1 Cardiac Anatomy Flashcards
What is a normal heart rate?
60-100 bpm
What is a normal ABP?
Arterial blood pressure; 120/80
What is a normal CVP? What does it estimate?
Central venous pressure; 2-6 (mean= 5)
**estimates right atrial pressure
What physical observation can be made in a patient with elevated CVP?
Jugular vein distension
What is a normal PAP? How is it measured?
Pulmonary arterial pressure; 25/10
**Measured via central line in internal jugular vein -> superior vena cava -> right atrium -> R ventricle -> pulmonary artery
What is a normal pulmonary wedge pressure? How is it measured?
Usually ~15
**Balloon inflated in pulmonary artery and “regurgitation pressure” measured (flow back from lungs)
What pressure is estimated by the pulmonary wedge? What could cause this to be elevated?
Left atrial pressure
**elevated in cardiac tamponade as blood fills the pericardium and allows less filling of the heart
On radiograph, how big should a patient’s heart be?
Less than half the greatest thoracic diameter (measured from inside the rib cage at its widest point near the diaphragm)
What is the most common part of the heart injured in a puncture wound to the right of the sternum? To the left?
To the right= right atrium
To the left= right ventricle
**the L ventricle has a small portion at the “front” of the heart but mostly wraps backward, the L atrium is completely posterior
What are the layers of the pericardium from superficial to deep?
- fibrous pericardium **non-distendable
- parietal layer of the serous pericardium
- visceral layer of the serous pericardium (outer layer of epicardium)
**Note; pericardial “cavity” is capillary thin (potential space)
Describe the areas where you would hear sounds from all 4 heart valves
- Aortic= intercostal space 2, right of sternum
- Pulmonary= intercostal space 2, left of sternum
- Tricuspid= just lateral to body of the sternum below rib 5
- Mitral= apex of heart at intercostal space 5
How can breathing affect cardiac output?
Deep breathing can increase cardiac output as the diaphragm pulls down and relieves some pressure on the heart
Name these numbered vessels
**What is the long vessel coming down off of “1”?
- R brachiocephalic (internal thoracic/mammary coming off inferiorly)
- R subclavian
- R common carotid
- L common carotid
- L subclavian
- R coronary (note SA nodal branch coming off superiorly)
When do the coronary arteries perfuse the heart?
When the aortic valve is closed in diastole
Where is the anterior ventricular artery?
Also called the LAD; branches off the left coronary artery and passes inferiorly to perfuse the left ventricle
What are the branches of the left coronary artery?
The anterior interventricular branch (LAD) and circumflex artery
What are the three most important vessel pairs perfusing the heart?
- Anterior interventricular artery (LAD) with the great cardiac vein
- R Marginal branch (off R coronary) with the small cardiac vein
- Posterior interventricular artery with the middle cardiac vein
What are the 2 semilunar valves?
**3 leaflets;
- Aortic
- Pulmonary
Where is the SA node located? AV node?
SA= where the superior vena cava and atrium meet (more external)
AV= where all the chambers of the heart meet (more internal; next to the fossa ovalis and opening of the coronary sinus)
When do the mitral and tricuspid valves close?
Atrioventricular valves close very soon after systole begins during isovolumetric ventricular contraction (LUB)
When do the aortic and pulmonary valves close?
Beginning of diastole (DUB)
Describe the wiggers diagram
What is the effect of parasympathetic innervation of the heart?
Motor control to decrease HR and SV
What is the effect of sympathetic innervation of the heart?
Postganglionic fibers come from upper chain ganglia to the heart (3 cervical and T1-T5) to increase HR and SV
Where do pain afferents coming from the heart enter the spinal cord?
T1-T5 (reason for referred pain at those dermatomes)
What chamber of the heart has the capability of compressing the esophagus when it hypertrophies?
Left atrium (hypertrophies most commonly with mitral valve stenosis/prolapse)
Describe the path usually taken to complete a coronary angioplasty/stent
femoral artery -> external iliac -> common iliac -> aorta -> R/L coronary artery to occlusion
Describe a triple bypass
Vein grafts from the legs are taken, flipped (to correct direction of valves) and sewn to the aorta and the…
- right coronary artery
- LAD
- circumflex artery
**Can also take the left internal thoracic/mammary artery branching off the L subclavian artery and reattach it inferior to the clot in the LAD
Where are the most common sites of coronary occlusion? (6)
1= LAD
Describe the cardiac effects/causes of systolic and diastolic dysfunction of the heart
- Systolic dysfunction
- thinned cardiac muscle
- usually post-MI or from myocarditis
- Diastolic dysfunction
- hypertrophy
- usually due to hypertension (or can be just from aging; some genetic component)
Describe the systemic symptoms of left and right heart failure
- Left
- dyspnea
- severe pulmonary congestion
- NO increase in CVP
- Right
- cyanosis, hepatomegaly, ascites
- edema
- engorgement of jugular veins
- INCREASED venous pressure
