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c > anatomy of coronary arteries and the heart > Flashcards

anatomy of coronary arteries and the heart Flashcards

1
Q

what are the layers of the pericardium?

A

fibrous outer layer

serous pericardium- visceral and parietal

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2
Q

what does the fibrous pericardium attach to?

A

adventitia of the great vessels

central tendon of the diaphragm

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3
Q

what does the parietal pericardium attach to?

A

fibrous pericardium

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4
Q

what does the visceral pericardium attach to?

A

the myocardium - heart muscle

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5
Q

what is the pericardial cavity?

A

the cavity between the parietal and visceral layers

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6
Q

what are the functions of the pericardium?

A

fixes heart in the mediastinum (anchors it)
protects from infections from other organs
prevents excessive dilation of the heart
lubrication

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7
Q

define pericardial effusion

A

abnormal accumulation of fluid in the pericardial cavity which can lead to cardiac tamponade

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8
Q

define cardiac tamponade

A

when fluid causes the compression of the heart

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9
Q

what are the two types of cardiac tamponade?

A

acute

chronic

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10
Q

what causes acute tamponade?

A

trauma

e.g. myocardial infarction

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11
Q

what causes chronic tamponade?

A

metastasis

infection

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12
Q

how is chronic tamponade different from acute tamponade?

A

chronic - over a longer period of time.
chronic - the heart expands to hold 1.5 litres
acute - can only hold 100ml/150ml

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13
Q

what is the long term effect of cardiac tamponade?

A

equalises the pressure in all the heart chambers

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14
Q

what does accumulation of fluid under high pressure cause?

A

compression of all the heart chambers
impairs diastolic filling of both ventricles
affects venous pressure and the stroke volume

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15
Q

how does pericardial effusion affect the right ventricle?

A

compresses the RV
blood pools in the atrium
JVP is increased

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16
Q

why does pericardial effusion have a bigger effect on the right ventricle than the left?

A

RV is under lower pressure

RV has thinner walls

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17
Q

how is an increased JVP presented in a person?

A

engorged veins in the neck

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18
Q

how does pericardial effusion have an effect on the left ventricle?

A

impairs LV filling
blood backs up to the right ventricle
pulmonary congestion to the lungs

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19
Q

how does pulmonary congestion present in a person?

A

rales in the lung field

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20
Q

define stroke volume

A

the volume of blood that’s pumped out of the left ventricle per heartbeat

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21
Q

what is the usual stroke volume at rest?

A

60-100ml

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22
Q

define cardiac output

A

the volume of blood pumped out of the heart per minute

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23
Q

what is the equation for cardiac output?

A

HR x SV

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24
Q

how does pericardial effusion have an effect on stroke volume?

A

impaired diastolic filling
decreased stroke volume
decreased CO
hypotension

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25
Q

explain the mechanism of reflex tachycardia

A

increased systolic pressure
baroreceptors in the aorta detect this
increase heart contractions temporarily to increase SV
(reflex tachycardia)

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26
Q

what is pericardiocentesis?

A

a treatment for cardiac tamponade where the fluid is drained from the pericardial sac

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27
Q

name the three methods of pericardiocentesis

A

subxiphoid
parasternal
apical

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28
Q

name the layers of the heart

A

epicardium
myocardium
endocardium

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29
Q

what does the epicardium attach to?

A

the visceral layer of the serous pericardium

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30
Q

what is the myocardium made of?

A

cardiac muscle fibres arranged in bundles

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31
Q

where is the endocardium found?

A

continuous with endothelium

lining chambers and valves

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32
Q

what is another name for the coronary sulcus?

A

coronary groove

atrioventricular sulcus

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33
Q

what is the coronary sulcus?

A

the oblique plane which separates the atria and the ventricles

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34
Q

what are the auricles?

A

extensions/appendages of the atria, allowing more blood to be held

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35
Q

where does the right atrium receive blood from?

A

vena cava

coronary sinus

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36
Q

what is the coronary sinus?

A

a collection of veins that join together to form a large vessel which collects blood from the heart muscle

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37
Q

where is the coronary sinus?

A

posterior surface of the heart in the heart muscle

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38
Q

what is the fossa ovale?

A

one of the two fetal cardiac shunts which moved blood from the right atrium to the left atrium

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39
Q

when does the fossa ovale close?

A

at birth

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40
Q

what is the crista terminalis?

A

the ridge that divides the anterior and posterior wall

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41
Q

what is the sulcus terminalis?

A

how the crista terminalis is seen externally

42
Q

what do pectinate muscles do?

A

reinforce/protect the wall during filling

43
Q

what is the sinus venarum?

A

smooth region of the right atrium which receives input from the vena cava and the coronary sinus

44
Q

how many papillary muscles does the tricuspid valve have?

A

three

45
Q

name the papillary muscles of the tricuspid valve

A

septal
posterior
anterior

46
Q

what do the papillary muscles do?

A

anchor the chordeae tendinae

47
Q

what do chordae tendineae do?

A

cord like structures which attach onto valves to stop them from inverting into the atrium

48
Q

what are trabeculae carneae?

A

rounded or irregular muscular columns which project from the inner surface of the right ventricle

49
Q

how are trabeculae carneae different from pectinate muscles?

A

trabeculae carneae are found in the ventricles while pectinate muscles are found in the atria

50
Q

what do trabeculae carneae do?

