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Thorax Anatomy > 3 - The heart and mediastinum > Flashcards

3 - The heart and mediastinum Flashcards

1
Q

The transverse thoracic plane is the horizontal plane from
the sternal angle (2nd rib level) to the intervertebral disc of T4-T5 vertebrae , which divides _____ mediastinum from
________ mediastinum

A

Superior; posterior

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2
Q

Name the 8 notable structures at the level of the transverse thoracic plane.

A

RATPLANT

  1. Rib 2
  2. Arch of aorta
  3. Trachea bifurcation
  4. Pulmonary trunk
  5. Ligamentum arteriosum
  6. Azygous vein enters SVC
  7. Nerves: left recurrent laryngeal nerve, cardiac plexus, sympathetic trunk
  8. Thoracic duct crosses from the right to the left (not happen in asians)
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3
Q

Branches of the aorta?

A 
"ABCS"
Aorta
Brachiocephalic trunk
left common Carotid artery
left Subclavian vein
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4
Q

What are the 4 main structures present in the superior mediastinum?

A
  1. Thymus
  2. Great vessels:
    - ABCS, SVC
  3. Trachea and its main branches
    - tracheobronchial lymph nodes
  4. Nerves:
    - Phrenic nerves
    - Vagus nerves
    - Left recurrent laryngeal nerve
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5
Q

What are the 5 main structures present in the posterior mediastinum?

A
  1. Esophagus
  2. Thoracic aorta and intercostal arteries
  3. Azygous and hemiazygous veins
  4. Nerves
    - Parasympathetic: vagus nerve (esophageal and cardiac plexus)
    - Sympathetic: Sympathetic trunk, splanchnic nerves (greater and lesser) (SSS)
  5. Lymphatics: Thoracic duct (posterior to esophagus)
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6
Q

The middle mediastinum contains:

A

Heart and pericardium

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7
Q

The 2 pericardium that the heart has are:

A
  1. Serous pericardium
    (inner, visceral and parietal layers)
  2. Fibrous pericardium (outer)
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8
Q

What are the 2 sinuses of the heart? What are their clinical correlations?

A
  1. Transverse pericardial sinus
    - space behind the
    aorta and pulmonary trunk
    - By passing a surgical clamp, can stop or divert the
    circulation of blood in these large arteries while
    performing cardiac surgery
  2. The oblique pericardial sinus
    - space behind the heart
    within the pulmonary veins.
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9
Q

If your finger is put in the transverse pericardial sinus, what are the structures anteriorly and posteriorly?

A

Anterior: Ascending aorta and pulmonary trunk

Posterior: Arch of aorta

(can refer to notes for a diagram)

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10
Q

What is pericarditis?

What is the treatment of it?

A

Pericarditis is the inflammation of the serous pericardium, causing accumulation of fluid in the pericardial cavity which compresses on the heart (cardiac tamponade)

Treatment:
Pericardiocentesis
- drawing fluid /blood accumulated in the pericardial cavity.

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11
Q

What are the borders of the heart? (4!)

A

Superior: Root of great vessels
Right border: RA, IVC, SVC
Left border: LV, apex of heart
Inferior border: Diaphragmatic surface of the heart

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12
Q

What are the 3 surfaces of the heart? What structures are located there respectively?

A

Anterior surface:
RA, RV (mostly), LV, atrioventricular groove (RA,RV) = coronary sulcus, anterior interventricular sulcus (LV,RV)

Inferior surface (Diaphragmatic) :
LV (most), RV, posterior interventricular sulcus, (with the apex)

Posterior surface:
RA, LA, origin of great vessels

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13
Q

The posterior interventricular sulcus separates the left
and right ventricles on the posterior side, it contains the
____________ artery and the ________ vein.

A

Posterior interventricular;

Middle cardiac vein

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14
Q

The anterior interventricular sulcus separates the left and

right ventricles on the anterior side, it contains the___________artery and the ___________ vein

A

Anterior interventricular;

Great cardiac vein

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15
Q

The papillary muscles are muscle projections with one end attaching to the ________ and the other end to ________.

A

ventricular wall;

Chordae tendineae

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16
Q

____________ a network structure forming an elevated platform: papillary muscles are examples of them

A

Trabeculae carneae

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17
Q

The right atrium receives blood from:

A

SVC, IVC, coronary sinus

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18
Q

In the atria, the appendages projects from the atrium like an add-on room, and are with _________ muscles.

A

pectinate muscles

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19
Q

The crista terminalis
A. the junction between the sinus venosus and the heart in the developing embryo.

B. is a smooth muscular ridge that separates the rough part and smooth part of the right atrial wall

C. provides the origin for the pectinate muscles

A

All

B: Rough part: presence of pectinate muscles

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20
Q

Auricle refers to ___________.

A

the space within the atrial

appendage

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21
Q

The AV node is on the septum and located near the opening of the ___________.

A

coronary sinus

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22
Q

Fossa ovalis locates on the __________. It is equivalent to the _________ of the fetal heart.

A

Atrial septum;

foramen ovale

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23
Q

_________ is the pacemaker of the heart.

A

SA node (sinoatrial node)

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24
Q

Valves are present at the openings of the ____ and _______ into the right atrium.

