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CARDIO - RESP BLOCK > ANATOMY of the heart > Flashcards

ANATOMY of the heart Flashcards

1
Q

What are the features of the thorax?

A

Superior thoracic aperture

Inferior thoracic aperture

Thoracic wall

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2
Q

The thoracic cavity contains?

A
  • Two pleural cavities

- The mediastinum

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3
Q

On average a heart pumps?

A

5/6 L blood/min

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4
Q

Location of the heart

A

5th Intercostal midclavicular line

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5
Q

What is the Pericaridium

A

Specialised double walled sac that contains :

  • heart
  • roots
  • great vessels
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6
Q

Functions of pericardium

A

• Confines the heart to the middle of the inferior mediastinum
• Allows sufficient free movement
• Provides lubrication between the external
surface of the heart and the inner
pericardial layer
• Prevents excessive dilation of the heart
• Protects from infection

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7
Q

The pericardium is anchored in place superiority ?

A

Superiorly by the great vessels – it is continuous with the adventitia layer of the great vessels

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8
Q

The pericardium is anchored in place anteriorly?

A

Anteriorly by sterno-pericardial ligaments which attach to the posterior surface of the sternum

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9
Q

The pericardium is anchored posteriorly ?

A

Posteriorly by loose connective tissue to structures in the posterior mediastinum

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10
Q

The pericardium is anchored inferiority?

A

Inferiorly by the central tendon of the diaphragm

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11
Q

What are the layers of the Pericardium?

A

Fibrous pericardium

Serous pericardium

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12
Q

Layers of serous pericardium

A

Parietal serous pericardium

Visceral serous pericardium

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13
Q

What is the fibrous pericardium ?

A

The tough conical outermost layer, whose apex is pierced by the aorta, pulmonary trunk and SVC. Dull in appearance.

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14
Q

What is the pericardial cavity ?

A

Potential space between parietal and visceral serous pericardium.

CONTAINS PERICARDIAL FLUID

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15
Q

What is the Parietal serous pericardium?

A

Lines inner surface of the fibrous pericardium

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16
Q

What is the Visceral pericardium?

A

Aka EPICARDIUM

lines the surface of the heart

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17
Q

Nerve supply of Fibrous layer of pericardium

A

Phrenic- main sensory and motor supply

Vagus nerve (CN X) and sympathetic nerves

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18
Q

Nerve supply of Parietal layer of Serious Pericardium

A

Phrenic main sensory and motor supply

Vagus (CN X) and sympathetic nerves

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19
Q

Which layer of the Serous pericardium is insensate- not perceived by senses?

A

Visceral

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20
Q

Arterial supply of Pericardium

A
  1. Pericardiophrenic & musculophrenic arteries
    Main supply
  2. Pericardial arteries - supply dorsal pericardium
  3. Coronary arteries - supply epicardium
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21
Q

Main blood supply of pericardium

A

Pericardiacophrenic & musculophrenic arteries

From internal thoracic artery

From subclavian

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22
Q

Blood supply to dorsal pericardium

A

Pericardial arteries

From bronchial, oesophageal and superior phrenic arteries

From thoracic aorta

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23
Q

Blood supply to epicardium

A

Coronary arteries

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24
Q

Explain venous supply of pericardium

A

Veins of pericardium enter at :

  • Accessory hemiazygos vein
  • internal thoracic vein - pericardiophrenic veins
  • hemiazygos vein
  • azygos vein
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25
Q

What are the borders of the heart In a standard postero-anterior (PA) view on a chest radiograph?

A

Right border = SVC, RA, IVC

Left border = The arch of the aorta,
pulmonary trunk, left auricle, LV

Inferior border = RV, LV at the apex

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26
Q

Coronary sulcus contains

A

Right coronary artery

Small cardiac vein

Coronary sinus

Left circumflex artery

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27
Q

What is the Coronary sulcus?

A

Separates atria and ventricles

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28
Q

What is the Anterior interventricular sulcus?

