Thoracic Cavity Flashcards
(206 cards)
1
Q
the chest cavity is bounded by the ____ and below by the _____
A
bound by chest wall and inferiorly to diaphragm
2
Q
superiorly the thoracic cavity extends _____ and inferiorly the thoracic cavity goes to the _____
A
superiorly the thoracic cavity extends upward into the root of the neck about one finger-breadth above the clavicle on each side. Inferiorly the chest cavity goes to the diaphragm
3
Q
the chest cavity divided by a median partition called the ____ and laterally placed by ____
A
median partition is the mediastinum, laterally placed by the pleurae and lungs
4
Q
the sternal angle is used to find the position of rib _____ as a reference for counting ribs.
A
rib 2
5
Q
The sternal angle separates the _____ from the ______ mediastinum. It also marks the position of the superior limit of the ____ and where _____ begins and ends. The sternal angle also has what structure in the area aortic arch and pulmonary arch? it used to old remnant
A
the sternal angle (position of rib 2) separates the superior mediastinum from the inferior mediastinum. It marks the position of the superior limit of the pericardium and also marks where the arch of the aorta begins and ends. the ligamentum arterosium also here
6
Q
the sternal angle marks the superior limit of the _____ trunk. Also has the connection to the aortic arch called
A
pulmonary trunk, the connection of pulmonary trunk to aortic arch is the ligamentum arterosium
7
Q
the sternal angle is found at rib __ and creates the ____ plane when it transverses between the IVDs of what vertebrae
A
rib 2, creates the transverse thoracic plane as it goes posteriorly to pierce the IVD between T4 and T5
8
Q
the sternal angle marks the _____ of the trachea into the _____
A
bifurcation of trachea into left and main bronchi
9
Q
the sternal angle marks the passage of the ____ from right to left posterior to the esophagus
A
thoracic duct
10
Q
the sternal angle passes through the site the _____ penetrates the pericardium to enter the heart
A
superior vena cava
11
Q
the sternal angle has this nerve through it
A
the loop of left recurrent laryngeal nerve around aortic arch
12
Q
the mediastinum houses all of the organs between
A
the left and right mediastinal pleurae
13
Q
the extent of anteroposterior mediastinum
A
extends from the sternum anteriorly to the vertebral column posteriorly
14
Q
the extent of superoinferior mediastinum
A
superiorly from thoracic inlet to diaphragm inferiorly
15
Q
the demarcation of mediastinum aka the transverse thoracic plane is marked by what
A
mediastinum divided into superior and inferior mediastina by imaginary plane passing from sternal angle anteriorly to the lower border of body of T4 posteriorly
16
Q
the inferior mediastinum is divided into:
A
anterior, middle, and posterior
17
Q
is the superior mediastinum divided?
A
no, just inferior mediastinum. Into anterior, middle, and posterior
18
Q
the superior mediastinum is bounded by?
A
Superior: thoracic inlet
inferior: plane extending from level of sternal angle anteriorly to lower border of T4 vertebra posteriorly (transverse thoracic plane)
anterior: the manubrium sterni
posterior: the first four thoracic vertebrae T1-T4
19
Q
superficial/anterior contents of superior mediastinum?
A
-thymus
large veins:
- left brachiocephalic vein and right brachiocephalic vein, -superior vena cava
20
Q
middle contents of superior mediastinum?
A
- aortic arch and 3 branches
- phrenic nerve
- vagus nerve
21
Q
posterior contents of superior mediastinum?
A
trachea, esophagus, thoracic duct
22
Q
the inferior mediastinum is bounded by?
A
bounded in front of the body of the sternum and behind by the lower eight thoracic vertebrae T5-T12
23
Q
the anterior aspect of the inferior mediastinum is located and contains?
A
located: between posterior body of the sternum and attached costal cartilages and goes to the pericardium
contains: fat, remnants of thymus gland, anterior mediastinal lymph nodes
24
Q
the middle aspect of the inferior mediastinum is located and contains?
