Thoracic Cardiology

Question 1

What are the superior and inferior borders of the superior mediastinum?

Answer 1

superior - superior thoracic aperture

inferior - sternal angle

Question 2

What are the superior and inferior borders of the inferior mediastinum?

Answer 2

superior - sternal angle

inferior - inferior thoracic aperture

Question 3

What are the divisions of the inferior mediastinum?

Answer 3

anterior (in front of the heart)
middle (where the heart is)
posterior

Question 4

What are the layers of the pericardium, superficial to deep?

Answer 4

fibrous pericardium
parietal serous pericardium
pericardial cavity
visceral serous pericardium (epicardium)

Question 5

Where is the transverse pericardial sinus?

Answer 5

traverses between the arterial and venous vessels at the superior part of the heart

Question 6

What is the surgical significance of the transverse pericardial sinus?

Answer 6

allows access to the area posterior to the aorta and pulmonary trunk to clamp or insert tubes of a bypass machine into these vessels

Question 7

What is the oblique pericardial sinus?

Answer 7

wide recess posterior to the base of the heart

-not a passage … just a result of the way the veins “fan out”

Question 8

Delineate the flow of blood through the heart.

Answer 8

superior and inferior vena cava … R atrium … tricuspid valve … R ventricle … pulmonary valve … pulmonary trunk … pulmonary A. … lungs … pulmonary V. … L atrium … bicuspid valve … L ventricle … aortic valve … ascending aorta

Question 9

What are the borders of the heart?

Answer 9

right - R atrium
inferior - R ventricle
left - L ventricle
superior - L atrium

Question 10

What are the surfaces of the heart?

Answer 10

pulmonary - R atrium and L ventricle
diaphragmatic - R and L ventricles
sternocostal - R ventricle

Question 11

What is the groove between the R atrium and the R ventricle and what vessel(s) runs there?

Answer 11

right atrioventricular groove

right coronary A.

Question 12

What is the groove on the anterior side of the heart between the two ventricles and what vessel(s) run there?

Answer 12

anterior interventricular groove
anterior interventricular A.
great cardiac V.

Question 13

What is the groove on the posterior side of the heart between the left atrium and left ventricle and what vessel(s) run there?

Answer 13

left atrioventricular groove

coronary sinus

Question 14

What is the groove on the posterior side of the heart between the two ventricles and what vessel(s) run there?

Answer 14

posterior interventricular groove
posterior interventricular A.
middle cardiac V.

Question 15

In the right atrium, what is the structure separating the smooth wall from the rough wall?

Answer 15

crista terminalis

Question 16

In the right atrium, what is the rough wall?

Answer 16

pectinate m.

Question 17

What are the pocket-like embryological remnants of the splitting into a right and left atrium?

Answer 17

right and left auricles

Question 18

What is the smooth wall of the right atrium?

Answer 18

sinus venarum

• posterior
• thin-walled region where the venae cavae and coronary sinus empty

Question 19

Where is the fossa ovalis and what is it?

Answer 19

on the interatrial septum in the right atrium

-embryological remnant of the foramen ovalis

Question 20

In what heart chamber is the opening for the coronary sinus?

Answer 20

right atrium

Question 21

Where is the tricuspid valve?

Answer 21

separating the right atrium from the right ventricle

Question 22

What are the names of the cusps of the tricuspid valve?

Answer 22

anterior
posterior
septal

Question 23

What attaches each cusp to its corresponding papillary muscle?

Answer 23

chordae tendinae

Question 24

What is the name of the rough wall in the right ventricle?

Answer 24

trabecula carnae

Question 25

Where is the septomarginal trabeculum (aka moderator band)?

Answer 25

in the right ventricle, runs from interventricular septum to the base of the anterior papillary muscle

Question 26

What is housed in the septomarginal trabeculum?

Answer 26

right bundle branch of the atrioventricular bundle

Question 27

What is the name of the smooth wall in the right ventricle?

Answer 27

conus ateriorsus

Question 28

The conus arteriosus is near the entrance to which great vessel?

Answer 28

pulmonary trunk

Question 29

Where is the pulmonary valve?

Answer 29

separates the right ventricle from the pulmonary trunk

Question 30

What are the names of the cusps of the pulmonary valve?

Answer 30

right left anterior

Question 31

What is the pulmonary sinus?

Answer 31

space b/w the wall of the pulmonary trunk and the cusps -"disappears" when the valve is open for blood flow

Question 32

Which walls are thicker, the right atrium or the left atrium?

Answer 32

left

Question 33

Which openings are in the left atrium?

Answer 33

4 pulmonary veins

Question 34

Where is the bicuspid valve?

Answer 34

separating the left atrium from the left ventricle

Question 35

What are the names of the cusps of the bicuspid valve?

Answer 35

anterior | posterior

Question 36

What is the name of the rough wall in the left ventricle?

Answer 36

trabecula carnae

Question 37

What is the aortic vestibule?

