3-H Heart Gross Anatomy 2 Flashcards
pulmonary veins
return oxygentated blood from the lungs to the left atrium
ligmentum arteriosum
adult reminent of the ductus arteriosum
Decribe the structure of the “skeleton” of the heart
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
What is the function fo the cardiac skeleton?
attachment site for cardiac myocytes and valves, electically isolates atria from ventricles and an optimal placement of sutures (contain no myocytes)
Describe the histology fo the semilunar and atrioventricular valves
the cusps of the valves are composed of dense connective tissue that is continuous with cardia skeleton
What must the cusps, chordae tendinae, and papillary muscles be covered in since they come in contact with blood?
endothelium
Where can you best hear the sounds of the aortic valve?
the second intercostal space to the right of the sternum
Where can you best hear the sounds of the pulmonary valve?
over the second intercostal space, left of stenum
Where can you best hear the tricuspid sounds?
left of the sternum at the level fo the 5th costal cartilage
Where can you best hear the mitral valve sounds?
over the apex of the heart
Describe the anatomical position of the SA and AV nodes.
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
Where is the AV bundle located?
descending through the membranous portion of the intervetnricular septum, dividing into bundle branches
What are right and left crura
two bundle branches that descend witin the endocarium on eiter side of of the muscular interventricular septum
Discuss the vagal and sympathetic innervation of the heart
sympathetics from the sympathtic trunk (increase HR), parasympathetics form the vagus nerve (decrease HR) and sensory fibers also travel with the autnomics (viscerosensory)
right coronary artery position
arises from the right side fo the aorta and lies in the coronary sulcus
posterior interventricular position
supplies right and left ventricles ans posterior muscular interventricular septum
right marginal position
supplies the right ventricle, following the lower right margin of the heart
left coronary artery
major branch fro the aorta, just above the aortic valve
great vein location
follows the circumflex artery back around the heart
middle cardiac vein
travesl with the LAD, superficially long the intervetricular septum
small cardiac vein
travels with the right marginal artery (lower right margin)
All cardiac veins drain into?
coronary sinus
Discuss implication of coronary collateral circulation and consequences if collateral circulation fails.
sympathetics from the sympathtic trunk (increase HR), parasympathetics form the vagus nerve (decrease HR) and sensory fibers also travel with the autnomics (viscerosensory)
Describe common treatments for atherosclerosis of coronary arteries.
Angioplasty- mechanically reopen a vessel and possible place a stent; Atherectomy- remove a plaque; Coronary artery bypass grafting- create collateral circulation from transplanted vessels
Describe the superior margin of the heart with surface projections.
visualized by drawing a line from the let second intercostal space to the right third costal cartilage
Describe the right border of the heart based on surface projections
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
Describe the inferior border of the heart based on surface projections
a line between the right sixth costal cartilage and the fifth intercostal space about 3.5 inches to the left of the sternum
Describe the left border of the heart based on surface projections
line connecting the second and with intercostal spaces, the line is 2-3 inches from the left border of the sternum
Which part of the heart forms the diaphragmatic interface?
left ventricle
What is cardiac tamponade
when the pericardium becomes full of fluid and does not leave the heart to expand and adequately to fill the blood
What tissues does a physician penetrate if they perform a pericardiocentesis?
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
Where does the phrenic nerve enter the superior mediastinum?
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
What types of fibers does the diaphragm carry?
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)
The cardiac skeleton is composed of four interconnected rings of dense connective tissue called ?
annuli fibrosi
T/F There are cardiac myocytes in the cardiac skeleton?
False
What are the two functions of the cardiac skeleton?
attachment site for cardiac myocytes and valves and it electrically insulates the atria from the ventricles to allow them to contract in succession
The atrioventricular bundle (of His) traverses the fibrous skeleton between which valves continuing to the apex of the heart before stimulating ventricular contraction.
bicuspid and tricuspid valves
Cusps of the heart valves are composed of ____ _____ tissue that is continuous with that of the cardiac skeleton.
dense connective tissue
Valve cusps, chord tendineae and papillary muscles are covered with _______ because they are directly in contact with blood.
endothelium
Where is the sternal angle?
where the second rib articulates with the sternum
Why are ribs 8 through 12 called false ribs?
because their costal cartilages do not reach the sternum
Why are ribs 11 and 12 also called floating ribs?
their tips end in the soft tissue of the body wall
Where are the heart sounds for each of the valves best heard?
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)
What are crura of the heart?
another name for bundle branches, they end as purkinje fibers that stimulate contraction of the ventricular myocytes
Describe the innervation to the heart, what types of fibers and what named nerves carry those fibers
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
What portion of the heart does the LAD supply?
right and left ventricles and the anterior region of the muscular inter ventricular septum
What portion of the heart does the circumflex artery supply?
left atrium and left ventricle
Name 3 branches of the right coronary artery
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
T/F When variations occur in the coronary arteries such as right or left dominance, they always occur on the back of the heart
True
All cardiac veins drain into what structure?
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)
What are obvious consequences of severe damage to the muscular wall of the left ventricle during an AMI?
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)
