3-H Heart Gross Anatomy 2

Question 1

pulmonary veins

Answer 1

return oxygentated blood from the lungs to the left atrium

Question 2

ligmentum arteriosum

Answer 2

adult reminent of the ductus arteriosum

Question 3

Decribe the structure of the “skeleton” of the heart

Answer 3

composed of 4 interconnected rings of dense connective tissue called annuli fibrosis located at the opening of AV valves, pase of pulmonary trunk and base of the aorta

Question 4

What is the function fo the cardiac skeleton?

Answer 4

attachment site for cardiac myocytes and valves, electically isolates atria from ventricles and an optimal placement of sutures (contain no myocytes)

Question 5

Describe the histology fo the semilunar and atrioventricular valves

Answer 5

the cusps of the valves are composed of dense connective tissue that is continuous with cardia skeleton

Question 6

What must the cusps, chordae tendinae, and papillary muscles be covered in since they come in contact with blood?

Answer 6

endothelium

Question 7

Where can you best hear the sounds of the aortic valve?

Answer 7

the second intercostal space to the right of the sternum

Question 8

Where can you best hear the sounds of the pulmonary valve?

Answer 8

over the second intercostal space, left of stenum

Question 9

Where can you best hear the tricuspid sounds?

Answer 9

left of the sternum at the level fo the 5th costal cartilage

Question 10

Where can you best hear the mitral valve sounds?

Answer 10

over the apex of the heart

Question 11

Describe the anatomical position of the SA and AV nodes.

Answer 11

SA node at junction of superior vena cava and the right atrium, sending fibers to the right/left atrium and the AV node; b. AV node at the interatrial septum above the front of the opening of the coronary sinus, momentarily delays the conduction of the electrical impulse

Question 12

Where is the AV bundle located?

Answer 12

descending through the membranous portion of the intervetnricular septum, dividing into bundle branches

Question 13

What are right and left crura

Answer 13

two bundle branches that descend witin the endocarium on eiter side of of the muscular interventricular septum

Question 14

Discuss the vagal and sympathetic innervation of the heart

Answer 14

sympathetics from the sympathtic trunk (increase HR), parasympathetics form the vagus nerve (decrease HR) and sensory fibers also travel with the autnomics (viscerosensory)

Question 15

right coronary artery position

Answer 15

arises from the right side fo the aorta and lies in the coronary sulcus

Question 16

posterior interventricular position

Answer 16

supplies right and left ventricles ans posterior muscular interventricular septum

Question 17

right marginal position

Answer 17

supplies the right ventricle, following the lower right margin of the heart

Question 18

left coronary artery

Answer 18

major branch fro the aorta, just above the aortic valve

Question 19

great vein location

Answer 19

follows the circumflex artery back around the heart

Question 20

middle cardiac vein

Answer 20

travesl with the LAD, superficially long the intervetricular septum

Question 21

small cardiac vein

Answer 21

travels with the right marginal artery (lower right margin)

Question 22

All cardiac veins drain into?

Answer 22

coronary sinus

Question 23

Discuss implication of coronary collateral circulation and consequences if collateral circulation fails.

Answer 23

sympathetics from the sympathtic trunk (increase HR), parasympathetics form the vagus nerve (decrease HR) and sensory fibers also travel with the autnomics (viscerosensory)

Question 24

Describe common treatments for atherosclerosis of coronary arteries.

Answer 24

Angioplasty- mechanically reopen a vessel and possible place a stent; Atherectomy- remove a plaque; Coronary artery bypass grafting- create collateral circulation from transplanted vessels

Question 25

Describe the superior margin of the heart with surface projections.

Answer 25

visualized by drawing a line from the let second intercostal space to the right third costal cartilage

Question 26

Describe the right border of the heart based on surface projections

Answer 26

a line between the right third and sixth costal cartilages represents the right border of the heart, with the line extending about ½ inch to the right of the sternum

Question 27

Describe the inferior border of the heart based on surface projections

Answer 27

a line between the right sixth costal cartilage and the fifth intercostal space about 3.5 inches to the left of the sternum

Question 28

Describe the left border of the heart based on surface projections

Answer 28

line connecting the second and with intercostal spaces, the line is 2-3 inches from the left border of the sternum

Question 29

Which part of the heart forms the diaphragmatic interface?

Answer 29

left ventricle

Question 30

What is cardiac tamponade

Answer 30

when the pericardium becomes full of fluid and does not leave the heart to expand and adequately to fill the blood

Question 31

What tissues does a physician penetrate if they perform a pericardiocentesis?

