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1020: Anatomy FM1020 (E) > A: Heart 1-2 spots > Flashcards

A: Heart 1-2 spots Flashcards

1
Q

A patient experiences angina pectoris during training for a bike race. Cardiac evaluation reveals left coronary dominance. What is meant by this?

A

The posterior interventricular branch arises from the left coronary artery.

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2
Q

What are the surface markings of the inferior border of the heart? Which chambers of the heart form this border?

A

From the sternal end of 6th right costal cartilage to the 5th left intercostal space in the midclavicular line (ie to the apex).
Inferior border: mostly RV, with LV at the apex

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3
Q

A patient complains of difficulty swallowing. Radiological investigations reveal compression on the oesophagus by the base of the heart. Which chamber of the heart is compressing the oesophagus?

A

Left atrium
(Note: oesophagus is immediately posterior to base of heart)

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4
Q

What are the surface markings of the superior border of the heart? List the feature(s) which form the superior border of the heart.

A

3rd right costal cartilage to the 2nd left intercostal space. Superior border: RA, LA. Aorta and pulmonary trunk exit from
this border and the superior vena cava enters.

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5
Q

What are the surface markings of the left border of the heart? List the feature(s) which form the left border of the heart.

A

2nd left intercostal space to apex of heart (i.e. 5th left intercostal space near the midclavicular line).
Left border: Left Ventricle mostly (and slightly by left auricle).

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6
Q

List the areas usually supplied by Right Coronary Artery.

A

RA and RV, LV (posterior part), some of LA, interatrial septum, part of IV septum (posterior 1/3), SA node (60% individuals), AV node (80% individuals).

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7
Q

Investigations were performed on a patient complaining of chest pain. They revealed decreased blood supply to the muscle of the diaphragmatic surface of the heart. Which coronary artery is most likely occluded in this patient?

A

Posterior interventricular branch of right coronary artery.

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8
Q

List the areas usually supplied by left Coronary Artery.

A

Most of LA, most of LV, part of RV, most of IV septum (anterior 2/3) incl. AV bundle of conducting tissue, SA node (40% individuals).

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9
Q

Coronary angiography reveals a blockage of the circumflex branch of the left coronary artery. Which parts of the heart will be damaged as a result of occlusion of this artery?

A

Left atrium and left ventricle

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10
Q

During coronary catherisation, a catheter is inserted into the femoral artery. List the vessels it passes through to reach the origin of the coronary arteries.

A

Femoral artery –> external iliac artery –> common iliac artery –> abdominal aorta –> descending thoracic aorta –> aortic arch –> ascending aorta –> coronary arteries.

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11
Q

What are the surface markings of the right border of the heart? Which chambers of the heart form this border?

A

From 3rd right costal cartilage to 6th right costal cartilage.
Right border: Right atrium (i.e. between SVC above & IVC below).

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12
Q

What is the ligamentum arteriosum? Explain its relevance in the fetus.

A

The remnant of an embryonic connection between pulmonary trunk and aorta.
During embryology, the lungs are not functional so blood is shunted (through the ductus arteriosus) from pulmonary trunk into aortic arch, thus bypassing the lungs. Oxygen exchange in the embryo occurs at the placenta and not lungs.

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13
Q

During surgery, the surgeon accidentally injures the vein accompanying the marginal branch of the right coronary artery. Which vein was injured?

A

Small cardiac vein

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14
Q

During a coronary bypass procedure to the anterior interventricular branch of left coronary artery, the surgeon accidentally injures the accompanying vein. Which vein was injured?

A

Great cardiac vein

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15
Q

During cardiothoracic surgery, bleeding comes from the vein
which accompanies the posterior interventricular branch of right coronary artery. Which vein is most likely injured?

A

Middle cardiac vein

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16
Q

A patient with pericarditis experiences pain in the shoulder region. Why?

A

This is referred pain. Phrenic nerve (visceral afferent from pericardium) carries fibers to C3, C4, C5. The shoulder area dermatome is C4.

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17
Q
A

Oblique pericardial sinus
Pass her fingers under the apex of the heart and move upwards into a recess between the pericardium and the posterior surface (left atrium) of the heart.
Bounded by the pulmonary veins.

18
Q
A

Transverse pericardial sinus
The pulmonary trunk and ascending aorta

19
Q

Why is cardiac function impaired in Cardiac Tamponade?

A

Pericardial cavity is confined space (fibrous pericardium cannot expand) so excess fluid in cavity compresses heart.

20
Q

A man experiences chest pain during physical exertion. Following examination, a diagnosis of angina pectoris is made. How do visceral afferent fibers from the heart reach the CNS? What cords?

A

Visceral afferent fibers (carrying pain) are carried with the sympathetic system to spinal cord segments T1-T4.

21
Q

Where should a stethoscope be positioned to listen to the mitral valve?

A

5th left intercostal space in the midclavicular line

22
Q

To what dermatomes + areas is pain from the heart referred?

A

Dermatomes T1-T4 i.e. chest wall over the heart area, left arm, and neck

23
Q

Name the part of the valve leaflet to which the chordeae tendineae are attached.

A

To the free margin and ventricular surface of each AV valve leaflet.

24
Q

The murmur (sound) associated with aortic stenosis (narrowing) in a patient would be best heard by placing the stethoscope at which location on the chest wall?

A

Medial end of 2nd right intercostal space (aortic valve)

25
Q

What is the fossa ovalis a remnant of? Describe its function.

A

Remnant of foramen ovale
In the embryo, the lungs are not functional so blood is shunted through an opening in septum (foramen ovale) from right atrium into left atrium, thus bypassing the lungs. Oxygen exchange in the embryo occurs at the placenta and not lungs.

26
Q
A

Trabeculae carnae
RV and LV

27
Q

The murmur (sound) associated with tricuspid stenosis
(narrowing) in a patient would be best heard by placing the stethoscope at which location on the chest wall?

A

Medial end of left 5th intercostal space.

28
Q
A

Interatrial septum
In the lower part of the interatrial septum

29
Q

Where is the SA node located?

A

At the junction of the superior vena cava and the right atrium.

30
Q

What tissue is drained by the coronary sinus?

A

Wall of the heart

31
Q
A

Sulcus terminalis
Right atrium only

32
Q
A

Right pulmonary vein
Oxygenated blood

33
Q
A

Endocardium

34
Q
A

Myocardium
Cardiac muscle

35
Q

A patient is diagnosed with aortic stenosis which has resulted in hypertrophy of the heart. Which of the chambers of the heart is most likely hypertrophied? Explain.

A

Left ventricle.
Hypertrophy is enlargement and thickening of the wall. In this patient, the LV is hypertrophied due to the higher pressure needed to eject blood through the narrowed aortic valve.

36
Q
A

Septomarginal trabecula OR moderator band
It carries part of the conduction system of the heart to the anterior wall of the RV.

37
Q

Explain the anatomy of referred pain from the heart

A

Pain from both the dermatomes T1-T4 and visceral afferents from the heart enter the spinal cord at the same level, the brain can interpret the pain impulse as coming from the skin of these dermatomes.

38
Q

Why is pain from the heart sometimes felt in the left arm?

A

Because branches of the 2nd and 3rd intercostal (T2, T3) nerves (intercostobrachial nerves) join with the medial cutaneous nerve of the arm.

39
Q

The two main anastomoses in the coronary circulation occur between:

A
  • Right coronary artery and the left circumflex artery
  • Anterior and posterior interventricular arteries.
40
Q
A
41
Q
A

Mitral (bicuspid) valve

1020: Anatomy FM1020 (E) (10 decks)

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