A
located: between anterior mediastinum and posterior mediastinum
contains: heart and pericardium, beginning or termination of great vessels, phrenic nerves, pericardiophrenic vessels, lymph nodes
25
the posterior aspect of the inferior mediastinum is located and contains?
located: posterior to heart and pericardium, anterior to vertebrae T5-T12
contains: esophagus, vagus nerve, thoracic aorta, azygos system of veins, thoracic duct, thoracic sympathetic trunk, posterior mediastinal lymph nodes
26
the pleurae and lungs lie ______ within the ______
on either side of the mediastinum within the chest cavity
27
each pleura has two parts which are:
the parietal layer and the visceral layer
28
the two layers of the pleura are continuous with each other by the means of ?
a cuff of pleura
29
the pleura cuff surrounds ______ and hangs down as a loose fold called _______
the cuff surrounds the structures entering and leaving the lung at the hilum of each lung. The pleural cuff hangs down as a loose fold called the pulmonary ligament
30
the parietal pleura lines _____ and covers ________ it extends into the root of the ________ to line the undersurface of the ________ at the thoracic outlet
the parietal pleura lines the thoracic wall, covers the thoracic surface of the diaphragm and the lateral aspect of the mediastinum. It extends into the root of the neck to line the undersurface of the supra-pleural membrane (Sibson's fascia) at the thoracic outlet/inlet
31
the visceral layer of pleura covers _____ and extends into?
completely covers the surface of the outer surface of the lungs and extends into the depths of the interlobar fissures
32
the pleural cavity or space are formed by _____. clinicians use the term pleural _____ instead of anatomic term _______. The pleural cavity contains _____ called ______. The fluid permits the two layers to _____ with minimum______
the pleural cavity- anatomical term
pleural space- clinical term
is a slitlike space formed by the seperation of the parietal and visceral layers.
Inside the space or cavity is the pleural fluid which is a thin film of tissue fluid
the fluid allows movement between the layers on each other with minimum friction
33
the parietal pleura is divided into:
the region in which it lies or the surface it covers
cervical
costal
diaphragmatic
mediastinal
34
the cervical parietal pleura extends where? what does it line?
the cervical pleura extends up into the neck, it lines the undersurface of the supra-pleural membrane (Sibson's Fascia). It reaches a level of 1-1.5 inches or 2.5-4 cm above the medial third of the clavicle
35
the costal parietal pleura lines what structures?
it lines the inner surfaces of the:
- ribs
- costal cartilages
- intercostal spaces
- sides of the verterbral bodies
- back of the sternum
36
the diaphragmatic parietal pleura covers?
covers the thoracic surface of diaphragm
37
in quiet respiration, the ____ and ____ pleurae are in apposition to each other below the ________ of the lung. These two pleura ______ during _____ inspiration.
the diaphragmatic and costal pleurae are in apposition to each other below the lower border of the lung. These two pleura separate during deep inspiration.
38
the costophrenic aka costodiaphragmatic recess is?
the lower area of the pleural cavity into which the lung expands on inspiration is referred to as the costodiaphragmatic recess
39
the mediastinal parietal pleura covers:
it covers and forms the lateral boundary of the mediastinum. It is reflected as a cuff around the vessels and bronchi at the hilum of the lung. It then continues with the visceral pleura.
40
each lung lies free except at the ____ , it is attached to the _____ that constitute to lung _____
hilum, it is attached to the blood vessels and bronchi that constitute the lung root
41
during full inspiration, the lungs?
the lungs expand and fill the pleural cavities
42
during quiet inspiration, the lungs _____ occupy the pleural cavities at four sites, which are _____?
they do not fully occupy the pleural cavities at four sites,
- the right and left costodiaphragmatic recesses
- the right and left costomediastinal recesses
43
the costodiaphragmatic recesses are ____ and are separated only by ____
they are slitlike spaces between the costal and diaphragmatic parietal pleurae, separated only by a capillary later of pleural fluid
44
during inspiration, the lower margins of the lungs do what?
the lower margins of the lungs descend into the recesses
45
during expiration, the lower margins of the lungs do what?
the lower margins of lungs ascend so that the costal and diaphragmatic parietal pleurae come together again
46
the costomediastinal recesses are situated where? What are they? Separated by what?
They are situated along the anterior margins of the pleura. They are slitlike spaces between the costal and the mediastinal parietal pleurae. Separated by a capillary layer of pleural fluid
47
during inspiration and expiration what do the lungs do in the costomediastinal recesses?
the anterior borders of the lungs slide in and out of the recesses
48
the parietal pleura is sensitive to ?
pain, temperature, touch, and pressure
49
the costal pleura is segmentally supplied by what nerve(s)
the intercostal nerves
50
the mediastinal pleura is supplied by what nerve?
the phrenic nerve
51
the diaphragmatic pleura is supplied by what nerve?
the pleura over the domes of diaphragm are supplied by the phrenic nerve.
the periphery of the diaphragmatic pleura is supplied by the lower 6 intercostal nerves (spinal nerves T7-12)
52
the lungs are describe, located where, color, and shape?
a pair of soft, spongy, elastic structure in the thoracic cavity.
The lie on each side of the mediastinum.
