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ANATOMY II Exam #1- Lo > 01-12: Heart and Mediastinum > Flashcards

01-12: Heart and Mediastinum Flashcards

1
Q 
Which of the following structures makes up the superior boundary of the mediastinum?
A) Thoracic inlet
B) Pleura
C) Diaphragm
D) Thoracic vertebrae
E) Costal cartilage
A

A) Thoracic inlet

Bony hole where the 1st rib attaches

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2
Q 
Which of the following structures is/are found in the middle part of the inferior mediastinum?
A) Fat and lymph tissue
B) Cardiac and autonomic nerve plexuses
C) Heart and its pericardial tissues
D) Thoracic aorta
E) Thoracic splanchnic nerves
A

C) Heart and its pericardial tissues

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3
Q

What are the boundaries of the mediastinum?

Superior:
Inferior:
Anterior:
Posterior:
Lateral:
A

Superior: Thoracic inlet

Inferior: Diaphragm

Anterior: Sternum and Costal cartilages

Posterior: Thoracic vertebrae

Lateral: Pleura

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4
Q

What are the 10 Superior contents of the mediastinum?

A
  • Great vessels of the heart
  • Thoracic duct (Left)
  • Superior parts of azygos system
  • R&L Vagus nerves (recurrent laryngeal nerves)
  • Pulmonary nerve plexus
  • Esophageal nerve plexus
  • Cardiac nerve plexus
  • Thymus
  • Parts of trachea
  • Parts of esophagus
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5
Q

What are the 4 Inferior Anterior contents of the mediastinum?

A
  • Fat
  • Lymph tissue
  • Vessels
  • Thymus (in children)
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6
Q

What are the 2 Inferior Middle contents of the mediastinum?

A
  • Heart

- Heart’s pericardial tissues

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7
Q

What are the 8 Inferior Posterior contents of the mediastinum?

A
  • Thoracic aorta
  • Esophagus
  • Pulmonary arteries
  • Pulmonary veins
  • Azygos system
  • Thoracic duct
  • Sympathetic trunk
  • Thoracic splanchnic nerves
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8
Q

Where is the Thoracic Sympathetic Trunk located?

A
  • Bilateral

- Lateral to the vertebral bodies

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9
Q

What is the Thoracic Sympathetic Trunk continuous with?

A

Cervical and lumbar parts of sympathetic trunk

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10
Q

What runs along the Thoracic Sympathetic Trunk?

A

Paravertebral ganglia

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11
Q

Where are the Thoracic Splanchnic Nerves located?

A
  • Bilateral

- Emerge from Thoracic Sympathetic trunks

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12
Q

What are the 3 Thoracic/Abdominopelvis Splanchnic Nerves?

A
  • Greater
  • Lesser
  • Least
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13
Q

What do the Thoracic Splanchnic Nerves provide sympathetic innervation to?

A

Viscera inferior to the diaphragm

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14
Q

What do the Thoracic Splanchnic Nerves (presynaptic fibers) synapse with?

A

Prevertebral ganglia in the abdomen

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15
Q

Arteries carry blood _______ the heart

A

AWAY from

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16
Q

Veins carry blood ______ the heart

A

TO

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17
Q

Arteries carry blood _______ in oxygen

A

HIGH

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18
Q

What arteries are the exception and do not carry blood that is high in oxygen?

A

Pulmonary arteries (deox blood)

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19
Q

Veins carry blood ______ in oxygen

A

LOW

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20
Q

What veins are the exception and do not carry blood that is low in oxygen?

A

Pulmonary veins

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21
Q

What are great vessels?

A

Arteries and veins entering and leaving the heart

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22
Q

What kind of blood flow through the heart and the blood vessels does the heart ensure?

A

Unidirectional

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23
Q

How is back flow of blood prevented within the heart?

A

valves

  • Between Atria & Ventricles
  • Between Ventricles & Great Vessels
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24
Q

The heart acts like 2 independent, side-by-side _______ that work independently but ___________

A
  • Pumps (Right=Pulmonary) (Left=Systemic)

- At the same rate

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25
Q

One side of the heart directs blood to the lungs for what?

A

gas exchange = Pulmonary

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26
Q

One side of the heart directs blood to the body tissues for what?

A

nutrient delivery = Systemic

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27
Q

What is essential to push blood through blood vessels to the body tissues for nutrient and waste exchange?