A

Anteriori partition between ventricles

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29
Q

Anterior interventricular sulcus contains?

A

Anterior interventricular artery

Great cardiac vein

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30
Q

What is the Posterior interventricular sulcus?

A

Posterior partition between ventricles

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31
Q

Posterior interventricular sulcus contains

A

Posterior interventricular artery

Middle cardiac vein

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32
Q

Layers of heart

A

Epicardium - outermost

Myocardium - muscular

Endocardium - thin inner layer

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33
Q

Which layer of the heart contains myocytes?

A- epicardium
B- myocardium
C- endocardium

A

B

Myocardium

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34
Q

Features of Epicardial fat

A
  • Lies between the epicardium (visceral pericardium and the myocardium of the heart
  • Accumulates around the coronary arteries
  • increased amounts are associated with CVD; atherosclerosis and obesity
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35
Q

Chambers of the Heart

A

Right atrium

Right ventricle

Left atrium

Left ventricle

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36
Q

Features of Right Atrium

A

Forms right border/ a portion of the heart’s anterior surface

The SVC, IVC and coronary sinus all return deoxygenated blood to the RA.
This blood enters the RV through the right AV orifice, (location of the tricuspid valve)

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37
Q

What is the muscular ridge that internally in the right atrium?

A

Crista terminalis - divides sinus of venar from atrium proper

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38
Q

What is the muscular ridge of the right atrium called externally?

A

Sulcus terminal is

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39
Q

The fossa oval is is a remnant of the ?

A

Foramen ovale - connects the atria in the fetal circulation

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40
Q

At what depression does the fossa oval is exist?

A

At the level of the inter atrial septum ( separates left atrium and right atrium)

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41
Q

Which structure forms right border - anteriori surface of heart ?

A

Right atrium

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42
Q

Which structure form most of the heart’s anterior surface and some of the diaphragmatic surface?

A

Right ventricle

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43
Q

How does blood Exeter the right ventricle?

A

From the RA through the tricuspid valve in a HORIZONTAL FORWARD DIRECTION

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44
Q

Key features of Right Ventricle

A
  • Inflow portion (conus arteriosus)
    Smooth-walled and located on the superior aspect of the ventricle, near the opening to the pulmonary artery
  • Outflow portion
    Walls contain irregular muscular columns (trabeculae carnae) - increases the heart’s mechanical and conductive performance
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45
Q

Types of Trabeculae Carnae

A
  • Ridges
  • Bridges
  • Pillars
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46
Q

Contraction of which muscles prevents prolapse/ eversion of cusps intro atria during systole?

A

Papillary muscles attached to AV valve

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47
Q

Example of Bridges?

A

Moderator band

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48
Q

Example of pillars in Trabeculae carnae

A

Papillary muscles - attach to tricuspid valve via cusps via chordate tendinae

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49
Q

The left atria forms?

A

The base of the heart

50
Q

The left atrium receives blood from ?

A

Pulmonary vein through mistrial valve, to LV

51
Q

Fractures of Left Atrium compared to RA?

A

Also has a (left) auricle
Interior surface consists of a smooth inflow portion, and a more rugged outflow portion (lined by pectinate muscle)

NO CRISTA TERMINALIS

52
Q

Location of Left ventricle in situ

A

Contributes to the anterior, diaphragmatic, and left pulmonary surfaces of the heart, and forms the apex

53
Q

Features of LV compared to RV

A

CHAMBER IS LONGWR

MYOCARDIUM IS THICKER

Trabecular carneae: Finer and more delicate

NUMBER OF PAPILLARY MUSCLES : Has TWO (rather than three) attaching to the cusps of the mitral (rather than tricuspid) valve leaflets

Size of PAPILLLARY MUSCLES: Those in LV are LARGER

NO MODERATOR BAND:
Blood enters ascending aorta through aortic valve (rather than pulmonary trunk through pulmonary valve)

54
Q

What are semilunar valves?

