCTUS ARTERIOSUS that does not close at birth.
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(IN THE CLINIC: Common congenital heart defects) What sort of shunt does an ASD, VSD and PDA produce?
All of these defects produce a left-to-right shunt
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(IN THE CLINIC: Common congenital heart defects) Give examples of a left-to-right shunt.
- ATRIAL SEPTAL DEFECT (ASD) - VENTRICULOSEPTAL DEFECT (VSD) - PATENT DUCTUS ARTERIOSUS (PDA)
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(IN THE CLINIC: Common congenital heart defects) What occurs in a left-to-right (L-R) shunt?
Oxygenated blood from the left heart is being mixed with deoxygenated blood from the right heart before being recirculated into the pulmonary circulation
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(IN THE CLINIC: Common congenital heart defects) What blood is mixed in a L-R shunt?
Oxygenated blood from the left heart is being mixed with deoxygenated blood from the right heart
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(IN THE CLINIC: Common congenital heart defects) What blood is abnormal in a L-R shunt?
Oxygenated blood is being recirculated into the pulmonary circulation.
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(IN THE CLINIC: Common congenital heart defects) What is the prognosis for a L-R shunt?
These shunts are normally compatible with life, but surgery or endovascular treatment may be necessary.
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(IN THE CLINIC: Common congenital heart defects) What treatment is there for a L-R shunt?
- Surgery | - Endovascular treatment
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(IN THE CLINIC: Common congenital heart defects) How common are L-R and right-to-left (R-L) shunts?
L-R is more common | R-L is rare
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(IN THE CLINIC: Common congenital heart defects) What is the prognosis for a R-L shunt?
In isolation, this is fatal.
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(IN THE CLINIC: Common congenital heart defects) How is a R-L shunt viable for life?
In isolation this is fatal; however, this type of shunt is often associated with other anomalies, so some deoxygenated blood is returned to the lungs and the systemic circulation.
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(IN THE CLINIC: Common congenital heart defects) Where does deoxygenated blood go in a R-L shunt?
Due to other anomalies, some deoxygenated blood is returned to the lungs and the systemic circulation
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(IN THE CLINIC: Common congenital heart defects) Define pulmonary and systemic circulation.
Pulmonary circulation refers to the circulation of blood in which deoxygenated blood is pumped from the heart to the lungs and oxygenated blood is returned to back to the heart. Pulmonary circulation only occurs between the heart and the lungs. Systemic circulation refers to the circulation of blood in which oxygenated blood is pumped from the heart to the body and deoxygenated blood is returned back to the heart. Systemic circulation occurs between the heart and the entire body.
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(IN THE CLINIC: Common congenital heart defects) Define pulmonary circulation.
Pulmonary circulation refers to the circulation of blood in which deoxygenated blood is pumped from the heart to the lungs and oxygenated blood is returned to back to the heart. Pulmonary circulation only occurs between the heart and the lungs.
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(IN THE CLINIC: Common congenital heart defects) Define systemic circulation.
Systemic circulation refers to the circulation of blood in which oxygenated blood is pumped from the heart to the body and deoxygenated blood is returned back to the heart. Systemic circulation occurs between the heart and the entire body.
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(IN THE CLINIC: Cardiac auscultation) What does auscultation of the heart reveal?
The normal audible cardiac cycle
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(IN THE CLINIC: Cardiac auscultation) What does auscultation of the heart allow the clinician to do?
Assess heart rate, rhythm and regularity.
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(IN THE CLINIC: Cardiac auscultation) What can auscultation of the heart discern?
Cardiac murmurs that have characteristic sounds within the phases of the cardiac cycle can be demonstrated (Fig. 3.74).
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(IN THE CLINIC: Cardiac auscultation) Fig. 3.74 Label when the closure of the valves occur
- Closure of mitral and tricuspid valves | - Closure of aortic and pulmonary valves
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(IN THE CLINIC: Cardiac auscultation) Fig. 3.74 Label the red line.
VENTRICULAR PRESSURE | - Atrial contraction
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(IN THE CLINIC: Cardiac auscultation) Fig. 3.74 Label the blue line.
ECG | P Q R S T
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(IN THE CLINIC: Cardiac auscultation) Fig. 3.74 Label the green line.
HEART SOUNDS 1st 2nd 1st "lub" "dub" "lub"
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(IN THE CLINIC: Cardiac auscultation) Fig. 3.74 Indicate when systole and diastole occur.
SYSTOLE -- DIASTOLE -- SYSTOLE
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(IN THE CLINIC: Cardiac auscultation) Fig. 3.74 Label and caption the image.
- Closure of mitral and tricuspid valves - Closure of aortic and pulmonary valves VENTRICULAR PRESSURE - Atrial contraction ECG P Q R S T HEART SOUNDS 1st 2nd 1st "lub" "dub" "lub" SYSTOLE -- DIASTOLE -- SYSTOLE Heart sounds and how they relate to valve closure, the electrocardiogram (ECG), and ventricular pressure.
