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Anatomy Flashcards

1
Q

How many layers are there in the heart?

A
  1. Pericardium
  2. Myocardium
  3. Endocardium
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2
Q

What are the layers in endocardium?

A

Endothelium (simple squamous epithelium) & areolar tissue

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3
Q

Where is the pericardial cavity lie within? And what is found inside the cavity?

A

Pericardial cavity is within the parietal layer and visceral layer of serous pericardium. Pericardial fluid is in the cavity.

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4
Q

What is cardiac tamponade and pericarditis?

A

Cardiac tamponade - accumulation of pericardial fluid
Pericarditis - inflammation of pericardium

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5
Q

What is the nerve supply of pericardium?

A

Fibrous pericardium: pericardium nerve
Parietal layer of serous pericardium: phrenic nerve

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6
Q

What are the pericardial sinuses and their location and importance.

A

Transverse sinus: aorta and pulmonary artery anteriorly and superior vena cava posteriorly

  • ligate during coronary artery bypass surgery

Oblique sinus: posterior to the left atrium

  • can be used in paracentesis while treating cardiac tamponade.
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7
Q

What is the flow of blood in the heart

A

SVC - RA -(tricuspid valve)- RV - (semilunar valve)- pulmonary trunk - lungs - pulmonary vein - LA -(bicuspid valve)- LV -(semilunar valve)- Aorta

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8
Q

Peculiar features of cardiac muslce

A
  • smaller in size
  • single, centrally located nucleus
  • intercalated disc
  • present only in heart
  • striated
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9
Q

What is intercalated disc

A

Intertwined plasma membranes of adjacent cardiac muscle cells. Attached by desmosomes and gap junctions. Gap junctions allow action potential to spread cell to cell; allow all interconnected cells to function together as single unit = functional syncytium

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10
Q

What are the external features of heart?

A
  1. Chambers - atria & ventricles
  2. Sulci - atrioventricular (coronary), interventricular (ant. & post.)
  3. Surfaces - Sternocostal, left, diaphragmatic
  4. Borders - right, inferior & left
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11
Q
  1. Where is the apex of heart located and is formed by what?
  2. What forms the base of the heart and what opening is present?
A
  1. Formed by left ventricle only and apex is at left 5th intercostal space.
  2. Two atria - 2/3 by left atrium and 1/3 by right atrium. Opening of SVC & IVC to right atrium and opening of 4 pulmonary veins into left atrium.
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12
Q

How many sulcus present in the heart and what are the contents?

A
  1. Anterior atrioventricular
  2. Posterior atrioventricular
  3. Anterior interventricular
  4. Posteriors interventricular

Contents: artery, vein, fat

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13
Q

Right atrium received venus blood through

A
  1. Superior vena cava
  2. Inferior vena cava
  3. Coronary sinus
  4. Venae cordis minimae
  5. Anterior cardiac veins
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14
Q

Interior of right atrium

A
  1. Atrium proper (anterior rough part - pectinate muscle, right auricle)
    CRISTA TERMINALIS (inner elevation) / SULCUS TERMINALIS (outer depression)
  2. Sinus venarum (posterior smooth part)
    - opening of SVC - no valve
    - opening of IVC - Eustachian valve
    - opening of coronary sinus - Thebesian valve
  3. Septal wall (fossa ovalis, limbus fossa ovalis)
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15
Q

Interior of left atrium

A
  1. Musculus pectinate
  2. Lunate fossa
  3. Semilunar fold
  4. Left auricle
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16
Q

Interior of right ventricle

A
  1. Inflow tract - ventricle proper (rough part)
    - Tricuspid valve complex (Rt. atrio-ventricular orifice, Tricuspid annulus, 3 Leaflets / Cusps, Chordae tendinae, papillary muscles)
    - Trabecular carnea (ridges, bridges, pillars)
  2. supraventricular crest
  3. outflow tract - conus arteriorsus / infundibulum (smooth part)
    - pulmonary orifice (guarded by 3 semilunar cusps)
    - pulmonary sinus (above each cusps)
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17
Q

What is the course of right coronary artery.
Branches of right coronary artery.
Distribution of right coronary artery.