A

help papillary muscles in contraction
prevent cusps from inverting
stop chambers from sucking together

51
Q

what is another name for the septomarginal trabecula?

A

moderator band

52
Q

where is the moderator band?

A

part of the trabeculae carneae

runs from the septum to the margin of the heart muscle

53
Q

what is the function of the moderator band?

A

helps speed of conduction

54
Q

what does the interventricular septum do?

A

carries the bundle of His and the AV bundles before they separate into the Purkinje fibres

55
Q

where does the left atrium receive oxygenated blood from?

A

pulmonary veins

56
Q

where are pectinate muscles found in the left atrium?

A

left auricle

57
Q

how many pectinate muscles are found in the left atrium?

A

very few

58
Q

how many papillary muscles does the mitral valve have?

A

2

59
Q

what are aortic sinuses?

A

dilations in the aorta in the semilunar cusps

60
Q

name the aortic sinuses

A

left
right
middle

61
Q

how does blood leave each of the aortic sinuses?

A

left and right - leave via coronary arteries

middle - no arteries leaving

62
Q

where do the left and right coronary artery stem from?

A

the root of the aorta

63
Q

what is another name for the left coronary artery?

A

left main stem

64
Q

what does the left coronary artery branch into?

A

circumflex artery
anterior interventricular (LAD)
lateral branches

65
Q

what is another name for the anterior interventricular arteries?

A

left anterior descending

66
Q

what part of the heart does the circumflex artery supply?

A

the outer side and back of the heart

67
Q

what part of the heart does the left anterior descending supply?

A

front of the left side

68
Q

what part of the heart does the right coronary artery supply blood too?

A

right ventricle
right atrium
SAN
AVN

69
Q

what does the right coronary artery branch into?

A

posterior descending artery

acute marginal artery

70
Q

how much of the septum is supplied by the LCA?

A

2/3

71
Q

`how much of the septum is supplied by the RCA?

A

1/3

72
Q

what blood vessel determines the dominance of the heart?

A

posterior descending artery

73
Q

what is the most common site of occlusion in a myocardial infarction?

A

coronary arteries
1 - LCA 40/50%
2 - RCA 30-40%
3 - circumflex 15-20%

74
Q

how can damage to the coronary arteries damage the conducting system?

A

LAD to the septal branches supplies the AV bundles
RCA supplies the SAN and AVN
heart block

75
Q

what are the different views in a coronary angiogram?

A

left anterior oblique
right anterior oblique
anterior-posterior

76
Q

where are coronary veins found?

A

following the course of the arteries

77
Q

what do coronary veins do?

A

collects waste from cardiac muscle and drains into coronary sinus

78
Q

what is the fibrous skeleton of the heart made up of?

A

dense connective tissue

79
Q

describe the structure of the fibrous skeleton

A

4 fibrous rings, with each one surrounding each of the valves
fuse together and merge with the interventricular septum

80
Q

what is the function of the fibrous skeleton?

A

supports/anchor the cusps
prevents overstretching of the valves
attachment point for myocardium
electrical insulator between atria and ventricles

81
Q

when do the AV valves open?

A

when atrial pressure is greater than ventricular pressure

82
Q

how do AV valves open?

A

ventricles relax
chordae tendineae slack
papillary muscles relax

83
Q

when do AV valves close?

A

ventricular pressure is higher than atrial pressure

84
Q

how do AV valves close?

A

ventricle contract
chordae tendineae pulled taut
papillary muscles contract to pull cords and stop cusps from inverting

85
Q

how many cusps do the semilunar valves have?

A

3

86
Q

how do semi-lunar valves open and close?

A

by passive action

weight of the blood on the vessels causes them to close

87
Q

when do semi-lunar valves open and close?

A

open in ventricular systole

close in ventricular diastole

88
Q

what causes the first “lub” in the heart noise?

A

closing of AV valves just before systole

89
Q

what causes the second “dub” heart noise?

A

semilunar valves closes before diastole

90
Q

how do cardiac muscle fibres form atrial and ventricular networks?

A

via gap junctions at intercalated disks desmosomes

91
Q

how are impulses transmitted in the atrial network?

A

cell to cell conduction

92
Q

how are impulses transmitted in the ventricular network?

A

fibres in the conducting system,

93
Q

why are there no gap junctions between the atrial and ventricular networks?

A

bc they have to function as individual units

94
Q

what plexus innervates the heart?

A

cardiac plexus

95
Q

where is the deep plexus?

A

anterior to the carina

96
Q

where is the superficial plexus?

A

posterior to the aortic arch

97
Q

what does the cardiac plexus contain?

A

sympathetic
parasympathetic
general visceral afferents

98
Q

what are the two centres in the medulla oblongata?

A

cardionhibitory centre

cardioacceleratory centre

99
Q

how does the vagus slow down the heart rate?

A

ACh makes heart cells more permeable
K+ moves in
Hyperpolarisation
Decreases heart rate and force of contraction

100
Q

where are preganglionic sympathetic neurons found?

A

thoracic spinal cord

101
Q

where are postganglionic sympathetic neurons found?

A

innervating the SAN and AVN and to the coronary vascular smooth muscle

102
Q

how is cardiac referred pain felt?

A

stimulates visceral sensory nerve endings in the myocardium
ascend to CNS through cardiac branches of sympathetic trunk
organ and skin pain fibres go to the spinal cord together
pain isnt felt in the heart but is referred as though it came from somatic areas

c (25 decks)

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