Abdomen Lecture Notes Pt. 5 Flashcards
Where can we hear a tricuspid stenosis?
Left 5th intercostal space at sternal border
Where can we hear aortic stenosis?
Right second intercostal space at sternal border
Where can we hear aortic regurgitation?
Left 5th intercostal space at midclavicular line
Where can we hear pulmonic stenosis?
Left 2nd intercostal space at sternal border
Where can we hear pulmonary regurgitation?
Left 5th intercostal space at sternal border
Where can we hear mitral valve stenosis?
Left 5th intercostal space at midclavicular line
Where can we hear mitral valve regurgitation
Left axilla
Separates rough and smoothed walled parts of RIGHT atrium on anterior wall
Crista terminalis
The back wall of the right atrium is the
Atrial septum
The atrial septum contains the
-Oval shaped depression
Fossa ovalis
Contains the body of the tricuspid
Right ventricle
The smooth walled portion of the right ventricle is called the
Infundibulum
Attach AV valves to papillary muscle, but DO NOT pull valves open. Rather, they are involved in closure of the valves
Chordae tendinea
The septomarginal trabeculae plays an important role in conduction of the heart. It is located in the
Right ventricle
Each AV valve cusp is attached to more than one papillary muscle, and each papillary muscle is attached to more than one cusp. This helps maintain
Proper geometry of cusp
Opposite from the rest of our bodies, blood flows into the coronary arteries during
Diastole
Blood is pushed into the coronary arteries by way of the
Aortic recoil
When your posterior interventricular artery is a branch of the right coronary artery you are called
Right dominant (80% of population)
If you are ‘Left dominant” than you do not have an anastomosis between the
Left and right coronary arteries (because LAD and RPD both come from left coronary)
Visceral and parietal pleura are continuous at the
Hilum of the lungs
Continous where the 8 vessels of the heart enter the heart
Visceral and parietal pericardium
Bound by the pulmonary veins and inferior vena cava
-accessible by placing hand behind heart
Oblique sinus
Superficial to the SVC but then deep to the aorta and pulmonary trunk
Transverse sinus
Whenever one cardiac muscle cell depolarizes,
All cardiac muscle cells depolarize
Group of specialized cardiac muscle cells that depolarize faster than the rest of the heart
-acts as the pacemaker
SA node
Separates atrial muscle cells from ventricular muscle cells so that they do not communicate
-Layer of dense collagenous connective tissue
Fibrous skeleton
Bundle of muscle cells from atrial septum to ventricular septum
-electrical conduction between atrium and ventricle
Atrioventricuar (AV) Bundle
Located in the atrial septum where it retards/slows depolarization allowing the atria to contract before the ventricles
Atrioventricular (AV) Node
Once the signal is passed from the AV node to the AV bundle, it
Speeds up again
Gives off a branch that travels through the septomarginal trabeculae and into the anterior papillary muscle
Right bundle branch
This branch allows the anterior papillary muscle to contract before the
Apex of the heart
Shows atrial depolarization
P-wave
Shows ventricular depolarization
QRS complex
What will we see in an ECG if the V node is slowing the signal down more than it should?
Longer P-R interval
The sympathetic and parasympathetic innervation of the heart tells the heart when to
Speed up or slow down
In sensory innervation to the heart, sympathetic fibers tell us about
Ischemia
In sensory innervation to the heart, parasympathetic fibers tell us about
Reflex and pressure
Clusters of mesodermal cells that become the lining of blood vessels and the cells in that lining
Angiogenic clusters
Lateral angiogenic clusters get pulled ventrally to form
Endocardial tubes
Medial angiogenic clusters stay dorsal and become the
Right and Left dorsal aorta
The 1st aortic arch is formed by the
Head fold
Gets absorbed by the left atrium to form the smooth walled portion
Pulmonary vein
Thinner than the rest of the atrial septum because it is only one septum thick
Fossa ovalis
The endocardial cushions are made up of
Neural crest cells
Foramen primum is NOT a hole in
-rather it is a gap between the septum primum and endocardial cushions
septum primum
IS a hole in septum prium
Foramen secundum
Foramen secundum opens before septum primum finishes closing. This ensures that blood can still move from
Right to left atrium
Forms on right side of septum primer
-much thicker and less flexible
Septum secundum
The opening that forms when the fossa ovalis bends to the right due to the higher right atrial pressure
Foramen ovale
When the fossa ovalis and septum secundum don’t fuse properly
-relatively common and not dangerous under left to right pressure gradient in postnatals
Probe patency
What is more common, VSD’s or ASD’s?
