ANATOMY Flashcards
where is the heart contained?
middle mediastinum
what is the hilum?
root of the lung
what is contained within the hilum?
pulmonary artery
main bronchus
pulmonary veins
pulmonary lymphatic vessels and bronchopulmonary lymph nodes
pulmonary visceral afferents and autonomic motor nerves
where do the phrenic nerves travel?
descend across the lateral borders of the pericardium
what is haemopericardium?
when the pericardial cavity fills with blood
what is the consequence of haemopericardium?
pressure around the heart can prevent cardiac contraction - cardiac tamponade
what is pericardiocentesis?
drainage of fluid from the pericardial cavity
how is pericardiocentesis performed?
needle inserted via infrasternal angle and directed superoposteriorly, aspirating continuously
what is the transverse pericardial sinus?
a space within the pericardial cavity
where is the transverse pericardial sinus?
lies posteriorly to the ascending aorta and pulmonary trunk
name the surfaces of the heart
anterior (sternocostal) surface
base (posterior) surface
inferior (diaphragmatic) surface
name the borders of the heart
right border
left border
inferior border
superior border
where can the apex of the heart be palpated?
5th left intercostal space in the midclavicular line (mitral area)
where does cardiomegaly shift the apex beat to?
normally to the left
where are the coronary arteries contained?
just deep to the epicardium, usually embedded in adipose tissue
where do the coronary arteries arise from?
the ascending aorta
where is the right coronary artery?
in the right atrioventricular groove
what does the RCA branch into?
right marginal artery
posterior interventricular artery
where is the left (main stem) coronary artery?
in the left atrioventricular groove between pulmonary trunk and the left auricle
name the branches of the LCA
circumflex artery
left anterior descending
left marginal artery
lateral (diagonal) branch
what is the coronary sinus?
a short venous conduit which received deoxygenated blood from most of the cardiac veins and drains into the right atrium
where is the coronary sinus?
in the atrioventricular groove posteriorly
what divides the heart into right and left sides?
septum (interatrial and interventricular)
what are septal defects?
holes in the septum which can allow mixing of arterial ad venous blood
how does the heart allow unidirectional flow?
the cardiac valves
tricuspid valve
between right atrium and right ventricle
pulmonary valve
between right ventricle and pulmonary trunk
mitral (bicuspid) valve
between left atrium and left ventricle
aortic valve
between left ventricle and the aorta
tricuspid valve features
anterior, posterior and septal cusps
mitral valve features
papillary muscles
tendinous cords
valve leaflets
aortic valve features
right, left and posterior cusps and sinuses
pulmonary valve
anterior right and left cusps
where is the aortic valve auscultated?
2nd right ICS sternal edge
where is the pulmonary valve auscultated?
2nd left ICS sternal edge
where is the tricuspid valve auscultated?
4th left ICS sternal edge (lower left sternal edge)
where is themitral valve auscultated?
5th left ICS midclavicular line
summarise blood flow from chamber to chamber
Diastole: blood returns via vena cave to RA and pulmonary veins to LA
Tricuspid & mitral valves open so blood drains into RV & LV
Impulse originates at SA node and spreads across atria
Atrial contraction completes ventricular filling
Impulse spreads across ventricles
Ventricles begin to contract – once pressure in ventricles > pressure in atria tricuspid & mitral valves snap shut
Ventricles continue to contract – once pressure in ventricles > pressure in PT & aorta pulmonary and aortic valves forced open and blood ejected into great arteries
Ventricles begin to relax – once pressure in ventricles < pressure in great arteries blood starts to fall back towards ventricles causing pulmonary & aortic valves to snap shut
where do presynaptic sympathetic fibres exit the spinal cord?
in one of the T1-L2/3 spinal nerves (thoracolumbar)
what contains the sympathetic nerves to the heart and lungs?
cardiopulmonary splanchnic nerves
what is contained within the cardiac plexus?
sympathetic fibres
parasympathetic fibres
visceral afferent fibres
which cranial nerves contain parasympathetic ganglia?
CN III, VII, IX, X
which cranial nerve is the presynaptic parasympathetic fibre for the heart and lungs?
CN X (vagus nerve)
which nerves are the parasympathetic supply to the lower abdomen, pelvis and perineum?
sacral spinal nerves
describe somatic pain
sharp
stabbing
well localised
sources of somatic pain
muscular joint bony intervertebral disc fibrous pericardial nerve
describe visceral (organ) pain
dull
aching
nauseating
poorly localised
where does radiating pain from the chest go?
upper limbs
back
neck
sources of visceral chest pain
heart and great vessels
trachea
oesophagus
abdominal viscerae
describe referred pain
pain only felt at site remote from area of tissue damage in the chest
where does referred pain from the chest go?
upper limbs
back
neck
describe radiating pain
pain felt in the centre of the chest and felt spreading from there
postcentral gyrus of parietal lobe
somatosensory
Aps arriving here bring body wall sensations into consciousness
precentral gyrus of frontal lobe
somatomotor
aps originating here bring about contractions of body wall skeletal muscle
what is the normal pattern of arterial supply of the heart?
right dominant
name the sites of coronary atherosclerosis in order of most commonly seen to least commonly seen
- LAD of LCA
- RCA
- circumflex branch
- LCA (main stem)
where are grafts anastomosed in CABG?
proximally to the ascending aorta to coronary artery distal to the narrowing hence the narrowing is bypassed
what are commonly used grafts?
radial artery
internal thoracic (mammary artery)
great saphenous vein
which artery is used by pedicle and what does this mean?
internal thoracic artery meaning that the distal end of the vessel is anastomosed distal to the narrowing
where does the SA node usually receive blood from?
RCA
where does the AV node usually receive blood from?
posterior interventricular artery
where does the interventricular septum (containing the conducting branches) receive blood from?
LAD
posterior interventricular artery
what is the thoracic inlet bounded by?
ribs 1, T1 vertebra and jugular notch
where is the transverse thoracic plane?
between sternal angle and T4/T5 intervertebral discs
what is in the anterior mediastinum?
thymus
what is in the middle mediastinum?
pericardium
heart
parts of the great vessels
what is in the posterior mediastinum?
azygous vein sympathetic trunks thoracic duct oesophagus thoracic aorta trachea and 2 main bronchi vagus nerves
where does the right lymphatic duct drain lymph into?
right venous angle
top right 1/3 of the body
where does the left lymphatic duct drain lymph into?
left venous angles
rest of the body
what are the central veins?
the large veins close enough to the heart such that the pressure within them is said to approx reflect the pressure within the right atrium
name the central veins
internal jugular veins subclavian veins brachiocephalic veins superior vena cava inferior vena cava iliac veins femoral veins
which of the laryngeal nerves does not enter the chest?
right recurrent laryngeal nerve
where does referred pain from the diaphragm go?
shoulder
neck pulse
bifurcation of the common carotid artery
upper limb pulses
brachial artery
radial artery
lower limb pulses
femoral artery
popliteal artery
posterior tibial artery
dorsalis pedis artery
