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case two > anatomy of heart, pericardium and thorax > Flashcards

anatomy of heart, pericardium and thorax Flashcards

1
Q

label this diagram of the lungs, heart and great vessels

A

A - Right lung (Middle lobe of the right lung)

B - Right atrium of the heart

C - Right ventricle of the heart

D - Left lung (Superior lobe of the left lung)

E - Pulmonary trunk

F - Aorta (arch of the aorta)

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2
Q

which structures make up the inferior border of the heart?

A

LV, RV

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3
Q

which structures make up the superior border of the heart?

A

R and L atria, the great vessels (pulmonary artery, SVC and aorta)

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4
Q

which structures make up the left border?

A

LV, pulmonary artery

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5
Q

which structures make up the right border?

A

RA, SVC, IVC

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6
Q

identify the surfaces of the heart

A

A - Anterior surface

B - Left pulmonary surface

C - Diaphragmatic surface

D - Right pulmonary surface

E - Base

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7
Q

define pericardium

A

a membrane that covers the heart, consisting of 2 layers

  • An outer fibrous layer
  • An inner thin serous layer that reflects from the inside of the fibrous sac onto the surface of the heart (double layered)
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8
Q

describe the fibrous layer

A
  • Outer layer of the pericardium
  • Continuous with great vessels adventitia
  • Rigid structure
  • Prevents overfilling of the heart
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9
Q

describe the serous layer

A

Contained within the fibrous pericardial sac

Analogous to pleural membrane

Double layer

  • Visceral layer (epicardium) - the inner layer of the serous pericardium
  • Parietal layer - the outer layer of the serous pericardium

Between the double layer is a lubricating fluid which reduces the friction caused when the heart contracts

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10
Q

identify relevant structures in the image

A

1 Costodiaphragmatic recess

2 Diaphragm

3 Fibrous pericardium

4 Inferior lobe of left lung

5 Inferior lobe of right lung

6 Intercostal muscles

7 Line of anterior reflection of left pleura

8 Line of anterior reflection of right pleura

9 Middle lobe of right lung

10 Oblique fissure of left lung

11 Oblique fissure of right lung

12 Parietal pericardium

13 Parietal diaphragmatic pleura

14 Sternocleidomastoid

15 Second rib

16 Seventh rib

17 Superior lobe of left lung

18 Superior lobe of right lung

19 Thymic remnants

20 Transverse fissure of right lung

21 Visceral pericardium overlying myocardium

22 Visceral pleura

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11
Q

define pericarditis

A

inflammation of the pericardium, usually caused by a viral infection

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12
Q

define cardiac tamponade

A

acute pericardial effusion (fluid in the pericardial cavity)

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13
Q

how are pericardial sinuses formed?

A

when serous pericardium meets the great vessels, it reflects off and fuses with pericardium on other side, forming blind-ended spaces called pericardial sinuses

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14
Q

where is the transverse pericardial sinus?

A

posterior to aorta and pulmonary trunk

bounded superiorly by reflection of serous pericardium onto pulmonary arteries and inferiorly by reflection onto the upper pulmonary veins

under aortic arch

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15
Q

where is the oblique pericardial sinus?

A

posterior to the heart

mainly between posterior aspect of LV and the pericardial sac

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16
Q

name the two pericardial sinuses

A

transverse

oblique

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17
Q

label this diagram with the layer of the pericardium

A

A - Fibrous pericardium

B - Parietal layer of serous pericardium

C - Visceral layer of serous pericardium

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18
Q

label this diagram (hint: includes sinuses)

A

A - Oblique sinus

B - Inferior vena cava

C - Pulmonary veins

D - Right pulmonary artery

E - Transverse sinus

F - Superior vena cava

G - Aortic arch

H - Left pulmonary artery

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19
Q

label this diagram of heart (includes sulcus)

A

A - Anterior interventricular sulcus

B - Coronary sulcus

C - Apex

D - Inferior vena cava

E - Right ventricle

F - Right auricle

G - Ascending aorta

H - Superior vena cava

I - Aortic arch

J - Pulmonary trunk

K - Left auricle

L - Left ventricle

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20
Q

identify the structures on this cadaveric image of a heart

A

A - Right auricle

B - Right ventricle

C - Apex

D - Left ventricle

E - Pulmonary trunk

F - Aorta

G - Superior vena cava

H - Left pulmonary vein

I - Left auricle

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21
Q

what are the functions of the pericardium?

