6- Thoracic Cardiology Flashcards by Staci Thomas

What are the divisions of the Mediastinum?

Superior Mediastinum

Inferior Mediastinum – further divides into Anterior, Middle, and Posterior Mediastinum

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The Superior and Inferior Mediastinum are separated by the…

Sternal Angle

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Describe the location of the Anterior, Middle, and Posterior Mediastinum.

Anterior Mediastinum = Anterior to the heart

Middle Mediastinum = Heart

Posterior Mediastinum = Posterior to the heart

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This is a two-sided, four-chambered, self-initializing, self-adjusting pump that propels blood to all parts of the body.

Heart

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The right side of the heart receives blood from the _______ _______ _______ and _______ _______ _______ and pumps it out to the ________ for oxygenation.

Superior Vena Cava
Inferior Vena Cava
Lungs

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The left side of the heart receives oxygen-rich blood from the _______ and pumps it out to the entire body via the _______.

Lungs

Aorta

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Briefly describe the path of Systemic Circulation.

Left Atrium – Bicuspid Valve – Left Ventricle – Aortic Valve – Aorta – Arterial System – Capillaries – Venous System – Inferior and Superior Vena Cava (begins Pulmonary Circulation)

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Briefly describe the path of Pulmonary Circulation.

Superior and Inferior Vena Cava – Right Atrium – Tricuspid Valve – Right Ventricle – Pulmonary Valve – Pulmonary Trunk – Right and Left Lungs – Pulmonary Veins – Left Atrium (begins Systemic Circulation)

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What are the serous layers surrounding the heart?

Fibrous Pericardium (outermost)
Parietal Serous Pericardium
Pericardial Cavity
Visceral Serous Pericardium (also called Epicardium)

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What are the layers of the heart?

Epicardium (also called Visceral Serous Pericardium)
Myocardium
Endocardium
Fibrous Skeleton

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This layer of the heart is a thick muscular layer made up of spiraling, overlapping layers of Cardiac muscle.

Myocardium

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This layer of the heart is a thin internal endothelial and subendothelial layer lining the inside of the chambers of the heart and valves.

Endocardium

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The fibrous skeleton of the heart is composed of dense collagenous fibers and has 4 functions, which are…

– Produce attachment points for Myocardium

– Produce attachment points for cuspid valves

– Support and strengthen Atrioventricular and Semilunar orifices

– Provide an electrically insulated barrier between the Atria and Ventricles

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This is caused by a lack of blood flow to a specific area of the Myocardium, usually the result of a blockage in a Coronary A.

Myocardial Infarction

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This is the term for a buildup of lipids on the internal walls of the Coronary Arteries, deceasing the size of lumen of that vessel and increasing the likelihood of an embolus or plug blocking off the vessel entirely.

Coronary Atherosclerosis

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This is the term for pain that originates in the heart and produces a strangling pain of the chest. It is usually the result of narrow or obstructed Coronary Arteries that produces ischemia of the Myocardium.

Angina Pectoris

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This external feature of the heart is the inferolateral part of the Left Ventricle, and projects predominantly to the Left.

Apex

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This external feature of the heart is the posterior portion and is near the Left Atrium.

Base

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What are the surfaces of the heart?

Sternocostal – covers Right Ventricle
Diaphragmatic – covers Right and Left Ventricle
Pulmonary – Paired; Right Atrium and Left Ventricle

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What are the borders of the heart?

Right – Right Atrium
Left – Left Ventricle
Superior – Right and Left Atria
Inferior – Right Ventricle

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This border of the heart has the exit point for the Aorta and Pulmonary Trunk.

Superior

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This lies between the Right Atrium and Right Ventricle, and transmits the Right Coronary A.

Right Atrioventricular Groove

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This lies between the Left Atrium and Left Ventricle, and houses the Coronary Sinus.