A
  1. Right coronary artery arises from right aortic sinus, runs in coronary sulcus between right auricle and infundibulum to the inferior border of the heart. It then turns posteriorly to continue along the coronary sulcus and anastomose with the terminal branch of left coronary artery across the posterior interventricular-groove.
    • SA nodal artery
    • AV nodal artery
    • Right marginal branch
    • posterior interventricular branch
    • Both atria & interatrial septum
    • SA node (60%) AV (90%) and bundle of his
    • right ventricle except for a narrow strip along the anterior interventricular groove
    • posterior 1/3 of interventricular septum
    • A narrow strip of left ventricle along the posterior interventricular groove
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18
Q

What is the course of left coronary artery and branches

A
  1. arises from the left posterior aortic sinus. It is the larger branch of the ascending aorta. It passes between the left auricle and infundibulum. After a short course it divides into 2 terminal branches, the anterior interventricular branch and circumflex branch.
    - anterior interventricular artery descends in the anterior inter-ventricular groove to the apex where it turns posteriorly and anastomoses with the posterior inter-ventricular artery
    - circumflex branch is the continuation of parent trunk. It follows coronary sulcus around the left border of heart and runs along the posterior part of the sulcus & terminates by anastomosing with the end of right coronary artery
    - left marginal branch arises from the circumflex branch, it follows the left border of the heart.
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19
Q

Distribution of left coronary artery

A
  1. SA node (40%) AV node (10%)
  2. Left atrium (upper part)
  3. Left ventricle except for a narrow strip along posterior interventricular groove
  4. anterior 1/2 of interventricular septum
  5. A narrow strip of right ventricle along the anterior inter-ventricular groove
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20
Q

What are the venous drainage of the heart

A
  1. mainly by veins that empty into the coronary sinus
  2. partly by small veins (venae cordis minimae & anterior cardiac veins) that open directly into the chambers of the heart
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21
Q

Tributaries of coronary sinus

A
  1. Great cardiac vein - accompanies the anterior interventricular artery & circumflex artery and enters the coronary sinus at its left end
  2. Middle cardiac vein - accompanies the posterior interventricular artery and opens into the coronary sinus near its termination
  3. Small cardiac vein - accompanies the right marginal artery and opens into the coronary sinus at its right end.
  4. Posterior veins of left ventricle - joins the coronary sinus to the left of the middle cardiac vein
  5. Oblique vein of Marshall - runs over the posterior wall of left atrium and drains into the coronary sinus near its left end
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22
Q

Clinical application of coronary circulation

A
  1. coronary arteries are functional end arteries
  2. they are the largest vasa vasorum of the whole body
  3. coronary insufficiency may lead to myocardial ischemia and angina pectoris, myocardial infarction in severe cases
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23
Q

What are the most common sites of coronary artery occlusion

A
  1. anterior interventricular branch of left coronary artery
  2. right coronary artery
  3. circumflex branch of left coronary artery
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24
Q

Brief description of layers of vessels

A
  1. Tunica intima:
    * thin, innermost layer of vessel wall
    * endothelium and thin layer of areolar connective tissue
  2. Tunica media:
    * middle layer of vessel wall, thickest layer in arteries
    * smooth muscle cells, circular arrangement
  3. Tunica externa:
    * outermost layer, thickest layer in veins
    * areolar connective tissue, helps to anchod vessels to other structures
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25
Q

What are the examples of elastic arteries.
Histology of elastic arteries

A
  1. Aorta, common carotid artery, pulmonay artery
    • walls are thinner in relation to lumen
    • Tunica intima - endothelial lining (simple squamous epithelium) , subendothelial lining (loose connective tissue layer) , internal elastic lamina (fenestration often present, less prominent than in muscular arteries)
    • Tunica media - wavy appearance of elastic fibers mixed with smooth muscle
    • Tunica adventitia - vasa vasorum present
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26
Q