A

IVC and coronary sinus.

but not the SVC

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25
Q

What are the actions of the papillary muscles when blood flow from RA to RV?

A

The papillary muscles begin to contract before contraction of right ventricle, pulling on chordae tendineae, preventing the tricuspid valves from being driven into the right atrium.

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26
Q

______________ carries
conducting tissue to the papillary muscles so papillary
muscle contracts earlier than the right ventricle

A

Moderator band

only in RV!

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27
Q

The _______ is the superior part of the right ventricle. It

is cone-shaped and leads into the pulmonary trunk

A

Infundibulum

28
Q

Where are the SA node and AV node specifically?

A

SA node: entrance of SVC, right atrium, superior end of cristae terminalis

AV node: within the Koch’s
triangle , the triangle with borders formed by the coronary sinus orifice , septal leaflet of tricuspid valve and fossa ovale

29
Q

The left atrium receives blood from __________.

A

Pulmonary veins

30
Q

__________ locates posteriorly to the left atrium

A

Esophagus

31
Q

Behind the left cusp and right cusp of the aortic valves, are
holes on the wall. These holes lead to the ______ and _________.

A

left coronary artery and right coronary artery

32
Q

Opening and closing of valves is ALWAYS driven by

__________ of the two sides of the valve

A

the pressure difference

33
Q 
The left ventricle has
A. the thickest wall
B.  Trabeculae carneae
C. papillary muscles with cordae tendineae
D. Mitral valves and aortic values
A

All

34
Q

Atrioventricular valves (tricuspid, mitral): close during __________ to prevent blood backflow from ventricles to atria

A

ventricular systole or constriction

35
Q

__________ close during ventricular diastole or dilation to prevent blood backflow from arteries to ventricles; cusps of aortic valves – origins of coronary arteries

A

Arterial (pulmonary, aortic) valves

36
Q

What is the mnemonic to remember the arteries supplying the heart?

A

○ Form a fist with the left hand, place left fist anterior to heart. Fingers represent the position and direction of
blood vessels
○ Left coronary artery indicated by thumb and index finger
■ Thumb: circumflex artery (curls to the
posterior side of heart)
■ Index finger: anterior IV branch (runs inferiorly)
○ Pinky finger: Right coronary artery (runs inferiorly)

37
Q

Heart valve diseases:

___________ : failure to open valve completely > impeding flow from atrium to ventricle

A

Stenosis

38
Q

Heart valve diseases:

__________: failure to close valve completely > backflow of blood from ventricle to atrium

A

Incompetence

39
Q

What are the 2 ○ Mitral (bicuspid) valve diseases?

A 
Mitral stenosis (narrowing)
Mitral regurgitation (incompetence)
40
Q

What are the 2 Aortic valve diseases?

A 
§ Aortic stenosis (narrowing)
Aortic regurgitation (incompetence)
41
Q

Both Right and left coronary arteries arise from _____________.
State the vessel pathway from right coronary artery and left coronary artery respectively.

A

the cusps of the aortic valves;

Pathway:
Right coronary artery:
SA node artery> Right marginal artery > posterior interventricular artery* > AV node artery

Left coronary artery:
Anterior interventricular artery* > circumflex artery > left marginal artery

Just remember the *

42
Q

What is the mnemonic to remember the veins draining the heart?

A

○ Form a “6” (fist with thumb and pinky finger pointing
out) with the right hand, place right hand posterior to
heart. Align knuckles on coronary sinus
○ Thumb ( greatest finger): Great cardiac vein (runs
laterally to the left)
○ Index finger: Left marginal vein (runs toward the
apex)
○ Middle finger: Posterior ventricular vein (runs
toward the apex)
○ Ring finger: Middle cardiac vein (runs toward the
apex)
○ Pinky finger (the smallest finger): Small cardiac vein
(runs laterally to the right)

43
Q

The great cardiac vein runs along the _______
artery and _______ artery (arteries of the left coronary
artery) in an L-shape and drains into the ____________.

A

Anterior interventricular artery;
Circumflex artery;

Coronary sinus

44
Q

The middle cardiac vein runs along the _______.

A

posterior

interventricular artery

45
Q

The small cardiac vein runs along the _______.

A

right marginal artery

46
Q

○ Great cardiac vein drains the areas supplied by the
_______________
○ Middle and small cardiac veins drain areas supplied
by the ______________.

A

Left coronary artery;

Right coronary artery

47
Q

Which of the following about Sympathetic actions on the heart is/are correct?

A. Thoracolumbar outflow (T1-L2/L3
B. by sympathetic trunk
C. Cranosacral outflow 
D. 4 cranial nerves: 3,7,9,10
E. S2-4 sacral nerves 
F.  increases contraction of cardiac muscle and heartbeat
G. Dilates the coronary vessels
A

A,B,F,G

C,D and E are parasympathetic

*Parasympathetic action:
decrease heartbeat, constricts coronary vessels

48
Q

__________ is where blood flows from the right atrium (the higher pressure side in foetus) to the left atrium, bypassing the pulmonary circuit (fetal lungs are of high vascular resistance).

