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PHA 500 > 4. Mediastinum + Heart I > Flashcards

4. Mediastinum + Heart I Flashcards

1
Q

Mediastinum (def)

A

Midline region between R and L pleural cavities

Houses all thoracic organs except lungs

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2
Q

Mediastinum (borders, plane)

A

Superior: superior thoracic aperture

Inferior: diaphragm

Divided into superior and inferior mediastinum by horizontal plane through sternal angle

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3
Q

Superior Thoracic Aperture

A

Ring of bones

T1 vertebrae, Rib 1, Manubrium

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4
Q

Thymus

A

Lymphoid organ

Important in development and maintenance of immune system

Gradual involution: shrinks and replaced with fat

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5
Q

Thymus (location)

A

Posterior to manubrium, body

Anterior to pericardium

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6
Q

Pericardium

A

AKA Pericardial Sac

Fiberoserous membrane surrounding heart, roots of great vessels

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7
Q

Phrenic Nerves

A

Motor: diaphragm

Sensory: diaphragm, parietal pleura, fibrous pericardium, parietal layer of serous pericardium

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8
Q

Pericardium (layers)

A

Fibrous
Parietal Serous
Visceral Serous

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9
Q

Fibrous Pericardium

A

Tough

External layer

Inelastic (prevents heart from overfilling)

Attached to central tendon of diaphragm

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10
Q

Serous Pericardium

A

Parietal lines fibrous pericardium

Visceral lines heart

Continuous w/ each other

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11
Q

Pericardial Cavity

A

Potential space between parietal and visceral layers of serous pericardium

Contains serous fluid

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12
Q

Pericarditis

A

Inflammation of serous pericardium

Leads to roughened surfaces and pericardial friction

Auscultation sign: fabric rubbing together

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13
Q

Cardiac Tamponade

A

Accumulation of fluid in pericardial cavity

This leads to compression and restriction of heart’s ability to fill to capacity

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14
Q

Pericardiocentesis

A

Drains fluids from pericardial cavity

Need to avoid lungs

  1. intercostal nerve block
  2. subxiphoid approach or parasternal approach
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15
Q

Subxiphoid Approach

A

Insert needle to the left of the xiphoid process, directly superiorly deep to costal margin

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16
Q

Parasternal Approach

A

Insert needle to the left of the sternum in the left 5th or 6th intercostal space – cardiac notch!!

17
Q

Heart Chambers

A

Right Atrium
Left Atrium
Right Ventricle
Left Ventricle

18
Q

Heart Chamber (orientation)

A

R Ventricle: anterior

L Atrium: posterior

19
Q

Borders of the Heart

A

Superior: B atria
Inferior: L ventricle
Left: L ventricle
Right: R atrium

20
Q

Apex of the Heart

A

Look at a picture

Directed anteroinferiorly and to the left

Formed by L ventricle

21
Q

Base of the Heart

A

Look at a picture

Directed posteriorly

Formed by L atrium

22
Q

Great Vessels (veins)

A

Look at a picture

Internal jugular veins
Subclavian veins
Brachiocephalic veins
Superior Vena Cava (SVC)

23
Q

Brachiocephalic Veins

A

L is longer than R because it must cross midline to reach SVC

24
Q

Superior Vena Cava

A

returns oxygen poor blood to R atrium from structures superior to diaphragm (except heart)

25
Q

Inferior Vena Cava

A

returns oxygen poor blood to R atrium from structures inferior to diaphragm

26
Q

Great Vessels (Aorta)

A

Ascending Aorta (emerges from L ventricle)
Arch of Aorta
Descending (Thoracic) Aorta

Name changes at sternal angle

27
Q

Great Vessels (Arch of the Aorta)

A

Brachiocephalic Trunk (R Subclavian, R Common Carotid)
L Common Carotid
L Subclavian

28
Q

Transverse Pericardial Sinus

A

Posterior to aorta and pulmonary trunk

Good for ligation - allows control of arterial outflow

29
Q

Vagus Nerve

A

CN X

Parasympathetic innervation

Slows down heart rate, reduces force of contractions

30
Q

Vagus Nerve (pathway)

A

Pre cell bodies: brain
Pre fiber: vagus nerve
Post cell bodies: heart
Post fiber: heart

31
Q

Right Recurrent Laryngeal Nerve

A

Branch of Vagus

Courses posterior to R subclavian artery - makes a U turn back up to larynx

Contributes to cardiac plexus, R pulmonary plexus, esophageal plexus

32
Q

Left Recurrent Laryngeal Nerve

A

Branch of Vagus

Courses under arch of aorta - makes a U turn in mediastinum back up to larynx

Contributes to cardiac plexus, esophageal plexus

Clinical significance: aneurysm of aortic arch/enlargement of lymph nodes compresses nerve -> hoarseness of voice

33
Q

Sympathetic Innervation

A

Increases heart rate

Lateral horn
Ventral root
Spinal nerve
Ventral ramus
White ramus communicans
Sympathetic trunk
Paravertebral ganglia (upper thoracic, cervical)
Cardiac nerves
Heart
34
Q

Cardiac Nerves

A

Arise from upper thoracic and cervical sympathetic trunk

35
Q

Referred Cardiac Pain

A

Visceral sensory fibers follow pathway of sympathetic nerves

Visceral pain (normally vague) misinterpreted as somatic pain (sharp)

PHA 500 (11 decks)

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