Anatomy cardio Flashcards
Random things for spot test (GI, Resp, Cardio)
What is the primary function of the right Phrenic nerve?
The right phrenic nerve primarily serves a motor function by innervating the diaphragm, facilitating its contraction for breathing. Additionally, it provides sensory innervation to structures such as the central part of the diaphragm, the pericardium, and the mediastinal part of the parietal pleura, aiding in the detection of sensations such as pain or discomfort in these areas
What is the structure held between the forceps?
Perietal pleura
The superior vena cava drains into which chamber of the heart?
right atrium
What are all the major veins that drain into the right atrium?
- SVC
- IVC
- Coronary sinus
- Anterior, posterior and small cardiac veins
What drains into let atrium?
Pulmonary veins
What are the borders for the superior mediastinum?
First rib > T4
Contents in order within the superior mediastinum from superior to inferior
Thymus, Esophagus, Thoracic Duct, aortic arch, Veins, nerves, lymphatics
What makes up the nerves in the superior mediastinum
vagus, phrenic and left recurrent laryngeal
What borders the anterior inferior mediastinum
T4 > T9
Sternum > pericardium
What borders the posterior inferior mediastinum
T4 > T12
> spine
Role of the pulmonary artery
Transport deoxygenated blood from the right ventricle to airway
Role of the Pulmonary vein
Transports oxygenated blood to left atrium
From anterior to posterior, the structures of the posterior mediastinum are what?
(1) Brachiocephalic veins + SVC.
(2) Arch of the aorta.
(3) Trachea.
(4) Oesophagus.
(5) Thoracic duct.
In the anatomy lab, you are examining a prosection of the thoracic cavity. Which lymphatic duct receives drainage from the inferior lobe of the left lung?
thoracic duct
What is the order of the great vessels from right to left?
SVC, aorta, pulmonary artery
What structure sits deep to the coronary groove containing the right coronary artery?
The tricuspid valve.
What marks the boundary between the two ventricles and contains the Left Anterior Descending branch of the left coronary artery?
Anterior interventricular groove.
Which artery is a branch of the right coronary artery and sits in the posterior interventricular groove?
Posterior interventricular artery.
What are the two main branches of the right coronary artery?
Right marginal artery and posterior interventricular artery.
Where is the left coronary artery found?
In the left atrioventricular groove
Name the four branches of the left coronary artery
Circumflex, left anterior descending, left marginal, and lateral/diagonal bran
What are the three openings in the right atrium?
Superior vena cava, Inferior vena cava, Coronary sinu
What is the remnants of the foramen ovale in the right atrium?
Fossa ovalis
How are the cusps of heart valves connected to the heart wall?
By tendinous cords, which are anchored to papillary muscles.
Where does the left recurrent laryngeal nerve hook under?
Under the arch of the aorta.
What anatomical landmark separates the superior mediastinum from the inferior mediastinum?
The transverse thoracic plane, which extends from the sternal angle to the T4/T5 intervertebral disc.
Which vein drains into the superior vena cava?
The azygous vein.
What nerve passes through the diaphragm with the oesophagus?
vagus nerve
What nerve sits posterior to the lung root, while another nerve lies anterior?
The vagus nerve sits posterior, while the phrenic nerve lies anterior.
Explain the atrioventricular groove
CORONARY SULCUS (Groove) - AV node
Location: Separates the atria from the ventricles.
Contains: Coronary arteries (right (mainly) and left - All), coronary veins, and the coronary sinus
Explain the anterior interventricular groove
Location: Separates the left and right ventricles.
Contains: Anterior interventricular artery (left anterior descending artery - 1 ) and anterior cardiac veins.
Explain the posterior interventricular groove
Location: posterior surface of the heart, separating the left and right ventricles.
Contains: Posterior interventricular artery (right coronary arteries- All) and posterior cardiac veins.
A 67-year-old man undergoes a carotid endarterectomy and seems to recover well following surgery. When he is reviewed on the ward post operatively he complains that his voice is hoarse. What is the most likely cause?
Damage to the Vagus nerve
- specially recurrent laryngeal
A 65-year-old man presents to the emergency department with complaints of right foot pain.
On examination, you find a cold right foot with a slow capillary refill. It is tender, and the patient cannot move his toes. You can feel a pulse posterior to his medial malleolus and in his popliteal fossa but cannot appreciate any pulses on his foot.
What artery is likely involved in this patient’s presentation?
Anterior Tibial Artery
The cephalic vein pierces the clavipectoral fascia to terminate in which vein?
axillary vein
A 16-year-old boy is brought to the emergency department by air ambulance having been involved in a fight. He is peripherally shut down with an unrecordable blood pressure. He has sustained a stab wound to the chest which has pierced through the left atrium and the artery supplying it.
