Anatomy Flashcards by Jasdyl Singh

How is the location of the phrenic nerve different to the vagus nerve near the heart

The phrenic nerve is anterior to the lung hilum while the vagus nerve is posterior to the lung hilum

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Layers of the pericardium from outside to inside (5)

Fibrous pericardium - For protection
Parietal Serous pericardium 
Pericardial cavity 
Visceral Serous pericardium 
Epicardium - Secretes fluid lubricant and makes anterior surface of heart

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Cardiac tamponade

When the pericardial cavity fills with blood (haemopericardium) causing the pressure to increase and prevent cardiac contraction

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Pericardiocentasis (2)

Drainage of fluid from the pericardial cavity

Done via needle inserted at infrasternal angle and directed superoposteriorly, aspirating continuously

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Heart surfaces (3)

Anterior (sternocostal) surface
Base (posterior) surface
Inferior (diaphragmatic) surface

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Heart borders (4)

Right (lateral) border
Left (lateral) border
Inferior border
Superior border

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Location to palpate apex beat of the heart and indication (2)

Left 5th intercostal space in the midclavicular line

Cardiac enlargement often moves beat to the left

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Which structure separates the base border from the diaphragmatic border

The coronary sinus in the atrioventricular groove posteriorly

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Coronary arteries function and implication

Arterial blood supply to epicardium and myocardium

Blockage results in myocardial infarction

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Where do the coronary arteries arise from

Ascending aorta

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What is the coronary sinus

A short venous conduit which receives deoxygenated blood from most of the cardiac veins and drains into the right atrium

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Septum and its parts (3)

Divides the heart into right and left
Interatrial septum - Part of septum between the 2 atria
Interventricular septum - Part of the septum between the 2 ventricles

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Septal defect types and implications (3)

Atrial septal defect - Hole in the interatrial septum
ventricular septal defect - Hole in the interventricular septum
Allows mixing of arterial and venous blood in the heart causing hypoxaemia due to a decrease in oxygen content of systemic arterial blood in the aorta

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Role of papillary muscles and tendinous cords

Prevents prolapse of the tricuspid and mitral valves during ventricular contraction

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Function of moderator band (septomarginal trabecula)

Carries fibres of right bundle branch to the 3 papillary muscles of the anterior cusp to ensure uniform contraction

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Presynaptic sympathetic fibres from the brain (2)

Travel inferiorly within spinal cord tracts

Then exit the spinal cord in one of T1-L2/3 spinal nerves (thoracolumbar)

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Fates presynaptic sympathetic fibres (5)

Go into the ganglion of that level and synapse
Travel superiorly in the sympathetic chain to another ganglion and synapse
Travel inferiorly in the sympathetic chain to another ganglion and synapse
Pass straight through the sympathetic chain ganglion without synapsing, as abdominopelvic splanchnic nerves ,to synapse in one of the prevertebral ganglia of the abdomen
Pass straight to the adrenal medulla without synapsing as an abdominopelvic splanchnic nerve

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How do postsynaptic sympathetic fibres reach the heart and lungs(2)

By cardiopulmonary splanchnic nerves

In a midline organ there will be bilateral sympathetic innervation

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Cardiopulmonary splanchnic nerves location

Postsynaptic fibres from cervical and upper thoracic sympathetic chains

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The cardiac plexus contains (3)

Sympathetic fibres
Parasympathetic fibres
Visceral afferent fibres

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Where are the parasympathetic ganglion synapse located

On the surface of organs

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Vagus nerve function in the heart

Supplies presynaptic parasympathetic fibres onto postsynaptic neurones on the surface of the heart

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Somatic chest pain origins and description

Muscular, joint, bony, nerve, pericardial, intervertebral disc
Nature is sharp, stabbing and well localized

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Visceral chest pain origins and description

Heart, great vessels, trachea, oesophagus, abdominal viscerae (gastritis, pancreatitis, hepatitis)
Nature is dull, aching, nauseating and poorly localized

How is pain generated in chest

Skin mechanoreceptors propagates AP stimulated in anterior ramus and travels centrally to spinal cord where pain pathway crosses to brain

