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๐˜พ๐™ก๐™ž๐™ฃ๐™ž๐™˜๐™–๐™ก ๐˜ผ๐™ฃ๐™–๐™ฉ๐™ค๐™ข๐™ฎ > 3. Thorax III > Flashcards

3. Thorax III Flashcards

1
Q

What is the pectinate muscle (musculae pectinatae)?

A

Muscle at atrium (โ€œallowsโ€ expansion of the muscles)

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2
Q

What are the projections on the trabeculae carnae called? and what are they for?

A

Papillary muscles, suspending the chordae tendinae to close valve when needed

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3
Q

What is this structure? what is its function?

A
  • Fibrous pericardium
  • tough, stiff protective layer which does not move, it prevents heart from over-expanding
  • inferior border is attached to central tendon of the diaphragm
  • attached anteriorly to the sternum by sternopericardial ligaments
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4
Q

which pericardial layer โ€˜allowsโ€™ contraction and movelent of heart due to presence of lubrication?

A

Serous pericarium

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5
Q

What are the two layers of the serous pericardium?

A
  • Visceral pericardium (tightly lines the heart) and parietal pericardium (lies fibrous pericardium)
  • space betwen the two layers = pericardial cavity (and is filled with fluid)
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6
Q

Which structure forms most of base of heart?

A

Left atrium

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7
Q

What is the equivalent of the christa terminalis on the left atrium?

A

There is no equivalent because the left atrium is continuous with the left auricle

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8
Q

What is this structure? and what is its function?

A
  • They are the cusps of the aortic valve
  • form aortic sinuses in which the coronary orifice is present
  • so when left ventricle contracts and blood flows out and then backflows it is collected in these aortic sinuses and flows through the coronary orifices to enter coronary circulation (coronary orifice is only present on the right and left cusps)
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9
Q

What is this image and what is the structure highlighted in red?

A
  • Cardiac silhouette
  • structure is the aortic notch/nob due to distal aortic arch as it curves posterolaterally
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10
Q

How is the SVC โ€˜formedโ€™?

A

Right and left brachiocephalic vein fusion

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11
Q

how is brachiocephalic vein โ€˜formedโ€™?

A

fusion of subclavian vein and jugular vein

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12
Q

What are the auscultation points for the different valves?

A
  • placement of stethescope differs from position of the valve being examined (valve sounds travel through surrounding structures of thoracic wall)
  • so placement is downstream of bloodflow
  • Red = aortic valve - medial end 2nd right intercostal space
  • Blue = pulmonary valve - medial end 2nd left intercorstal space
  • Green = tricuspid valve - 4th left intercostal space at sternal border
  • Puprle = mitral valvue - 5th left intercostal space at mid-clavicular line
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13
Q

What are these layers of the heart?

A
  • Endocardium - innermost layer, lining heart cavitieis and valves
  • Myocardium - composed of cardiac muscle, โ€˜responsible forโ€™ heart contraction
  • Epicardium - outermost layer of the heart formed by visceral layer of serous pericardium. Epicardium is composed of connective tissue and fat.
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14
Q

Which part of the heart contains the purkinje fibres?

A

Subendocardial tissue (deep to the endocardium)

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15
Q

What kind of tissue is the endocardium composed of?

A

Loose connective tissue and simple squamous epithelium

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16
Q

What does the subendocarium/subendocardial tissue contain?

A
  • loose vascularised connective tissue
  • nerve fibres
  • purkinje fibres
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17
Q

What is the ratio of myocardial thickness to endocardial thickness?

A
  • inverse
  • in areas where myocardium is thinner (like atria) the endocardium is relatively thick
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18
Q

What are the features of the myocardium?

A
  • Middle layer of heart
  • contains large quantity of muscle cells (cardiomyocytes)
  • cardiomyocytes are arranged in a branched, linear manner (have a striated appearance)
  • myocardium is highly vascularised
  • cardiomyocytes contain glycogen granules as an additional energy soure
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19
Q

What are features of cardiac muscle?

A
  • consists of striated muscle fibres which branch and unite with each other
  • muscles are straited but branch and rejoin each other
  • fibres are arranged in whorls and spirals (so not super linear striated fibres like skeletal muscle)
  • coordinated contraction of the cardiomyocytes propels blood from atria to ventricles
  • cardiomyocytes are connected by intercalated discs forming a cardiac syncytium
  • this connection via intercalated discs enables transmission of electrical impulses through network and coordinated contraction of myocardium
20
Q

What is epicardium?