What artery is most likely to have been damaged?
left coronary artery
A 25-year-old student presents to the emergency department with severe abdominal pain and vomiting blood. She is tachycardic with a pulse of 110 and has a blood pressure of 95/60. She has recently been taking naproxen for Achilles tendinopathy. She is sent for an urgent endoscopy which reveals a bleeding peptic ulcer. To definitively stop the bleeding she is sent for embolisation of the left gastric artery via angiogram.
During an angiogram what vertebral level can be used as a radiological marker for the origin of the artery supplying the left gastric artery?
T12
What are the branches of the subclavian artery?
(1) Vertebral artery
(2) Internal thoracic artery
(3) Thyrocervical trunk
(4) Costocervical trunk
(5) Dorsal scapular artery
Origin of IVC
L5
What veins form the IVC?
Left and right common iliac veins merge to form the IVC
L4 branch is where what happens?
Bifurcation of the aorta
During the repair of an atrial septal defect the surgeons note that blood starts to leak from the coronary sinus. Which structure forms the largest tributary of the coronary sinus?
Great cardiac veins
A 23-year-old man has a cannula inserted into his cephalic vein. Through which structure does the cephalic vein pass?
Calvipectoral fascia
What is the corresponding artery to the foramen magnum?
Vertebral arteries
A 75-year-old man is seen in the acute medical ward following a myocardial infarction. He is found to have a heart rate of 40. Your consultant explains that this is because he has damaged the conduction pathways between the sino-atrial and atrioventricular (AV) node and so his ventricles are being paced by the AV node only.
What is the blood supply of the AV node in the majority of patients?
right coronary artery
A 21-year-old develops tonsillitis. He is in considerable pain. Which one of the following nerves is responsible for the sensory innervation of the tonsillar fossa?
glossopharyngeal nerve
An individual is noted to have a left sided superior vena cava. By which pathway is blood from this system most likely to enter the heart?
Coronary sinus
Origin and its termination spot for the thoracic aorta
T4 - T12
A 61-year-old man presents to the emergency department with central crushing chest pain. He is nauseated and is sweating profusely. You perform an ECG which shows sinus bradycardia and ST-segment elevation in multiple chest leads. Sinus bradycardia can result from myocardial infarction. Which arterial vessel usually supplies both the sinoatrial (SA) node and the atrioventricular (AV) node?
Right Coronary Artery
A 58-year-old gentleman presented with abdominal pain exacerbated by eating, nausea and weight loss. After imagining, it is suspected that he has median arcuate ligament syndrome. This is causing a compression of the branch of the abdominal aorta supplying the foregut, so he is scheduled for surgical decompression of this vessel.
What are the 3 branches of this occluded branch of the aorta?
Left gastric
Hepatic
Splenic
A 45-year-old man arrives at the emergency department with severe tearing chest pain. A diagnosis of aortic dissection is suspected.
Between which layers is the blood most likely to be flowing?
The tunica intima is separated from tunica media in an aortic dissection
Where is the greatest proportion of musculi pectinati found?
Right atrium
The IVC pierces the central tendon of the diaphragm at what level?
T8
How many valves lie between the superior vena cava (SVC) and the right atrium?
NONE
Which structure separates the subclavian artery from the subclavian vein?
scalenus anterior
Where is the bifurcation of the common carotid artery located?
Anterior to the sternocleidomastoid muscle at the level of the superior border of the thyroid cartilage
Describe the position of the brachial artery in the upper limb
medial to the biceps tendon in the cubital fossa
Where can you locate the radial artery in the upper limb?
Lateral to the tendon of flexor carpi radialis
Identify the location of the femoral artery in the lower limb.
Inferior to the midpoint of the inguinal ligament
Where is the popliteal artery located in relation to the knee joint?
Found in the popliteal fossa, immediately posterior to the knee joint
Describe the position of the posterior tibial artery in the lower limb
Between the posterior border of the medial malleolus and the Achilles tendon
Where can you find the dorsalis pedis artery in the lower limb?
Medial to the tendon of extensor hallucis longus on the dorsum of the foot
An infant is born at 30 weeks gestation with tachypnea, central cyanosis, and flaring of the nostrils with each breath. Which of the following is most likely responsible for the infant’s symptoms?
Phrenic nerve
A 67-year-old female presents to the emergency department with dyspnea, a persistent cough, fatigue, and chest pain. Subsequent imaging reveals a mass in the left lung, anterior to the hilum.
Which choice includes the nerve(s) most likely compressed by the tumour, causing dyspnea in this patient?
Phrenic nerve
Path of phrenic nerve
diaphragm - left atrium of heart - tumour anterior to helium of left lung - hilum of left lung
A 55-year-old female with a past medical history of diabetes and cigarette smoking, as well as a family history of coronary artery disease, is admitted to the emergency department with chest pain, shortness of breath, and fatigue. Following abnormal stress test results, cardiac catheterization with left coronary artery angiography (right anterior oblique view) reveals a narrowing of one of the vessels of the heart.
