Anatomy Flashcards
What are the major features of the hilum?
Pulmonary arteries and veins and the main bronchi
What are the minor features of the hilum?
Pulmonary lymphatic vessels, bronchopulmonary lymph nodes, pulmonary visceral afferents and autonomic motor nerves
Where do the phrenic nerves run in relation to the lung?
Anterior
Where does the vagus nerve run in relation to the lung?
Posterior
Where do the phrenic nerves run in relation to the pericardium?
Lateral
What is the fibrous pericardium lined internally by?
Parietal serous pericardium
What is another name for the visceral serous pericardium which covers the anterior surface of the heart?
Epicardium
What secretes pericardial fluid?
Visceral serous pericardium/epicardium
Where is the pericardial cavity?
Between the visceral and parietal serous pericardium
What is a haemopericardium and what can this cause?
Pericardial cavity fills with blood, causing pressure to rise and contractions be prevented= cardiac tamponade
Where is the needle inserted for a pericardiocentesis?
Via the subcostal angle and ascending superoposteriorly
What is the transverse pericardial sinus?
A space within the pericardial cavity posterosuperiorly
Where does the transverse pericardial sinus lie posterior to?
Ascending aorta and pulmonary trunk
What comprises the base (posterior) surface of the heart?
Left atrium
What does the inferior surface of the heart sit on top of?
Diaphragm
Where is the apex beat usually felt, what will happen to it if cardiomegaly is present?
Usually 5th intercostal space mid-clavicular line- cardiomegaly will shift it left
The heart is in the ? mediastinum?
Middle
The lateral nerve seen on the heart is the ? and the medial nerve is the ?
Lateral- phrenic
Medial- vagus
The internal jugular vein and subclavian vein join to make the ? and the left and right of these join to make the ?
Brachiocephalic veins
SVC
What does the aortic arch give off?
Brachiocephalic trunk, left common carotid artery and left subclavian artery
What does the brachiocephalic trunk give off?
Right subclavian artery and right common carotid artery
Which coronary artery is found in the coronary/atrio-ventricular groove?
Right coronary artery
The right atrio-ventricular groove is the surface marking for what?
Tricuspid valve
The LAD artery is a branch of the ? and is found in the ? groove
Left coronary artery
Anterior interventricular groove
The LAD artery is also known as what?
Anterior interventricular artery
The coronary sinus is what type of vessel?
Vein
Where is the coronary sinus found?
Atrioventricular groove posteriorly
The coronary sinus drains blood from the cardiac veins into where?
Right atrium
What are the first branches of the aorta?
Left and right coronary arteries
What does the right coronary artery give off?
Right marginal artery and posterior interventricular artery
What does the left coronary artery give off?
LAD artery and left circumflex artery and left marginal artery
The lateral/diagonal is a coronary artery branched from where?
The LAD artery
What coronary vessels anastomose?
Left circumflex artery and braches of the right coronary artery
What can a septal defect lead to?
- Mixed oxygenated and deoxygenated blood
- reduces oxygen content of arterial blood
- causes hypoxaemia
What are the part between the atria and auricle?
Crista terminalis
Which two valves have a semilunar design?
Aortic and pulmonary
Which two valves have a leaflet design?
Mitral and tricuspid
What are cardiac muscles attached to the chamber walls?
Papillary muscles
What connects the papillary muscles to the valves?
Chordae tendinae
What does the modurator band do?
Carries fibres of the right bundle branch to the papillary muscle
Which valve has anterior, posterior and septal cusps?
Tricuspid
Which valve has posterior and anterior cusps?
Mitral
The remains of what embryological structure may be present in the interior of the left atrium?
Foramen ovale
What nerves reach the heart via the cardiac plexus?
Sympathetic and parasympathetic nerves and visceral afferents (i.e. autonomic innervation)
Where do visceral reflex afferents to the heart travel within?
Vagus nerve
Where does the sympathetic chain lie?
Posterior mediastinum
What does a presynaptic sympathetic fibre do?
Connects signal between CNS and ganglion (synapse)
What does a ganglion do?
Allows the synapse between the axon of the presynaptic neuron and the body of the postsynaptic neurone
What is the general name for the chemical signal that allows a synapse?
Neurotransmitters
What is the specific pre-synaptic neurotransmitter in sympathetic fibres?
Acetylcholine
What is the specific post-synaptic neurotransmitter in sympathetic fibres?
Noradrenaline
What does a postsynaptic fibre do?
Connects between the ganglion (synapse) and organ
Where do sympathetic nerves leave the spinal cord?
T1-L2
When sympathetic nerves leave the spinal cord what can they do?
Synapse at that level, or travel inferiorly or superiorly in the sympathetic chain to synapse at another level
What are the post-ganglionic sympathetic nerves to the heart and lungs known as?
Cardiopulmonary splanchnic nerves (T1-T5 ganglia)
Sympathetic ganglia which don’t from the cardiopulmonary splanchnic nerves will instead form what?
Abdominopelvic splanchnic nerves
Where are cardiopulmonary splanchnic nerves found?
Deep to the heart, superficial to the trachea
What is the specific pre-synaptic neurotransmitter in parasympathetic fibres?
Acetylcholine
What is the specific post-synaptic neurotransmitter in parasympathetic fibres?
Acetylcholine
What 4 cranial nerves does parasympathetic innervation travel in? Which is involved in innervation of the heart?
III, VII, IX, X
Vagus to heart
What is vagal tone?
Continuous outflow of APs from the vagus nerve to slow the heart rate
When does pain sensation reach consciousness?
Cerebral cortex
Where are body wall sensations brought into consciousness after APs arriving in visceral afferents?