A
  • visceral portion of serous pericardium
  • it is a mesothelium derivative rich in adipocytes and neurovascular tissue
21
Q

what is it called when a large blood vessel has its own blood supply?

A

Vasa Vasorum

22
Q

What is translation of โ€˜vasa vasorumโ€™?

A

Vessel of the vessel

23
Q

Why does the heart need its own blood supply?

A

Because muscular wall of the heart is too thick for diffusion to be sufficient

24
Q

where do the coronary arteries (right and left) โ€˜ariseโ€™ from?

A

aortic sinuses of the ascending aorta

25
Q

What other strucutre has its own vasa vasorum?

A

aorta to โ€˜supplyโ€™ its thick muscular wall with necessary oxygen and nutrients, however these vessels are not named

26
Q

label this image

A
27
Q

What are the features of the right coronary artery?

A
  • Arises from aorta
  • it runs in between the pulmonary trunk and the right auricle
  • it descends almost vertically in the right atrioventricular groove
  • at the inferior border it continues posteriorly to anastomose with left coronary artery
  • has a marginal branch and a posterior interventricular branch (right dominant heart)
28
Q

Are there anastomoses between right and left coronary arteries?

A

Yes, and this is good as it means there are alternative routes of blood supply for the heart if a vessel become occluded due to ischaemia

29
Q

What are some features of the left coronary artery?

A
  • slightly larger than the right coronary artery
  • runs in between the left auricle and pulmonary trunk
  • it divides into the anterior interventricular branch (aka LAD) and the circumflex branch
30
Q

What percentage of people have their right coronary artery โ€˜supplyโ€™ the SA node?

A

60%

31
Q

What percentage of people have the left coronary artery โ€˜supplyingโ€™ the SA node?

A

40%

32
Q

What does circumflex artery anastomose with?

A

anastomoses with the posterior aspect of right coronary artery

33
Q

What is effect on SA node if one of the coronary arteries becomes occluded?

A

may not be an issue to the conduction system if the SA node is not โ€˜supplied byโ€™ that specific coronary artery

34
Q

What kind of heart is this and why?

A

Left dominant heart because the posterior interventricular artery branched from the left coronary artery (~8% of the population)

35
Q

What kind of heart is this?

A

Codominant heart because the posterior interventricular artery branched form both the right and left coronary arteries (~8% of the population)

36
Q

What kind of heart is this?

A

Right dominant because the posterior interventricular artery branches from the right coronary artery

37
Q

What structures are โ€˜supplied byโ€™ the right coronary artery?

A
  1. right atrium
  2. right ventricle (most)
  3. left ventricle (diaphragmatic part)
  4. interventricular septum (posterior 1/3)
  5. SA node (60% of people)
38
Q

What structures are โ€˜supplied byโ€™ the left coronary artery?

A
  1. left atrium
  2. left ventricle (most)
  3. right ventricle (partly)
  4. anterior 2/3 of interventricular septum
  5. SA node (40% of people)
  6. AV node and bundle
39
Q

Where do the cardiac veins drain into?

A

Coronary sinus of right atrium

40
Q

What are the tributaries of the coronary sinus?

A
  • great cardiac vein
  • middle cardiac vein
  • small cardiac vein
  • posterior cardiac vein
41
Q

Label this image

A
42
Q

Describe the route of the great cardiac vein

A
  • arises from apex of heart
  • ascends up the anterior surface of the interventricular septum
  • then crosses around coronary sulcus from the front
  • goes around the back and empties into the coronary sinus
43
Q

Describe the route of the middle cardiac vein

A
  • ascends up posterior surface of interventricular septum and drains into the coronary sinus
44
Q

Describe the route of the small cardiac vein

A
  • arises from tissue along the right margin of the heart
  • goes to the coronary sulcus to drain into the coronary sinus
45
Q

Describe the anterior cardiac veins and how they drain

A
  • They are small and only drain the anterior portion of the right ventricle
  • and they drain directly into the right atrium, not via the coronary sinus
46
Q

Describe left posterior cardiac vein

A
  • a.k.a the left posterior ventricular vein
  • present on the left side of the middle cardiac vein
  • empties into the coronary sinus

๐˜พ๐™ก๐™ž๐™ฃ๐™ž๐™˜๐™–๐™ก ๐˜ผ๐™ฃ๐™–๐™ฉ๐™ค๐™ข๐™ฎ (20 decks)

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