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CVB > Anatomy and Histology > Flashcards

Anatomy and Histology Flashcards

1
Q

What’s the difference between pericardium and pleura?

Define the two layers of the pericardium

A
  • Pericardium is not attached to the rib cage (pleura is)
  • Visceral pericardium = epicardium = serous layer covering the fat/coronary vessels
  • Parietal pericardium
    • Has two laters (unlike parietal pleura):
      • Fibrous pericardium (outer fibrous layer)
      • Inner serous layer
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2
Q

Cardiac tamponade

A

Describes the condition of when the sinus space between parietal and visceral pericardium is too large, causing compression of heart and restriction of filling with blood

  • Can be caused by effusion in pericardial sac
  • Can affect heart rhythm
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3
Q

Describes the heart’s anatomical position

A
  • Between ribs 2-6, from sternal angle to xiphoid process
  • Tocuhes right middle lobe and lingula of left upper lobe
  • Apex points anteriorly and to the left
    • RV is anterior
    • RA and LV are left and right margins (respectively)
    • LA is posterior and anchored by pulmonary veins
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4
Q

Where do you place the stethoscope to hear valvular sounds?

A
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5
Q

Describe the right atrium

A
  • Auricle (ear-like appendage)
  • Pectinate muscle and smooth posterior wall separated by crista terminalis
  • Fossa ovalis
  • Coronary sinus opening
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6
Q

Crista terminalis

A
  • Thick portion of heart muscle that contains pacemaker tissue and SA node
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7
Q

Describe the right ventricle

A
  • Conus arteriosus - smooth wall that tapers into pulmonary semilunar valve
  • Membraneous and muscular interventricular septum
  • Trabeculae carnae
  • Papillary muscles
  • Septomarginal trabeculae (Ex. Moderator Band)
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8
Q

Describe the left atrium

A
  • Similar to right atrium: Auricel, pectinate muscles
  • Usually receives two left and two right pulmonary veins
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9
Q

Describe the left ventricle

A
  • Thick walled (3x thicker than RV)
  • Aortic vestibule (conus arteriosus equivalent) tapers to aortic valve
  • Membraneous and muscular interventricular septum
  • Trabeculae carnase
  • Papillary muscles
  • Septomarginal trabeculae (Ex. moderator band)
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10
Q

AV valves

A
  • Tricuspid and Mitral (Bicuspid)
  • Papillary muscles + chordae tendinae
  • Close during S1, ventricular systole
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11
Q

Semilunar valves

A
  • Pulmonary and Aortic
  • Close during S2, ventricular diastole
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12
Q

Myocardium arrangement in ventricular walls and how does this relate to its function (contraction, pressures, and flow)?

A
  • Muscle layers arranged in spiral fashion
  • Contraction proceeds from the apex upwards, squeezing blood toward AV valves
  • Attaches to fibrous skeleton surrounding and interconnecting the heart valves providing support
  • Insulates/separates atrial and ventricular electrical activity
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13
Q

Left vs right coronary artery branches and supply

A
  • LCA
    • LAD (anterior interventricular), circumflex, and left marginal branches
    • Most of LA and LV, anterior part of RV, anterior 2/3 of IV septum, and AV bundle branches in the septum
  • RCA
    • Posterior interventricular, marginal branch, and right artrial “nodal” branch
    • Most of RA and RV, posterior part of LV, posterior 1/3 of IV septum, and SA/AV nodes (majority population)
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14
Q

Coronary sinus

A
  • Collection vein where all the coronary veins converge
  • Drains directly into the RA
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15
Q

Pathway of the Conduction System

A
  • SA node –> 2 atrial internodal pathways –> AV node –> AV bundle (of His), L+R bundle (septal) branches –> Purkinje fibers up ventricular walls
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16
Q