A
  • Fixes heart in mediastinum
  • Prevents overfilling of heart
  • Provides lubrication, reducing friction when the heart is pumping
  • Protection from infection
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22
Q

describe the route of blood flow through the heart

A
  1. Deoxy blood from inferior and superior parts of body travels through SVC AND IVC respectively into RA
  2. RA fills with deoxy blood
  3. Blood flow from RA into RV via tricuspid valve (AV valve)
  4. RV fills with deoxy blood
  5. Blood flows from RV into pulmonary trunk via pulmonary valve (semi-lunar valve)
  6. Pulmonary trunk splits into L and R pulmonary arteries. Blood flows through these to lungs to be oxygenated
  7. Once oxygenated, blood flows through pulmonary veins into LA
  8. LA fills w oxy blood
  9. Blood flows from LA into LV via bicuspid (mitral valve)
  10. LV fills with oxy blood
  11. Blood flows from LV into aorta via aortic valve
  12. Aorta becomes aortic arch where it gives off three main branches to superior body tissues and descending aorta supplies the inferior body tissues
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23
Q

which vessels return blood to the right atrium?

A

SVC and IVC

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24
Q

describe the atrioventricular orifice (right)

A

aperture in which blood slows from RA to RV where the tricuspid valve is positioned

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25
Q

describe the AV node

A

the electrical relay station between the atria and ventricles

located in posteroinferior region of interatrial septum near the opening of the coronary sinus

(RA feature)

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26
Q

describe the coronary sinus orifice

A

where most venous draining of the heart is returned to the heart’s circulation

located anteromedially

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27
Q

describe the crista terminalis

A

meaning: terminal crest

origin of pectinate muscles

sulcus terminalis acts as surface marking for internal crista terminalis

(RA feature)

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28
Q

name major features of the RA

A
  • AV orifice (right)
  • AV node
  • coronary sinus orifice
  • crista terminalis
  • eustachian valve
  • fossa ovalis
  • interatrial septum
  • pectinate muscles
  • right auricle
  • SA node
  • sulcus terminalis
  • thebesian valve
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29
Q

describe the eustachian valve

A

valve of inferior cava

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30
Q

describe the fossa ovalis

A

depression in the RA at the level of the interatrial septum (the wall between RA and LA)

embryological remnants of oval septal defect - foramen ovale

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31
Q

describe the interatrial septum

A

fibromuscular wall between LA and RA

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32
Q

describe the pectinate muscles

A

parallel ridges located in walls of atria

meaning: comb-like

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33
Q

describe the left/right auricle

A

muscular pouch that acts to increase capacity of the atrum

aka the right atrial appendage

34
Q

describe the SA node

A

pacemaker of the heart

located in posterior wall of RA, inferolateral to opening of SVC, along the superior part of the crista terminalis

35
Q

describe the sulcus terminalis

A

shallow depression marking point of fusion between venous part of the RA and the true RA

36
Q

describe the thebesian valve

A

valve of the coronary sinus

(RA feature)

37
Q

describe the chordinae tendineae

A

attach to cusps of AV valves and papillary muscles found in ventricles

act to secure the valves in place

38
Q

describe the conus arteriosus

A

anterosuperior portion of the RV of the heart from which the pulmonary trunk arises

39
Q

describe the interventricular groove

A

the groove positioned on the external surface which marks the separation between the two ventricles

40
Q

list the major features of the RV

A
  • Papillary muscle
  • Trabeculae carneae
  • AV orifice (right)
  • Chordae tendineae
  • Conus arteriosus
  • Interventricular groove
  • Interventricular septum
  • Moderator band
  • Pulmonary valve
41
Q

describe the interventricular septum

A

fibromuscular wall between LV and RV

42
Q

describe the moderator band

A

thick muscular strcutures which arises from interventricular septum and ends at the anterior papillaru muscles in the RV

acts as a shortcut for right AV bundle tract

43
Q

describe the papillary muscles

A

attached to the chordae tendinae which act to prevent the prolapse of the AV valves

in the RV, there is an anterior, posterior and septal papillary muscle

in the LV, there is an anterior and posterior

44
Q

describe the pulmonary valve

A

valve between RV and the pulmonary trunk

45
Q

describe the trabeculae carnae

A

irregular muscular columns found on internal surface of the ventricles of the heart

46
Q

which vessels return oxy blood to the LA?

A

pulmonary veins

47
Q

describe the AV orifice (left)

A

aperture in which blood flows from LA to LV

bicuspid valve positioned here

48
Q

describe the aortic valve

A

valve between aorta and LV

49
Q

identify the structures on this diagram of the RA

A
50
Q

label this diagram of the ventricles

A

A - Bicuspid (mitral) atrioventricular valve

B - Chordae tendinae

C - Papillary muscle(s)

D - Trabeculae carneae

51
Q

name the 2 types of valves in the heart

A

atrioventricular valves and the semilunar valves

52
Q

what are the two types of AV valves?