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(IN THE CLINIC: Classic symptoms of heart attack) What are the typical symptoms of heart attack?
Chest heaviness/pressure --- severe; >20 mins, + sweating. ``` Chest pain (Levine sign) --- often radiates to arms (left more commonly), +/- nausea ```
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(IN THE CLINIC: Classic symptoms of heart attack) How long can chest heaviness/pressure last in heart attacks?
If severe, >20 mins.
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(IN THE CLINIC: Classic symptoms of heart attack) What is chest heaviness/pressure often associated with in heart attacks?
Sweating
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(IN THE CLINIC: Classic symptoms of heart attack) How is the chest pain often described orally in a heart attack?
"elephant sitting on my chest"
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(IN THE CLINIC: Classic symptoms of heart attack) What physical cues might someone do to describe chest pain in a heart attack?
Clenched fist to describe the pain (Levine sign)
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(IN THE CLINIC: Classic symptoms of heart attack) How is chest pain often described in a heart attack?
"elephant sitting on my chest" or by using a clenched fist (Levine sign)
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(IN THE CLINIC: Classic symptoms of heart attack) What is Levine's sign?
A clenched fist held over the chest to describe a heart attack (ischaemic chest pain)
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(IN THE CLINIC: Classic symptoms of heart attack) Where does chest pain in heart attacks often radiate to?
The arms (left more common than the right)
191
(IN THE CLINIC: Classic symptoms of heart attack) Which arm does chest pain in heart attacks often radiate to?
Left more common than the right
192
(IN THE CLINIC: Classic symptoms of heart attack) Describe the chest heaviness associated with a heart attack.
(Chest heaviness or pressure, which can be severe, lasting more than 20 minutes, and often associated with sweating.)
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(IN THE CLINIC: Classic symptoms of heart attack) What can chest pain in a heart attack often be associated with?
Nausea
194
(IN THE CLINIC: Classic symptoms of heart attack) What is sweating often associated with in a heart attack?
Chest heaviness/pressure
195
(IN THE CLINIC: Classic symptoms of heart attack) What is nausea often associated with in a heart attack?
Chest pain
196
(IN THE CLINIC: Classic symptoms of heart attack) What does the severity of ischaemia and infarction depend on in a heart attack?
The rate at which the occlusion or stenosis has occurred and whether or not collateral channels have had a chance to develop (rate + collateral supply)
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(IN THE CLINIC: Classic symptoms of heart attack) The rate of what affects the severity of what in a heart attack?
The rate at which the occlusion or stenosis has occurred affects the severity of the ischaemia and infarction
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(IN THE CLINIC: Classic symptoms of heart attack) As well as rate, what else affects the severity of ___ in a heart attack?
Whether or not collateral channels have had a chance to develop affects the severity of the ischaemia and infarction
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(IN THE CLINIC: Are heart attack symptoms the same in men and women?) What are the typical symptoms of heart attack in men and women?
- severe chest pain - cold sweats - pain in the left arm
200
(IN THE CLINIC: Are heart attack symptoms the same in men and women?) Are heart attack symptoms the same in men and women?
Although men and women can experience the typical symptoms of severe chest pain, cold sweats, and pain in the left arm, women are more likely than men to have subtler, less recognisable symptoms
201
(IN THE CLINIC: Are heart attack symptoms the same in men and women?) Which group of people are more likely to have subtler, less recognisable symptoms in a heart attack?
Women (Gray's Anatomy for Students) Elderly Diabetes (NHS)
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(IN THE CLINIC: Are heart attack symptoms the same in men and women?) What are the more subtle symptoms of a heart attack?
- Abdominal pain - Achiness in the jaw or back - Nausea - Shortness of breath - Fatigue
203
(IN THE CLINIC: Are heart attack symptoms the same in men and women?) Why do heart attack symptoms differ in males and females?
The mechanism of this difference is not understood
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(IN THE CLINIC: Are heart attack symptoms the same in men and women?) Why is it important to know that heart attack symptoms differ in males and females?
It is important to consider cardiac ischaemia for a wide range of symptoms.
205
Fig. 3.75A Label and caption the image.
- Anterior veins of right ventricle - Coronary sinus - Small cardiac vein - Right marginal vein - Middle cardiac vein - Anterior interventricular vein - Great cardiac vein Major cardiac veins. A. Anterior view of major cardiac veins.
206
Fig. 3.75B Label and caption the image.
- Great cardiac vein - Posterior cardiac vein - Coronary sinus - Small cardiac vein - Middle cardiac vein Major cardiac veins. B. Posteroinferior view of major cardiac veins.

ESA 3 - Respiratory (28 decks)

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