Specify neurons that innervate the heart

A
  • Sympathetic
    • Stellate ganglion
    • Cardiopulm splanchnic nerves –> lower cervical and upper thoracic levels of sympathetic trunk –> cardiac plexus
  • Parasympathetic
    • Vagus nerve (ACh = postsynaptic parasympathetic neurotransmitter that slows HR via vagus nerve) –> links with postsynapctic sympathetics and visceral sensory fibers to cardiac plexus
  • Visceral sensory
    • Cardiopulm splanchnic nerves –> sympathetic trunk –> dorsal root –> spinal cord
    • Angina and referred pain (via T1)
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17
Q

Azygos system

A
  • System of veins that receives blood from the intercostal veins
  • Left posterior intercostal veins drain into the hemiazygos veins that pass over vertebral bodies to join the azygos vein.
  • Azygos vein arches over the root of the right lung to empty all intercostal blood into the superior vena cava
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18
Q
A
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19
Q

What are examples in the circulation of resistances in series?

A
  • Renal circulation (Kidneys)
    • Glomerular and peritubular are the two capillary beds in series
  • Portal circulation (Liver)
    • Splenic to hepatic
    • Mesenteric (intestines) to hepatic
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20
Q

Which organ gets dual circulation and from where?

A
  • Lungs
    • Pulmonary circulation and bronchial circulation
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21
Q

What’s the main vessel that provides systemic vasacular resistance?

A
  • Arterioles
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22
Q

Layers of blood vessels (in to out)

A
  • Tunica intima (endothelium)
  • Internal elastic tissue
  • Tunica media (smooth muscle)
  • External eleastic tissue
  • Tunica adventitia (fibrous connective tissue)
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23
Q

How do the parametes of length, radius, and viscosity affect resistance?

A
  • Length directly proportional to resistance
  • Radius indirectly proportional to resistance
  • Viscosity directly proportional to resistance
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24
Q

Reynolds number

(Equation and Application)

A

N = p (density) * d (diameter) * v (velocity) / n (viscosity)

  • Threshold separating laminar flow from turbulent flow = 2000 (unitless)
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25
Q

What is shear and how does it apply?

A
  • Lateral stress on fluid as consequence of traveling at different velocities
  • Greatest at wall of blood vessels and if shear stress is too high it can result in hemolytic anemia (rupturing of RBCs)
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26
Q

Poiseuille’s Law

A

R = (8 * n * l) / (pi * r^4)

  • n = viscosity
  • l = length
  • r = radius
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27
Q

Resistance: Parallel vs Series

A
  • Series is sum
  • Parallel is reciprocal sum of reciprocals
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28
Q

Define compliance

A
  • Change in volume that results from change in pressure

(Veins are most compliant vessels in body)

29
Q

Pulse Pressure

A

Difference between SBP and DBP

30
Q

Mean Arterial Pressure

A
  • Mean pressure across cardiac cycle
  • MAP = DBP + PP/3
31
Q

BP Equation

A
  • BP = CO x Total Peripheral Resistance
32
Q

Cardiac Output Equation

A
  • CO = HR * SV (Stroke volume)
33
Q

What is stroke volume

A

Difference between EDV and ESV

34
Q

Why do pressures in the aorta/arteries never drop significantly?

A

There’s still blood remaining during diastole, distending the aorta/artery when the next systole comes around

35
Q
A

Elastic Artery (Ex. Aorta)

  • >10mm diameter
  • Tunica intima: Endothelium with connective tissue plus smooth muscle cells and thin internal elastic membrane
  • Tunica media: Thick with alternating layers of smooth muscle cells and fenestrated elastic lamellae
  • Tunica adventitia: Thin layer of connective tissue containing fibroblasts, macrophages, and vasa vasorum
36
Q
A

Muscular Artery

  • 2-10mm in diameter
  • Tunica intima: Endothelial cells with thin prominent internal elastic membrane
  • Tunica media: Smooth muscle layer (with very small amount of collagen and elastin)
  • Tunica adventitia: thick, mostly collagen and elastin
37
Q

What is the vasa vasorum?