A

Minimum blood pressure

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28
Q

How does the heart develop blood pressure?

A

Through alternate cycles of heart wall contraction and relaxation

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29
Q

Thinking about pulmonary circulation, the systemic pathway of this circuit involves which part of the heart?

A) Right atrium, SVC, and IVC
B) Right atrium and pulmonary veins
C) Left atrium and pulmonary arteries
D) Left atrium and pulmonary veins

A

D) Left atrium and pulmonary veins

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30
Q

Thinking about the position of the heart in the mediastinum, which of the following heart structures is located more posteriorly and makes up most of what is called the base of the heart?

A) Right atrium
B) Right ventricle
C) Left atrium
D) Left ventricle

A

C) Left atrium

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31
Q

Pericardium of the heart has 3 primary layers. If the PERICARDIUM of the heart is pierced by a needle, which of these primary layers would the needle first pass through?

A) Visceral pericardium
B) Pleural pericardium
C) Parietal pericardium
D) Fibrous pericardium
E) Epicardium
A

D) Fibrous pericardium

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32
Q

Which of the following heart structures is a framework of dense collagen that anchors and provides support for the atrioventricular AND semilunar valves of the heart?

A) Chordae tendineae
B) Papillary muscles
C) Fibrous skeleton
D) Fossa ovalis

A

C) Fibrous skeleton

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33
Q

Pericardium of the heart has 3 primary layers. If the heart WALL is pierced by a needle, which of these primary layers would the needle first pass through?

A) Visceral pericardium
B) Pleural pericardium
C) Parietal pericardium
D) Fibrous pericardium
E) Epicardium
A

A) Visceral pericardium

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34
Q

What makes up the pulmonary circuit?

A
  • Right atrium
  • Right ventricle
  • Pulmonary arteries
  • Pulmonary veins
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35
Q

What is the function of the pulmonary circuit?

A

Conveys blood to the lungs (via pulmonary arteries) to reduce CO2 and replenish O2 levels in the blood before returning to the heart in the pulmonary veins

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36
Q

Coming from the pulmonary circuit, which side of the heart does the blood flow through?

A

Left side of the heart

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37
Q

Where does the blood flow after it goes from the pulmonary circuit and through the left side of the heart?

A

it enters the systemic circuit

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38
Q

What makes up the systemic circuit?

A
  • Left atrium
  • Left ventricle
  • All other named blood vessels
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39
Q

What is the function of the systemic circuit?

A

Carries blood to all the peripheral organs and tissues of the body

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40
Q

Oxygenated blood from the Left side of the heart is pumped into __________ and then into smaller systemic ___________

A
  • the aorta

- arteries

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41
Q

Where does gas exchange in the tissues occur?

A

in the capillaries

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42
Q

Is deoxygenated blood high or low in CO2?

A

HIGH

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43
Q

Are systemic veins oxygenated or deoxygenated?

A

deoxygenated

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44
Q

What 2 things do systemic veins carry?

A
  • deoxygenated blood

- waste products

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45
Q

Where do most veins merge and drain into?

A

SVC and IVC

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46
Q

Where do the SVC and IVC drain blood into?

A

Right atrium

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47
Q

When blood enters the Right Atrium, what circuit is it entering?

A

Pulmonary circuit

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48
Q

Where is the heart located?

A
  • Left of the body midline
  • Posterior to the sternum
  • In the middle mediastinum
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49
Q

The heart is rotated so that the Right side/border (Right atrium and Right ventricle) is located more _________, while its Left side/border (Left atrium and Left ventricle) is located more ___________

A
  • Anteriorly (RIGHT)

- Posteriorly (LEFT)

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50
Q

What rib outlines the superior aspect (base) of the heart?

A

3rd rib

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51
Q

What rib outlines the inferior aspect (apex) of the heart?

A

6th/7th

behind the body of the sternum

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52
Q

What does the anterior part of the heart sit on?

A

The diaphragm

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53
Q

What makes up the base of the heart?

A

The posterosuperior surface of the heart

primarily the Left Atrium

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54
Q

What veins border the base of the heart?

A

The pulmonary veins that enter the Left Atrium

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55
Q

What is the inferior, conical end of the heart called?

A

The apex

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56
Q

Which way does the apex of the heart project slightly?