Left Atrioventricular Groove

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This lies between the Right and Left Ventricles on the anterior aspect of the Heart, and transmits the Anterior Interventricular A. and Great Cardiac V.

Anterior Interventricular Groove

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This lies between the Right and Left Ventricles on the posterior aspect of the Heart, and transmits the Posterior Interventricular A. and Middle Cardiac V.

Posterior Interventricular Groove

This is the external vertical groove corresponding to the internal Crista Terminalis. Outside of Right Atrium.

Sulcus Terminalis

This is an embryological remnant of the Ductus Arteriosus, and is the communication between the Pulmonary Trunk and the Arch of the Aorta.

Ligamentum Arteriosum

The ________ ________ travels from the superior aspect of the Pulmonary Trunk to the inferior concave border of the Aortic Arch.

Ligamentum Arteriosum

The Ligamentum Arteriosum is the adult remnant of the embryological _______ _______, which shunted blood from the Pulmonary Trunk to the Aorta to bypass the nonfunctional lungs.

Ductus Arteriosus

This branch of the Vagus N. loops around the Aortic Arch and Ligamentum Arteriosum then ascends to the Larynx.

Left Recurrent Laryngeal N.

What are the internal features of the Right Atrium?

``` Sinus Venarum Pectinate Muscle Crista Terminalis Interatrial Septum Opening for Coronary Sinus ```

This internal feature of the Right Atrium is the posterior, thin, smooth walled region where the Venae Cavae and Coronary Sinus empty.

Sinus Venarum

This internal feature of the Right Atrium is the anterior, rough muscular wall.

Pectinate Muscle

The Pectinate Muscle also contains the ______ ______.

Right Auricle

This internal feature of the Right Atrium is an internal ridge separating smooth and rough regions.

Crista Terminalis

This internal feature of the Right Atrium is a wall between the two Atria.

Interatrial Septum

The Interatrial Septum also contains the _______ ______, which is an embryologic remnant of the _______ _______.

Fossa Ovalis | Foramen Ovalis

Atrial Septal defects typically involved an incomplete closure of the _______ _______.

Foramen Ovale

It is estimated that 15-20 percent of adults have a small latency of their _______ ______ which is considered clinically insignificant. Larger openings in the ________ _______ can be clinically significant as they allow mixture of oxygen-rich and oxygen-depleted blood.

Foramen Ovale | Interatrial Septum

This is the passage from the Right Atrium to the Right Ventricle, and is variably occluded by the Tricuspid Valve.

Right Atrioventricular Orifice

What are the internal features of the Right Ventricle?

Tricuspid Valve Trabecula Carnae Conus Arteriosus (Infundibulum) Pulmonary Valve

This is what internally separates the Right Atrium and Right Ventricle.

Tricuspid Valve ***To help remember which valve comes first in the circulatory pathway, remember you have to TRY (Tricuspid) before you BUY (Bicuspid).

The Tricuspid Valve is made up of what 3 cusps?

Anterior Cusp Posterior Cusp Septal Cusp

This is what attaches the free edges of the three cusps of the Tricuspid Valve to the three corresponding Papillary Muscles.

Chordae Tendineae

This is joined to the Anterior Cusp of the Tricuspid Valve via Chordae Tendineae.

Anterior Papillary M.

This is joined to the Posterior Cusp of the Tricuspid Valve via Chordae Tendineae.

Posterior Pupillary M.

This is joined to the Septal Cusp of the Tricuspid Valve via Chordae Tendineae.

Septal Papillary M.

This is the rough muscular region of the Right Ventricle.

Trabecula Carnae

This is located in the Trabecula Carnae (rough muscular region) of the Right Ventricle. It goes from the Interventricular Septum to the Base of the Anterior Papillary M. and transmits the right bundle branch of Atrioventricular bundle to the Anterior Papillary M.

Septomarginal Trabeculum (Moderator Band)

This part of the Right Ventricle is smooth-walled and leads into the Pulmonary Trunk.

Conus Arteriosus

This is a Semilunar Valve, and contains a Right, Left, and Anterior Cusp. It separates the Right Ventricle from the Pulmonary Trunk.

Pulmonary Valve

This is the space between the wall of the Pulmonary Trunk and the Cusps of the Pulmonary Valve.

Pulmonary Sinuses

This is the term for the insertion of a catheter into the Femoral V. which is then passed up to the Inferior Vena Cava allowing radiographic visualization of the Right Atrium, Right Ventricle, Pulmonary Trunk, and Pulmonary Arteries.

Cardiac Catheterization

What is the Left Atrium and Ventricle thicker-walled than the Right Atrium and Ventricle?

Because it's pumping blood to the rest of the body, so it needs to be stronger to pump it out.

What are the internal features of the Left Atrium?

Left Auricle (contains Pectinate M.) Openings for the 4 Pulmonary V. Interatrial Septum

This is the passage from the Left Atrium to the Left Ventricle, variably occluded by the Bicuspid Valve.

Left Atrioventricular Orifice

What are the internal features of the Left Ventricle?