In child they are pink but becomes darker with age with the inhalation of dust particles.
the shape: each lung is conical covered with visceral pleura and suspended free in its own pleural cavity
53
the apex of lung is what shape
blunt, but comes to blunt point
54
the base of lung sits on what
the diaphragm
55
the costal surface of the lung corresponds to_____ the mediastinal surface contains a depression called the ______ which is a passage way for what structures?
The costal surface corresponds to the chest.
The mediastinal surface contains a depression called the hilum in the middle. The hilum is a passageway for the bronchi, vessels, and nerves to enter and leave the lung through the hilum
56
the anterior border of the lung
left lung is thin and overlaps the heart, has cardiac notch
57
the posterior border of the lung
is thick, rounded, and lies beside the vertebral column
58
each lung is divided into ____. Each _____ bronchus, which passes to a lobe of the lung, gives off branches called _____ bronchi.
each lung is divided into lobes. Each lobar or secondary bronchus, which passes to a lobe of the lung, gives off branches called segmental or (tertiary) bronchi.
59
each segmental bronchus passes to a structurally and functionally independent unit of a lung lobe called a ______ which is surrounded by ______. On entering a BPS, each ______ divides repeatedly.
segmental bronchus forms the bronchopulmonary segments which is functionally independent and is surrounded by connective tissue
60
bronchopulmonary segments summarized as what?
- subdivision of a lung lobe
- pyramid shaped with apex toward the lung root
- surrounded by connective tissue
- has a segmental bronchus, a segmental artery, lymph vessels, and autonomic nerves
- the segmental vein lies in the connective tissue between adjacent bronchopulmonary segments
- because it is a structural unit, a diseases segement can be removed surgically
61
the right lung lobes are ___ than the left and are divided by the ______ and _____ fissures? what separates what
the right lung is larger and the lobes are divided by the oblique and horizontal fissures. The horizontal fissure is most superior and creates superior and middle lobe. The oblique fissure is oblique in orientation and separates the middle lobe and lower lobe
62
the superior lobe of R lung has what segments?
apical, posterior, and anterior
63
the middle lobe of R lung has what segments?
lateral and medial
64
the inferior lobe of R lung has what segments?
superior (apical), medial basal, anterior basal, lateral basal, and posterior basal
- note, same as inferior lobe of L lung
65
the left lung is divided by an _____ fissure into ______ lobes, the ______. There is no _____ fissure in the left lung.
left lung divided into 2 lobes by the oblique fissure, the upper and lower lobes. There is no horizontal fissure in the left lung.
66
the superior or upper lobe of left lung divided into what segments
apical, posterior, anterior,
superior lingual, and inferior lingual
67
the inferior or lower lobe of left lung divided into what segments
superior (apical), medial basal, anterior basal, lateral basal, and posterior basal
-note, same as inferior lobe of R lung
68
the root of the lung is formed by structures that are _____ the lung, which are what structures? the root is surrounded by what?
formed by structures entering and leaving.
They are:
1 pulmonary artery, 2 pulmonary veins, 1 main bronchus, bronchial vessels, nerves, and lymphatics
the root of the lung is surrounded by a tubular sheath of pleura which joins the mediastinal parietal pleura to the visceral pleura covering the lungs
69
blood supply to the bronchi, connective tissues of the lung and visceral pleura supplied by what____ which is a branch of ____
supplied by bronchial arteries which are branches of the thoracic aorta
70
the bronchial vein drain into?
into the azygos and hemiazygos vein
71
___ pulmonary veins leave each lung root to empty into the ____
2 pulmonary veins leave each lung root to empty into the left atrium of heart
72
the right bronchial artery originates from
the 3rd posterior intercostal artery or the upper left bronchial artery
73
the two left bronchial arteries come from?
both from the anterior surface of the thoracic aorta.
the superior left bronchial artery; arises at vertebral level T5
the inferior left bronchial artery; arises below the left bronchus
74
nerve supply to bronchi
the pulmonary plexus composed of autonomic nerve fibers of sympathetic and parasympathetic from the vagus nerve
75
sympathetic efferent fibers produce what effect
bronchodialtion and vasoconstriction
76
parasympathetic efferent fibers produce what effect
bronchoconstriction, vasodilation, and increased glandular secretion
77
afferent supply from _____ and from _____ receptors in the alveolar walls pass to the central nervous system in both ______ and _____ nerves
bronchial mucous membrane and from stretch receptors in the alveolar walls pass to the CNS in both sympathetic and parasympathetic nerves
78
lymph drainage of lungs divided into:
superficial and deep
79
superficial lymph drainage of lungs consists of
- drainage of lung surface
- lies beneath the visceral pleura and drains over the surface of the lung toward the hilum
- drain into lymph vessels of the bronchopulmonary nodes
80
deep lymph drainage of lungs drains what and describe its course
the deep drainage drains the bronchial tree, pulmonary vessels, and connective tissues
- travels along the bronchi and pulmonary vessels toward the hilum of the lung
- passes through the pulmonary nodes located within the lung substance
- the lymph then enters the bronchopulmonary nodes in the hilum of the lung
- finally, into the bronchomediastinal trunk and to the thoracic duct, right lymphatic duct or brachiocephalic veins
note- lymph vessels are not present in alveolar walls
81
the pericardium is a _____ layered ______ that encloses the _____ and the roots of _______
double layered fibrous sac that encloses the heart and the roots of the great vessels
82
the two main functions of the pericardium?