A

Anteroinferiorly towards the Left side of the body

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57
Q

Is the coronary sinus anterior or posterior to the base of the heart?

A

Anterior

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58
Q

Does the circumflex branch of the Left Coronary artery on the anterior or posterior surface of the heart?

A

Posterior surface of the heart

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59
Q

Is the Anterior Interventricular artery located on the anterior or posterior surface of the heart?

A

Anterior surface of the heart

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60
Q

What do arterioles do?

A

Help prevent pooling by keeping blood flowing

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61
Q

Where are the auricles of the heart located?

A

Bilaterally on the sides of the heart

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62
Q

What are the functions of the pericardium?

A
  • Restricts heart movements so it doesn’t bounce and move in the thoracic cavity
  • Prevents heart from overfilling with blood
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63
Q

What is the fibrous pericardium?

A
  • Outer portion of pericardium
  • Tough
  • Dense connective tissue
  • Attached to sternum and diaphragm
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64
Q

What is the serous pericardium?

A
  • Inner portion of pericardium
  • Thin
  • Double layered serous membrane
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65
Q

What are the 2 layers of the serous pericardium?

A
  • Parietal layer

- Visceral layer

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66
Q

What are the 3 layers of the heart wall?

A
  • Epicardium
  • Myocardium
  • Endocardium
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67
Q

What is the outermost layer of the heart called?

A

Epicardium or Visceral layer of serous pericardium

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68
Q

As we age, what layer of the heart is more fat deposited?

A

Epicardium

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69
Q

What layer of the heart is thickest in the Left Atrium?

A

Myocardium

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70
Q

What are the layers of the pericardium and heart from outside to inside?

A
  • Fibrous pericardium
  • Parietal layer of serous pericardium
  • Pericardial cavity
  • Visceral layer of serous pericardium (Epicardium)
  • Myocardium
  • Subendocardial layer (areolar CT)
  • Endocardium
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71
Q

What kind of tissue composes the myocardium?

A

Cardiac muscle tissue

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72
Q

Which heart wall layer is the thickest?

A

Myocardium

Left ventricle

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73
Q

Where is the myocardium located?

A
  • Deep to the epicardium

- Superficial to the endocardium

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74
Q

Which heart wall layer covers the internal surface of the heart and the external surfaces of the heart valves?

A

Endocardium

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75
Q

Where is the subendocardial layer?

A

Between the endocardium and myocardium

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76
Q

What is the subendocardial layer composed of?

A

Areolar connective tissue

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77
Q

What are the auricles?

A

Wrinkled, flap-like extensions of the anterior part of each atrium

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78
Q

Where does the Right Atrium receive blood from?

A

Systemic circuit

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79
Q

Where does the Left Atrium receive blood from?

A

Pulmonary circuit

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80
Q

What 2 large arteries exit the heart at the basal surface (posterior to ventricles)?

A
  • Pulmonary trunk

- Aorta

81
Q

The pulmonary trunk carries blood from the ________ to the _________.

A
  • Right ventricle

- Pulmonary circuit

82
Q

The aorta conducts blood from the _________ to the __________

A
  • Left ventricle

- Systemic circuit

83
Q

What separates the atria from the ventricles?

A

The Coronary Sinus/Atrioventricular Sulcus

84
Q

Where are the Anterior Interventricular Sulcus and the Posterior Interventricular Sulcus located?

A
  • Anterior and Posterior heart surfaces

- Between the Left and Right Ventricles

85
Q

The Anterior Interventricular Sulcus and the Posterior Interventricular Sulcus extend inferiorly from the _________ toward the ________ of the heart

A
  • Coronary sulcus

- Apex

86
Q

Where is the fibrous heart skeleton located?

A

Between the atria and the ventricles

Around all the valves

87
Q

What kind of tissue forms the fibrous heart skeleton?

A

Dense irregular connective tissue

88
Q

What are the functions of the fibrous heart skeleton?

A
  • SEPARATES atria and ventricles
  • ANCHORS valves (forming supportive rings at their attachment points
  • ELECTRICAL INSULATION between atria and ventricles
  • RIGID FRAMEWORK for the attachment of cardiac muscle tissue
89
Q

What is the function of the electrical insulation between the atria and ventricles that is provided by the fibrous skeleton of the heart?

