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Block 2 Week 1 > ANAT - Heart & Mediastinum > Flashcards

ANAT - Heart & Mediastinum Flashcards

1
Q

HEART CHAMBERS

A
  • Blood flow
    • ​SVC/IVC –> RA –> tricuspid valve –> RV –> pulmonary vein –> lungs –> pulmonary artery –> LA –> mitral valve –> LV –> aortic valve –> aorta –> system
  • Right chamber = pulmonary circuit (decreased BP, 15-20 mmHg)
  • **Left chmaber ** = systemic circuit (increased BP, 100 mmHg)
  • Blood volume must be equal on both sides or else will cause backup
    • ​LV failure = pulmonary edema
    • RV failure = peripheral edema
  • Aortic stenosis
    • ​Aortic valve doesn’t fully open
    • LV must contract harder (heart grows and gets stronger as a result)
    • So, they sometimes don’t fix it until symptomic because its advantageous to have a strong heart
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2
Q

CARDIAC CYCLE

A
  • Diastole = Filling

​​1. A/P valves close

  1. T/M valves open
  2. Atria contract
    * Systole = Emptying
  3. T/M valves close​
  4. Ventricles contract
  5. A/P valves open
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3
Q

CHEST CAVITIES

A
  • Two pulmonary cavities (1 per lung) and mediastinum
  • Pulmonary cavities surrounded by parietal pleura
  • Mediastinum surrounded by fibrous pericardium
  • Fibrous pericardium = dense CT sac around heart
    • Lined by parietal pericardium
    • Limited distensibility (but can stretch it over time)
      • If it fills with fluid (blood), puts pressure on ventricles –> tamponade
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4
Q

DIAPHRAGMATIC SURFACE OF THE HEART

A
  • Esophagus runs posterior to pericardial sac; therefore, transesophageal US’s can be used to visualize the heart
  • costomedial recess formed by the parietal leural from costal side reflecting over fibrous pericadium creating a space
  • Heart attches to diaphragm at is central tendon
  • R/L of heart = phrenic nerves and pericardiacophrenic vessels
    • ​Pericardiacophrenic vessels supply fibrous pericardium and parietal pericardium
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5
Q

MEDIASTINUM

A
  • Divided into superior/inferior at T4/Angle of Louis
  • Superior
    • ​Aortic arch
    • Esophagus
    • Trachea
    • Roots of great vessels
    • Phrenic, vegus, and cardiac nerves
  • Inferior
    • ​Anterior
      • ​Fat, branches of internal thoracic artery
      • Thymus (in children)
    • Middle
      • ​Pericardial sac and heart
      • Pulmonary trunk
      • Ascending aorta
      • SVC
    • Posterior
      • ​Everything anterior to vertebrae and in between parietal pleural of lungs
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6
Q

FORMATION OF THE PERICARDIAL SAC

A
  • Heart grows, invaginating the serous pericardium
  • Creates 2 layers with a serous fluid filled space in between
  • Inside to out:
    • ​Endocardium
    • Myocardium
    • Epicardium
      • Visceral pericardium
      • Parietal pericardium
    • Fibrous pericardium
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7
Q

BORDERS OF HEART IN SITU

A
  • Phrenic nerves = between fibrous pericardium and parietal pericardium (therefore, not technically in the mediastinum)
  • Left vagus nerve = runs along aortic arch, branches into left recurrent pharygneal
  • Right vagus nerve = runs behind SVC
  • Left and right vagus meet and mix in the esophageal plexus
  • During fetal period, blood =/= pumped to lungs, but heart still needs to receive blood on L side to grow strong…
    • ​Shunt between L & R atria = ductus arteriosis
    • Closes before birth
  • Base of heart = LA (mostly, but a little bit of RA)
  • Apex = where L & R ventricles meet (on diaphragm)
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8
Q