the pericardium is to restrict excessive movements of the heart as a whole and to serve as a lubricated container in which the different parts of the heart can contract
83
the pericardium is located
in the middle mediastinum, about 1-1.5 cm to the right of the sternum, 5-7.5 cm to the left of the median plane at the level of the 5th intercostal space
84
the boundaries of the pericardium, anterior and posterior
anterior: body of the the sternum and the 2nd to the 6th costal cartilages
posterior: 5th to 8th thoracic vertebrae
85
the fibrous layer of the pericardium is and what is its function
the strong outer layer, composed of tough fibrous tissue. It protects the heart against sudden overfilling
86
serous layer is a transparent membrane with how many layers and what are they?
the inner transparent membrane has 2 layers the parietal and visceral layer
87
superiorly the fibrous layer of pericardium is pierced by which structures and becomes fused with?
the superior border of the pericardium is pierced by the aorta, pulmonary trunk, and superior vena cava
it becomes fused with the central tendon of the diaphragm
88
interiorly the fibrous layer of pericardium rests on _____ and is fused with_______
the inferior border rests on the diaphragm and is fused with the central tendon of the diaphragm
89
anteriorly the fibrous layer is attached to the?
the anterior pericardium is attached to the posterior surface of sternum by condensations of connective tissue called the sternopericardial ligaments
90
posteriorly the fibrous pericardium is pierced by which structures? and fuses with the ?
pierced by the pulmonary veins and inferior vena cava. it fuses with the tunica adventitia of these vessels (the aorta, the pulmonary trunk, the superior and inferior vena cava, and the pulmonary veins)
91
the parietal layer of the serous layer of the pericardium lines what and becomes what?
the parietal layer lines the fibrous pericardium and becomes continuous with the visceral layer around the roots of the great vessels
92
the visceral layer of the serous layer of the pericardium lines what and becomes what?
the visceral layer reflected onto the heart or closely applied to the heart is often called the epicardium which is the external layer of the heart wall (epicardium)
93
the two layers of the _____ are continuous with each other at the base of the _____
the two laters of the serous membrane of the pericardium are continuous with each other at the base of large vessels
94
the pericardial cavity lies between _______ and contains a thin _______ of which helps in frictionless movement of the heart (about how much?)
the pericardial cavity is potential space that lies between parietal and visceral pericardium. It contains a small amount of serous fluid called the pericardial fluid, about 50 mLs
95
the pericardial sinuses develop when?
during the folding of embryonic heart
96
the two pericardial sinsues are the _____ and______
transverse and oblique sinus
97
the transverse sinus is located where and communicates with what where?
the transverse sinus lies posterior to the ascending aorta and pulmonary trunk, anterior to the superior vena cava
it communicates with the main part of the pericardial cavity at its right and left ends
98
the oblique sinus is what and is located where? it is produced by what?