A
  • Ensures the muscles impulses are not spread randomly throughout the heart
  • Prevents all the heart chambers from beating at the same time
90
Q

What permits the passage of blood in one direction and prevents its back flow?

A

valves

91
Q

From where does the Right Atrium receive venous blood?

A
  • Systemic circuit

- Heart muscle

92
Q

What are the 3 major vessels that empty into the Right Atrium?

A
  • SVC
  • IVC
  • Coronary sinus
93
Q

What does the SVC drain blood from?

A
  • Head
  • Upper limbs
  • Superior regions of the trunk
94
Q

What does the IVC drain blood from?

A
  • Lower limbs

- Trunk

95
Q

What does the Coronary Sinus drain blood from?

A

-The heart wall

96
Q

What does the Interatrial septum do?

A

Forms a wall between the Right and Left Atria

97
Q

What kind of muscle does the Right Atrium have?

A

Pectinate muscle

98
Q

What does the Right Atrioventricular Valve separate?

A

Right atrium from the Right ventricle

99
Q

What is another name for the AV valve?

A

Tricuspid valve

100
Q

When is the AV valve forced closed?

A

When the Right Ventricle begins to contract

101
Q

What does the Right Ventricle receive blood from?

A

Right atrium

102
Q

What kind of blood does the Right Ventricle receive from the Right Atrium?

A

Deoxygenated venous blood

103
Q

What does the Interventricular Septum do?

A

Forms wall between the Right and Left Ventricles

104
Q

What are the 3 cone-shaped, muscular projections on the internal wall surface of each ventricle called?

A

Papillary muscles

105
Q

What do the papillary muscles do?

A

Anchor chordae tendineae

106
Q

What do the chordae tendineae attach to?

A

The cusp of the Right AV valve

107
Q

What do the chordae tendineae do?

A

Prevent everting and flipping of the Right AV valve into the atrium when contracting

108
Q

The ligamentum arteriosum, a fetal remnant of the ductus arteriosis is located where?

A) Between the Right and Left Atria
B) Between the SVC and IVC
C) Between the Pulmonary Trunk and Aorta
D) Between the Pulmonary Arteries and Pulmonary Veins

A

C) Between the Pulmonary Trunk and Aorta

109
Q

What is the conus arteriosus?

A
  • Smooth-walled
  • Conical region
  • At the superior end of the Pulmonary Trunk
110
Q

What marks the end of the Right Ventricle and the entrance into the Pulmonary Trunk?

A

Pulmonary Semilunar Valve

111
Q

What does the Pulmonary Trunk divide shortly into?

A

Right and Left Pulmonary Arteries

112
Q

What kind of blood does the Right and Left Pulmonary arteries carry to the lungs?

A

Deoxygenated

113
Q

Where are the semilunar valves located?

A

within the walls of both ventricles (immediately before the connection of the ventricle to the pulmonary trunk and aorta)

114
Q

How many thin pocket like semilunar cusps are there in each Semilunar Valve?

A

3

115
Q

How do the Semilunar Valves open?

A

Blood that is pumped into the arterial trunks pushes against the cusps, forcing the valves to open

116
Q

What happens to the Semilunar Valves when ventricular contraction ceases?

A
  • Blood enters the pockets of the semilunar valves between the cusp and the chamber wall
  • Blood is prevented from flowing back into the ventricles from the arterial trunk
  • Causes the cusps to INFLATE and meet at the artery center/close (blocking blood back flow)
117
Q

Once gas exchange occurs in the lungs, the oxygenated blood flows through the Pulmonary Veins to _____________

A

The Left Atrium

118
Q

Where are the 4 Pulmonary Veins located?

A

On the smooth posterior wall of the Left Atrium

119
Q

What kind of muscles are located within the Left Atrium?

A

Some pectinate muscles

120
Q

What does the Left Atrioventricular Valve separate?

A

Left Atrium from the Left Ventricle

121
Q

What are 2 other names for the Left AV Valve?

A
  • Bicuspid valve

- Mitral valve

122
Q

Does oxygenated or deoxygenated blood flow from the Left Atrium to the Left Ventricle?

A

Oxygenated blood

123
Q

What happens to the Left AV valve when the Left Ventricle begins to contract?

A
  • The valve is forced closed

- Prevents blood back flow into the Left Atrium

124
Q

Which is the largest heart chamber?

A

Left Ventricle

125
Q

How thick is the Left Ventricle wall?

