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SF3 > Anatomical Clinical Correlates of the Mediatinum > Flashcards

Anatomical Clinical Correlates of the Mediatinum Flashcards

1
Q

Strangling of the chest is also known as what?

A

Angina Pectoris

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2
Q

What are the predisposing factors that may lead to Agina

Pectoris?

A 
Heavy meal 
Exertion 
cold weather 
obesity 
smoking
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3
Q

Describe the mechanism behind angina pectoris.

A

The predisposing factors create a greater demand on the heart, which requires it to work harder so it can increase cardiac output.

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4
Q

Teddy comes in complaining of an aching in his chest. You notice that he is overweight and reports having a ten year history of smoking. Test results show myocardium ischemia. What is the possible diagnosis?

A

Angina Pectoris

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5
Q

The heart receives GVA innervation from 2 sources, what are they

A
  1. GVA fibers run with the Sympathetic from the upper thoracic ganglia (preganglionic splanchnic nerves), especially from the lefts.
  2. GVA fibers run with the vagus nerve. These fibers are important for visceromotor reflexes (heart rate/secretory).
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6
Q

How do the GVA fibers (that supply the heart) from the sympathetic vs the vagus nerve differ?

A

The GVA fibers from the Sympathetic convey pain sensation and the GVA fibers from the vagus nerve do not carry pain sensation.

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7
Q

Along with the GVA fibers the heart also receives GVE fibers. What do they control?

A

GVE fibers control cardiac output

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8
Q

High intense stimulation of the GVA fibers leads to what?

A

Angina

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9
Q

Innervation of the heart originates from where?

A

Sympathetic ganglion

  1. Superior Cervical
  2. Middle Cervical
  3. Stellate ganglion
  4. 2nd thoracic
  5. 4th thoracic
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10
Q

As we know the GVA fibers run with the sympathetic ganglion. At which level of the sympathetic ganglion do they run?

A

Originate from the stelae ganglion and go all the way to the 4th thoracic.

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11
Q

Sensory innervation to the heart (GVA fibers) are insensitive to? And Sensitive to?

A

Insensitive to:
Cutting, cold, hot, and touch

Sensitive to:
Ischemia and the accumulation of metabolites

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12
Q

Teddy comes in stating that he has chest pain along with pain is in arm. It is determined that he is suffering from Agina Pectoris. Why does he feel pain in his arm?

A

Pain from an ischemic heart is referred to the dermatomes supplied by the spinal cord segments T1-T5. These spinal cord segments are where the GVA fibers terminate. T1-T5 dermatome are located on the chest and T1 dermatome continues on through the upper limb.

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13
Q

What is the typical feeling/symptom of angina pectoris?

A

Feeling heavy weight or choking radiating out substernally to the left shoulder and upper limb.

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14
Q

Are there variations to the typical feeling/symptoms of angina pectoris?

A

YES
typically it involves the left substernal area and shoulder + arm

but

a person can also feel pain in the both the left and right substernal area together + arm
or
they can only experience pain on the right chest + arm

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15
Q

Not everyone who has an MI will feel chest pain. Some people, instead of feeling discomfort, they have symptoms of malaise and fatigue. Which individuals would typically experience these different symptoms?

A

Women
Seniors
People with diabetes

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16
Q

What is the cause of angina pectoris?

A

Blood supply cannot meet the metabolic needs of the heart.
Due to the increase demand of the heart to pump more blood the heart begins to work harder and harder. This leads to an increase in cardiac muscle and atherosclerotic narrowing. The narrowing of the vessels increases resistance and decreases blood supply in the coronary arteries.

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17
Q

What defines flow?

A

Flow is P/R

P = pressure pushing the blood 
R = resistance
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18
Q

Area

A

pie*radius^2

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19
Q

Resistance

A

1/radius^4

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20
Q

What type of arteries supply to myocardium?

A

For the most part, end arteries (not collaterals)

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21
Q

What is the issue with the heart not having a adequate collateral system?

A

Without collateral circulation, blockage of a branch of a major coronary artery results in an area of muscular ischemia, death and necrosis -> Myocardial Infarct

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22
Q

Is it better to have a long history of coronary artery disease or to have no history of symptoms and have a MI?

A

It is better to have a long history of coronary artery disease. This is because with coronary artery disease angiogenesis occurs and the heart blood supply creates more collaterals. Therefore, if you have a MI you have a better chance of survival.

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23
Q

What are the effects of coronary artery disease (atherosclerosis)?

A

Intermittent Ischemia -> Angina Pectoris
Chronic Ischemia -> Myocardial Fibrosis
Acute Occlusion -> Myocardial Infarction

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24
Q

What happens when cardiac muscle cells dies?

A

They are replaced by scar tissue, which is non-contracting. This deceases the force of contraction

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25
Q

An infarct that involves the interventricular septum may disrupt the conduction system of the heart resulting in?

A

Bundle branch (heart) block

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26
Q

What is a heart block?

A

Partial or total disruption of the atrioventricular bundle that results in arrhythmias or disruption of the coordination of atrial and ventricular contractions

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27
Q

A pacemaker is used to treat what?