SINUSES

A
  • Tranverse sinus - anterior to SVC and posterior to pulmonary trunk and aorta
  • Oblique sinus - between parietal pericardium and posterior heart
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9
Q

VARIATIONS IN CORONARY CIRCULATION

A
  • Left Dominant Heart - PD comes off of left coronary artery
  • Right Dominant Heart - PD comes off right coronary artery
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10
Q

RIGHT ATRIUM

A
  • Outer wall = pectinate muscles
  • Inner wall = smooth
  • Fossia ovalis = fetal R-L shunt
  • Valve & ostium or coronary sinus
  • Atrial appendage = auricle
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11
Q

LEFT ATRIUM

A
  • All smooth walls
  • Remnant of septum primium
  • Left appendage = auricle
    • ​Afrib –> clot formation –> easily throws
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12
Q

VENTRICLES

A
  • Papillary muscles
    • ​Connect to valve flaps via chordae tendineae
    • Prevent valve inversion during contraction to prevent regurgitation by contracting –> tension on chordae
    • Regulated by modulatory band arising from heart conduction system
    • During contraction, pull apex up toward cardiac skeleton = fibrous disc between atria and ventricles from which valves arise
      • ​During contraction, all valves (A, P, T, M) in same plane
  • Muscles on ventricular wall = traberculae carneae​​
  • Left Ventricle
    • ​Anterior and posterior papillary muscles
    • Anterior and posterior valve flaps
    • THICK walled
  • Right Ventricle
    • ​Septal, anterior, and posterior papillary muscles
    • Septal, anterior, and posterior papillary muscles
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13
Q

VALVES

A
  • Aortic/Pulmonary
    • ​Diastole: OPEN
    • Systole: CLOSED
    • Inversion prevented by SEMILUNAR SHAPE
  • Mitral/Tricuspid
    • ​Diastole CLOSED
    • Systole OPENED
    • Inversion prevented by PAPILLARY MUSCLES
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14
Q

ANGIOGRAM

A
  • Inject dye through ostium of coronary artery in aorta
  • Fills during diastole because the aortic valve flaps are down, exposing the ostium
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15
Q

FIBROUS SKELETON

A
  1. Attachment point of cardiac muscle fibers
  2. Electrical insulator between atria/ventricles
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16
Q

CONDUCTION

A
  • SA –> internodal fiber –> AV –> bifurcates –> Purkinje –> modulator band
  • Infarct = break in the conduction system
  • Within CM, electrical current spreads spontaneously through all cells
  • EKG = summation of various AP through all the different conductors, atria, and ventricles
17
Q

NERVES

A
  • Efferent
    • ​From vagus, T1-T4 and cervical chain ganglia
    • Thoracic splanchnic –> white rami –> synapse in chain –> cervical ganglia –> cardiopulmonary plexus –> heart/coronary arteries
  • Afferent
    • ​Follow vagus back to CNS…gray –> DRG –> central process –> spinal cord
    • Enter at C5=T1 with upper limb afferents –> referred pain
18
Q

VALVE AUSCULTATION

A

All Physicians Take Money

  • Aortic Valve
    • ​Location: sternum @ 3rd intercostal
    • Auscultate: parasternally, R, 2nd intercostal
  • Pulmonary Valve
    • ​Location: L of sternum @ 3rd costal cartilage
    • Auscultate: parasternally, L, 2nd intercostal
  • Tricuspid Valve
    • ​Location: sternum @ 4th intercostal
    • Auscultate: parasternally, L, 5th/6th intercostal
  • Mitral Valve
    • ​Location: L of sternum @ 4th intercostal
    • Auscultate: midclavicularly, L, 5th intercostal
19
Q

VASCULATURE OF THE ANTERIOR SURFACE OF THE HEART

A
20
Q

VASCULATURE OF THE POSTERIOR SURFACE OF THE HEART

A
21
Q

DIAPHRAGMATIC SURFACE OF THE HEART

A

Block 2 Week 1 (8 decks)

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