Unit 4: Heart

Question 1

What is the path of blood?

Answer 1

SVC/ICV
Right atrium
tricuspid valve
Right ventricle
pulmonary valve
pulmonary arteries (deoxygenated blood)
lungs
pulmonary veins (oxygenated blood)
left atrium
bicuspid valve
left ventricle
aortic valve
Aorta

Question 2

Which parts of the heart contract together?

Answer 2

both atriums contract together and both ventricles contract together

Question 3

What is the landmark for the superior and inferior mediastinum?

Answer 3

T4/T5

Question 4

What are the three major events happening at T4/T5?

Answer 4

sternal angle
trachea bifurcates
border of superior/inferior mediastinum

Question 5

What rib is present at the sternal angle?

Answer 5

2nd rib

Question 6

Superior mediastinum structures ?

Answer 6

ABCs, SBIS
Thymus gland
Trachea
Esophagus

Question 7

where does the brachiocephalic trunk travel and what branches off from it?

Answer 7

to the right
R subclavian artery and R common carotid

Question 8

What are the ABCs?

Answer 8

Major arteries in superior mediastinum:

aorta, brachiocephalic trunk, L common carotid, L subclavian artery

Question 9

What are the SBIS?

Answer 9

Major vessels in superior mediastinum:

superior vena cava -> R/L brachiocephalic vein -> R/L subclavian vein & R/L internal jugular vein

Question 10

Inferior mediastinum structures?

Answer 10

Heart, thoracic aorta, esophagus, trachea

Question 11

What is the most anterior structure of superior mediastinum right behind menubrium?

Answer 11

Thymus gland

Question 12

Layers of the pericardium

Answer 12

Parietal layer
Visceral layer (epicardium)

Question 13

What is the pericardium attached to?

Answer 13

Central tendon

Question 14

What is the parent structure of the pericardicophrenic artery?

Answer 14

Internal thoracic artery

Question 15

What are the structures supplying the pericardium?

Answer 15

Pericardicophrenic artery/vein
Phrenic nerve

Question 16

Common causes of pericarditis

Answer 16

viral/bacterial infections
systematic illnesses (renal faliure)
secondary to myocardial infarction

Question 17

What is pericarditis?

Answer 17

inflammatory condition with chest pain and UE referral

Question 18

What is constrictive pericarditis?

Answer 18

Excessive thickening of the pericardial sac (only partial layer)

Question 19

What can constrictive pericarditis lead to?

Answer 19

compress heart
heart failure
scarring
drop in jugular venous pulse

Question 20

What is the parent structure for the arch of azygos vein?

Answer 20

Right brachiocephalic trunk (SVC)

Question 21

Where does the coronary sinus sit?

Answer 21

In the coronary sulcus

Question 22

What separates the left and right ventricles?

Answer 22

posterior interventricular groove

Question 23

Where does the apex of the heart lie?

Answer 23

deep to 5th intercostal space

Question 24

What other structures in the body have a apex at the bottom?

Answer 24

Patella, sacrum, coccyx

Question 25

What vessels come off the aorta and have the cleanest blood supplied to the heart

Answer 25

Right and Left coronary arteries

Question 26

What main branches come off the left coronary artery?

Answer 26

Circumflex branch of LCA Anterior interventricular brach of LCA (LAD) Left marginal artery

Question 27

What main branches come off the right coronary artery?

Answer 27

Posterior interventricular branch of RCA Right marginal branch of RCA SA nodal branch

Question 28

Which arteries are the main causes for myocardial infarction (heart attack)?

Answer 28

1. Anterior interventricular (LAD) (40-50%) 2. RCA (30-40%) 3. Circumflex branch of LCA (15-20%)

Question 29

What is the common entry sight for the cardiac catheterization?

Answer 29

Femoral artery/vein

Question 30

What would be performed with severe coronary occlusion?

Answer 30

Coronary artery bypass graft (CABG)

Question 31

What structure is used at a bypass structure in CABG?

Answer 31

Great saphenous vein

Question 32

CABG precautions

Answer 32

Avoid lifting No pushing/pulling use pillow to brace chest when coughing limit overhead activity avoid twisting torso

Question 33

Which valves open at the same time?

Answer 33

Tricuspid and Bicuspid valves Pulmonary and aortic valves

Question 34

What do the papillary muscles do?

Answer 34

help close/keep valve closed

Question 35

What makes the "LUB" sound?

Answer 35

The Tricuspid and Bicuspid valves CLOSING (aortic and pulmonary are open)

Question 36

What makes the "DUB" sound?

Answer 36

The pulmonary and aortic valves CLOSING (tri and bicuspid are open)

Question 37

What fossa in the right atrium is a remnant from a fetal opening in the heart?

Answer 37

Oval fossa (communication between atriums before born)

Question 38

Why might someone have cardiac neck pain?

Answer 38

Patent formen ovalis (PFO) the oval opening does not close in embryo

Question 39

What do the tendinous cords do in the tricuspid valve?

Answer 39

keep valve in place during systole (ventricle contraction)

Question 40

How many pulmonary veins feed into the left atrium?

Answer 40

4

Question 41

What are the superior borders of the heart?

Answer 41

between 2nd and 3rd rib (formed by BOTH atria)

Question 42

What is the right border of the heart?

Answer 42

R 3rd costal cartilage junction at sternum (formed by Right atrium)

Question 43

What is the left border of the heart?

Answer 43

5th intercostal space at L "midclavicular line" (Formed by left ventricle)

Question 44

What is the inferior border of the heart?

Answer 44

6th costal cartilage - midcostal portion (formed by right ventricle)

Question 45

What is the conduction system order of the heart?

Answer 45

SA node AV node Atrioventricular bundle (bundle of his) R/L bundle branches Subendocardial branches (Purkinje fibers)

Question 46

What is systole in BP

Answer 46

upper number

Question 47

What is diastole in BP

Answer 47

lower number

Question 48

What is happening at the QRS in EKG?

Answer 48

1. closure of mitral/tricuspid valves - "LUB" 2. Systole - ventricles contract

Question 49

What is happening after the T wave ends in EKG?

Answer 49

1. closure of aortic and pulmonary valves - "DUB" 2. Diastole - atriums contract

Question 50

Which cranial nerve has the most extensive and longest course?

Answer 50

Vagus nerve (CN X)

Question 51

Where does the phrenic nerve supply innervation?

Answer 51

diaphragm, central tendon, and pericardium

Question 52

What is the parent structure of internal jugular vein?

Answer 52

brachiocephalic vein

Question 53

Where does the phrenic nerve travel on the right side?

Answer 53

along SVC and IVC

Question 54

Where does the vagus nerve travel on the right side?

Answer 54

trachea and espohagus

Question 55

Where does the phrenic nerve travel on the left side?

Answer 55

over pericardium

Question 56

Where does the vagus nerve travel on the left side?

Answer 56

aortic arch and BEHIND pulmonary veins

Question 57

What is the parent structure of left recurrent larygeal nerve

Answer 57

vagus nerve - loops under aorta and back up the trachea/esophagus can be compressed by lung cancer (causes hoarseness)

Question 58

what does the parasympathetic NS do to cardiac?

Answer 58

decrease and constrict coronary arteries

Question 59

what does the sympathetic NS do to cardiac?

Answer 59

increase and dilate coronary arteries

Question 60

what does the cardiac plexus do to cardiac?

Answer 60

visceral afferents to send cardiac pain