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Cardio 1 > Anatomy Middle Mediastinum > Flashcards

Anatomy Middle Mediastinum Flashcards

1
Q

Contents of the middle mediastinum

A

Heart

Pericardium

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2
Q

Components of the pericardium

A

Fibrous pericardium

Serous pericardium

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3
Q

Fibrous pericardium is a dense connective tissue ___ shaped bag with its base sitting on the ___ (attached by ___) and its apex is continuous with the ____.
It is connected to the sternum via ___

A
  • cone
  • diaphragm (connected by pericardiacophrenic ligament)
  • adventitia of the great vessels
  • sternopericardial ligaments
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4
Q

The serous pericardium forms a closed sac with 2 layers:

A

Parietal-fused with fibrous pericardium

Visceral-fused with the heart (in histology it is called the epicardium)

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5
Q

The pericardial cavity is a closed space between ____ which contains ___

A
  • The parietal and visceral layers of the serous pericardium
  • A thin layer of fluid
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6
Q

If there is excess fluid in the pericardial cavity it is called ___, which typically results from ____. As the outer fibrous pericardium is composed of dense CT, the accumulation of fluid in the pericardial cavity causes compression of ____, which can result in ____. The treatment includes a surgical procedure with aspiration of the fluid, called ____. It is performed by inserting a needle into the ___ intercostal space in the area medial to the ___

A
  • pericardial effusion
  • inflammatory process caused by acute pericarditis
  • the heart and cardiac tamponade
  • biventricular heart failure
  • pericardiocentesis
  • 5th or 6th
  • cardiac notch of the left lung
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7
Q

___ are subdivisions of the pericardial sac, formed by the reflections of the ____ around the ___

A

Pericardial sinuses
Serous pericardium
Greater vessels

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8
Q

Pericardial sinuses & locations

A
  1. Transverse-part of a pericardial sac posterior to ascending aorta and pulmonary trunk
  2. Oblique-J shaped cul de sac behind the heart surrounded by reflection of serous pericardium around right and left pulmonary v. and IVC
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9
Q

The transverse pericardial sinus has great significance to cardiac surgeons

A

During surgeries on the aorta or pulmonary trunk they can pass a finger through the sinus and cut through in order to stop circulation

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10
Q

The apex of the heart is the ___ which points ____ and is located ____.
*this is the area for ___

A

Left ventricle
Anterior, inferior, and left
5th intercostal space 7-9 cm from midline
*auscultating the mitral valve

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11
Q

Surfaces of the heart:

*pyramid shaped

A
  1. Sternocostal/anterior-mainly right ventricle
  2. Diaphragmatic/inferior-mainly left ventricle, partly right
  3. Left pulmonary-left ventricle
  4. Right pulmonary-right atrium
  5. Posterior/base-mainly left atrium, partly right.
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12
Q

Blood supply to and from the pericardium

A

Internal thoracic a - pericardiacophrenic a.

Same names for veins

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13
Q

The posterior surface (or base) of the heart is separated from the diaphragmatic surface by the ___

A

Coronary sinus and sulcus

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14
Q

Margins of the heart:

1. Inferior/acute

A
  • formed by right ventricle and small part of left.

- Sharp boundary between anterior and diaphragmatic surfaces

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15
Q

Margins of the heart:

2. Obtuse

A
  • formed mainly by left ventricle

- rounded boundary between sternocostal/anterior surface and left pulmonary surface

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16
Q

Margins of the heart:

3. Left

A
  • formed by left ventricle and left auricle

- boundary between sternocostal/anterior surface and left pulmonary surface

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17
Q

Margins of the heart:

4. Right

A
  • formed by right atrium

- boundary between sternocostal/anterior surface and right pulmonary surface

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18
Q

Layers of the heart wall

A
  1. External epicardium (formed by visceral layer of serous pericardium)
  2. Middle myocardium- muscle, thickest
  3. Internal endocardium-formed by endothelial lining and subendothelial CT, contains conducting system
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19
Q

There are two main external sulci that reflect the internal segmentation of the heart into 4 chambers:

A
  1. Coronary sulcus circles the heart and separates atria from ventricles
  2. Interventricular sulcus (on anterior and posterior sides of the heart)
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20
Q

The coronary sinus contains what?

