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My Cardiovascular > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Where is the middle mediastinum?

A

the central area that contains the heart in the pericardium

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2
Q

What is the pericardium?

A

the grey tissue over the heart, it is a tough fibrous sac

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3
Q

What are the layer of the pericardium?

A
  • grey outermost layer is the fibrous pericardium
  • serous pericardium which has two parts which are differentiated by what side it is in contact with
  • if it is in contact with the fibrous part then it is the parietal serous pericardium
  • if it is in contact with the heart side it is the visceral pericardium
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4
Q

What is the epicardium another name for?

A

visceral serous pericardium

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5
Q

What is a haemopericardium and when does it become a cardiac tamponade?

A

haemopericardium is when there is blood in the pericardial space and if there is a lot of blood and the heart becomes crushed then this is cardiac tamponade

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6
Q

What is a pericardiocentesis and how is it performed?

A

A pericardiocentesis is moving a needle into the cavity to remove any excess blood or fluid

A needle is inserted via the infrasternal angle which is then moved superiorly and posteriorly while you are continuously aspirating so the fluid will be removed

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7
Q

Where is the transverse pericardial sinus and what is it used for?

A

the transverse pericardial sinus is a space within the cavity behind the ascending aorta and the pulmonary trunk that a surgeon puts his finger in to locate the great vessels and put the patient on bypass

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8
Q

What is another name for the anterior surface of the heart?

A

sternocostal surface

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9
Q

What is another name for the posterior surface of the heart?

A

base surface

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10
Q

What is another name for the inferior surface of the heart?

A

diaphragmatic surface

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11
Q

What are the borders of the heart?

A
  • right lateral
  • left lateral
  • inferior border
  • superior border
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12
Q

Where does the phrenic nerve Iie?

A

anterior to the root of the lung

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13
Q

Where does the vagus nerve lie?

A

posterior to the root of the lung

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14
Q

Where does the internal jugular been bring blood from?

A

head and neck

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15
Q

Where does the subclavian vein bring blood from?

A

upper limb

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16
Q

What vein in made when the internal jugular join with the subclavian?

A

brachiocephalic vein

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17
Q

What forms when the right and left brachiocephalic veins join?

A

superior vena cava

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18
Q

What does the pulmonary trunk split into?

A

right and left pulmonary arteries

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19
Q

What are then three parts of the aorta?

A

ascending, descending and arch

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20
Q

What does the brachiocephalic trunk of the aorta spilt into?

A

common carotid artery and the right subclavian

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21
Q

Where does the brachiocephalic trunk of the aorta take blood to?

A

the heart and upper limb

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22
Q

What is the purpose of the auricles?

A

to increase the surface-area of the atria

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23
Q

What does the right coronary groove mark?

A

the separation between the atria and the ventricles

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24
Q

What does the anterior inter ventricular groove mark?

A

the separation between the right and left ventricles

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25
Q

What artery is contained in the anterior interventricular groove?

A

the anterior inter ventricular artery

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26
Q

What separates the base and the inferior surface of the heart?

A

the coronary sinus

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27
Q

What does the coronary sinus do?

A

it is the big venous drain for the heart muscle

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28
Q

What does the azygous vein do?

A

drains the blood from the intercostal veins back to the heart

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29
Q

What is the first branch off the aorta?

A

the coronary arteries (before brachiocephalic trunk)

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30
Q

What does the right coronary artery branch into?

A

the right marginal artery which runs down the side and the posterior interventricular artery that moves around the back

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31
Q

What are the branches off the left coronary artery?

A

the left anterior descending which branches into the lateral diagonal branch
the circumflex artery (anastomoses with the posterior interventricular artery)
the left marginal artery

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32
Q

What is the only coronary vein we need to know?

A

coronary sinus

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33
Q

Where does the coronary sinus drain to?

A

the right atrium

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34
Q

What are the two type of holes in the heart?