the oblique sinus is an inverted U-shaped blind recess that lies posterior to the heart extending posterior to the left atrium, can be entered inferiorly
it is produced by the reflection of pericardium onto the pulmonary veins and inferior vena cava
99
the fibrous pericardium is innervated by
the phrenic nerve
100
the parietal pericardium is innervated by
the phrenic nerve
101
the visceral pericardium is innervated by
sympathetic trunk and parasympathetic fibers of the vagus nerves
102
the arterial supply to the fibrous pericardium is from what arteries
- pericardiophrenic artery
- musculophrenic artery (branches of internal thoracic)
- pericardial branches of the bronchial, esophageal, and superior phrenic arteries
103
the parietal layer of the serous pericardium is supplies by what arteries
- pericardiophrenic artery
- musculophrenic artery (branches of internal thoracic)
- pericardial branches of the bronchial, esophageal, and superior phrenic arteries
104
the visceral layer of the serous pericardium (epicardium) is supplied by what arteries
the coronary arteries
105
the venous drainage of the pericardium is by which veins
veins are tributaries of the azygos system
| pericardiophrenic veins also drain into the internal thoracic vein
106
pericarditis
inflammation of the pericardium which results in build up fluid, pericardial effusion- accumulation of fluid in pericardial space (ie between visceral and parietal pericardium)
107
cardiac tamponade
accumulation of fluid in the pericardial space, whether from bleeding, over production of pericardial fluid or other causes results in increased pericardial pressure and eventual progressively reduced ventricular filling, severe compression on the heart from build up of fluid in
slow accumulation of fluid can allow pericardium to stretch, can hold up to a liter of fluid in the space
fast accumulation, as with severe bleeding, allows no time for stretching of the pericardium and can lead to tamponade with as little as 100 mL of fluid
tamponade is a medical emergency, the complications include pulmonary edema, shock, and death unless the fluid is drained
108
friction rub
the rubbing/friction of heart against the pericardium creates sound known as heart rub- signs of pericarditis
109
pericardiocentesis
a wide bore needle may be inserted through the left 5th and 6th intercostal space near the sternum (area of cardiac notch). Intracardial injections are also given through this area
110
the heart characteristics basic and location
the heart is a hollow muscular organ and has a conical or somewhat pyramid shape.
It lies within the pericardium in the mediastinum.
it is connected at its base to the great blood vessels but otherwise lies free within the pericardium. Although, the fibrous pericardium is connected to the diaphragm, the heart rises and falls with every breath
111
the features of heart surface
the sternocostal (anterior) surface
diaphragmatic surface (inferior)
base (posterior surface)
apex
112
the sternocostal surface of the heart is formed mainly by what chambers
the right atrium and right ventricle separated by the vertical atrioventricular groove
113
the anterior inter-ventricular groove separates
the right ventricle from the left ventricle
114
the diaphragmatic surface is formed mainly by what chambers separated by what structure
the diaphragmatic surface is formed mainly by the right and left ventricles separated by posterior interventricular groove, and a small part of the right atrium, into which the inferior vena cava opens
115
the base (posterior surface of heart) is formed mainly by what chamber and opens to what structures, what is the shape? which way does it face?
the base or posterior surface of the heart is formed mainly by the left atrium, into which open the 4 pulmonary veins. It is quadrilateral in shape. Lies opposite the apex. Faces posteriorly, superiorly, and toward the right shoulder.
116
the apex of the heart is formed by what structure
the left ventricle
117
the apex of the heart is directed in which direction
directed downward, forward and to the left
inferiorly, anteriorly, and to left
118
the apex of the heart is located?
located posterior to the left 5th intercostal space, 7-9 cm from the median plane just medial to the left midclavicular line
position varies slightly with the person's position and the phase of respiration
119
the apex is the point of what and can be _____ as well as palpated
the apex is the point of maximal pulsation of the heart (the apex can be seen as well as palpated)
120
the right border of the heart is formed by
the right border is formed by the right atrium
121
the left border of the heart is formed by
formed by left auricle above and the left ventricle below
122
the inferior border is formed mainly by
the right ventricle and right atrium , also apex of left ventricle
123
the superior border (where great vessels enter or leave the heart) is formed by the
formed by right and left auricles and superior part of right and left ventricle
124
the chambers of the heart are divided into how many chambers by what structure
the heart is divided into 4 chambers by vertical septa
125
the 4 chambers of the heart and their location
- two atria superiorly, two ventricles inferiorly
| - separated from each other by atrioventricular and inter-ventricular grooves
126
_____ are the retrieving chambers
atria
127
______ are the pumping chambers
ventricles
128
the right atrium lies _____ to the left atrium
anterior
129
the right ventricle lies ______ to the left ventricle
anterior
130
right side of the heart contains _____ blood and the left side of the heart contains ______ blood
deoxygenated on right
| oxygenated on left
131
the right atrium has which features
- external auricle
- anterior coronary veins
- opening for SVC and IVC
- opening for coronary sinus (drains coronary veins)
- fossa ovalis
- pectinate muscles on atria wall
- crista terminalis
- leads into the tricuspid valve
132
the right atrioventricular valve aka the tricuspid valve are made up of how many cusps, and what are they called. This valve is anchored by what surrounding structure.
the 3 cusps are
- anterior (anterosuperior)
- posterior (inferior)
- septal
the valve is anchored by a surrounding fibrous ring (annulus)
133
during ventricular systole, what attachments prevents prolapse of the valve leaflets into the right atrium and how does this mechanism work, and what happens if fails?
the attachments to the tendinous chords (chordae tendinae) which are attached to papillary muscles prevents prolapse of valve leaflets into the right atrium by arresting the leaflets exactly in contact with one another. If the cusps do not meet precisely during closure, they will leak and allow regurgitation of blood black to the RA.