Precentral gyrus of frontal lobe function

APs originating here bring about contractions of somatic skeletal muscle

Postcentral gyrus of parietal lobe function

APs arriving here bring somatic sensations into “consciousness”

Sensory homunculus

Indicates pain regions of the cerebral neocortex where sensation from various body structures reaches consciousness

Vagus nerve location (2)

Posterior to hilum of the lung | Anterior to the aortic arch

How do pain signals from the heart reach the brain (2)

Cardiopulmonary splanchnic nerves contain visceral afferents | Visceral afferent APs pass bilaterally to thalamus and hypothalamus then diffuse into cortex

Radiating pain of the heart

If from the heart the radiation is to the dermatomes supplied by the spinal cord levels at which the cardiac visceral afferents enter the sympathetic chain/spinal cord - Bilaterally to cervical and upper thoracic dermatomes

Referred pain of the heart (3)

Pain is felt at site remote to place of injury This is due to to afferent (sensory) fibres from soma and from viscera (visceral afferents) entering the spinal cord at the same levels The brain believes that the pain signals coming from the organ are actually coming from the soma

Types of MI (3)

Anterior MI Inferior MI Anterolateral MI

Coronary Atherosclerosis common sites (Most to least) (4)

Anterior interventricular branch - 40 to 50% Right coronary artery - 30 to 40% Circumflex branch of LCA - 15 to 20% Left (main stem) coronary artery

Coronary Artery Bypass Grafting (CABG)

Grafts from radial artery, internal thoracic artery and great saphenous vein are anastomosed to coronary arteries proximal to ascending aorta

Blood supply to conducting system of the heart (2)

SAN branch from right coronary artery near its origin | AVN branch from right coronary artery near origin of posterior interventricular artery

Blood supply of interventricular septum (2)

Anterior interventricular artery | Posterior interventricular artery

Transverse thoracic plane located

Between sternal angle and T4/T5 intervertebral disc

Thoracic inlet location

Bounded by ribs 1, T1 vertebra and jugular notch

Anterior mediastinum features (2)

Between sternum and fibrous pericardium | In childhood it is location of thymus gland

Middle mediastinum contains (3)

Pericardium Heart Great vessels

Posterior mediastinum contains (8)

``` Vagus nerves Trachea and main bronchi Thoracic aorta Oesophagus Vagal trunks Thoracic duct Sympathetic chains Azygous vein ```

Azygous vein function

Drains venous blood of each intercoastal space to SVC

Aorta parts (4)

Ascending Arch Thoracic Abdominal/ descending

Branches of the aorta (first to last) (4)

Coronary arteries Brachiocephalic trunk Left common carotid artery Left subclavian artery

Branches from thoracic aorta anterior surface (5)

``` Bronchial Oesophageal Mediastinal Pericardial Pherenic ```

Aortic hiatus function

Opening in diaphragm for abdominal aorta

What drain drains lymph into right venous angle

Right lymphatic duct

What drains lymph into left venous angle

Thoracic duct

Cisterna Chyli

Swollen start of thoracic duct in abdomen

Left venous angle location

Between subclavian vein and internal jugular vein

Ligamentum arteriosum (2)

Remnant of ductus arteriosus | Located between laryngeal branch of left vagus nerve and phernic nerve

Superior mediastinum components (Anterior to posterior) (5)

``` Brachiocephalic veins & SVC Arch of aorta Trachea Oesophagus Thoracic duct ```

Superior mediastinum components (lateral to medial) (3)

Phrenic nerves Vagus nerves Recurrent laryngeal nerves

Central veins (7)

``` Internal jugular veins Subclavian veins Brachiocephalic veins SVC IVC Iliac veins Femoral veins ```

Right recurrent laryngeal nerve (2)

Hooks under right subclavian artery | DOES NOT enter chest

Left recurrent laryngeal nerve (2)

Hooks under aortic arch | DOES enter chest

Referred pain of diaphragm (3)

``` Lining of inferior surface is by phrenic nerve C3,4 and 5 Supraclavicular nerves (C3 and 4) supply dermatomes over shoulder tip Brain refers to pain as more superficial structures so pain indicates sensory territory of phrenic nerve ```