A

an atrial septal defect or a ventricular septal defect

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35
Q

What does a hole in the heart result in?

A

hypoxaemia

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36
Q

What are the three openings in the right atrium?

A

IVC and SVC and the opening of the coronary sinus

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37
Q

What feature is on the wall of the atria?

A

oval fossa

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38
Q

What does the crista terminalis divide?

A

smooth from the rough

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39
Q

What cusps is the tricuspid valve made up of?

A

anterior, posterior and septal cusps

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40
Q

What are the names of the mitral cusps?

A

anterior and posterior

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41
Q

What design are the atrioventricular valves and what design are the pulmonary/aortic valves?

A

leaflet for tri and mit

semilunar for aortic and pulmonary

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42
Q

What are the cords from the leafs in the a-v valves and what are they attached to?

A

tendinous cords that join to the papillary muscles

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43
Q

What is the purpose of the tendinous cords and the papillary muscles on the a-v valves?

A

to prevent prolapse of the valves

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44
Q

What do the moderator bands on the valves do?

A

ensure that the cusps of the tricuspid valve all close at the same time

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45
Q

What is the Lub from?

A

closure of the mitral and the tricuspid

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46
Q

What is the Dub from?

A

the closure of the aortic and pulmonary

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47
Q

Where do pain fibres travel to?

A

the spinal cord alongside sympathetic nerves

48
Q

Where do reflex afferents mainly travel to?

A

vagus nerve

49
Q

What is the anatomy of the sympathetic chain and the neurotransmitters involved?

A

CNS→ preganglionic fibre→ sympathetic chain ganglion→ postsynaptic fibres→ organ

ACh is the neurotransmitter in the synapse between the axon of the presynaptic neuron and the cell body of the postsynaptic neuron then noradrenaline between the postsynaptic fibre and the organ

50
Q

Where do presynaptic sympathetic fibres travel and where do they exit?

A

Presynaptic sympathetic fibres form the brain travel inferiorly within spinal cord tracts and then exit in one of the T1-L2 nerves (thoracolumbar outflow)

51
Q

Where do the postsynaptic sympathetic fibres go?

A

get to organs by the cardiopulmonary splanchnic nerves

52
Q

What are the cardiopulmonary splanchnic nerves?

A

part of the nerve structure carrying post-synaptic fibres towards heart

53
Q

What is the cardiac plexus?

A

a network of nerves with the sympathetic fibres, the parasympathetic fibres and visceral afferents

54
Q

What delivers the parasympathetic fibres to the cardiac plexus?

A

vagus nerve

55
Q

What is the route for the parasympathetic fibres from CNS to organ?

A

CNS→ presynaptic fibre→ parasympathetic ganglion synapse→ postsynaptic→ organ

56
Q

What are the neurotransmitters for the parasympathetic fibres?

A

ACh for both

57
Q

What nerves get the parasympathetic fibres to the organs?

A

CN 3,7,9 and 10

58
Q

Which of abdominopelvic and pelvic splanchnic is sympathetic and which is parasympathetic?

A

Abdominopelvic is sympathetic

Pelvic splanchnic nerves are parasympathetic

59
Q

Where is somatic pain from and what does it feel like?

A

Somatic pain is from muscle, joint, bone, intervertebral etc and feels sharp, stabbing and localised

60
Q

Where is visceral pain from and what does it feel like?

A

Visceral pain is from heart, trachea etc and feels dull, aching, nauseating and poorly localised

61
Q

What is the precentral gyrus and what does it do?

A

is the somatomotor gyrus which is where APs originate that bring about contractions of body wall skeletal muscle

62
Q

What is the postcentral gyrus and what does it do?

A

is the somatosensory gyrus and APs that arrive here bring the body wall sensations into consciousness

63
Q

What is the role of the sensory homunculus?

A

sensory homunculus is the different areas of the cerebral neocortex where sensations from different body wall structure reach consciousness

64
Q

What are examples of conditions that would give rise to central chest pain?