A

Right coronary a.
Circumflex branch of left coronary a.
Coronary sinus
Small cardiac v.

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21
Q

The anterior interventricular sulcus contains what?

A

Anterior interventricular a.

Great cardiac v.

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22
Q

The posterior interventricular sulcus contains what?

A

Posterior interventricular a.

Middle cardiac v.

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23
Q

The atria have ___ walls while the ventricles have __

A

Thin

Thick

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24
Q

The ___ receives deoxygenated blood from the SCV and IVC and coronary sinus. It is then pumped to the ___, which pumps blood into the ____ which delivers the blood to the ___

A

Right atrium
Right ventricle
Pulmonary trunk
Lungs

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25
Q

The ___ receives blood from the 4 pulmonary veins and pumps it into the ___, which then pumps it into the ___

A

Left atrium
Left ventricle
Aorta for systemic circulation

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26
Q

The right atrium is divided into:

A

2 continuous spaces, sinus of vena cavae and atrium proper

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27
Q

Sinus of venae cavae is separated from the atrium proper externally by ___ and internally by ___.
Embryologically it is derived from ___

A
  • The sulcus terminalis cordis (shallow verticals groove)
  • Crista terminalis (muscular ridge)
  • sinus venosus
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28
Q

___ empty into the sinus of venae cavae

A

IVC and SVC

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29
Q

The ___ receives blood from most of the cardiac veins and opens medially into the opening of the ___

A

Coronary sinus

IVC

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30
Q

Located in the ___ is the right atrioventricular orifice with the ___ valvle

A

Atrioventricular septum

Tricuspid

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31
Q

The ___ separates the right and left atria. It contains the ___ which has a prominent margin, called the ___

A

Interatrial septum
Fossa ovalis
Limbus fossa ovalis

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32
Q

The space anterior to the crista terminalis, including the right auricle, is called the ___. It’s walls are covered by. The right auricle is ___

A

Atrium proper
Musculi pectinati
Ear-like conical muscular pouch (also has musculi pectinati and is an additional space to store blood)

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33
Q

The ___ forms most of the anterior surface of the heart and a portion of the diaphragmatic surface. The larger ____is separated from the ____ by a muscular ridge, the ____.

A

Right ventricle
Inflow portion
Outflow portion
supraventricular crest

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34
Q

The right ventricle receives blood from the ___ through the ___, which contains the triscuspid valve. The walls of the inflow portion of the right ventricle have ____

A

Right atrium
Atrioventricular orifice
Trabeculae carneae

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35
Q

Three of the ___ form the papillary muscles, which have one end attached to the ___ and the other to the ___, which connect to the free edges of the ___

A

Traveculae carneae
Ventricular surface
Chordae tendineae
Cusps of the tricuspid valve

36
Q

Papillary muscles:

A

Anterior
Posterior
Septal

37
Q

The largest and most constant papillary muscle

Extent?

A

Anterior

From the anterior wall of the ventricle to the anterior and posterior valves of the tricuspid

38
Q

This papillary muscle may consist of 1, 2 or 3 structures with some chordae tendineae arising directly from the ventricular wall.
Extent?

A

Posterior

Posterior ventricular wall to the posterior and septal valves of the tricuspid

39
Q

The most inconsistent papillary muscle, it is either small or absent.
Extent?

A

Septal

To the septal and anterior valves of the tricuspid

40
Q

The ___ forms a bridge between the base of the anterior papillary muscle and the interventricular septum. What does it do?

A

Septomarginal trabecula (moderator band)

  • prevents the overdistenstion of the right ventricle
  • carries the right limb of the AV bundle from the IV septum
41
Q

The right atrioventricular orifice is ___ during ventricular contraction by the ___, which consists of ___, which are attached to ____ through ___.

A
  • Closed
  • Tricuspid valve
  • 3 cusps/leaflets (anterior, posterior, septal)
  • corresponding papillary muscles
  • chordae tendineae
42
Q

The base of each cusp of the tricuspid valve is secured to ___

A

The fibrous ring that surrounds the AV orifice

43
Q

The ___ of the right ventricle has the conus arteriosus, which contains the ___. This area has smooth walls and is derived from the embryonic ___

A

Outflow tract
Pulmonary valve
Bulbus cordis

44
Q

The pulmonary valve consists of 3 ___. Each of which forms a pocket-like sinus, which fills with blood after ___ and forces the cusps ___. This prevents ___.

