Anatomical/Clinical Correlates of the Mediastinum Flashcards
Angina Pectoris
Chest pain or discomfort due to coronary heart disease. It occurs when the heart muscle doesn’t get as much blood as it needs. This usually happens because one or more of the heart’s arteries is narrowed or blocked, also called ischemia.
What are the predisposing factors of angina pectoris?
Heavy meal
Exertion
Cold weather
Obesity
Smoking
The heart receives GVA innevation from 2 sources. What are they and what do they convey?
-
Sympathetics from upper thoracic ganglia
- Convey pain sensation
-
Vagus nerve
- Important for visceromotor reflexes
True or False. CN X does not carry pain sensation.
True
The heart receives GVA innervation from fibers that run with sympathetics from the ___________ ganglia.
Upper thoracic (T1-5)
Which sympathetic ganglion innervate the heart?
- Superior cervical
- Middle cervical
- Stellate ganglion (GVA fibers)
- 2nd thoracic (GVA fibers)
- 3rd thoracic (GVA fibers)
- 4th thoracic (GVA fibers)
GVA fibers from the heart are insensitive to which modalities?
Cutting
Cold
Hot
Touch
GVA fibers from the heart are sensitive to which modalities?
Ischemia
Accumulation of metabolites
T1 dermatome supplies the ___________
Upper limb
Pain from an ischemic heart is referred to the ____________ supplied by the spinal cord segment from which the GVA fibers terminate.
dermatome
Where is angina pectoris pain typically referred to?
To left shoulder and upper limb from dermatome T1
NOTE: Because of variation, patients will experience angina pectoris differently
What are the heart disease symptoms in women, seniors, and people with diabetes?
For many women, seniors, and people with diabetes, pain is NOT a symptom of heart disease at all. Instead of experiencing discomfort, they often have symptoms of malaise or fatigue.
For the most part, ________ supply blood to the myocardium.
End arteries
*No collaterals
Without collateral circulation, blockage of a branch of a major coronary artery results in an area of muscular ischemia, death and necrosis, which is also known as ____________________.
Myocardial infarct
Intermittent ischemia can lead to __________, while chronic ischemia can lead to______, and acute occlusion can lead to ___________.
Angina pectoris; myocardial fibrosis; myocardial infarction
An infarct that involves the interventricular septum may disrupt the conduction system of the heart resulting in ____________.
Bundle-branch (heart) block
Total heart block can be treated with an implanted pacemaker. The electrode is placed int eh apex of the ____________.
Right ventricle
The necrotic tissue is replaced by a __________.
Non-contracting scar
Cardiac output of the right heart must equal the output of the left heart. If the output of the right side is less than the output of the left then you end up with ________. If the output of the left side is less than that of the right, you end up with __________.
Systemic congestion; Pulmonary congestion
What are the causes of active and passive pulmonary congestion, respectively?
Active
- Increased flow of blood to lungs
Passive
- “Back pressure” on venos return from lungs, due to decreased left side output.
What factors could lead to an increased flow of blood to the lungs?
- Increased rapidity of circulation
- Due to: anemia, thyrotoxicosis, beriberi
- Increase blood volume
- Pregnancy
Left heart failure can be due to which factors?
- Systemic hypertension
- Coarctation (narrowing) of aorta
- Patent ductus arterioros
- Aortic stenosis
- Aortic insufficiency
- Mitral insufficiency
- Myocardial damage
Obstruction to pulmonary flow can be due to…
- Compression of pulmonary veins
- Atrial thrombosis
- Mitral stenosis
- Constrictive pericarditis
- Amyloidosis
- Endocardial fribroelastosis
Left hear failure and pumonary congestion can lead to…
- Dyspnea
- Orthopnea
What is orthopnea?
Difficulty breathing except in standing/sitting position
Preductal coarctation usually occurs in ________ (children/adults).
Children
NOTE: Structures distal to the coarctation receive blood via collateral pathways
Postductal coarctation usually occurs in ________ (children/adults).
Adults
How does the body bypass an aortic obstruction to get blood to areas supplied by the aorta, downstream from the blockage?
Via collateral pathways
NOTE: In the formation of collateral pathways, arteries become dilated and tortuous
Anterior intercostal branches of the ___________ anastomose with posterior intercostal branches of the ____.
Internal thoraci; aorta
The superior epigastric, a terminal branch of the ___________, anastomosis with the inferior epigastic, a branch of the _________.
Internal thoracic; external iliac
Anastomes form around the shoulder with ___________ arteries.
Intercostal
Diminished pulse in lower limbs may indicate _________.
Aortic obstruction
What is the effect of aortic coarctation on the left ventricle?
It hypertophies
NOTE: Muscles hypertrophy when challenged with a load
What are the signs of an enlarged left ventricle and pulmonary congestion?
- Heart is greater than 50% of the thoracic diameter
- Congestion in lungs (increased vascular markings
What substances promote the closure of the ductus arteriosus?
- Prostaglandin inhibitor,
- ACh
- Histamine
- Catecholamines
In what cases is patent ductus arteriosus common?
- Premature infants
- Maternal rubella cases
Ductus arteriosus
A blood vessel connecting the main pulmonary artery to the proximal descending aorta. It allows most of the blood from the right ventricle to bypass the fetus’s fluid-filled non-functioning lungs.
The_________ series of prostaglandins are responsible for maintaining the patency of the DA throughout the fetal period
E
NOTE: This is done by promoting dilation of vascular smooth muscle
In rheumatic fever and other bacterial infections, the valves of the heart may thicken at contact points. Over time, the thicken cusps of valves may scar and develop ______.
Vegetations
Scarring cusps may fuse producing __________ and ____________.
Stenosis; insufficiency (incomplete closing)
NOTE: The heart has to work harder to pump blood through a stenotic valve
The ______ is the most often diseased or damaged valve.
Mitrial valve
Anything that reduces blood flow through the ______ (left/right) heart results in systemic congestion.
Right
What are some contributing factors to causation of edema?
High blood volume
Hemodilution (low collodial osmotic pressure of blood- induced by proteins)
Right heart failure and system congestion can lead to what problems?
- Engorgement of jugular veins
- Elevated venous pressure
- Ascites
- Enlarged and tender liver
- Cyanosis
- Edema (swollen ankles)
- Dilation of right heart
What are some signs of a dilated right heart?
- The heart’s diameter is over 50% of the thoracic cage
- The lungs are relatively clear
___________ defects between the atria or ventricles result in blood being shunted from the left to the right heart (because of pressure differentials).
Septal
NOTE: This cause the right heart to have to pump more blood resulting in dilation and or/ hypertrophy of the affected chambers
An infarct may result in the formation of a thrombus. If disloged from the right side of the heart, a ____________ results. If dislodged from the left side, a ________ may result.
Pulmonary embolism; cerebral embolism.
NOTE: A cerebral embolism may result in a cerebral infarct or stroke
Purulent pericaditis
a rare disease that is most often caused by organisms such as Staphylococcus aureus, Streptococcus pneumoniae, viridans streptococci, Haemophilus influenzae, and anaerobic bacteria.
Pericarditis may result in ________ forming between the heart pericardium.
adhesions
NOTE: Adhesion tether the heart restricting contraction and expansion