``` Bicuspid (Mitral) Valve Trabecula Carnae Aortic Vestibule Interventricular Septum Aortic Valve ```

This is what separates the Left Atrium from the Left Ventricle internally.

Bicuspid Valve

What are the cusps of the Bicuspid Valve?

Anterior Cusp | Posterior Cusp

This is what attaches the free edges of the two cusps of the Bicuspid Valve to the ventricular surfaces.

Chordae Tendineae

This is joined to the Anterior Cusp of the Bicuspid Valve via Chordae Tendineae.

Anterior Papillary M.

This is joined to the Posterior Cusp of the Bicuspid Valve via Chordae Tendineae.

Posterior Papillary M.

This is the rough muscular region of the Left Ventricle.

Trabecula Carnae ***Same as Right Ventricle

This is the smooth-walled portion of the Left Ventricle that leads into the Ascending Aorta.

Aortic Vestibule ***Smooth-walled portion in Right Ventricle was Conus Arteriosus

This is a myocardial wall separating the two ventricles, and houses the Atrioventricular Bundle, Right and Left Bundle Branches, and Subendocardial Branches.

Interventricular Septum

The Interventricular Septum is described as having a membranous (fibrous) part that belongs to the ________ ________ of the heart, and a much larger ________ part.

Fibrous Skeleton | Muscular

For Ventricular Septal Defects, due to the embryologically divergent tissues that make up the Interventricular Septum that structures is particularly susceptible to defects. All defects are clinically relevant as they allow the mixture of _______ _______ and _______ _______ blood.

Oxygen rich | Oxygen depleted

This is a Semilunar Valve possessing Right, Left, and Posterior (Non-Coronary) Cusps. It separates the Left Ventricle from the Ascending Aorta and occupies the Aortic Orifice.

Aortic Valve

These are the spaces between the wall of the Ascending Aorta and the cusps of the Aortic Valve.

Aortic Sinuses

The Right and Left Aortic Sinuses house the openings for what?

Right and Left Coronary A.

The conducting system of the heart consists of _______ _______ cells, specialized conducting fibers, and two bundles of _______ _______ responsible for coordinating the Cardiac Cycle.

Cardiac Muscle | Nodal Tissue

Explain the Cardiac Cycle in terms of Diastole and Systole and what's happening with the Atria and Ventricles.

-- Beginning of Diastole - Aortic and Pulmonary Valves close due to drop in pressure inside the Ventricles. -- Early Diastole - As the Ventricles relax the heart lengthens and the Atrioventricular Valves (Tricuspid and Bicuspid) open flooding the Ventricles with blood. -- Diastole - Atrial contraction takes place in the late moments of Diastole and expulsion of blood into the Ventricles. -- Beginning of Systole - Atrioventricular Valves close due to an increased pressure in the Ventricles. -- Early Systole - Ventricles begin to contract thereby increasing the pressure, opening the Aortic Valve and Pulmonary Valve. -- Systole - Full Ventricular contraction and expulsion of blood into the Ascending Aorta and Pulmonary Trunk.