What are the examples of muscular arteries.
Histology of muscular arteries

A
  1. brachial artery, radial artery, ulnar artery, femoral artery, popliteal artery
    2.
    * walls are thicker in relation with lumen
    * Tunica intima - flattened endothelial cells (simple squamous), subendothelial layer (elastic and connective tissue fibers), internal elastic lamina (prominent)
    * Tunica media - circulary arranged smooth muscle with few elastic fibers
    * Tunica adventitia - outer region is chiefly with vasa vasorum
    * External elastic membrane - between Tunica Media & Tunica adventitia (condensation of inner elastic fibers form a nonfenestrated external elastic membrane)
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27
Q

What are the large veins
Histology of large veins (main)

A
  1. SVC, IVC, portal vein
    * Thick Tunica Adventitia (consists of bundle of smooth muscle and connective tissue)
    * No external elastic membrane
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28
Q

Histology of capillaries

A
  • only one layer (simple squamous epithelium and basement membrane)
  • in some areas they have pores - Choroid plexus, intestine, endocrine, renal glomerulus
  • 2 types - fenestrated and continuous type (lack pores)
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29
Q

Histology of sinusoids

A
  • found in liver, spleen and blood forming organs (thymus, bone marrow, lymph node)
  • larger diameter than sinusoidal capillaries of endocrine glands
  • no basement membrane
30
Q

What are the conducting system of the heart and its function.

A

Consists of cardiac muscle cells and specialized conducting fibers called Purkinje fiber. They initiate the heart beat and co-ordinate the contraction of 4 chambers.

31
Q

Which compartment of the heart is located at?

A

Middle mediastinum

32
Q

suprasternal notch is located at which border

A

Lower border of T2

33
Q

Briefly describe the sternal angle / angle of Louis

A
  • it is located at the lower border of T4
    1. it is a line of division between superior, inferior & middle mediastinum
    2. 2 anterior borders of pleura meet
    3. begining and end of arch of aorta
    4. bifurcation of trachea
    5. bifurcation of pulmonary artery
    6. azoygous vein enter the SVC
    7. Ligamentum arteriosum lies
    8. superficial and deep cardiac plexus lies on this plane
    9. left recurrent laryngeal nerve begins
    10. SVC pierces the fibrous pericardium
    11. thoracic duct reach to left
34
Q

Xiphisternal angle is located at which border

A

Upper border of T9

35
Q

What are the contents in superior mediastinum

A
  1. Great vessels
  2. Trachea
  3. Oesophagus
  4. Thymus
36
Q

What are the contents of anterior and middle mediastinum

A

Anterior mediastinum: thymus
Middle mediastinum: Heart and roots of great vessels, pericardium

37
Q

What are the contents of posterior mediastinum

A
  1. Oesophagus
  2. Descending thoracic aorta
  3. Thoracic duct
  4. Azygous and hemiazygous vein
  5. Sympathetic trunk
38
Q

Describe thoracic duct

A

It is a large lymphatic duct which conveys lymph from the greater part of the body and it extends from the upper end of cisterna chyli. It is located at posterior mediastinum in front of the vertebral column. It joins left subclavian vein and left internal jugular vein.