A

bicuspid (mitral) valve = between LA and LV

tricuspid valve = between RA and RV

53
Q

when do AV valves close?

A

start of ventricular systole, allowing blood to flow into the arteries and not back into the atria

54
Q

what are the two types of semilunar valves?

A

aortic valve = between LV and aorta

pulmonary valve = between RV and pulmonary trunk

55
Q

what is the function of semilunar valves?

A

stop blood flowing back into the ventricls during ventricular diastole

56
Q

how do valves cause heart sounds and which valves produce them?

A

closing of the valves causes heart sounds

1st heard sound ‘lub’ = closing of AV valves

2nd heart sound ‘dub’ = closing of semilunar valves

57
Q

what is the sequence of the conducting system?

A
  1. An excitation signal is produced by the sinoatrial (SA) node - Tte pacemaker of the heart
  2. This signal spreads across the atria, causing them to contract.
  3. The signal is delayed at the atrioventricular (AV) node as their are less gap junctions between cells on the approach. This is to ensure the atria have enough time to pump the blood into the ventricles before contraction.
  4. The signal is then conducted into the atrioventricular bundle (bundle of His), down the interventricular septum in left and right bundle branches.
  5. The bundle branches and the Purkinje fibres transmit the signal along the ventricle walls, causing them to contract.
58
Q

describe the fibrous skeleton

A

acts as electrical insulator between atria and ventricles

helps with the delay at the AV node

59
Q

identify the key components of the conduction system in this diagram

A

A - Sinoatrial node

B - Atrioventricular node

C - Septomarginal trabeculae (Moderator band)

D - Papillary muscle

E - Atrioventricular bundle (of His)

F - Interventricular septum

G - Purkinje fibres

60
Q

define coronary circulation

A

the blood supply to the heart

61
Q

what is the SA nodal artery a branch of?

A

RCA (60%)

LCA (40%)

62
Q

what is the posterior interventricular vein/posterior descending artery a branch of?

A

RCA (70%) - right dominance

LCA (10%) - left dominance

both (20%) - co-dominance

63
Q

define cardiac dominance

A

the vessel which gives rise to the posterior interventricular artery/posterior descending artery

64
Q

label this diagram of the coronary arteries

A
65
Q

label this diagram of the cardiac veins

A
66
Q

label the colours of the diagram with which vessel supplies it

A
67
Q

describe the intrinsic conducting system

A

Intrinsic conducting system = within heart

Made up of specialised cardiac muscle cells – not nervous tissues

68
Q

describe the extrinsic conducting system

A

Extrinsic conducting system = controlled by nerves

Controls heart rate, contraction force

69
Q

describe the components of the extrinsic conducting system

A
  • Parasympathetic innervation = vagus nerve (C10) - inhibits heart beat
  • Sympathetic innervation = sympathetic trunk - stimulates heart beat
  • Cardiac plexus (superficial and deep) = network of parasympathetic and sympathetic nerves
70
Q

list the components of the intrinsic conducting system

A
  • SA node
  • AV node – close to coronary sinus and tricuspid valve
  • AV bundle (bundle of His) - membranous part intraventricular septum
  • Purkinje fibres
  • Papillary muscles
  • Right bundle branch
  • Moderator band – shortcut to anterior papillary muscle
71
Q

define angiogram

A

type of x-ray which uses a contrast dye in order to visualise blood vessels

72
Q

what is the clinical significance of cardiac dominance?

A
  • implant planning for operations
  • people with left dominance can be at more risk of some heart problems
73
Q

what does the RCA supply?

A
  • RA
  • bit of RV
  • SA node
  • AV node
74
Q

which chambers does the left marginal coronary artery supply?

A

LV

75
Q

which chambers does the right marginal coronary artery supply?

A

RV

76
Q

which chambers does the left anterior descending coronary artery supply?

A
  • mostly RV
  • bit of LV
77
Q

which chambers does the circumflex supply?

A
  • LA
  • bit of LV
78
Q

which chambers does the posterior interventricular artery (aka post descending artery) supply?

A

bit of both ventricles

79
Q

where does the coronary sinus drain into?

A

vena cava

80
Q

list the cardiac veins

A
  • Anterior interventricular veins
  • Great cardiac vein
  • Posterior cardiac vein
  • Middle cardiac vein
  • Small cardiac vein
  • Coronary sinus
81
Q

identify the structures by the surface anatomy

A

A - Clavicle

B - Jugular notch

C - Manubrium of the sternum

D - Sternal angle

E - Sternal body

F - Xiphoid process

G - Costal margin

H - Costal cartilage

I - Ribs

case two (10 decks)

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