A

3x thicker than the Right Ventricle wall

126
Q

Why does the Left Ventricle need a thick wall?

A

In order to generate enough pressure to force the oxygenated blood from the Lungs > Aorta > Systemic circuit

*Right Ventricle only has to pump blood to the lungs

127
Q

What is more prominent on the Left Ventricle compared to the Right Ventricle?

A

Trabeculae Carneae

128
Q

What 2 muscles attach to the chordae tendineae in the Left Ventricle to help support the Left AV valve?

A

2 Large Papillary Muscles

129
Q

What marks the end of the Left Ventricle and the entrance into the Aorta at the superior end of the Left Ventricular cavity?

A

Aortic Semilunar Valve

130
Q

What nervous system innervates the heart?

A

Autonomic

131
Q

What are the sympathetic and parasympathetic components of the innervation of the heart called?

A

Cardiac plexus

Coronary plexus

132
Q

What does sympathetic innervation do to the heart rate and the force of contractions?

A
  • Increases HR

- Increases force of contraction

133
Q

What does the parasympathetic innervation do to the heart rate and the force of contractions?

A
  • Decreases HR

- NO effect on force of contraction (Except in special circumstances)

134
Q

Where do the Left and Right Coronary arteries travel in to supply the heart wall?

A

In the Coronary Sulcus (Atrioventricular Groove)

135
Q

What are the only branches of the ascending aorta?

A

The Left and Right Coronary arteries

136
Q

The Left and Right Coronary arteries are located immediately superior to what valve?

A

Aortic Semilunar Valve

137
Q

What does the Right Coronary Artery branch into?

A
  • Marginal artery

- Posterior interventricular artery

138
Q

What does the Marginal artery supple?

A

The right border of the heart

139
Q

What does the Posterior Interventricular artery supply?

A

Both the Left and Right Ventricles

140
Q

What does the Left Coronary Artery branch into?

A
  • Anterior Interventricular artery (LAD)

- Circumflex artery

141
Q

What does the Anterior Interventricular artery supply?

A
  • Anterior surface of both ventricles

- Most of the interventricular septum

142
Q

What is another name for the Anterior Interventricular artery?

A

Left Anterior Descending Artery (LAD)

143
Q

What does the Circumflex artery supply?

A
  • Left Atrium

- Posterior aspect of Left Ventricle

144
Q

The main tributary of the coronary sinus/sulcus is the:

A) Great cardiac vein
B) Middle cardiac vein
C) Great vein of Galen
D) Small cardiac vein

A

A) Great cardiac vein

145
Q

What 3 venous structures drain into the Right Atrium?

A
  • SVC
  • IVC
  • Coronary sinus
146
Q

What initiates the heartbeat?

A

Cardiac muscle fibers of the Sinoatrial node

147
Q

Where is the SA node located?

A
  • Posterior wall of the Right Atrium

- Adjacent to the entrance of the SVC

148
Q

How many times does the SA node initiate an impulse per minute?

A

70-80 times per minute

149
Q

The impulse from the SA node travels to both atria, stimulating ______________

A

Atrial Systole

150
Q

Where is the AV node located?

A

In the floor of the Right Atrium between the Right AV valve and the Coronary Sinus

151
Q

Where does the impulse travel through within the internodal conduction pathway?

A

Through an opening in the fibrous skeleton to the AV node

152
Q

After the impulse travels to the AV node, where does it go?

A

To the AV Bundle/Bundle of His

153
Q

Where is the Bundle of His located?

A

-Extends into the Interventricular Septum

154
Q

How many branches does the Bundle of His divide into?

A

1 RBB
2 LBB

BB = Bundle Branches

155
Q

What are the fibers located in the heart apex that the Bundle of His conducts impulses to?

A

Purkinje fibers

156
Q

Which fibers are larger, Purkinje fibers or other Cardiac Muscle Fibers?

A

Purkinje fibers

157
Q

After the impulse travels to the Purkinje fibers, where does it spread to?

A

Spreads immediately throughout the Ventricular Myocardium

158
Q

What does the phrenic nerve sit in?

A

the fascia of the anterior scalene muscle

159
Q

What does the Right recurrent laryngeal nerve go around?

A

the brachiocephalic duct

160
Q

What does the Left recurrent laryngeal nerve go around?