39
Q

Describe the constituents of the conducting system of heart

A
  • SA Node : located at the superior end of crista terminalis in front of opening of SVC. It is natural pace-maker of heart and is supplied by both divisions of ANS. Sympathetic division accelerates heart rate and parasympathetic division slow heart rate
  • AV Node: located in the inter-atrial septum, above the opening of coronary sinus. Impulses from both atria converge on the AV node which distributes them to the ventricles via the Bundle of His.
  • Interventricular bundle (bundle of His):: specialized cardiac fibers which originates in the AV bundle and runs through the membranous part of the interventricular septum. At the junction of the membranous and muscular parts, it divides into right and left branches to distribute into the walls of ventricles
40
Q

Describe the component that made up of cardiac plexus

A

10th CN - vagus nerve & sympathetic trunk. Branches from both vagi and sympathetic trunks T1 - T4 form the cardiac plexus. Although the cardiac plexus is described as superficial and deep, functionally they are one.
* superficial cardiac plexus: inferior to arch of aorta around the ligamentum arteriosum
* deep cardiac plexus: larger, lies in front of tracheal bifurcation

41
Q

What are the superficial and deep cardiac plexus made of?

A

superficial cardiac plexus:
* superior cervical cardiac branch of left sympathetic trunk
* inferior cervical cardiac branch of left vagus nerve

deep cardiac plexus
* 3 cervical cardiac branch of right symphathetic trunk
* superior and inferior cervical cardiac branch of right vagus nerve
* middle and inferior cervical cardiac branch of left sympathetic trunk
* superior cervical cardiac branch of left vagus nerve

42
Q

The origin, course and end of arch of aorta

A
  • arch of aorta is the part of the aorta that rises above the sternal angle
  • origin: begins behind the right half of sternal angle, as the continuation of ascending aorta
  • course: upward, backward and to the left to the level of T4
  • ends: ends at the lower border of T4 where it continues as descending thoracic aorta
43
Q

Describe the relations of left anterior surface of arch of aorta

A
  • covered by left lung & mediastinal pleura
  • crossed by 4 nerves
    1. left phrenic nerve
    2. cardiac branches of vagus & sympathetic
    3. left vagus nerve
    4. left superior intercostal vein
44
Q

Describe the relations of right posterior surface of arch of aorta

A
  • related to the “unit of 4 parallel structures”
    1. trachea
    2. oesophagus
    3. left recurrent laryngeal nerve
    4. thoracic duct
45
Q

what are the relations of concave lower surface of arch of aorta

A
  1. inferiorly pulmonary trunk bifurcates into right and left branches
  2. the ligamentum arteriosum joins the left pulmonary artery to the concavity of the arch
  3. on the left of ligamentum arteriorsum is the left reccurent laryngeal nerve
  4. on the right is the superficial cardiac plexus
46
Q

How to know if there is enlargment of heart

A

inferior border of heart occupies 1/3 of thoracic cavity - if more than 1/3 - enlargement of heart

47
Q

How do you know if there is left ventricle enlargement

A

Apex of heart: 5th rib, mid clavicular line
if apex beyond mid clavicular line - left ventricle enlargement

48
Q

Descending thoracic aorta pierce diagphram at what level

A

T10

49
Q

What does right and left recurrent laryngeal nerve hook around

A

Rt: right subclavian A.
Lf: ligamentum arteriosum

50
Q

Branches of descending thoracic aorta

A

1.Parietal branches
* Right & left posterior intercostal arteries (3rd - 11th)
* subcostal arteries
* superior phrenic arteries

2.Visceral branches
* Bronchial artery (2 left + 1 right)
* esophageal arteries
* pericardial branches
* mediastinal branches

51
Q

The level of
1. vena cava opening
2. abdominal aorta opening

A
  1. T8
  2. T12
52
Q

what are the root values of phrenic nerve

A

C3, C4, C5 of spinal nerve

53
Q

What are the derivatives of the aortic arches

A

I: disappears on both sides, remaining part forms maxillary artery
II: disappears on both sides, reamining part forms hyoid & stapedial arteries

III:
* common carotid artery
* 1st part of ICA
* ECA sprout of 3rd aortic arch (connects with remaining arteries of 1st & 2nd aortic arches
remainder of ICA: dorsal aorta

IV:
* Lf: parts of arch of aorta between CCA & Lf. subclavian A.
* Rt: proximal Rt. subclavian A.
Distal: Rt. dorsal aorta + 7th intersegmental artery