A

A total heart block

The catheter is placed in through a vein and the elected is placed at the electrode is placed at the apex of the right ventricle (septomarginal band).

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28
Q

Left or right heart failure are results of what?

A

Myocardial Infarct

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29
Q

The right heart pumps to the _________ __________ and the left heart pumps to the _________ ________.

A

Pulmonary circuit
Systemic Circuit

Normally, Out (rh) = Out (lh) within a series of 3-4 heart beats

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30
Q

What happens if the cardiac output of the right heart is less than the cardiac output of the left heart?

A

This leads to systemic congestion also known as Right heart failure

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31
Q

What happens if the cardiac output of the left heart is less than the cardiac output of the right heart?

A

This leads to pulmonary congestion also know as Left heart failure.

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32
Q

Left heart failure causes what?

A

Growing venous congestion of the lungs

Pulling of the blood leads to pulmonary edema

33
Q

What are the causes obstruction to pulmonary flow?

there are a lot

A
  1. Compression of the pulmonary veins
  2. Atrial Thrombosis
  3. Mitral Stenosis
  4. Constrictive Pericarditis
  5. Amyloidosis
  6. Endocardial Fibroelastosis
34
Q

There are two main categories of pulmonary congestion/Edema , what are they?

A

Obstruction to the pulmonary flow and

failure of the left heart

35
Q

What are the causes of left heart failure?

A 
Systemis hypertension 
Coarctation of Aorta 
Patent Ductus Arteriosus 
Aortic Stenosis/ Aortic Insufficiency 
Myocardial damage (Infarction, fibrosis, myocarditis, toxic or metabolic injury)
36
Q

LaQuan comes stating that he is not feeling well and has difficulty breathing. You notice that he is short of breath when walking but when he sits and props his arm it is easier for him to breath. What is your suspected diagnosis?

A

Left heart failure & Pulmonary congestion

Patient shows signs of dyspnea (shortness of breath, gasping for air) and Orthopnea (difficulty breathing except in standing/sitting position)

37
Q

Why do patients prop their arm when they have difficulty breathing?

A

They do this expand their chest cavity. Because of the pulmonary edema the chest cavity is not expanding well so they are not getting enough oxygen.

Expanding of the chest cavity is done by the accessory respiratory muscles (SCM, Scalene, Pectorals, Serratus Anterior). They attach to the ribs and pull the thoracic cavity up.

38
Q

Postductal Aortic Coarctation is an example of what type of disorder?

A

Obstructive Disorder of the left heart

This condition is stenosis in the arch of the aorta after the ligamentum (ductus) arteriosum.
Structures distal to coarctation receive blood via collateral pathways

39
Q

What is the difference between preductal coarctation and postductal coarctation?

A

Preductal coarctation usually occurs in children and postductal coarctation usually occurs in adults.

Additional fact:
In both cases, the initial 3 branches of the arch of aorta that supply the head neck are unaffected but the branches supplying the lower limbs are affected.

40
Q

How does the body bypass an aortic obstruction to get blood to areas supplied by the aorta, downstream from blockage?

A

Through the anterior intercostal branches of the internal thoracic artery (branch of subclavian). These branches anastomose with the posterior intercostal branches of the aorta (which are not receiving blood supply)

41
Q

Erosion or notching of the costal groove is caused by what?

A

An enlarges, tortuous intercostal artery

This occurs due to the increase demand in blood supply needed due to blockage of the posterior intercostal artery

42
Q

The superior epigastric artery (terminal branch of the internal thoracic artery, anastomoses with which artery?

A

Inferior epigastric artery, which is a branch of the external iliac.

This is how blood supply of the anterior chest wall supplies the lower limb

43
Q

Coartication of the aorta results in the development of collateral pathways (arteries become dilated and tortuous) , including?

A

Internal thoracic artery
transverse cervical artery
suprascapular artery
intercostal artery

44
Q

T/F

Pulse in the lower limbs are weaker than the upper limbs

A

True

45
Q

Diminished pulse in the lower limbs is indicative of what?

A

Aortic Obstruction

46
Q

What is the effect of aortic cortication on the left ventricle?

A

Muscles of the heart hypertrophy (mainly the left ventricle)

47
Q

Enlarges left ventricle and pulmonary congestion has what effect on the thoracic cage?

A

The heart is greater than 50% of the thoracic diameter

Congestion in lungs (increased vascular markings)

48
Q

What is the ductus arteriosus?

A

Shunt from the Left pulmonary artery to the arch of the aorta. Bypass the lungs

49
Q

When the baby is born and takes it first breath what occurs?

A

There is an increase in O2 levels and decrease in Prostaglandin E.
This causes the Ductus Arteriosus to close

50
Q

If the ductus arteriosus does not close immediately, as a physician what do you do?

A

You can give the baby prostaglandin inhibitors, ACh, histamine, and Catecholamines. These all promote closure.

51
Q

What is it called the ductus arteriosus does not closed?