A

Tiny network of vessels that deliver blood to the larger vessels

38
Q
A

Large Vein

  • Thin tunica intima and tunica media
  • Thick tunica adventitia with prominent longitudinal bundles of smooth muscle in the adventitia
39
Q
A

Small/Medium Vein

  • Thin tunica intima and tunica media w/ many layers of circular smooth muscle + collagen + elastin fibers
  • Thick tunica adventitia w/ elastic fibers and often bundles of longitudinal muscle at the interface between media and adventitia
40
Q
A
  • 5 - Venule: Larger but thinner walled, and smoother contour to the lumen
  • 6 - Arteriole: Smaller but thicker walled (more smooth muscle layers surrounding endothelium)
41
Q
A

Muscular Artery

42
Q

Different types of capillaries

A
  • Continuous
    • Muscle, BBB, fat
  • Fenestrated
    • Endocrine organs and sites of extensive passage of fluid and metabolites (GI, gall bladder, kidney)
  • Sinusoid (Discontinuous)
    • Typically larger in diameter
    • Areas w/ great degree of leakiness (Liver, spleen, and BM)
43
Q

How does capillary endothelium impact permeability?

A
  • Capillaries don’t have multiple layers (Tunica media or adventitia) and primarily consists of endothelial cells that are elongated along with their nuclei in the direction of blood flow
    • Usually surrounded by pericytes
44
Q

Pros and Cons of Echocardiogram

A
  • Pros: Versatile, portable, inexpensive, no radiation. Useful for:
    • Chamber size and function
    • Valvular structure and function
    • Aortic/Pulmonary artery diameter and pressure
  • Cons: Imaging limitations include:
    • Can’t acquire overall anatomical structure, low image quality and resolution, can’t be used for assessing coronary artery function
45
Q

Pros and Cons of CMR

A
  • Pros: Higher res, no radiation. Useful for:
    • Cardiac and great vessel anatomy
    • Ventricular size and function
    • Myocardial scarring and viability
  • Cons: Less available and more expensive
    • Just okay at assessing coronary artery structure, valve structure and function, and diastolic function
46
Q

Pros and Cons of CMT (Cardiac computed tomography)

A
  • Pros: High res. Useful for:
    • Cardiac and great vessel anatomy
    • Ventricular size and function
    • Coronary artery calcification
    • Coronary artery anatomy and severity of atherosclerotic obstruction
  • Cons: Relatively high radiation burden
    • Not that great at valvular structure and function, or diastolic function
47
Q

Parameters (w/ equations) to measure ventricular systolic function?

A
  • Stroke Volume: SV = EDV - ESV
  • Cardiac Output: CO = HR * SV
  • Ejection Fraction: SV/EDV
48
Q

Three Early embryonic vascular systems

A
  • Intra-embryonic: Aorta and cardinal veins in embryo
  • Placental: Umbilical arteries and veins to placenta
  • Vitelline: Vessels to and from the yolk sac
49
Q

Source of first embryonic blood cells

A

Yolk sac (specifically the wall)

50
Q

What is the fate of the embryonic vitelline system of veins?

A
  • It traverses the abdominal wall and forms the hepatic portal system and veins + intrahepatic inferior vena cava
51
Q

What is the fate of the embryonic cardinal system of veins?

A
  • Remains to form the veins above the heart (superior vena cava and L+R brachiocephalic veins)
52
Q

What is the fate of the embryonic umbilical system of veins?