A
  • Shingles: reactivation of dormant chicken pox, pain within T4/5 and blistering on the body wall
  • Muscle, joint and bone: pectoralis muscle strain, joint inflammation, slipped disc
  • Parietal pleura and fibrous pericardium: pleurisy and pericarditis
65
Q

What are the parts of the mediastinum?

A
  • superior

- inferior (anterior, middle and posterior)

66
Q

Where do visceral afferent action potentials move to?

A

pass bilaterally to thalamus and hypothalamus then diffuse areas of the cortex

67
Q

What is radiating pain?

A

radiating pain is felt at the site and moves to a peripheral area

68
Q

Where does somatic radiating pain move to?

A

if is originating in a somatic structure the radiation is along the affected dermatome

69
Q

Where does radiating pain from the heart move to?

A

the radiation is to the dermatomes supplied by the spinal cord levels at which the cardiac visceral afferent enter the sympathetic chain so bilaterally to cervical and upper thoracic dermatomes

70
Q

What is referred pain and what is it due to?

A

Referred pain is only felt at a site remote from the area of tissue damage
It is due to afferent sensory fibres from soma and from viscera entering the spinal cord at the same level so the brain thinks the pain is from the soma

71
Q

What is an MI?

A

MI is irreversible death of the myocardium due to occlusion of its arterial blood supply

72
Q

What are the different type of dominance in relation to the arteries?

A

there is a right dominant artery in around 70% of patients, some have left-dominance and even less have codominance

73
Q

What are the most common places for a coronary artery occlusion in descending order?

A

LAD of left coronary artery
Right coronary artery
Circumflex branch of left coronary artery
Left main stem coronary artery

74
Q

What is a coronary artery bypass graft?

A

coronary artery bypass grafting is when there is a blockage identified and a graft from somewhere else in the body
eg great saphenous vein in the leg, radial artery, internal thoracic artery by pedicle is taken and replaces the old one

75
Q

Where are the SA and AV nodal branches?

A

from the right coronary artery

76
Q

Where is the blood supply to the septum from?

A

the left anterior descending

77
Q

Where is the mediastinum?

A

the area between the lungs

78
Q

Where exactly is the superior mediastinum?

A

above the line between the sternal angle and the T4 vertebrae all the way up to the thoracic inlet
(contains aortic arch)

79
Q

What is the inferior border of the mediastinum?

A

the diaphragm

80
Q

Where is the anterior mediastinum?

A

between the sternum and the line of the fibrous pericardium

81
Q

What is the anterior mediastinum filled with in adults and children?

A

in adults = fat

in children prior to puberty = the thymus gland that produces T lymphocytes

82
Q

What does the middle mediastinum contain?

A

heart and the first parts of the great vessels
pericardial sac
just the ascending aorta not the arch

83
Q

What does the posterior mediastinum contain?

A

trachea, primary bronchi, oesophagus, vagus nerve, azygous vein and sympathetic chain

84
Q

Where does the right vagus nerve travel?

A

along the surface of the trachea and becomes a plexus with the left nerve extending the full length of the oesophagus

85
Q

Where does the left vagus nerve travel?

A

along arch of aorta then becomes a plexus with the right nerve extending the full length of the oesophagus

86
Q

What happens to the plexus made up of the right and left vagal nerves as it descends?

A

spilts into right and left vagal trunk that passes through the diaphragm

87
Q

Where do the intercostal veins drain into?

A

the azygous vein

88
Q

What are the benches coming off the aorta?

A

coronary arteries which come off the ascending aorta, then the brachiocephalic trunk, the left common carotid and the left subclavian artery

89
Q

What are the midline branches that come off the descending aorta?

A

bronchial, oesophageal, mediastinal, pericardial and phrenic

90
Q

What is the aortic hiatus?

