Thorax 4: Mediastinum and Heart Flashcards by Elizabeth Dower

What are the different subdivisions of the mediastinum

Superior and inferior mediastinum

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What divides the superior and inferior mediastinum

angle of louis: line from sternal angle to T4

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The inferior mediastinum is divided further into what and how

based on coverings of the heart
anterior
middle
and poster

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What are the boundaries of the superior mediastinum

thoracic inlet
sternum
vertebral bodies

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What are the boundaries of the inferior mediastinum

diaphragm

sternum, pleural cavities, thoracic vertebral bodies

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What type of space is the pericardial sac

potential space

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What are the layers of the pericardial sac

fibrous outer layer
serous pericardium (visceral and parietal)

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Where will pericardiocentesis be performed

between parietal and visceral layer of the serous pericardium

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What is the arterial and venous support of the pericardium

internal thoracic artery and aorta

Venous: brachiocephalic vein and azygos system

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What is the innervation of pericardium

phrenic nerve

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What vessels are associated with phrenic nerve

pericardiophrenic vessels

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What are the two pericardial sinuses

Oblique and Transverse sinus

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Where is the transverse sinus

space posterior to the ascending aorta and pulmonary trunk

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What is important to note about the attachment of the pericardium on the heart

also covers the trunks of the great vessels

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What is the apex of the heart

inferior, conical end. Tip of left ventricle

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What is the innervation to the serous pericardium

Visceral: vagus
Parietal: phrenic

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What is the anatomical base of the heart

posterior aspect composed of left atrium

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What is the diaphragmatic surface of the heart

right and left ventricles that rest on diaphragm

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What is the sternocostal surface of the heart

most anterior aspect composed of right ventricle

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What is the right pulmonary surface of the heart

right atrium

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What is the most anterior chamber of the heart

right ventricle

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What is the most posterior chamber of the heart

left atrium

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What composes the right side of the heart

right atrium

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What composes the left side of the heart

left ventricle

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Where is the coronary sulcus located

encircles the heart between atria and ventricles

Where is the inter ventricular sulcus found

between ventricles

What are the characteristic features of the right atrium

sinus venarum pectinate muscles fossa ovalis

What is the sinus venarum

smooth walls of right atrium

What is the fossa ovalis

remnant of foramen ovale

Where is the fossa ovalis located

right atrium on intertatrial septum

What are septomarginal trabeculae

extensions of cardiac muscle from inter ventricular septum to papillary muscles

What is the function of septomarginal trabeculae

carry parts of conduction system of the heart

What is the inflow tract of right ventricle

muscular

What is the outflow tract of right ventricle

trunks arterioses is smooth

What is the function of papillary muscles and chordae tendinae

papillary muscle connect to valves through chord tendinae which will pull the valves shut when contracted

What are the different parts of the inter ventricular septum

membranous and muscular portion

What portion of the inter ventricular septum do most presenting ISD occur

membranous portion

What are the characteristic features of the right ventricle

``` inflow outflow tracts papillary muscles moderator band tricuspid valve IV septum ```

What type of blood will enter the right atrium

deoxygenated

What are the associated veins that enter right atrium

IVC, SVC coronary sinus anterior coronary arteries venus minimum

What type of blood will be found in the left atrium

oxygenated

What veins are associated with left atrium

pulmonary veins

What is the muscle of the left atrium like

smooth except for auricle

What are characteristics of left ventricle

inflow through mitral valve, smooth wall towards outflow to aorta, trabecualtions on bottom

List the sequence of signals through the conduction system of the heart

SA node AV node Bundle of his (right and left branches through IV septum to each ventricle) which communicates with purkinje fibers

Where is SA node located

where crista terminales and SVC meet

Where is the AV node

junction of atria and ventricles

Where is the bundle of His located

IV septum

Where are purkinje fibers located

walls of ventricles (endocardium)

How are valves of the heart anchored

through a DCT skeleton

Where will the heart valves be ausculatated

aortic: right 2nd intercostal space parasternally Pulmonary: left 2nd intercostal space parasternally Tricuspid: left 5th intercostal space parasternally Mitral: left 5th intercostal space midclavicular

What are the main branches of the right coronary artery

marginal artery posterior descending artery SA nodal

What are the main branches of the left coronary artery

circumflex left anteriordescending artery left marginal

What determines dominance of the heart

what every coronary artery side the posterior descending artery comes off

Which coronary artery is longer

right

What are common variants of cardiac arteries

SA nodal can come off left | Posterior inerventricular can come off left circumflex coronary artery

What is the arterial support to the conducting system of the heart

SA node: right coronary artery AV node: small vessel as right coronary becomes posterior interventricular Right and Left bundle: LAD

What is the most common site of occlusion

LAD

What is the second most common site of occlusion

right marginal

What is the third most common site of occlusion

circumflex

What is CABG and what is used

coronary artery bypass grafting usually uses greater saphenous vein from leg

What is more common, right or left sided dominance of heart

right (75%)

What artery runs with LAD

great cardiac vein

What artery runs with right marginal

small cardiac vein

What artery runs with PDA

middle cardiac vein

What vein of the heart will drain directly into the right atrium

anterior cardiac veins

What levels are the sympathetic innervation to the heart

T1-T4 (5)

Where are the preganglionic GVE cell bodies that go to the heart found

IML of T1-T4

Where are the postganglionic GVE cell bodies that go to the heart found

cervical sympathetic chain

Where are the cell bodies that sense pain in the heart located

DRG of T1-T4

What type of neurons are contained within the sympathetic cardiac nerve

postganglionic GVE | GVA

Where is referred pain from the heart located to

left chest and down left arm (T1-T4 dermatomes), up neck too

What causes referred pain

convergence at DRG of GVA and GSA, and pain referred to GSA territory

Where is pericardiocentesis performed

under the xiphoid process and slightly to the left

What layers are traversed in pericardiocentesis

skin, superficial fascia, fibrous pericardium, parietal layer of serous pericardium