A
  • Collapses from lack of blood
53
Q

Order and fate of embryonic vein development

A
  • Cardinal
    • Anterior + Posterior → Common cardinal vein
    • Anterior → Head/Upper extremities veins
    • Posterior → Pelvic/Leg veins
  • Subcardinal
    • Middle inferior vena cava + renal and gonadal veins
  • Supracardinal
    • Azygos system and lower inferior vena cava
54
Q

Embryonic Heart Development (prior to Day 28ish)

A
  • Cardiogenic mesoderm from primitive streak
  • L+R heart tubes merge into single tube (Day 22)
  • Heart bends to the right to form 2 ventricles in sequence (Day 25)
  • Sinus venosus → Atrium → AV canal → Ventricle → Bulbus cordis → Truncus arteriosus → Aortic sac
55
Q

Embryonic Heart Development (from Day 28ish)

A
  • Endocardial cushions (dorsal and ventral) divide blood flow into L+R (Day 28)
  • Growth of Septum Primum (Day 28)
  • Appearance of foramen secundum in septum primum and beginning of growth of septum secundum (Day 32)
  • Growth of intraventricular septum (yet to fuse w/ endocardial cushions) and formation of the two inter-atrial septa
  • Septum primum and then septum secundum
56
Q
A
57
Q

How do atrial septal defects typically occur?

A
  • Foramen ovale and/or the foramen secundum are too large and overlap with each other
  • Septum primum fails to fuse with the endocardial cushions
  • Holes appear anywhere in the inter-atrial septum
58
Q

Structure and function of the spiral septum

A
  • AKA aortico-pulmonary septum
  • Divides truncus arteriosus into the aorta and pulmonary trunk
  • Grows obliquely to fuse with the IV septum and the endocardial cushions and completes ventricular division
59
Q

Adult derivative of sinus venosus

A
  • Left horn → Coronary sinus
  • Right horn → Smooth posterior wall of RA
60
Q

Adult derivative of bulbus cordis

A
  • Conus arteriosus (smooth part of LV)
  • Aortic vestibule (smooth part of RV)
61
Q

Trace the flow of blood in the fetus with emphasis on the two shunts

A
  • Placenta/umbilical cord → bypasses liver via ductus venosus, mixes with venous blood from lower half of the fetus (still highly oxygenated) at inferior vena cava → RA → RV OR foramen ovale → LA
  • … RV (as mixed blood) → pulmonary trunk → (some goes to lungs but most goes to) DUCTUS ARTERIOSUS → arch of the aorta (after it’s already branched to upper extremities)…
62
Q

Identify the changes that occur at birth to transform the system into the postnatal pattern

A
  • Blood rushes into the lungs (pulmonary flow increases) and not so much into the aorta through the ductus arteriosus due to such low blood pressure in the lungs
  • LA pressure increases with blood coming from pulm veins
  • Foramen ovale closes
  • Umbilical arteries get higher oxygenated blood, spasm and constrict – blood flow to placenta is greatly reduced
  • Umbilical vein collapses
  • Ductus arteriosus becomes ligamentum arteriosum (after a few weeks)
  • Ductus venosus becomes the ligamentum venosum
63
Q

Postnatal lungs acquiring too much blood indicates?

A

Septal defects

64
Q

Postnatal lungs acquiring too little blood indicates?

A

Tetralogy of Fallot

65
Q

Tetralogy of Fallot

A
  • Faulty spiral (aortico-pulmonary) septum defect that leads to cascade of abnormalities:
    • Pulmonary stenosis
    • IV septal defect
    • Overriding aorta
    • RV hypertrophy
66
Q

What’s more concerning, ventricular or atrial septal defects?

A
  • Ventricular defects (and other high pressure chamber/vessel defects) are more serious than atrial defects that operate at lower pressures
67
Q

Transposition of the Great Arteries

A
  • Systemic and Pulmonary circulations in parallel not in series
  • RV to aorta, LV to pulmonary trunk - indicates defect with spiral septum
  • Huge IV septal defect can be beneficial in this case because it allows just enough mixing of the blood to keep neonate alive until surgical intervention
68
Q

IV septal defects

Types and effects on cardiopulm system

A
  • Membraneous - most common, hole high up on IV wall where IV septum fuses with endocardial cushion and spiral septum. Also the thinnest part and where blood is most dynamic
  • Muscular - hole in muscular wall of IV septum
  • With IV septal defects, lungs acquire higher volume and pressure overload which flow into the LA and affect the mitral valve → distention and blood backup → CHF

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