anatomy Flashcards
RCA supplies
- right atrium
- most of the right ventricle
- part of the left ventricle
- part of the IV septum (posterior 1/3)
- SA node in 60%
- AV node in 80%
LCA supplies
- left atrium
- most of the left ventricle
- part of the right ventricle
- most of the IVS, including the AV bundle
- SA node in 40%
Which aortic cusp does not give rise to a coronary artery?
posterior cusp
vibratory sensations felt on the skin over the area of turbulence
thrills
most frequent valve abnormality
aortic stenosis
caused by degenerative calcification and results in LV hypertrophy
produces heart murmur and collapsing pulse
aortic valve insufficiency
why saphenous vein is used for graft in CABG
-diameter equal to or greater than coronary artery
-can be easily dissected from lower limb
-lengthy portions with minimal branching
(also contains slightly more smooth muscle cells)
levels of spinal cord associated with cardiac referred pain
T1-T4 or T5
most common location for obstruction of flow in the aorta due to coarctation
near the ligamentum arteriosum
inadvertent injury to this during surgical procedures causes release of milky substance into thoracic cavity
thoracic duct
causes chylothorax
The thoracic duct enters the venous system at the left venous angle -> junction of the left subclavian vein and left internal jugular vein
What drains the thoracic, abdominal and back regions should the IVC become occluded?
azygos
hemiazygos and accessory hemiazygos veins
What can be seen at the right border of heart on radiograph?
R braciocephalic vein
SVC
Right atrium
IVC
What can be seen at the left border of the heart on radiograph?
terminal part of the arch of the aorta
pulmonary trunk
left auricle
left ventricle
Where is the apex of the heart on radiograph?
inferior to the shadow of the diaphragm
what produces a vertical cardiac shadow on CXR?
narrow chest
What produces a transverse type cardiac shadow on CXR?
obesity
pregnancy
infant
What ribs articulate with the sternum?
1-7 (the true ribs)
maximum width of the heart divided by the maximum internal diameter of the thoracic cage (cardiothoracic ratio) as seen on frontal view of chest xray is greater than 50%
-assess on lateral view as well to determine AP diameter
cardiomegaly (enlarged heart)
What vein becomes prominent to the right of the trachea on CXR in a patient with CHF?
azygos vein
Which arteries branch from the RCA?
right marginal arteries
Which arteries branch from the LAD?
- septal branches
- diagonals
How is dominance determined?
by which vessel supplies the inferolateral wall of the left ventricle
What branches from the LCX?
left marginal
Where does the LAD run?
IV groove
sternal angle to T4-T5 vertebrae
superior mediastinum
from superior thoracic aperture to diaphragm
inferior mediastinum
includes the pericardium and its contents, including the great vessels
middle mediastinum
What is continuous with the fibrous pericardium?
pericardiacophrenic ligament
What is on the right in a position analogous to the aorta?
arch of the azygos vein
drains the thoracic wall and passes over the root of the right lung
posterior to the manubrium and divides into right common carotid and right subclavian arteries
brachiocephalic trunk
Which branch off the aorta does not have any other branches in the mediastinum?
left subclavian artery
Does the left vagus nerve pass anterior or posterior to the left lung root?
posterior
Do the phrenic nerves pass anterior or posterior to the roots of the lungs?
anterior
Describe the route of the right vagus
Descends in the neck posterior to the common carotids and passes anterior to the right subclavian. It gives rise to the right recurrent laryngeal nerve which hooks around the right subclavian artery and travels superiorly between the esophagus and the trachea to innervate the right larynx
Describe the route of the left vagus
Descends the neck posterior to the left common carotid and passes into the mediastinum between the left common carotid and left subclavian. The left recurrent laryngeal nerve branches from it and passes inferior to the aortic arch immediately lateral to the ligamentum arteriosum and travels to the larynx between the esophagus and trachea
Which nerve runs along the fibrous pericardium superficial to the left atrium and left ventricle?
left phrenic nerve
Is the thoracic duct on the left or right side of the esophagus?
left
Contents are: loose CT, fat, lymphatic vessels, a few lymph nodes and branches of the internal thoracic vessels
anterior mediastinum
bounded by sternum and tranverse thoracis muscles anteriorly and pericardium posteriorly
contains inferior part of thymus in children
contains the thoracic aorta, thoracic duct and lymphatic trunks, posterior mediastinal lymph nodes, azygos and hemiazygos veins, esophagus and esophageal nerve plexus
posterior mediastinum
What level does the thoracic aorta become the abdominal aorta?
T12 where it enters the aortic hiatus in the diaphragm
the thoracic aorta starts at T4
the thoracic duct drains lymph from?
lower limbs, left upper quadrant (limb, head and neck), pelvic cavity and abdominal cavity
What forms a collateral pathway between the IVC and SVC?
azygos system of veins
What vein runs in the anterior IV sulcus with the LAD?
great cardiac vein
What vein runs in the posterior IV sulcus with the posterior descending branch of the RCA?
middle cardiac vein
the small cardiac vein also drains regions served by the RCA
Arterial branch off the LCX?
posterior left ventricular branch
What is the origin of the phrenic nerve?
anterior rami of C3-C5
What is the origin of the intercostal nerves?
anterior rami of T1-T11
Remember that when viewing the intercostals, the order inferior to the rib is V A N (vein, artery, nerve)
What is the blood supply of the pericardium?
internal thoracic artery pericardiocophrenic artery musculophrenic artery bronchial, esophageal, & superior phrenic arteries coronary arteries
Venous drainage is by pericardiocophrenic veins (off the brachiocephalic veins)
innervation of the pericardium
C3-C5 (commonly referred pain to the skin)
vagus
sympathetic trunks
largest papillary muscle in right ventricle?
anterior
attaches to anterior and posterior cusps of tricuspid
which papillary muscle attaches to the posterior and septal cusps of the tricuspid?
posterior
Which papillary muscle attaches to the anterior and septal cusps of the tricuspid?
septal
level of the pulmonic valve
left 3rd costal cartilage
what vein is the remnant of the embryonic SVC?
oblique vein
horizontal ridges of muscle in the right atrium
pectinate muscles
vertical ridge of muscle that connects the pectinate muscles
crista terminalis
SA node is at its superior end
located in the interatrial septum above the opening of the coronary sinus
AV node
Which veins drain into the right atrium?
anterior cardiac veins
coronary sinus
SVC and IVC
which adrenergic receptors are in highest concentration in the coronary vessels?
beta-2
with increased activity these cause dilation which promotes more nutrient and oxygen delivery to the myocardium
what does the right lymphatic duct drain?
right upper quadrant, including right side of head, neck and thorax as well as RU limb