VI:
* Lf proximal: Lf. pulmonary A
* Lf distal: ductus arteriosus (connects PA & aorta)
* Rt proximal: Rt. pulmonary A
* Rt distal: disappears

54
Q

Changes of aortic arch system

A
  1. dorsal aorta between 3rd & 4th carotid duct disappears
  2. part of Rt. dorsal aorta between 7th intersegmental A. & common dorsal aorta disappears
  3. Rt. recurrent laryngeal nerve hooks around proximal Rt. subclavian A.
  4. Lf. recurrent laryngeal nerve initially hooks around arch of aorta, after birth hook around ligamentum arteriosum
55
Q

3 main veins in development of venous system of heart

A
  1. vitelline V. (Rt - forms hepatocardiac portion of IVC)
  2. umbilical V. (Lf - after birth forms ligamentum teres)
  3. cardinal V. (Ant + Post)
56
Q

Describe the development of vascular system (Extraembryonic)

A

Extraembryonic (early part of 3rd week)
1. Hemangioblast are formed (by differentiation of mesoderm)
2. Hemangioblast proliferate and form blood islands
3. Blood islands is made up of peripheral layer (flattened endothelium: angioblast) and central layer (Hemoblasts)
4. Numerous cleft appears.
5. Blood islands appear first in splanchnic mesoderm (surrounding wall of yolk sac)
6. lateral plate mesoderm forms intra embryonic blood vessels
7. connecting stalk
8. chorion & its villi

Extraembryonic blood vessles arising from
* wall of yolk sac - vitelline vessels
* chorion & connecting stalk - umbilical vessels

57
Q

Development of vascular system (Intraembryonic)

A

later part of 3rd week
1. Angioblasts of intraembryonic mesoderm
2. Establish a secondary connection with extra embryonic blood vessels
3. There are 2 dorsal aorta on either side of notochord
* cephalic end invade cardiogenic plate
* caudal end extend into the connecting stalk

58
Q

What are the foldings of embryo

A
  1. cranio-caudal folding (head and tail fold)
  2. Lateral folding
59
Q

Formation of heart

A
  1. the 2 paramediam endothelial tubes of the heart lies ventral to the foregut
  2. due to folding of embryo, 2 endothelial tubes comes closer in the thoracic region
  3. they meet and fuse in the cranio-caudal direction
  4. forms a single primitive heart tube
    * cranial end (arterial end) - divides into 2 branches (first aortic arches)
    * caudal end (venous end) - divides into rt. & lf. horns
60
Q

What are the parts of primitive heart tube

A
  1. Bulbous cordis - distal 1/3: truncus arteriosus, middle 1/3: conus
  2. Primitive ventricle
  3. Primitive atrium
  4. Sinus venosus: common cardinal, vitelline, umbilical veins
61
Q

Formation of cardiac loop

A
  1. Posterior bend
  2. Upper bend
62
Q

Formation of inter atrial septum

A
  1. Septum primum appears
  2. Septum primum grows towards AV cushion. The gap between septum primum and AV cushion is foramen primum.
  3. Septum primum touches AV cushion and divides into 2. The gap between 2 parts of septum primum is foramen secundum.
  4. The septum secundum is formed to the right of septum primum.
  5. Septum secundum grows towards AV cushion but will not touch it.
  6. Blood flows from right to left through oblique passage / foramen ovale between 2 septa
63
Q