Postcentral gyrus of parietal lobe
Where are APs originated to bring about contractions of skeletal muscle in the body wall?
Precentral gyrus of frontal lobe
Which side of the mediastinum is known as the venous side and which is the arterial side?
Left- arterial side
Right- venous side
What is the ligamentum arteriosum?
Remnants of the ductus arteriosus connecting the pulmonary trunk to the aortic arch
What is the only part of the aorta which will be in the posterior mediastinum?
Thoracic (descending)
Where do visceral (pain) afferents enter once they reach the spinal cord?
Posterior rootlets
Somatic pain radiates where?
Along the affected dermatome
Visceral pain radiates where?
Along the dermatome supplied by the spinal nerve where the visceral afferent enters the spinal cord
Where is cardiac pain referred to?
Upper limbs, back, neck or jaw
What vessels are used for a CABG?
Great saphenous vein, radial artery, internal thoracic (mammary) artery
A branch of what coronary artery usually supplies the SA and AV nodes?
Branch of right coronary
What can it result in if the coronary branch to the SA and AV nodes are damaged by ischaemia?
Arrhythmias
Ischaemia of the AV node and bundle branches lead to what?
Complete heart block
Bundle branch block
What is the thoracic inlet bound by?
Rib 1, T1 and jugular notch
What is found between the sternal angle and the T4/5 intervertebral discs?
Transverse thoracic plane
Where is the anterior mediastinum?
Between the sternum and fibrous pericardium
What is found in the anterior pericardium?
Thymus gland in childhood, this is replaced by adipose tissue after puberty
What is found in the middle mediastinum?
Pericardium, heart and parts of great vessels which connect to the heart
What parts of great vessels are found in the middle mediastinum?
Inferior part of SVC, superior part of IVC, pulmonary arteries/veins/trunk and ascending aorta
Where does the thoracic duct carry lymph to?
Left venous angle
What are the 7 things in the posterior mediastinum?
Azygous vein, sympathetic chains, thoracic duct, vagus nerves/vagal trunks, main bronchi, thoracic aorta, oesophagus
Where does the trachea bifurcate and what part of the mediastinum is it in?
Sternal angle- superior mediastinum
Vagal trunks pass through the diaphragm with the ? onto the ?
With oesophagus, onto stomach
What does the vagal plexus arise from?
Right and left vagus nerves combining behind the heart
Where is the thoracic duct found?
Between the azygous vein and oesophagus
What vessel can be ruptured during chest trauma?
Azygous vein
Where is the azygous vein in relation to the lung root?
Superior
What drains posteriorly into the azygous vein?
Intercostal veins
What are the first branches of the aorta?
Coronary arteries
What branch bilaterally from the thoracic aorta and what do these supply?
Posterior intercostal arteries to supply intercostal spaces
What are the 5 branches of the anterior surface of the thoracic aorta?
Bronchial, oesophageal, mediastinal, pericardial, phrenic
What do bronchial arteries supply?
Lung tissue
What do mediastinal arteries supply?
Lymph nodes
Right lymphatic duct drains lymph where?
Right venous angle
Where is the left venous angle?
Between the subclavian and internal jugular vein
Where does lymph from the lungs drain to first?
Broncho-pulmonary lymph nodes
Where are broncho-pulmonary lymph nodes found?
Surrounding main bronchus at the lung root
Where does lymph from the lungs drain to secondly?
Tracheo-bronchial lymph nodes
Where are the tracheo-bronchial lymph nodes?
Around the bifurcation of the trachea
What is the surface anatomy of the left venous angle?
Sternoclavicular joint
What is the cisterna chyli?
The swollen part of the thoracic duct in the abdomen
What does the right phrenic nerve pass through the diaphragm with?
IVC
Where is the vagus nerve in relation to the trachea?
Lateral aspect
Left vagus nerve crosses the ? and then gives off the ? which hooks underneath ?
Left vagus nerve crosses the aorta (anteriorly) and then gives off the recurrent laryngeal branch which hooks underneath ligamentum arteriosum and aortic arch
What 5 things are found in the superior mediastinum from anterior to posterior?
Brachiocephalic veins and SVC, arch of aorta, trachea, oesophagus, thoracic duct
What are the 3 things found in the superior mediastinum from lateral to medial?
Phrenic nerves, vagus nerves, recurrent laryngeal nerves
What are central veins?
Veins which are close enough to the heart to reflect the pressure in the right atrium
There are many central veins, what are the main 2?
Internal jugular vein, femoral veins
At 45 degrees the JVP should be no more than ?cm superior to the sternal angle?
3cm
Where does the right recurrent laryngeal nerve hook under? Does it enter the chest?
Under the subclavian artery
Does not enter the chest
Where does the left recurrent laryngeal nerve hook under? Does it enter the check?
Under the aortic arch
Does enter the chest
What is the phrenic nerve formed from?
Anterior rami of C3, 4, 5
Where does the phrenic nerve supply somatic sensory sensation to?
Diaphragmatic parietal peritoneum and pleura, mediastinal parietal pleura and fibrous pericardium
What can cause referred pain from the diaphragm?
Liver abscess or inflammation of the gallbladder
What are C3 and 4 known as? What do they supply?
Supraclavicular nerves, supply shoulder tip
What should you always think of if a patient presents with shoulder tip pain?
Something affecting the sensory territory of the phrenic nerve
What does the vagus nerve contain?
Somatic sensory and motor nerves and autonomic parasympathetic nerves
The recurrent laryngeal nerve contains somatic sensory and motor supply to where?
Sensory- palate, laryngopharynx, larynx
Motor- pharynx and larynx
What does the vagus nerve contain once it has branched to form the recurrent laryngeal nerve?
Parasympathetic nerves for thoracic and abdominal organs