134
failure to open widely during ventricular diastole is known as what?
valve stenosis
135
the right ventricle characteristics
- deoxygenated blood from the RA enter the RV through the tricuspid valve as it relaxes
- the blood pumped into the lungs passing through the pulmonary semilunar valve via the pulmonary arteries
- inside the right ventricle there are the chordae tendineae, papillary muscles, and trabeculae carnea
- ventricular septum borders posteriorly
- the conus arteriosus- the conical arterial pouch or infundibulum
136
what is the conus arteriosus
conical arterial pouch or infundibulum of the heart found in the upper left corner of the ventricle and gives rise to the pulmonary artery, the tendon of the conus arteriosus is a fibrous band that extends superiorly from the right atrioventricular fibrous ring and stretches between the posterior surface of the conus arteriosus and the aorta
137
size and volume vs RV and LV
can contain same amount of blood
RV is 3-6 thinner though in muscle wall
so LV is a-lot larger in mass, same volume inside
138
the left atrium characteristics
- now oxygenated blood leaves lungs through the pulmonary arteries and enters left atrium
- the left atrium has an auricle on external surface
- external surface has cornonary groove with circumflex artery and great cardiac vein
- the 4 pulmonary veins open into the upper posterolateral surfaces of the left atrium, two on each side
- the left atrial aspect of the septum has a characteristically rough appearance bounded by a crescentic appearance, concave upwards, which marks site of foramen ovale
- the oxygenated blood then will leave through mitral valve
139
which atrium is smaller
the left atrium is smaller in volume than the right but has thicker walls (3mm on average)
140
the left ventricle characteristics
- inlet region guarded by mitral valve or bicuspid valve
- the left AV orifice admits atrial blood during diastole
- chordae tendinae and papillary muscles
- trabecular carneae
141
the mitral valve, where located? how many cusps? controlled by?
the mitral valve, aka bicuspid valve, aka left AV valve
the mitral valve guards the left ventricle from regurgitation back to left atria
2 cusps, anterior and posterior
controlled by chordae tendineae and papillary muscles
142
unlike the right ventricle, and the orifices of the left ventricle are _____ with ______ continuity between the cusps of the _____ and ______ valves
the orifices of the left ventricle are in close contact with each other with a fibrous continuity between the cusps of the mitral and aortic valves
143
the inter-ventricular septum
separates right and left ventricle duh
144
the fibrous skeleton of the heart is and what does it do
a set of connective tissue rings and extensions that
- provides a strong framework for attachment of cardiac muscle fibers
- physically separates atrial and ventricular myocardia and blocks the spread of myocardial excitation across the atrioventricular border (coronary sulcus)
- supports all 4 heart valves by providing anchoring rings and also forms fibrous ribs in the semilunar valves
145
the fibrous skeleton is comprised of these 3 components and where are they in location
```
fibrous rings (annulus fibrosi) around valves and extensions into semilunar leaflets
fibrous trigones (trigona fibrosa)-between aortic valve and atrioventricular valves
membranous portion of inter-ventricular septum (septum membranceum)
```
146
the conducting system of the heart is an ____ conduction system made up of ______ which lead to contraction of ______ cells without the need of _______ impulses, in a regular continuous way
```
intrinsic conduction system
made up of specialized epithelial cells
contract heart cells
without nerve impulses
in a regular continuous way
```
147
the conducting system of the heart includes these nodes/fibers, in what order
```
SA node aka pacemaker
AV node
AV bundle or Bundle of His
Bundle branches (RBB and LBB)
Purkinje Fibers
```
148
the aortic semilunar valve has how many cusps and what are they
3
right coronary cusp, left coronary cusp, posterior cusp (non-coronary cusp)
149
stenosis of aortic semilunar valve causes of _____ blood _____ of the valve and what does what to the left ventricle?
turbulence of blood and narrowingwhen listen to heart this sounds like
this causes left ventricle to increase in size to pump harder to push blood through narrowing (left ventricular hypertrophy)
this can lead to stages of heart failure
150
the aortic semilunar valve characterisitis
- aortic sinus: dilations of root of aorta just above leaflets
- the 3 cusps: (RC, LC, posterior(non-coronary)
- nodule: a fibrous reinforcement in the edge of each cusp. The three nodules meet in the middle when the valve close
- lunule: thin memranous edge of cusp
151
stenosis of aortic semilunar valve causes of _____ blood _____ of the valve and what does what to the left ventricle?
