6. Thoracic Cardiology Flashcards
what seperates superior & inferior mediastinum
sternal angle (where manubrium meets with body of sternum)
what are the 3 parts of the inferior mediastinum
ant
middle
post
what is the flow of blood thru the heart
sup/inf vena cava –> R atrium –> tricuspid valve –> R ventricle –> pul valve –> pul trunk –> lungs –> Pul V –> L atrium –> bicuspid valve –> L ventricle –> aortic valve –> aorta –> body
what occurs after the blood is pushed out of the aorta
oxygenated blood thru arterial system -> capillaries for gas exchange –> deoxygenated blook via venous system –> sup/inf vena cava
what seperates the arterial and venous ends (which are together bc of the way the heart folds)
transverse pericardial sinus
what are the layers of the heart (innermost to outermost)
endocardium
myocardium
visceral serous pericardium (epicardium)
pericardial cavity
parietal serous pericardium
fibrous pericardium
what is the endocardium made of
layers of epithelium that seperate blood from M
= thin internal endothelial & subendothelial layer lining the inside change of the heart & valves
what is the result of lack of blood flow to specific areas of the myocardium
myocardium infarction
what can lead to a MI
coronary arthresclerosis =
build up of lipids on internal walls of coronary As -> decrease size of lumen of vessel –> increase change of embolism or blockage
pt presents w/ SOB & gripping pain in chest and left arm; imaging shows narrowed coronary A. What does this pt likely have
angina pectoris
pain in heart usually bc narrow or obstructed coronary A resulting in ischemic myocardium
what is the purpose of the fibrous skeleton of the heart
- attachment point of all myocardium
- attachment point for vales of cuspid valves
- support & strengthen AV & semilunar orifices (aortic/pul valve)
- electrical insulation barrier btn atria & ventricles
where is the apex of the heart located
inf.lat part of L ventricle
predominantly project to L
where is the sternocostal surface
R ventricle against ribs & costal cartilage
where is the diphragmatic surface
R & L ventricles
sits on thoracic diaphragm
where is the pulmonary surface
paired - R atrium & L ventricle
cardiac impression on both lungs
what are the borders of the heart and where are they located
Right: R atrium
Left: L ventricle
Superior: R & L atria & pul trunk/aorta
Inferior: R ventricle
what houses the coronary sinus
left AV groove
btn L atrium & ventricle
which groove transmits the R coronary A
right AV groove
btn R atrium & ventricle
which groove transmit the anterior interventricular A and great cardiac V
Ant Interventricular Groove
btn R & L ventricles on ant part of heart
which groove transmits the post interventricular A & middle cardiac V
Post Interventricular Groove
btn R & L ventricles on post part of heart
what is the sulcus terminalis
external verticle groove corresponding to the internal crista terminalis
at R atrium
what is the embryological remnant of the ductus arteriosus
ligamentum arteriosum
pt comes into your office and he cant talk- what N may be hit & what can be the cause
left recurrent laryngeal N (rmr loops around aortic arch then ascends to larynx)
aneurysm of ligamentum arteriosum
what was the purpose of the ductus arteriosis embryologically
shunted bloodk from pul trunk to arch of aorta to bypass nonfxnal lungs
What contributes to the smooth and rough surface of the R atrium
rough : Pectinate M
smooth: Sinus Venarum (thin)
what seperates the smooth and rough region in the R atrium
crista terminalis
where do the vena cavae & coronary sinus empty
sinus venarum
what is the interatrial septum
wall btn 2 atria = part of the smooth wall
contains fossa ovalis: remant of foramen ovalis
all blood from heart, out of the myocardium, is drained —
into Vs –> that end up in coronary sinus –> that go to R side to get reoxygenated
what happens if there is an incomplete closure of the foramen ovale
atrial septral defect
hole in wall btn atria
small openings = insig
large openings = sig bc mixing of deoxy & oxy blood
what is the R AV Orifice
passage from the R atrium to R ventricle
variable occluded by tricuspid valve
How many cusps does the tricuspid valve have & what are they
3
septal
ant
post
what is the purpose of the cusps?