Answer 37

smooth wall in the left ventricle before entry into the ascending aorta

Question 38

What is housed inside the interventricular septum?

Answer 38

atrioventricular bundle right bundle branch left bundle branch

Question 39

What are the two parts of the interventricular septum?

Answer 39

``` fibrous part muscular part (larger) ```

Question 40

Where is the aortic valve?

Answer 40

separating the left ventricle from the ascending aorta

Question 41

What are the names of the cusps of the aortic valve?

Answer 41

left right posterior

Question 42

What openings are in the walls of the aortic sinuses?

Answer 42

right - right coronary A. | left - left coronary A.

Question 43

Where is the tricuspid valve in relation to other thoracic structures?

Answer 43

posterior to the body of the sternum and the level of the 4th and 5th intercostal spaces

Question 44

Where is the pulmonary valve in relation to other thoracic structures?

Answer 44

at the level of the 3rd costal cartilage

Question 45

Where is the bicuspid valve in relation to other thoracic structures?

Answer 45

posterior to the sternum, at the level of the 4th costal cartilage

Question 46

Where is the aortic valve in relation to other thoracic structures?

Answer 46

posterior to the left side of the sternum, at the level of the 3rd intercostal space

Question 47

What is the fibrous skeleton of the heart comprised of?

Answer 47

dense collagenous fibers

Question 48

What are the functions of the fibrous skeleton?

Answer 48

- attachment for myocardium and valves - supports and strengthens the atrioventricular and semilumar orifices -electrical barrier b/w atria and ventricles

Question 49

What happens at the beginning of diastole?

Answer 49

aortic and pulmonary valves close due to a drop in ventricular pressure

Question 50

What happens in early diastole?

Answer 50

-heart lengthens as the ventricles relax - atrioventricular valves open - blood enters ventricles

Question 51

What happens at the end of diastole?

Answer 51

atrial contraction to expel blood into the ventricles

Question 52

What happens at the beginning of systole?

Answer 52

atrioventricular valves close due to increased ventricular pressure

Question 53

What happens in early systole?

Answer 53

ventricles begin to contract -increased pressure opens the pulmonary and aortic valves

Question 54

What happens at the end of systole?

Answer 54

full ventricular contraction and expel blood into the pulmonary trunk and aorta

Question 55

What is the sinuatrial node?

Answer 55

self-initializing collection of cardiac muscle fibers capable of creating its own action potential

Question 56

What does the atrioventricular node do?

Answer 56

receives signals from the SA node

Question 57

Which walls are thicker, atria or ventricles?

Answer 57

ventricles

Question 58

What structures help propagate the electric signal through the ventricle walls?

Answer 58

atrioventricular bundle R and L bundle branches subendocardial branches

Question 59

What is a myocardial infarction?

Answer 59

lack of blood flow to a specific area of myocardium

Question 60

What are usual causes of a myocardial infarction?

Answer 60

- blockage of a coronary artery - coronary atherosclerosis - buildup of lipids on internal walls of coronary A.

Question 61

What is angina pectoris?

Answer 61

pain that originates in the heart and produces a strangling pain in the chest

Question 62

What is a typical cause of angina pectoris?

Answer 62

- narrow or obstructed coronary A. that produces ischemia of myocardium - pain that accompanies a myocardial infarction

Question 63

Pathology: Ligamentum Arteriosum

Answer 63

-embryological remnant of the ductus arteriosus

Question 64

What is the ductus arteriosus?

Answer 64

-connection b/w the pulmonary trunk and the aortic arch during the fetal stage of development

Question 65

What is the clinical implication of the ligamentum arteriosum?

Answer 65

it leaves a weak spot in the wall of the aortic arch that is susceptible to aneuryms

Question 66

What nerve would be affected by an aortic aneurysm at the site of the ligamentum arteriosum?

Answer 66

left recurrent laryngeal A.

Question 67

What parts of the heart are accessible through a cardiac catheterization and which vein is used for the access?

Answer 67

- right atrium, right ventricle, pulmonary trunk and pulmonary arteries - inserted into femoral V. and passed up into the inferior vena cava

Question 68

Why is the interventricular septum prone to defects?

Answer 68

it is comprised of two embryologically divergent tissues

Question 69

What is the result of atrial septal defects and ventricular septal defects?

Answer 69

mixing of oxygenated and de-oxygenated blood

Question 70

Where is an artificial pacemaker placed?

Answer 70

into the superior vena cava and down into the trabecula carnae of the right ventricle

Question 71

Pathology: Pericarditis

Answer 71

- inflammation of the pericardium - rough pericardium = friction - can be observed w/ a stethoscope - untreated = pericardium can calcify

Question 72

Pathology: Pericardial Effusion

Answer 72

- inflammation of the pericardium can result in fluid or pus in the pericardial sac - can compress the heart = cardiac tamponade

Question 73

Pathology: Pericardiocentesis

Answer 73

- drainage of blood, fluid, or pus from the pericardial sac | - usually done to relieve cardiac tamponade