Abdomen Lecture Notes Pt. 5 Flashcards by Joel Glotfelty

Where can we hear a tricuspid stenosis?

Left 5th intercostal space at sternal border

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Where can we hear aortic stenosis?

Right second intercostal space at sternal border

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Where can we hear aortic regurgitation?

Left 5th intercostal space at midclavicular line

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Where can we hear pulmonic stenosis?

Left 2nd intercostal space at sternal border

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Where can we hear pulmonary regurgitation?

Left 5th intercostal space at sternal border

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Where can we hear mitral valve stenosis?

Left 5th intercostal space at midclavicular line

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Where can we hear mitral valve regurgitation

Left axilla

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Separates rough and smoothed walled parts of RIGHT atrium on anterior wall

Crista terminalis

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The back wall of the right atrium is the

Atrial septum

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The atrial septum contains the

-Oval shaped depression

Fossa ovalis

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Contains the body of the tricuspid

Right ventricle

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The smooth walled portion of the right ventricle is called the

Infundibulum

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Attach AV valves to papillary muscle, but DO NOT pull valves open. Rather, they are involved in closure of the valves

Chordae tendinea

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The septomarginal trabeculae plays an important role in conduction of the heart. It is located in the

Right ventricle

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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

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Opposite from the rest of our bodies, blood flows into the coronary arteries during

Diastole

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Blood is pushed into the coronary arteries by way of the

Aortic recoil

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When your posterior interventricular artery is a branch of the right coronary artery you are called

Right dominant (80% of population)

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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)

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Visceral and parietal pleura are continuous at the

Hilum of the lungs

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Continous where the 8 vessels of the heart enter the heart

Visceral and parietal pericardium

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Bound by the pulmonary veins and inferior vena cava

-accessible by placing hand behind heart

Oblique sinus

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Superficial to the SVC but then deep to the aorta and pulmonary trunk

Transverse sinus

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Whenever one cardiac muscle cell depolarizes,

All cardiac muscle cells depolarize

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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?

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?

1. ) 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

1. ) Esophagus 2. ) Esophageal plexus 3. ) Thoracic aorta 4. ) Azygous vein 5. ) 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