cusp attach respective papillary M with chordae tendineae
prevent blood from flowing back from ventricle to atrium
what is the pulmonary valve
semilunar valve w/ R, L & Ant cusps
seperate R ventricle from pul trunk
contain pul sinuses
what is the smooth and rough wall of the R ventricle
smooth: Conus Arteriosus (lead into pul trunk)
rough: Trabecula Carnae
what is a type of trabecula carnae & what does it do
septomarginal trabeculum : run from interventricular septum to base of ant papillary M
transmit R bundle branch of AV bundle to ant papillary M
-for effective contraction
what are subendocardial branches
N fibers that run thru the trabecula carnae
what is the pul sinus
space btn wall of pul trunk and cusps of pul valve (= behind cusp)
= part that collapses when blood runs thru the opening of the valve
what is cardiac catheterization
insertion of catheter into femoral V which then is passed up to the inf vena cava to allow radiographic visualization of R atrium, R ventricle, Pul trunk & Pul As
which side of the heart is thicker
left
have to pump thru all of body (R only to lungs)
what are the R and L auricles
contain Pectinate M
-result of two parts pulling apart during heart formation
what valve can occlude the L AV orifice
bicuspid valve
L atrium –> L ventricle
what are the names of the bicuspid valve cusps
ant
post
what are the smooth and rough regions of the L Ventricle
smooth: Aortic Vestibule (least into ascending aorta)
rough: Trabecula Carnae (muscular region)
what houses the AV bundle, R & L bundle branches & subendocardial branches
interventricular septum
(contain membranous & muscular part)
what causes ventricular septal defects
embryologically divergent tissues that make up the interventricualr septum
all defects are clincally relevant bc mixture of deoxy & oxy blood
what is the aortic valve
sep L ventricle from ascending aorta
= semilunar valve w/ R, L & Post (noncoronary) cusps
-prevent backflow & protect coronary As
what is the aortic sinus
space btn wall of ascending aorta & cusps (= behind cusps)
-R & L aortic sinuses have openings for R & L coronary As
what is the pacemaker of the heart
sinuatrial nodes
= where sup vena cava meets R atrium = small bundle of cardiac M that initiates and regulates impulses that propogate atrial walls
How does the AV node initiate contraction
waits for signal from SA node
located in interatrial septum near the openings for coronary sinuses
what do AV bundles do
cross the electical insulated barrier provided by fibrous skeleton
& distribute impulse from AV node to R & L AV bundle branches - then to subendocardial branches
where do subendocardial branches distribute AV nodal impulses
from R & L bundle to interventricular septum then papillary Ms then ventricular walls (purkinje fibers)
how does an artificial pacemaker fxn
electrode inserted thru large V to sup vena cava into R atrium inot endocardium of trabecula carnae of R ventricle
-send signal straight to ventricle
what is irregular twitching of atrial cardiac M fibers & how does this affect circulation
atrial fibrillation
circulation = satisfactory
what is ventricular fibrillation
rapid irregular twitching of ventricles –> rendering heart unable to pump blood
why does cardiac referred pain occur
visceral sensory fibers share spinal ganglion w/ somatic sensory fibers of areas of upper limb & superiolateral chest wall
what is anginal pain
area innervated by L medial brachial cutaneous N, L substernal area, L pectoral area & medial aspect of L upper limb that lead to referred pain
what is the oblique pericaridal sinus
wide recess post to base of heart
what is the clinical significance of the transverse pericardial sinus
space that allows surgeons to access the area posterior to aorta & pul trunk to clamp/insert tubes of bypass machine into large vessels
-get behind aorta & pul trunk but infront of inf vena cava
what is pericarditis
inflam of pericardium - make it rough & produce friction - observe with a stethoscope
-if untreated it’ll calcify
what is cardiac tamponade & what is it often associated with
compressed heart trying to beat against fluid
associated with pericardium effusion - bc accumulate fluid/pus in pericardial sac and compress heart
what is pericardiocentesis
drainage of blood, fluid, or pus from pericardial sac
-do this to relieve cardiac tamponade