A
  • Semilunar cusps (left, right, anterior)
  • ventricular contraction
  • to close
  • blood in the pulmonary trunk from refilling the right ventricle
45
Q

The free, superior edge of each of the pulmonary cusps has a ___ portion and a ___ portion.

A

Middle, thickened portion (nodule)

Thin lateral portion (lunula)

46
Q

___ is a congenital defect in which the tricuspid valve is displaced toward the apex of the heart

A

Ebstein’s anomaly

47
Q

The ___ forms most of the base or posterior surface of the heart. Embryologically it consists of two parts ____ and ___ which are NOT physically divided by a crest.

A

Left atrium

Inflow portion and anterior portion

48
Q

The ___ portion of the left atrium is the posterior portion and receives ___. It has ___ walls

A

Inflow
The 4 pulmonary veins
Smooth

49
Q

The ___ portion of the left atrium is the atrium proper and contains the ___. Its walls have ___

A

Anterior portion
Left auricle
Pectinate muscles

50
Q

The ___ of the left atrium is part of the anterior wall. It has a thin or depressed area, the ___ and is opposite the floor of the fossa ovalis in the right atrium.

A

Interatrial septum

Valve if the foramen ovale

51
Q

The __ is the largest chamber of the heart and is ___ in shape. It contributes to what surfaces?

A

Left ventricle
Conical
-anterior, diaphragmatic left pulmonary surfaces
-forms the apex

52
Q

The inflow portion of the left ventricle contains the ____. In the left ventricle the trabeculae carneae are ___ in contrast to those in the right ventricle. There are __ papillary muscles (___), which are ___ than those in the right ventricle. They are attached to the leaflets of the mitral valve by chordae tendinae.

A
  • Left AV orifice with the mitral valve
  • fine and delicate
  • 2 (anterior, posterior)
  • larger
53
Q

The left AV orifice is ___ during ventricular contraction by the ___, which has ___

A

Closed
Mitral valve
2 cusps (anterior, posterior)

54
Q

The outflow tract of the left ventricle has ___ walls and is derived from the embryonic ___

A

Smooth

Bulbus cordis

55
Q

The opening from the left ventricle into the aorta is closed by the ___. It consists of ___

A

Aortic valve

3 semilunar cusps (left, posterior, right)

56
Q

The sinus of the left semilunar cusp of the aortic valve contains ___. Right contains ___??

A

Opening of left coronary a.

Opening of right coronary a.

57
Q

The interventricular septum consists of 2 parts:

A
  1. Muscular-thick, major part of septum

2. Membranous-thin, upper part of septum

58
Q

Two coronary arteries arise from ___ and supply the ___

A
  • The aortic sinuses in the ascending aorta

- muscles and other tissues of the heart

59
Q

The right coronary a. originates from the ___ and supplies the ___. It passes ___ between the ___ and the ___.

A

Right aortic sinus of the ascending aorta

  • right atrium and right ventricle, the SA and AV nodes, and the internal septum
  • anteriorly between the right auricle and pulmonary trunk
60
Q

Branches of the right coronary a.

A
  1. SA nodal branch
  2. Right marginal branch
  3. Posterior interventricular branch
  4. AV nodal branch
61
Q

The ___ of the right coronary a. passes posteriorly and around the SVC

A

SA nodal branch

62
Q

The ___ is given off as the right coronary a. approaches the inferior (acute) margin of the heart and continues along this border toward the apex of the heart

A

Right marginal branch

63
Q

The ___ is the continuation of the right coronary a. onto the posterior surface of the heart, where it lies in the posterior interventricular sulcus

A

Posterior interventricular branch

64
Q

The right coronary a. gives rise to the ____ at the junction of the interatrial and interventricular septa between the four heart chambers

A

AV nodal branch

65
Q

The left coronary a. originates from the ___. It passes between the ___ and the ___.