Briefly describe the foetal circulation

A
  1. 1 left umbilical vein carries oxygenated blood from placenta of mother to baby
  2. Right and left internal iliac arteries form 2 umbilical arteries which carries deoxygenated blood to placenta for oxygenation
  3. Deoxygenated blood from 2 external iliac artery goes to the inferior vena cava.
  4. 20% of blood from umbilical vein enters the liver for the growth of liver. Remaining 80% of blood will be directed to the IVC via ductus venosus.
  5. Right atrium receives blood from IVC and SVC which causes the pressure in right atrium to be high.
  6. Normally blood goes from Right atrium to right ventricle, but in fetus, majority of blood goes through foramen ovale / oblique passage and enter left atrium.
  7. Lungs are not functional, small and collapsed. Hence, resistance in lungs is very high. Blood cannot enter lungs due to high pressure. Therefore, pressure in pulmonary artery is also high.
  8. Blood flows from high pressure to low pressure. Blood flows from pulmonary artery to aorta via ductus arteriosus.
  9. Small amount of blood that went to pulmonary artery comes back to pulmonary vein but no oxygenation takes place.
64
Q

Briefly describe ductus arteriosus

A
  1. It is a duct, opens because of prostaglandin. Prostaglandin (PGE2) maintains the duct open.
  2. Cells in ductus arteriosus produces PGE2 which maintains the duct to be open. If reduction in PGE2, duct will close.

Ductus arteriosus is sensitive to 3 things
1. oxygenated blood
2. less production of PGE2
3. Bradykinin (when lungs starts first inspiration, it produces bradykinin

65
Q

What are the remants of foetal circulation after birth

A
  1. Ligamentum venosus: remnant of ductus venosus (carries 80% oxygenated blood from umbilical vein to IVC)
  2. Ligamentum teres: remnant of umbilical vein to liver (umbilical cord is cut outside but inside cannot be cut so become liggament. This causes IVC to receive less blood, pressure in atrium is low)
  3. Medial umbilical ligament: remnant of umbilical arteries (umbilical arteries from right and left internal iliac arteries. Initial part of umbilical arteries: superior vesical artery which supply urinary bladder)
  4. Fossa ovalis: remnant of foramen ovale (septum primum & septum secundum fuse together after 1 year because pressure in left atrium increases, shunting of blood, causing closure of foramen ovale like a flap.)
  5. Ligamentum arteriosum: remnant of ductus arteriosus (pulmonary artery pressure drops because lungs are nor functional and less resistance, aorta becomes high pressure, more blood pass through aorta, closes ductus arteriosum.)
66
Q

Pressure changes in foetal circulation before and after birth.

A

Before birth
1. right atrium: high pressure
2. left atrium: low pressure
3. aorta: low pressure
4. pulmonary artery: high pressure

After birth
1. right atrium: low pressure
2. left atrium: high pressure
3. aorta: high pressure
4. pulmonary artery: low pressure

67
Q

Features of pink baby

A
  1. Acyanotic
  2. Left to right shunt
  3. Pulmonary hypertension (more blood flows into the lungs)
  4. Right ventricle enlargement, RV failure
  5. Present with Congestive heart failure, respiratory distress
68
Q

What are the abnormal connections of blood vessels

A
  1. Tranposition of the Great arteries (TGA)
  2. Truncus arteriosus (TA)
69
Q

Features of cyanotic congenital heart defects

A
  1. Blue baby (bluish discolouration of skin)
  2. Right to left shunt causes hypoxia and central cyanosis
  3. venous blood is shunted from the right to the left side of heart without passing through the lungs to be oxygenated
  4. unoxygenated blood circulates in arteries - cyanosis
70
Q

Acyanotic vs Cyanotic

A

Acyanotic
1. left to right shunt
2. oxygenated blood mixes with venous return
3. impediment to systemic perfusion

Cyanotic
1. right to left shunt
2. venous blood mixes with systemic flow, as well as less blood going to the lungs for oxygenation
3. impediment to pulmonary perfusion

71
Q

What are the Acyanotic diseases

A
  1. Atrial septal defect
  2. Ventricular septal defect
  3. Atrioventricular canal defect
  4. Patent ductus arteriosus
72
Q

What are the cyanotic defects

A
  1. Tetralogy of Fallot (FOT)
  2. Tricuspid atresia
  3. Pulmonary valve atresia
  4. Transposition of Great vessels (TGA)
  5. Truncus arteriosus

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