turbulence of blood and narrowing when listen to heart this sounds like whooshing- murmur
this causes left ventricle to increase in size to pump harder to push blood through narrowing (left ventricular hypertrophy)
this can lead to stages of heart failure
152
the RBB course
runs along moderator band and anterior papillary muscle
153
the LBB course
LBB runs down septal wall and then fans out on papillary muscles and extends fibers throughout the apical region
154
fibrous tissue in coronary groove blocks conduction from ?
from atrium to ventricle
155
the SA node is located
in the right atrium (wall of the right atrium in upper part of the sulcus terminalis just to the right of the opening of the SVC)
156
the AV node is located
strategically placed on the lower part of the atrial septum just above the attachment of the septal cusp on the tricuspid valve
157
AV node impulse course
the cardiac impulse is conducted from it to the ventricles by the atrioventricular bundle (bundle of his). The AV node is stimulated by the excitation wave as it passes through the atrial myocardium
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_____ infection must be treated because can cause immune reaction that attack valves of
streptococcal infection must be treated because can attack heart valves and kidney
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the AV bundle course and what it turns into
the AV bundle descends through the fibrous skeleton of heart and then descends behind the septal cusp of the tricuspid valve to reach inferior border of the membranous part of the ventricular septum. at the upper border it divides into two branches, one for each ventricle
RBB and LBB.
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the LBB course
pierces the septum and passes down its left side beneath the endocardium, it usually divides into two branches (posterior and anterior) which eventually become continuous with Purkinje plexus of left ventricle
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the impulses from the SA node to AV node travel ____ through a system of inter-nodal conduction, formed by 3 pathways which are?
travel rapidly via,
The anterior internodal pathway:
•leaves the anterior end of the sinuatrialnode and passes anterior to the superior vena cavalopening. •It descends on the atrial septum and ends in the atrioventricular node
* The middle internodal pathway:
* leaves the posterior end of the sinuatrialnode and passes posterior to the superior vena cavalopening.•It descends on the atria septum to the atrioventricular node.•
The posterior internodal pathway:
•leaves the posterior part of the sinuatrialnode and descends through the crista terminalis and the valve of the inferior vena cava to the atrioventricular node.
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blood supply to heart via
R and L coronary arteries
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the coronary ostium function to
the L coronary and R coronary ostium are above aortic valves, R and L cusps- they allow blood from aorta to supply the heart (L and R coronary arteries)
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the coronary arteries arise from
the ascending aorta immediately above the aortic valves
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the R coronary artery anastomoses with at what space
the circumflex artery which is a branch of the L coronary artery
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branches of RCA
- SA node branch and atrial branches
- R conus artery
- Anterior ventricular branches (2-3), largest is marginal branch
- R marginal branch (on anterior side)
- posterior interventricular branch aka posterior descending artery (PDA
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the L coronary artery is ____ than the R
bigger, responsible for supplying most blood supply to heart
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the L coronary artery branches
-anterior interventricular artery aka left anterior descending artery, gives a small conus artery
- the circumflex artery gives,
- left marginal branch
- anterior ventricular branch
- posterior ventricular branch
- atrial branches
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blockage to any of branches of the circumflex arteries, will cause
region will suffer ischemia and may lead to tissue damage,
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blockage of anterior ventricular branch will affect what region of the heart
the apex, left ventricle
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blockage of circumflex artery affect which area
outer side and posterior aspect of heart
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the SA node is supplied by what artery
the R coronary artery in most people, sometimes left
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the AV node is supplied by what artery
the R coronary artery
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the AV bundle aka bundle of His is supplied by what artery
R coronary artery
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the RBB supplied by what artery
L coronary artery
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the LBB supplied by what artery
L coronary and R coronary arteries
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coronary artery anastomoses of terminal branches of R and L arteries, but are not large enough for
Though anastomoses do exist between the terminal branches of the right
and left coronary arteries, but these are not large enough to compensate for
any sudden blockage of a large branch.
• A sudden blockage of the larger branches results in myocardial infarction.
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venous drainage of heart mostly via
most of blood drains into the R atrium through the coronary sinus
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the coronary sinus lies where and is a continuation of what structure? it opens into ?
* Lies in the posterior part of the atrioventricular sulcus
* Is continuation of the great cardiac vein
* Opens into the right atrium to the left of the inferior vena cava
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the tributaries of the coronary sinus are
- great cardiac vein
- small cardiac vein
- Middle cardiac vein
- Posterior vein of the left ventricle
- Oblique vein of the left atrium
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anterior cardiac veins drain mainly into the? smallest cardiac veins drain?
anterior cardiac veins: drain into R atrium
| smallest cardiac vein: mostly to R atrium and ventricle
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The surface markings of the heart valves are as follows: The tricuspid valve lies behind and where do we place stethoscope?
