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CRAAB 1 > Ach: Heart and Mediastinum II > Flashcards

Ach: Heart and Mediastinum II Flashcards

1
Q

What is the SA node?

A

Pacemaker of the heart that produces the impulse?

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2
Q

Where is the SA node located?

A

At the upper end of the sulus terminalis of the right atrium (between the superior vena cava and the right auricle)

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3
Q

What does the SA node do?

A

It INITIATES the heart beat. Gives off an impulse about 70 times/min, which spreads across both atria to reach the AV node, the bundle of His, and finally branches that carry the impulse throughout the walls of the ventricle.

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4
Q

What supplies the SA node?

A

The right or left coronary arteries and the right vagus nerve

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5
Q

Where is the AV node located?

A

In the interatrial septum near the opening of the coronary sinus

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6
Q

What supplies the the AV node?

A

the right coronary artery and left vagus nerve

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7
Q

What type of cells make up the AV and SA nodes?

A

specialized cardiac cells

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8
Q

What makes up the atrioventricular bundle of His?

A

Purkinje fibers

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9
Q

What represents the sole communication between the atrial and ventricular musculature?

A

The AV bundle of His

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10
Q

Describe the path of the AV bundle of His.

A

It is specialized tissue that extends from the AV node through the fibrous skeleton of the ehart to the interventricular septum where it divides into right and left branches; these descend subendocardially in the interventricular septum to the respective ventricles.

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11
Q

The right branch of the AV bundle of his reaches the anterior papillary muscle via the….

A

moderator band

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12
Q

What is the difference in blood supply for the right and left bundle branches?

A

right- right coronary artery

left- both coronary arteries

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13
Q

Describe the path of contraction from the AV node.

A

Contraction begins in the region of the SA node, spreads across the atria. The AV node, once stimulated, transmits the electrical impulse to the apex of the ventricles. Contraction is initiated from apex to base in a wringing motion.

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14
Q

What is an ECG (electrocardiogram)?

A

method by which the impulses over the heart are amplified and recorded

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15
Q

What are the two components of the cardiac plexus? Are the pre or post-ganglionic?

A

Sympathetic- post

Parasympathetic- pre

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16
Q

Where do sympathetic cardiac nerve branches originate?

A

from the sympathetic trunk in the upper thoracic and cervical regions

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17
Q

What does sympathetic stimulation do to the heart?

A

increase the RATE and FORCE of contraction
DILATE the coronary arteries
Carry PAIN SENSATION

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18
Q

What is cardiac referred pain?

A

The pain of angina pectoris that radiates from the substernal region and the left pectoral region to the left shoulder and arm.

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19
Q

Describe the physiology behind cardiac referred pain.

A

Ischemia and metabolic products in the myocardium stimulate nerve endings that run in the cardiac branches of the sympathetic trunk and enter the spinal cord at segments T1-5 on the left side. The cutaneous zone of reference for referred pain coincides with the segmental distribution of the sensory fibers that enter the same spinal cord segments as those fibers coming from the heart.

20
Q

Where do parasympathetic cardiac nerve branches originate?

A

From the vagus nerve in the cervical and thoracic regions then synapse with ganglia in the wall of the heart.

21
Q

What does parasympathetic stimulation do to the heart?

A

SLOW the rate and force of contraction and CONSTRICT the coronary arteries

22
Q

Where are parasympathetic cardiac nerves located?

A

Anterior to the tracheal bifurcation

23
Q

What are the two parasympathetic extensions of the cardiac plexus?

A
  1. Right and left coronary plexuses follow the coronary arteries.
  2. Form portions of the pulmonary plexuses around the root of the lung.
24
Q

What defines coronary arterial dominance?

A

Which artery gives rise to the posterior interventricular artery. About 70% of humans are right dominant.

25
Q

Where does the left coronary arise?

A

Left aortic sinus

26
Q

What are the branches of left coronary artery?

A
  1. Anterior interventricular branch (LAD) descends in the anterior inter ventricular sulcus
  2. Circumflex branch (encircles the heart in the coronary sulcus)
27
Q

What does the left coronary artery supply?

A

The interventicular septum and both ventricles
Left atrium and left surface of the heart
May help supply the SA node.

28
Q

In what percent of people is the circumflex artery occluded?

A

15-20%

29
Q

What percent of coronary occlusion occurs in the Anterior IV artery (LAD)?

A

40-50%

30
Q

Where does the right coronary artery arise?

A

Right aortic sinus

31
Q

Where does the right coronary lie?

A

In the coronary sulcus between the right atrium and ventricle.

32
Q

What are the three branches that come off the right coronary artery?

A

The marginal branch
Postetrior interventricular artery (which descends in the posterior interventricular groove)
Nodal artery

33
Q

What does the right coronary artery supply?

A

Right atrium and right ventricle
SA node
AV node and AV bundle

34
Q

Most of the veins of the heart drain into the coronary sinus, which opens into the right atrium. What are these veins?

A 
Great cardiac vein
Middle cardiac vein
Small cardiac vein
Oblique vein of the left atrium
Posterior vein of the left ventricle
35
Q

What are the venae cordis minimae or smallest cardiac veins?

A

minute vessels that originate in the myocardium and drain directly into the chambers of the heart

36
Q

What are ausculatory areas?

A

Areas that are in direct line with the valve orifice through which the blood has flowed

37
Q

Where is the mitral valve located?

A

Posterior to the left half of the sternum at the level of the 4th costal cartilage, but is best listened to superficial to the apex beat at the left 5th intercostal space.

38
Q

Where is the aortic valve located?

A

At the 3rd intercostal space on the left side of the sternum but is listened for in the 2nd right intercostal space at the edge of the sternum.

39
Q

Where is the tricuspid valve located?

A

Underlies the sternum near the midline with its center at the level of the 4th intercostal space, but is best heard at the left lower end of the sternum

40
Q

Where is the PV located?

A

At the 3rd costal cartilage to the left of the sternum. It is audible in the 2nd left intercostal space just above the sternum

41
Q

What is an MI?

A

An area of necrosis resulting from a sudden occlusion of a major branch of a coronary artery. Since there is little to no overlap between vessels the effect is IMMEDIATE and devastating.

42
Q

What percentage of MIs are in the:
Anterior IV branch of the LCA?
RCA?
Circumflex branch of the LCA?

A

40-50
30-40
15-20

43
Q

What is myocardial ischemia?

A

When the heart muscle doesn’t receive enough oxygen during exercise or due to stress. Coronary atheroslcerosis progressively narrows the lumen and can cause these conditions.

44
Q

What is angina pectoris?

A

Chest pain characterized by substernal discomfort that can be relieved with 1-2 mins of rest.

45
Q

What is heart block?

A

When part of the conducting system is affected by a blockage (occluded AV nodal artery); the ventricles continue to beat at their own rate independently of the atria.

CRAAB 1 (11 decks)

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