A severe narrowing of the circumflex artery is observed, prompting a coronary bypass procedure to restore normal blood flow. During the surgery, it may be necessary to temporarily halt blood circulation by accessing the transverse pericardial sinus and clamping which of the following vessels?
Aortic and pulmonary trunk
A 55-year-old female with a past medical history of diabetes and cigarette smoking, as well as a family history of coronary artery disease, is admitted to the emergency department with chest pain, shortness of breath, and fatigue. Following abnormal stress test results, cardiac catheterization with left coronary artery angiography (right anterior oblique view) reveals a narrowing of one of the vessels of the heart.
While attempting to suture the distal end of the bypass onto the circumflex artery during a coronary bypass procedure, the surgeon accidentally passes the needle into the vein directly adjacent to it. Which vein was likely damaged?
A. Anterior cardiac vein
B. Great cardiac vein
C. Middle cardiac vein
D. Pulmonary vein
E. Small cardiac vein
B
Common sites of narrowing/occlusion
- RCA
- LAD
- Circumflex artery
- LCA
- Triple vessel disease = LAD + RCA + circumflex branch
- Treated by triple bypass
Common grafts for CABG?
radial artery, internal thoracic artery, great saphenous vein
A 76-year-old male is brought to the emergency department with shortness of breath and severe chest pain that radiates to the left shoulder and the medial aspect of the left upper limb. An emergency electrocardiogram (ECG) reveals an obstruction of the circumflex branch of the left coronary artery, leading to a diagnosis of myocardial infarction.
While performing a cardiac catheterization with balloon angioplasty, the physician injects contrast dye into the left coronary artery, revealing that the patient has a left dominant heart. Based on this new information, which of the following structures was most likely affected during the patient’s myocardial infarction?
Posterior 1/3rd of interventricular septum
as left dominant arises from circumflex
if it was right dominant it would arise from right coronary artery
A 41-year-old male is brought to the emergency room with a penetrating injury to the chest, intense pain, and bleeding. On physical examination, a knife wound is found at the right 1st intercostal space, immediately lateral to the sternum.
Which is most likely gonna get injured?
SVC
A 2-month-old male is brought to the emergency room after turning blue while crying. Suspecting an issue with the infant’s heart, the provider performs an echocardiogram, which reveals a clinically significant opening between the right and left atria.
Incomplete closure of which structures would account for this atrial septal defect?
Foreman ovale
A 4-month-old female was recently diagnosed with a membranous ventricular septal defect. After undergoing cardiac surgery to repair the septal defect, the infant develops asynchronous contraction of the ventricles. An electrocardiogram (ECG) is performed and reveals a slight delay of the left ventricle that results in a lower ejection fraction.
Based on the location of the repaired defect and the patient’s current symptoms, which part of the heart’s conduction system is likely damaged?
Left bundle branch
A 74-year-old male with hypertension presents to the emergency department experiencing chest pain and light-headedness. A cardiac CT reveals dilation of the left atrium chamber. Continued dilation of this chamber would likely compress what?
esophagus
A 75-year-old female with constrictive pericarditis undergoes a pericardiectomy to remove the pericardium. By removing the pericardium, the surgeon is disrupting which of the following mediastinal borders?
Anterior border of the middle mediastinal
An 88-year-old male presents to the clinic with a persistent cough and chest pain. Radiographic imaging of the thoracic cavity shows a midline tumor of the thymus. If the tumor continues to grow, which vein will be compressed?
Left brachophiellic vein
A 43-year-old female presents to the emergency department with severe dysphagia. Radiographic imaging reveals a mass in the oesophagus at the level of T9. The mass is found to be causing a blockage of the oesophagus, resulting in dilation of the oesophagus just superior to the point of obstruction.
Dilation of the oesophagus may compress which structure?
Thoracic duct
What is a left-dominant heart?
In a typical heart, the posterior descending artery (PDA) is usually supplied by the right coronary artery (RCA). However, there is anatomical variation in some hearts where the PDA is instead supplied by branches of the left coronary artery (LCA), a condition known as left dominance.
In a left-dominant heart, the PDA is supplied by the left coronary artery. Therefore, if there is an obstruction in the left circumflex artery (a branch of the left coronary artery), it can affect the blood supply to the posterior descending artery and consequently to the posterior one-third of the interventricular septum
left primary bronchus
T6
A 37 year old female patient attends her GP surgery reporting episodes of increased heart rate.
Which best describes the structure through which action potentials in postganglionic fibres travel to speed up the heart rate?
Sympathetic chain (trunk)