A

Patent ductus arteriosus

PDA is common in premature infants and maternal rubella cases

52
Q

In which situations would you want the ductus arteriosus to remain patent?

A

If the blood circuitry of the baby is not formed properly you would want to continue bypass the lungs until after it can be surgically repaired. You can give the baby drugs that would increase prostaglandin E and decrease O2.

53
Q

In Rheuematic fever and other bacterial infections what occurs to the heart?

A

The valves thicken at the contact points

Blood vessels grow into cusp to supply the increase in tissue. Normally the cusp relieve their nutrients from the blood the fills the chambers

54
Q

Obstructive coronary disease leads to which two conditions?

A

vulvar stenosis and incompetence

55
Q

Angie has obstructive coronary disease for an extended period of time. What can eventually happen to the cups of her heart valves?

A

Cusps will scar and develop vegetations

56
Q

Scaring cusps may fuse and produce what?

A

Produce Stenosis and Insufficiency (incomplete closing)

57
Q

Acquired Bicuspid Aortic Valve (rheumatic) can lead to what?

A

Moderate stenosis (beginning fusion of other commissures) -> stenosis and insufficiency (fusion of all commissure)

or

Calcific stenosis

58
Q

Congenital bicuspid valve can lead to what?

A

Calcific Stenosis

59
Q

What is the effect of having calcific stenosis?

A

The cusps of valves do not close completely, the valve becomes leaky and blood regurgitates backward increasing the work of the heart

60
Q

Which valve is most often diseased or damaged?

A

The Mitral valve (because pressure of blood from the left ventricle is the highest)

61
Q

What are the causes of peripheral congestion or Edema?

A

Pulmonary Stenosis
Tricuspid Stenosis/Insufficiency
Constrictive Pericarditis
Acute or Chronic Myocarditis (Rheumatic or Other)
Amyloidosis
Endocardial Fibroelastosis (Right Side)
Mitral Stenosis (back pressure via pulmonary circulation)
Pathologic Tachycardia, Anemia, Thyrotoxicosis, Beriberi
Atrial or ventricular septal defects
Arteriovenous fistulas

62
Q

What are the contributing factors to causation of edema?

A

High blood volume

Hemodilution (low colloidal osmotic pressure of blood)

63
Q

What are the symptoms of Right heart failure and systemic Congestion?

A
  1. Engorgement of jugular veins
  2. Elevated venous pressure
  3. Ascites
  4. Enlarged and tender liver
  5. Cyanosis
  6. Edema (Swollen ankles)
  7. Dilation of Right heart
64
Q

What effects does a dilated right heart have on the thoracic cavity?

A
  1. The heart’s diameter is over 50% of the thoracic cage

2/ The lungs are relatively clear

65
Q

What are signs of hypoxia?

A

Cyanosis

Clubbing of Fingers

66
Q

Lil baby Amy was born with a septal defects between the atria or ventricles. What does this result in?

A

Blood being shunted from the left to the right heart (because of the pressure differential)

Thus, the right heart has to pump more blood resulting in dilation and/or hypertrophy of the affected chambers.

67
Q

Before birth pulmonary resistance is hight where?

A

On the Right side, too blood is shunted from right to left.

After birth pressure is high on the left side.

68
Q

Blue Baby suffers from what?

A

Atrial Septal Defect (open foramen ovale)

This causes the baby to be cyanotic and there is dilation of the right atrium

69
Q

An infarct may result in the formation of a thrombus (blood clot). If this is dislodged from the right side of the heart what can occur?

A

Pulmonary embolism results

70
Q

Tedd is suffering from obesity and some heart issues. He has a clot in the left side of the heart and is in critical condition. What are you most concerned of?

A

The patient can throw a clot that would result in a cerebral embolism. Thus leading to a cerebral infarct or stroke

71
Q

The heart is surrounded by what?

A

Pericardial Sac

72
Q

Your patient has a build up of pus forming within the pericardial sac, what are they suffering from?

A

Purulent Pericarditis

73
Q

If Purulent Pericarditis persist what can it further cause?

A

Adhesions forming between the heart and the pericardium

74
Q

What is the consequence of adhesions?

A

They tether the heart restricting contraction and expansion

75
Q

What is Tamponade?

A

Fluid build-up in the pericardium

Note: Myocardial would bleeding into the pericardial cavity would increase the pressure of the cavity thus putting pressure on the heart.

76
Q

How much fluid should the pericardial sac have within it?

A

A single layer of fluid

77
Q

What is the upside and downside to Cardiac Tamponade?

A

Upside:
Compress the would and reduce bleeding

Downside:
Stops a beating heart

78
Q

How do you treat Cardiac Tamponade?

A

Pericardiocentesis

The needle must avoid the heart, lungs, and pleural cavity. It is typically inserted between the xiphoid process and the costal angle.

79
Q

What are the symptoms of cardiac tamponade?

A

Patient in variable degree of shock or in extremis
Neck veins distended
heart sounds are distant
Venous pressure elevated (Pathognomonic)
decrease arterial and pulse pressure (not pathognomonic)

SF3 (15 decks)

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