The tricuspid valve lies behind the right half of the sternum opposite the 4th intercostal space.
listen left of sternum at 5th intercostal space (between ribs 5 and 6)
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the surface markings of the heart valves are as follows:
| The mitral valve lies behind? where do we place stethoscope?
The mitral valve lies behind the left half of the sternum opposite the 4th costal cartilage.
listen at midclavicular line at 5th intercostal space (between ribs 5 and 6)
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the surface markings of the heart valves are as follows: The pulmonary valve lies behind? where do we place stethoscope?
The pulmonary valve lies behind the medial end of the third left costal cartilage and the adjoining part of the sternum.
listen left of sternum at 2nd intercostal space (between ribs 2 and 3)
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the surface markings of the heart valves are as follows: The aortic valve lies behind? where do we place stethoscope?
The aortic valve lies behind the left half of the sternum opposite the 3rd intercostal space.
listen on right side of sternum at 2nd intercostal space opposite side of pulmonary valve
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The trachea beginning and ending, whats the point of division called and what does it branch into?
• It begins in the neck as a continuation of the larynx at the lower border of the cricoid
cartilage (C6 level)
• Ends at the carina by dividing into right and left principal bronchi
its about 4.5 inch long in adult, 1 inch diameter
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trachea extent
• From 6th cervical vertebra to intervertebral disc between 4th and 5th thoracic vertebra
(level of sternal angle)
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During expiration the bifurcation rises by about
one vertebral level
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During deep inspiration: the bifurcation may be lowered as far as the
the 6th thoracic vertebra
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The fibroelastic tube is kept patent by the presence of
U-shaped bars (rings) of hyaline cartilage embedded in its wall
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The posterior free ends of the cartilage are connected by
smooth muscle, the trachealis muscle.
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at full exhalation, where carina of trachea at
above the IVD disc of T4 and T5 (know it rises above this level, no longer at the IVD disc level)
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relations of trachea in superior mediastinum: anterior, posterior, right and left sides?
The relations of the trachea in the superior mediastinum:
* Anteriorly: •The sternum, the thymus, the left brachiocephalic vein, the origins of the brachiocephalic and left common carotid arteries, and the arch of the aorta.
* Posteriorly: •The esophagus and the left recurrent laryngeal nerve.
* Right side: •The azygos vein, the right vagus nerve, and the pleura.
* Left side: •The arch of the aorta, the left common carotid and left subclavian arteries, the left vagus and left phrenic nerves, and the pleura.
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blood supply to trachea
The upper two thirds are supplied by the inferior thyroid arteries
the lower third is supplied by the bronchial arteries.
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sensory nerve supply to trachea
The sensory nerve supply is from the vagi and the recurrent laryngeal nerves.
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autonomic innervation to trachelais muscle
Sympathetic nerves supply the trachealis muscle
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lymph drainage of trachea
The pretracheal and paratracheal lymph nodes and the deep cervical nodes.
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The trachea bifurcates behind
The trachea bifurcates behind the arch of the aorta into the right and left principal (primary or main) bronchi
• The alveoli arise from the walls of the sacs as diverticula
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the bronchi divides giving rise to? that terminate where?
The bronchi divide giving rise to several million terminal bronchioles that terminate in one or more respiratory bronchioles.
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Each respiratory bronchiole divides into _____ ducts that enter the _____ sacs
Each respiratory bronchiole divides into 2 to 11 alveolar ducts that enter the alveolar sacs.
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The alveoli arise from the walls of the sacs as
diverticula
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Principal Bronchi of right vs left; size and orientation? clinical significance of orientation
The right principal (main) bronchus is wider, shorter, and
more vertical than the left and is about 1 in. (2.5cm) long.
any foreign objects going into trachea gonna go to R side because is more vertical oriented
The left principal (main) bronchus is narrower, longer, and more horizontal than the right and is about 2 in(5cm) long.
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Before entering the hilum of the right lung, the principal bronchus gives off ______
Before entering the hilum of the right lung, the principal bronchus gives off the superior lobar bronchus.
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On entering the hilum the R principal bronchus, it divides into what ?
a middle and an inferior lobar bronchus.
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the L main bronchus passes which structure
It passes to the left below the arch of the aorta and in front of the esophagus.
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On entering the hilum of the left lung, the L principal bronchus divides into
a superior and an inferior lobar bronchus.