A
  • left aortic sinus of the ascending aorta

- pulmonary trunk and left auricle

66
Q

Branches of the left coronary a.

A
  • anterior interventricular branch (LAD)
    a. Diagonal branch
  • circumflex branch
    a. Left marginal a.
67
Q

The ___ of the left coronary a. continues around the left side of the pulmonary trunk and descends obliquely toward the apex of the heart in the anterior interventricular sulcus

A

Anterior interventricular branch (LAD)

68
Q

The ___ branch of the LAD takes off at the mid-level of the left ventricle to supply the left ventricular wall

A

Diagonal

69
Q

The ____ branch of the left coronary a. Courses toward the left within the coronary sulcus and into the base/diaphragmatic surface of the heart

A

Circumflex

70
Q

The ____ branch of the left coronary a. usually arises from the circumflex a. and continues across the rounded obtuse margin of the heart

A

Left marginal a.

71
Q

Variations of the coronary arteries

A

Most common is the right dominant pattern:

  • posterior interventricular branch begins from RCA
  • in 15% of others it begins from the circumflex a. of the LCA
  • second most common variation is where it originates from the SA nodal branch
72
Q

Coronary a. disease:

A

Sudden occlusion of one of the major coronary arteries causes the infarction of the corresponding myocardium and consecutive necrosis

73
Q

The most common sites of coronary a. occlusion are:

A
  1. LAD branch of LCA (widow-maker)
  2. RCA
  3. Circumflex branch of LCA
74
Q

Most of the cardiac veins empty into the ___, which receives 4 major tributaries:

A

Coronary sinus

-great, middle, small, and posterior cardiac veins

75
Q

The ___ begins at the apex of the heart and ascends through the anterior interventricular sulcus, where it is often termed the ____. It then reaches thecoronary sulcus where it is associated with the circumflex branch of the LCA. It gradually enlarges and then enters the ___

A

Great cardiac v.
Anterior interventricular v.
Right atrium

76
Q

The ___ (aka ___) begins near the apex of the heart and ascends within the posterior interventricular sulcus towards the coronary sinus

A

Middle cardiac v.

Posterior interventricular v.

77
Q

The ___ (aka ____) begins at the lower anterior section of the coronary sulcus between the right atrium and right ventricle and accompanies the marginal branch of the RCA along the ___ of the heart

A

Small cardiac v.
Right marginal v.
Acute margin

78
Q

The ___ (aka ___) lies on the posterior surface of the left ventricle just to the left of the middle cardiac v. It either enters the coronary sinus directly or ___

A

Posterior cardiac v.
Left marginal v.
Joins the great cardiac v.

79
Q

The SA node is located __

A

At the superior end of the crista terminalis at the junction of the SVC and right auricle

80
Q

The AV node is located ___

A

Near the opening of the coronary sinus within the AV septum

81
Q

Impulses in the heart begin in the ___, then travel to the ____ via ___

A

Atria due to SA node

ventricles via the AV bundle

82
Q

The ___ is a direct continuation of the AV node. It follows along the lower border of the ____ before doing what?

A

Bundle of His

  • Membranous part of the interventricular septum
  • splitting into right and left bundle branches
83
Q

Right vs left bundle branches

A
  • right: goes to apex of right ventricle. Supplies ventricular muscles, including papillary muscles. Part of it passes through the moderator band (septomarginal trabecula)
  • left: goes to apex of left ventricle.
84
Q

The subendocardial plexus is found between the ___ and the ___.
It is formed by ____.

A

Endocardium and myocardium

Purkinje fibers

85
Q

The preganglinic sympathetic fibers to the heart originate in the ____. They travel to sympathetic ganglion within the ___

A

Lateral horn of the gray matter from spinal levels T1-T4

-thoracic chain

86
Q

The heart has pain nerve endings deep within the ___. The heart is insensitive to ___ but responds to ___

A
  • Myocardium
  • Touch, cutting, cold, heat
  • ischemia and accumulation of metabolic products
87
Q

Pain that originates in the heart is called ___, which usually appears as ___

A

Angina or angina pectoris

Transient moderately severe constricting pain as tightness in the thorax

Cardio 1 (14 decks)

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