VSD’s
Increase demand on pulmonary vessels which can lead to pulmonary hypertension
Septal defects
A neural crest migration defect that is liely to be seen in neural crest syndromes
-commonly associated with valve defects
Primum type ASD
8x more common and result from a continuous foramen ovale
Secundum type
Make up valves, septum primum, and aorticopulmonary septum. So disorders relating to these will show up in valves, septum primum, and aorticopulmonary septum
Neural crest cells
A primum type ASD is in a region near the AV valve and is unrelted to the
Fossa ovalis
The ascending aorta and pulmonary trunk are equal in
Diameter
When the aorticopulmonary septum does not form
-still have pulmonary arteries and aorta, but by the time of the split the blood has already mixed
Persistent truncus arteriosus
Forms 2 non-connected parallel circulation systems
-caused by lack off spiraling of aorticopulmonary septum
Transposition of the great arteries
All of the blood vessels that supply the brain branch from the aortic arch BEFORE the
-so brain gets most O2 rich blood
Ductus arteriosis
Why do kids not instantly die with transposition of the great arteries?
Because of accompanying ASD’s and VSD’s
Closure of ductus arteriosis is due to contraction of
-contracts harder than other atrial smooth muscle
Ductal smooth muscle
Is the closure of the ductus arteriosis instant?
No
Prostaglandin synthesis decreases at 9 months of development. This is why preterm babies are more likely to have
Patent ductus arteriosis
Narrowing of the aorta
Coarctation of the aorta
What are the two types of coarctations of the aorta?
- ) Preductal
2. ) Postductal
Coarctation of the aorta before the ductus arteriosis
Preductal
Shows symptoms in infants after the ductus arteriosis has closed because no collateral circulation develops to compensate in the womb since the ductus arteriosis is still oepn
Preductal Coarctation of the Aorta
Won’t be symptomatic until adulthood because extra collateral circulation was developed prenatally to compensate
Postductal Coarctation of the Aorta
Region in the thorax between the two pleural cavities
Mediastinum
Does not bifurcate symmetrically
SVC
How can we pass a catheter into the portal vein?
Right internal jugular –> R. brachiocephalic vein –> SVC –> IVC –> Hepatic veins
Will stretch the vagus nerve BEFORE the recurrent laryngeal nerve comes off
Anyeurism of the aortic arch
What is a symptom of Aortic arch aneurysm and left upper lung cancer
-But NOT RIGHT
Hoarseness of voice
The easiest way to find the ligamentum arteriosum is to find the
Left recurrent laryngeal nerve
What are the 5 contents of the posterior mediastinum
- ) Esophagus
- ) Esophageal plexus
- ) Thoracic aorta
- ) Azygous vein
- ) Thoracic duct
Drainage for chest wall structures from right intercostall veins
Azygous vein
Enlargement of the left atrium (like from mitral valve prolapse) causes
Dysphagia (difficulty swallowing)
Arches over the right bronchus
Azygous arch
Arches over the left bronchus
Aortic Arch
Passes in front of the root of the lung in the plane between the mediastinal pleura and pericardium
Phrenic nerve
Are just anterior rami of spinal nerves at that level
Intercostal nerves
Left side analogue to azygous vein that eventually drains into the azygous vein
Hemiazygous vein
A cross sectional CT of the heart WILL NOT show any
Trachea
In a CT at the aortic arch level of the superior mediastinum, we will see
Branches off aortic arch
In a CT below the aortic arch level, we will see the
Ascending and descending aorta
Located right infront of the trachia
Brachiocephalic trunk
The posterior surface of the lungs is the
Lower lobe