This is located in the myocardium, where the Superior Vena Cava meets the Right Atrium. It is a small bundle of specialized Cardiac muscle fibers that initiate and regulate impulses that propagates through the Atrial walls via Myogenic Conduction. It produces Diastole and is called the "Pacemaker of the Heart".

Sinuatrial Node (SA Node) **The SA Node makes its own action potential! It is the "LUB" of "LUB DUB".

This is a small bundle of specialized Cardiac muscle fibers located in the Interatrial Septum near the Opening for the Coronary Sinus. It responds to the impulse from the SA Node that is distributed through the wall of the Atrium and distributes that signal through the Ventricles.

Atrioventricular Node (AV Node) **Creates action potential from the SA Node. It is the "DUB" of "LUB DUB".

This is what crosses the electrically insulated barrier provided by the Fibrous Skeleton of the heart and distributes the impulse from the AV Node into a Right and Left AV Bundle, which then distributes as Subendocardial Branches.

Atrioventricular Bundle

This is what distributes the AV Nodal impulse from the Right and Left AV Bundle branches first to the Interventricular Septum, then to the Papillary muscles, and finally to the rest of the Ventricular wall.

Subendocardial Branches ***Also called Purkinje Fibers

This is a device that produces a regular electrical impulse that is carried to the Ventricles via electrodes which are inserted through a large vein to the Superior Vena Cava, into the Right Atrium past the Tricuspid Valve and into the Endocardium of the Trabecula Carnae of the Right Ventricle.

Artificial Cardiac Pacemaker

This is the term for irregular twitching of the Atrial cardiac muscle fibers to which the Ventricles respond at irregular intervals. Circulation usually remains satisfactory.

Atrial Fibrillation

This is the term for rapid irregular twitching of the Ventricles rendering the heart unable to pump blood.

Ventricular Fibrillation

For Ventricular Fibrillation, an electric shock administered by electrodes can cease all cardiac movement, called _________, in hopes that the heart may begin beating regularly after a period of time.

Defibrillation

For Cardiac Referred Pain, ischemia stimulates visceral pain sensory fibers in the heart of the ANS. These visceral sensory fibers often share a spinal ganglion with the somatic sensory fibers of areas such as the upper limb and superior lateral chest wall. Anginal pain is typically referred to the area innervated by what nerve?

Left Medial Brachial Cutaneous N.

What areas of the body usually have referred anginal pain?

Left substernal area Left pectoral area Medial aspect of left upper limb

The Pericardium has a serous component that includes the ________ Serous Pericardium that is adherent to the Fibrous Pericardium, and the ________ Serous Pericardium that is adherent to the heart (also called Epicardium).

Parietal | Visceral

This is the wide recess posterior to the base of the Heart.

Oblique Pericardial Sinus

This is the transverse passage traversing the origins of the Great Vessels.

Transverse Pericardial Sinus

This has surgical significance because it allows cardiac surgeons to access the area posterior to the Aorta and Pulmonary Trunk to clamp or insert the tubes of a bypass machine into these large vessels.

Transverse Pericardial Sinus

_________ is the term for inflammation of the pericardium. It can make the pericardium rough and produce friction. This friction, called a pericardial friction rub, can be observed with a stethoscope. If left untreated the pericardium can _________.

Pericarditis | Calcify

This is the term for the inflammation of the pericardium that results in accumulation of fluid or pus in the pericardial sac, which can compress the heart.

Pericardial Effusion

What is the term for heart compression?

Cardiac Tamponade

This is the term for the drainage of blood, fluid, or pus from the pericardial sac. This is usually done to relieve Cardiac Tamponade.

Pericardiocentesis