Answer 31

the chest wall under the xiphoid process and in a posterior, superior direction angles toward the left shoulder: penetrates through the chest wall, central tendon of the diaphragm and enters the pericardial sac

Question 32

Where does the phrenic nerve enter the superior mediastinum?

Answer 32

between the subclavian artery and the forming brachiocephalic veins; as it travels down the right phrenic nerve is found right of the brachiocephalic vein, superior vena cava and right atrium where it lies between the mediastinal pleura and fibrous pericardium; the left phrenic nerve crosses the arch of the aorta and travels inferiorly along the pericardium over the surface of the left atrium and left ventricle located between the mediastinal pleura and fibrous pericardium; both pass anterior to the root of their respective lung

Question 33

What types of fibers does the diaphragm carry?

Answer 33

motor fibers to the diaphragm, sensory fibers that transmit information from the mediastinal pleura, pericardium and diaphragm (perceived as pain in the base of the neck and upper limbs)

Question 34

The cardiac skeleton is composed of four interconnected rings of dense connective tissue called ?

Answer 34

annuli fibrosi

Question 35

T/F There are cardiac myocytes in the cardiac skeleton?

Answer 35

False

Question 36

What are the two functions of the cardiac skeleton?

Answer 36

attachment site for cardiac myocytes and valves and it electrically insulates the atria from the ventricles to allow them to contract in succession

Question 37

The atrioventricular bundle (of His) traverses the fibrous skeleton between which valves continuing to the apex of the heart before stimulating ventricular contraction.

Answer 37

bicuspid and tricuspid valves

Question 38

Cusps of the heart valves are composed of ____ _____ tissue that is continuous with that of the cardiac skeleton.

Answer 38

dense connective tissue

Question 39

Valve cusps, chord tendineae and papillary muscles are covered with _______ because they are directly in contact with blood.

Answer 39

endothelium

Question 40

Where is the sternal angle?

Answer 40

where the second rib articulates with the sternum

Question 41

Why are ribs 8 through 12 called false ribs?

Answer 41

because their costal cartilages do not reach the sternum

Question 42

Why are ribs 11 and 12 also called floating ribs?

Answer 42

their tips end in the soft tissue of the body wall

Question 43

Where are the heart sounds for each of the valves best heard?

Answer 43

aortic valve (over the second intercostal space to the left of the sternum) pulmonic valve (over the second intercostal space to the right of the sternum) tricuspid valve (left of the sternum at the level of the 5th costal cartilage) mitral valve (over the apex of the heart along the 5th intercostal space)

Question 44

What are crura of the heart?

Answer 44

another name for bundle branches, they end as purkinje fibers that stimulate contraction of the ventricular myocytes

Question 45

Describe the innervation to the heart, what types of fibers and what named nerves carry those fibers

Answer 45

SA and AV nodes are innervated by both parasympathetic and sympathetic fibers (in general) vagal efferent fibers to the heart synapse in ganglia in the cardiac plexus or in the walls of the atria; sympathetic efferent fibers are nearly all post ganglionic fibers from the cervical and upper thoracic ganglia of the sympathetic trunk; afferent information (not part of autonomic) from the heart travels with sympathetic and parasympathetic nerves. Vagal affronts carry info related to reflexes, blood pressure and oxygen and carbons dioxide but not pain sensation. Afferents traveling with sympathetic system relay pain. Bonus: axons lie in the endomysium among the myocytes

Question 46

What portion of the heart does the LAD supply?

Answer 46

right and left ventricles and the anterior region of the muscular inter ventricular septum

Question 47

What portion of the heart does the circumflex artery supply?

Answer 47

left atrium and left ventricle

Question 48

Name 3 branches of the right coronary artery

Answer 48

sinoatrial nodal artery (SA node supply), right marginal artery (right ventricle supply) and posterior inter ventricular artery (right and left ventricles and posterior portion of the muscular inter ventricular septum

Question 49

T/F When variations occur in the coronary arteries such as right or left dominance, they always occur on the back of the heart

Answer 49

True

Question 50

All cardiac veins drain into what structure?

Answer 50

coronary sinus which delivers deoxygenated blood to the right atrium Note not all venous blood from the myocardium returns via the coronary sinus (some anterior cardiac veins and smallest cardiac veins empty directly into the right atrium)

Question 51

What are obvious consequences of severe damage to the muscular wall of the left ventricle during an AMI?

Answer 51

dilation of the ventricle and incomplete emptying of the ventricle during systole which can lead to increased ventricular diastolic pressure, increased left atrial pressure and pulmonary congestion due to pulmonary venous pressures being elevated (analogous changes are seen in right heart failure concerning systemic edema)