A

the hole in the diaphragm where the descending aorta moves through

91
Q

Where does the right lymphatic duct drain to?

A

the right venous angle

92
Q

What drains into the right lymphatic duct?

A

the right arm and then half the body up from around the umbilicus

93
Q

Where does the thoracic duct drain?

A

the rest of the body (excluding the right arm and then half the body up from around the umbilicus)

94
Q

What are the two main types of lymph nodes in the lungs?

A

bronchopulmonary and tracheobronchial

95
Q

Where does the thoracic duct lie?

A

between the oesophagus and the azygous nerve

96
Q

Where does the vagus and phrenic nerves run in relation to the root of the lung?

A

vagus goes posterior to the root of the lung

phrenic goes anterior to the root of the lung

97
Q

Where is the recurrent laryngeal branches on the left and on the right?

A

right is root of the neck

left is in the chest

98
Q

What fibres remain in the vagus nerve after the recurrent laryngeal branch is given off?

A

parasympathetic nerve fibres

99
Q

What does the vagus nerve contain?

A

somatic sensory for the palate, laryngopharynx and larynx
somatic motor for the pharynx and the larynx
autonomic parasympathetic nerves for thoracic and abdominal organs

100
Q

What is in the superior mediastinum from anterior to posterior?

A 
Brachiocephalic veins and SVC
Arch of aorta
Trachea
Oesophagus
Thoracic duct
101
Q

What is in the superior mediastinum from lateral to medial?

A

Phrenic nerve
Vagus nerve
Recurrent laryngeal nerve

102
Q

What are the central veins?

A

internal jugular, subclavian, brachiocephalic, superior vena cava, right atrium, inferior vena cava, iliac and femoral veins

103
Q

What does the phrenic nerve contain?

A

somatic motor to the diaphragm
somatic sensory to the mediastinal parietal pleura, fibrous pericardium, diaphragmatic parietal pleura and diaphragmatic parietal peritoneum
contains sympathetic fibres that supply arterioles in all the structures innervated by the phrenic nerve

104
Q

Why does diaphragmatic pathology present as shoulder tip pain?

A

If an abscess irritates the parietal peritoneum lining the surface of the diaphragm, the phrenic nerves (C3,4,5) are affected
C3,4 supply the dermatomes over the shoulder tip and water the spinal cord at the same level as the phrenic nerve
the brain refers the pain to the more superficial structure which is the skin over the shoulder tip

105
Q

Where does the right recurrent laryngeal nerve run?

A

hooks under the right subclavian artery but does not enter the chest

106
Q

Where does the left recurrent laryngeal nerve run?

A

hooks under the arch of the aorta and does enter the chest

107
Q

What do the recurrent laryngeal nerves supply?

A

larynx and the laryngopharynx

108
Q

What causes the double pulsation in the JVP?

A

atrial contraction then filling of the right atrium against a closed tricuspid valve causes a double pulsation

109
Q

What are all the common pulses?

A

Neck-bifurcation of the common carotid artery
Upper limb- brachial artery, radial artery
Lower limb- femoral, popliteal, posterior tibial artery and dorsalis pedis artery

110
Q

What is the radial artery used for?

A

cannulation for arterial blood pressure monitor or ABG sampling

111
Q

What is the femoral artery used for?

A

intravascular interventions

112
Q

What is the subclavian artery used for?

A

insertion of cardiac pacing wire under ultrasound guidance

113
Q

What is the IJV used for?

A

insertion of central line with ultrasound

114
Q

What is the femoral vein used for?

A

insert central line

115
Q

What layer is most closely associated to the route of the phrenic nerve through the chest?

A

the fibrous pericardium

116
Q

What are the landmarks in the right atrium?

A

fossa ovalis (formaten in unborn child) and the crista terminalis (ridge)

117
Q

What are the three branches off the aortic arch?

A

brachiocephalic trunk, left common carotid and left subclavian

My Cardiovascular (13 decks)

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