A patent foramen ovale (when the interatrial septum fails to close) results in a congenital condition named ___________.

A

Foramen ovale;

atrial septal defect

49
Q

Conducting system of the heart:
SA node generates impulses to stimulate:
(use a flow chart)

A

atrial myocardium
> AV node
> bundle of His
> left and right bundle branches to ventricular myocardium

50
Q 
Referred pain:
Site of damage - Dermatomes referred to
A. diaphragm
B. heart
C. gall bladder
D. stomach
E. Appendix
A 
A. C 3-4
B. T 1-4 (left)
C. T 7-8 (right)
D. T 6-9 (left)
E. T 10
51
Q

Sympathetic trunk consists of
paired nerve bundles.
The paired referred to ______ and ______ that supplies the ________________________ and ___________________ respectively.

A
  • Upper fibers: thoracic viscera (esophagus, heart)

- Lower fibers: Splanchnic nerves (abdominal and pelvic viscera)

52
Q

3 divisions of the splanchnic nerves are:

List the vertebral level too

A
  1. Great splanchnic nerve (T5-T9)
  2. Lesser splanchnic nerve (T10-11)
  3. Least splanchnic nerve (T12)
53
Q

Vagus nerves give branches to the _____, ______ and _______ plexuses (*parasympathetic)

A

esophageal, cardiac and pulmonary

54
Q

The right vagus nerve gives rise to __________________ which loops under the ___________.

A

right recurrent laryngeal nerve;
right
subclavian artery

55
Q

The left vagus nerve gives rise to__________________ which passes posterior and
lateral to the ____________ under the ___________.

A

left recurrent laryngeal nerve;
Ligamentum arteriosum;
aortic arch

56
Q

Both recurrent branches of the vagus nerve innervate the ________.

A

Larynx

57
Q

The ligamentum arteriosum is the ___________
before birth. The _______ (same) acts as a shunt so blood in pulmonary trunks can bypass the lungs (gaseous exchange occurs in the placenta in foetus) and enters the aorta directly.

A

ductus arteriosus

○ Mnemonic: Note the consistent ending letters
○ Ligamentum arteriosum
○ Ductus arteriosus

extra:
○ Foramen ovale → fossa ovale
○ Duct us arterios us → ligament um arterios um
○ Duct us venos us → ligament um venos um
○ The first two function to bypass lungs, while the third
bypasses liver

58
Q

Summary of fetal circulation (just before birth):
placenta → umbilical vein (ligamentum teres hepatis)
→ ductus venosus (ligamentum venosum) →
inferior vena cava → right atrium → through foramen
ovale (fossa ovale) → left atrium → left ventricle →
ascending aorta → upper part of body (well
oxygenated blood to brain) → superior vena cava →
right atrium → right ventricle → pulmonary trunk →
ductus arteriosus (ligamentum arteriosum) →
descending aorta → lower part of body (less
oxygenated blood) → umbilical arteries (medial
umbilical ligaments) → placenta

A

Just understand it :)

59
Q

What are the 3 narrowed areas of the esophagus?

A
  1. Origin below pharynx (C6)
  2. Crossing of the left bronchus and aortic arch (T4)
  3. Esophageal opening at diaphragm

Structures related to/ compress on esophagus:

  1. Left bronchus (anterior)
  2. Aortic arch (left side)
  3. Left atrium (anterior surface of esophagus)
  4. Right pulmonary veins
60
Q

The azygos system forms anastomoses between _____ and __________.

A

SVC and IVC

61
Q 
Azygos vein (right) , accessory hemiazygos vein (left)  and
hemiazygos vein (left) drain \_\_\_\_\_\_\_\_\_\_\_\_\_. They are paried/unpaired.
A

posterior intercostal veins;
unpaired

like a “K”
up stroke: accessory hemiazygous
down stroke: hemiazygous vein

七上八下 T7 T8

62
Q

When portal circulation is impaired, blood bypasses the portal vein through ___________. One site of such
anastomoses is that of ________ and ______ at the esophagus. The increase in blood flow through
the anastomoses can cause varices and subsequently
hemorrhage.

The esophageal plexus then drain blood to the _______.

A

portal-systemic
anastomoses;

esophageal veins and left gastric vein.

Azygous vein

63
Q

Azygos vein drains the __________.
Accessory hemiazygos vein drains the ________ .
Hemiazygos vein drains the_________ .

A

right thoracic wall;
left upper thoracic wall;
left lower thoracic wall

64
Q

What can be a cause of portal hypertension in liver cirrhosis?

A

varicose of esophageal veins

65
Q

What is the ligamentum arteriosum? What is its embryological significance? What is its
relation to the recurrent laryngeal nerve(s)?

A

Ligament between the pulmonary trunk and aorta
Remnant of ductus arteriosus, one of the fetal shunts
The left recurrent laryngeal nerve runs behind the ligamentum arteriosum

66
Q

Where does the aorta first branch?

A

Coronary arteries (right above aortic cusps), not brachiocephalic trunk

Thorax Anatomy (3 decks)

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