Anatomy of chest pain

Question 1

What is meant by a visceral afferent?

Answer 1

sensory nerve from an organ

Question 2

What is a plexus?

Answer 2

Intertwining of nerves

Question 3

What is a ganglion?

Answer 3

Collection of nerve cell bodies outside th CNS

Question 4

Where are sympathetic ganglion located?

Answer 4

Along the sympathetic chain

Question 5

What are the two fibres used to get from CNS to organs?

Answer 5

presynaptic fibres and post synaptic fibres

Question 6

Where does presynaptic outflow occur in sympathetic signalling?

Answer 6

T1-L2/3

Question 7

How do sympathetic signals go from CNS to organs?

Answer 7

• travel down spinal cord
• exit spinal cors in one of the T1-L2/3 spinal nerves
• then do one of 5 options

Question 8

What are the 5 options in sympathetic signalling from CNS to organs?

Answer 8

• go into the ganglion of that level & synapse
• travel superiorly in the sympathetic chain to another ganglion & synapse
• travel inferiorly in the sympathetic chain to another ganglion & 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 (e.g. celiac ganglion)
• pass straight to the adrenal medulla without synapsing as an abdominopelvic splanchnic nerve (directly stimulating adrenaline release)

Question 9

What do Cardiopulmonary splanchnic nerves do?

Answer 9

send sympathetic signals to heart and lungs

Question 10

Where are Cardiopulmonary splanchnic nerves located?

Answer 10

behind the great vessels. They feed into the cardiac plexus

Question 11

What are the three fibres of the cardiac plexus?

Answer 11

parasympathetic, sympathetic and visceral afferent fibres

Question 12

Where are parasympathetic ganglia located?

Answer 12

isolated from chain

Question 13

Where is th parasympathetic ganglia for the heart located?

Answer 13

On the heart wall

Question 14

How do parasympathetic signals reach the organs?

Answer 14

cranial nerves 3,7,9,10 and sacral spinal nerves

Question 15

What accompany the sympathetic nerves to the heart?

Answer 15

cardiac visceral afferent accompany the sympathetic nerves which are carried together in the cardiopulmonary splanchnic nerves

Question 16

What are baroreceptors carried through?

Answer 16

The vagus nerve

Question 17

What pain characters are associated with somatic pain?

Answer 17

sharp, stabbing and well localised

Question 18

What pain characters are associated with visceral pain?

Answer 18

dull, aching, nauseating, poorly localised

Question 19

What does somatic refer to?

Answer 19

anything associated with body wall

Question 20

How does a painful prod to the chest become what we feel as pain?

Answer 20

• action potential passing through anterior ramus
• then pass through posterior root and rootlets
• to get to spinal cord
• pain pathway crosses in spinal cord to oposite side of brain where it then gets processed as consciousness

Question 21

What occurs at the precentral gyrus?

Answer 21

action potentials that originate here bring about contractions of skeletal muscles

Question 22

What occurs at the postcentral gyrus?

Answer 22

Action potentials that arrive here are brought into consciousness

Question 23

What does the sensory homunculus show?

Answer 23

Shows where APS arises

Question 24

Where can somatic central chest pain sources come from?

Answer 24

-shingles, muscle joint and bone, parietal pleura and fibrous pericardium

Question 25

Where does the vagus nerve sit?

Answer 25

on trachea and passes posterior to the route of the lung and then follows the oesophagus down

Question 26

Where do azygous veins drain into?

Answer 26

vena cava

Question 27

What nerve crosses the trachea?

Answer 27

right vagus nerve

Question 28

What nerve crosses the aorta?

Answer 28

left vagus nerve