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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
explain the mechanism of reflex tachycardia
increased systolic pressure baroreceptors in the aorta detect this increase heart contractions temporarily to increase SV (reflex tachycardia)
26
what is pericardiocentesis?
a treatment for cardiac tamponade where the fluid is drained from the pericardial sac
27
name the three methods of pericardiocentesis
subxiphoid parasternal apical
28
name the layers of the heart
epicardium myocardium endocardium
29
what does the epicardium attach to?
the visceral layer of the serous pericardium
30
what is the myocardium made of?
cardiac muscle fibres arranged in bundles
31
where is the endocardium found?
continuous with endothelium | lining chambers and valves
32
what is another name for the coronary sulcus?
coronary groove | atrioventricular sulcus
33
what is the coronary sulcus?
the oblique plane which separates the atria and the ventricles
34
what are the auricles?
extensions/appendages of the atria, allowing more blood to be held
35
where does the right atrium receive blood from?
vena cava | coronary sinus
36
what is the coronary sinus?
a collection of veins that join together to form a large vessel which collects blood from the heart muscle
37
where is the coronary sinus?
posterior surface of the heart in the heart muscle
38
what is the fossa ovale?
one of the two fetal cardiac shunts which moved blood from the right atrium to the left atrium
39
when does the fossa ovale close?
at birth
40
what is the crista terminalis?
the ridge that divides the anterior and posterior wall
41
what is the sulcus terminalis?
how the crista terminalis is seen externally
42
what do pectinate muscles do?
reinforce/protect the wall during filling
43
what is the sinus venarum?
smooth region of the right atrium which receives input from the vena cava and the coronary sinus
44
how many papillary muscles does the tricuspid valve have?
three
45
name the papillary muscles of the tricuspid valve
septal posterior anterior
46
what do the papillary muscles do?
anchor the chordeae tendinae
47
what do chordae tendineae do?
cord like structures which attach onto valves to stop them from inverting into the atrium
48
what are trabeculae carneae?
rounded or irregular muscular columns which project from the inner surface of the right ventricle
49
how are trabeculae carneae different from pectinate muscles?
trabeculae carneae are found in the ventricles while pectinate muscles are found in the atria
50
what do trabeculae carneae do?
help papillary muscles in contraction prevent cusps from inverting stop chambers from sucking together
51
what is another name for the septomarginal trabecula?
moderator band
52
where is the moderator band?
part of the trabeculae carneae | runs from the septum to the margin of the heart muscle
53
what is the function of the moderator band?
helps speed of conduction
54
what does the interventricular septum do?
carries the bundle of His and the AV bundles before they separate into the Purkinje fibres
55
where does the left atrium receive oxygenated blood from?
pulmonary veins
56
where are pectinate muscles found in the left atrium?
left auricle
57
how many pectinate muscles are found in the left atrium?
very few
58
how many papillary muscles does the mitral valve have?
2
59
what are aortic sinuses?
dilations in the aorta in the semilunar cusps
60
name the aortic sinuses
left right middle
61
how does blood leave each of the aortic sinuses?
left and right - leave via coronary arteries | middle - no arteries leaving
62
where do the left and right coronary artery stem from?
the root of the aorta
63
what is another name for the left coronary artery?
left main stem
64
what does the left coronary artery branch into?
circumflex artery anterior interventricular (LAD) lateral branches
65
what is another name for the anterior interventricular arteries?
left anterior descending
66
what part of the heart does the circumflex artery supply?
the outer side and back of the heart
67
what part of the heart does the left anterior descending supply?
front of the left side
68
what part of the heart does the right coronary artery supply blood too?
right ventricle right atrium SAN AVN
69
what does the right coronary artery branch into?
posterior descending artery | acute marginal artery
70
how much of the septum is supplied by the LCA?
2/3
71
`how much of the septum is supplied by the RCA?
1/3
72
what blood vessel determines the dominance of the heart?
posterior descending artery
73
what is the most common site of occlusion in a myocardial infarction?
coronary arteries 1 - LCA 40/50% 2 - RCA 30-40% 3 - circumflex 15-20%
74
how can damage to the coronary arteries damage the conducting system?
LAD to the septal branches supplies the AV bundles RCA supplies the SAN and AVN heart block
75
what are the different views in a coronary angiogram?
left anterior oblique right anterior oblique anterior-posterior
76
where are coronary veins found?
following the course of the arteries
77
what do coronary veins do?
collects waste from cardiac muscle and drains into coronary sinus
78
what is the fibrous skeleton of the heart made up of?
dense connective tissue
79
describe the structure of the fibrous skeleton
4 fibrous rings, with each one surrounding each of the valves fuse together and merge with the interventricular septum
80
what is the function of the fibrous skeleton?
supports/anchor the cusps prevents overstretching of the valves attachment point for myocardium electrical insulator between atria and ventricles
81
when do the AV valves open?
when atrial pressure is greater than ventricular pressure
82
how do AV valves open?
ventricles relax chordae tendineae slack papillary muscles relax
83
when do AV valves close?
ventricular pressure is higher than atrial pressure
84
how do AV valves close?
ventricle contract chordae tendineae pulled taut papillary muscles contract to pull cords and stop cusps from inverting
85
how many cusps do the semilunar valves have?
3
86
how do semi-lunar valves open and close?
by passive action | weight of the blood on the vessels causes them to close
87
when do semi-lunar valves open and close?
open in ventricular systole | close in ventricular diastole
88
what causes the first "lub" in the heart noise?
closing of AV valves just before systole
89
what causes the second "dub" heart noise?
semilunar valves closes before diastole
90
how do cardiac muscle fibres form atrial and ventricular networks?
via gap junctions at intercalated disks desmosomes
91
how are impulses transmitted in the atrial network?
cell to cell conduction
92
how are impulses transmitted in the ventricular network?
fibres in the conducting system,
93
why are there no gap junctions between the atrial and ventricular networks?
bc they have to function as individual units
94
what plexus innervates the heart?
cardiac plexus
95
where is the deep plexus?
anterior to the carina
96
where is the superficial plexus?
posterior to the aortic arch
97
what does the cardiac plexus contain?
sympathetic parasympathetic general visceral afferents
98
what are the two centres in the medulla oblongata?
cardionhibitory centre | cardioacceleratory centre
99
how does the vagus slow down the heart rate?
ACh makes heart cells more permeable K+ moves in Hyperpolarisation Decreases heart rate and force of contraction
100
where are preganglionic sympathetic neurons found?
thoracic spinal cord
101
where are postganglionic sympathetic neurons found?
innervating the SAN and AVN and to the coronary vascular smooth muscle
102
how is cardiac referred pain felt?
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

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