A

the aortic arch

161
Q

What is the Left recurrent laryngeal nerve just posterior to?

A

ligamentum arteriosum

162
Q

What does the Right lymphatic duct drain?

A

Right head, neck, UE, and right side of upper thorax

**Rest drains via the Thoracic duct

163
Q

What does the Right lymphatic duct lie between?

A
  • Right subclavian vein

- Right internal jugular vein

164
Q

What does the Left lymphatic duct lie between?

A
  • Left subclavian vein

- Left internal jugular vein

165
Q

As you descend down the mediastinum, what does the L vagus nerve become?

A

Anterior vagal trunk

166
Q

As you descend down the mediastinum, what does the R vagus nerve become?

A

Posterior vagal trunk

167
Q

Where do the Greater Splanchnic Nerves synapse?

A

NOT in the paravertebral ganglia

-Descend and synapse when they are below the diaphragm

168
Q

Where do the Lesser Splanchnic Nerves synapse?

A

Descends to the superior mediastinum

169
Q

Where do the Least Splanchnic Nerves synapse?

A

Descends to the inferior mediastinum

170
Q

What ganglion is near the esophagus posterior to the mediastinum?

A

cervicothoracic ganglion (Stellate ganglion)

171
Q

What 3 areas can become constricted when a swallowed foreign object is lodged?

A
  • Aortic arch
  • Left main bronchus
  • Diaphragm
172
Q

What are the intercostal arteries directly supplied by?

A

aorta

173
Q

Where do the intercostal veins drain?

A

azygos system

174
Q

Which side is the azygos vein on?

A

right

175
Q

Which side are the Hemiazygos and Accessory Hemiazygos vein on?

A

left

176
Q

What does the Left Superior Intercostal vein drain directly into?

A

Left Brachiocephalic Vein

177
Q

Which intercostal veins drain through the Accessory Hemiazygos?

A

Left 5, 6, 7, 8

178
Q

Which intercostal veins drain through the Hemiazygos?

A

Left 9, 10, 11, 12

179
Q

On both the Left and Right side, what do intercostal nerves 2, 3, and 4 drain into?

A

Left and Right Superior Intercostal

180
Q

What is a Mitral Valve prolapse?

A

Blood leaks back into the Left atrium when it should be going into the aorta

181
Q

Which arteries make up the first part of the systemic circuit?

A

coronary arteries

182
Q

What does the SVC and Azygos vein drain?

A
  • Upper limbs
  • Head
  • Neck
  • Thorax
183
Q

What does the IVC drain?

A

Everything from below the diaphragm

184
Q

What is the manubrosternal joint also called?

A

sternal angle

185
Q

What artery is the Left coronary artery associated with?

A

Anterior interventricular artery (LAD- Left Anterior Descending Artery)

186
Q

What kind of pleura does the fibrous pericardium sit up against?

A

mediastinal pleura

187
Q

What are not covered by endocardium?

A

valves

188
Q

What does the Right coronary artery run between?

A

Right atrium

Right ventricle

189
Q

What does the pulmonary trunk come off of?

A

Right ventricle

190
Q

What are the 2 branches of the Left Coronary Artery?

A
  • Circumflex artery

- Anterior interventricular artery (LAD)

191
Q

What is the Fossa Ovalis a remnant of?

A

Chordae ovali

Visible in Right Atrium

  • *Infants = Foramen Ovali
  • *Adults = Fossa Ovali
  • *Adults = Patent Foramen Ovali
192
Q

Does the Azygos vein drain into the Right Atrium?

A

NO…. It drains into the SVC

193
Q

How many cusps does the Right atrioventricular valve have?

A

3 (tricuspid valve)

194
Q

How many cusps does the Left atrioventricular valve have?

A

2 (bicuspid valve)

195
Q

What is the christa terminalis?

A
  • Smooth ridge on the Right atrium
  • Just before the opening to the Right ventricle
  • Mitigates blood flow into the Right ventricle
196
Q

The atria have __________ muscles and the ventricles have ____________

A 
Atria = Pectinate muscle
Ventricles = Trabeculae carnae
197
Q

Which cardiac vein does the LAD travel with and drains the Left side of the heart?

A

great cardiac vein

198
Q

Which cardiac vein drains the Right side of the heart?

A

small cardiac vein

ANATOMY II Exam #1- Lo (7 decks)

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