A

Aortic and pulmonary valves

Each valve has 3 crescent-shaped cusps

OPEN&raquo_space; Lets blood enter the pulmonary and
systemic circulations

CLOSE&raquo_space; Prevents back flow of blood from the
pulmonary trunk/aorta into the RV/LV

55
Q

Closure of which valves creates the sound DUB

A

Semi-lunar valves

56
Q

Do semilunar valves contain chordae tendinae?

A

No

Function like valves in veins

57
Q

The heart has a dense fibrous (cardiac) skeleton comprised of 4 connective tissue rings, which are?

A
  • Fibrous ring of pulmonary valve
  • Fibrous ring of aortic valve
  • Right atrioventricular ring
  • Left atrioventricular Ring
58
Q

Describe adult circulation

A
  1. SVC from systemic circulation
  2. RA
  3. RV via tricuspid valve
  4. Pulmonary arteries via pulmonary valve
  5. Lungs to get oxygenated
  6. Pulmonary veins from pulmonary circulation
  7. LA
  8. LV via biscuspid / mitriai valve
  9. Aorta via aortic valve
  10. Aorta to systemic circulation
59
Q

Collectively the right side of the heart in adults is the ?

A

Pulmonary circuit

60
Q

Collectively the left side of the heart is the?

A

Systemic circuit

61
Q

What are the 3 vascular shunts in fetal circulation?

A
  1. Foramen ovale
  2. Ductus arteriosus
  3. Ductus venosus
62
Q

Where us the Foramen ovale in the fetal circulation?

A

Between the atria. Blood bypasses the pulmonary circulation.

63
Q

Where is the Ductus arteriosus?

A

Links the distal arch of aorta with the pulmonary trunk.

Blood bypasses the pulmonary circulation.

64
Q

Where is the Ductus venosus?

A

Shunts 30% of umbilical blood from the primitive liver, to the IVC to ensure enough oxygen reaches the developing brain

65
Q

Why does the fetal circulation have three vascular shunts ?

A

To allow blood to bypass the liver and non-functioning lungs

66
Q

How does the Foramen ovale close in the fetal circulation?

A

A baby’s first breath causes a decrease in pulmonary vasculature resistance, which increases the relative pressure in the LA > RA and causes the foramen ovale to close

67
Q

How do the ductus arteriosus and venosus close in fetal circulation?

A

Increased O2 concentration within the blood leads to decreased prostaglandins (bradykinin), causing the walls of the ductus arteriosus and venosus to contract and close.

68
Q

What vessels supply oxygenated blood to the myocardium?

A

Right Cronary Artery and Left Coronary Artery

RCA & LCA

69
Q

RCA and LCA arise from?

A

Aorta at the aortic sinuses, just above the aortic valve

70
Q

RCA and LCA reside?

A

In the CORONARY SULCUS

71
Q

LCA arises from?

A

Left aortic sinus of th ascending aorta

72
Q

Branches of LCA

A
  1. Anterior interventricular artery (left anterior descending – LAD)
  2. Circumflex (LCx) artery
73
Q

Function of fibrous skeleton (cardiac) in heart

A

Maintain shape & support

Attachment site for valves & myocardium

Electrical insulation

74
Q

What is the anterior interventricular artery (left anterior descending - LAD)

A

Travels towards apex in the anterior interventricular sulcus.

Sometimes gives off diagonal branches

75
Q

What is the Circumflex artery

A

Courses left in the coronary sulcus onto the base/diaphragmatic surface of the heart.

The left marginal artery usually arises from the LCx and travels along the obtuse margin of the heart

76
Q

Branches of RCA

A
  1. Atrial branch
  2. Right marginal branch
  3. Atrio-ventricular branch
  4. Posterior interventricular branch
77
Q

Describe Atrial branch

A

Between the right auricle and ascending aorta.

Gives off sinu-atrial nodal branch (which supplies the SAN)

78
Q

Describe Right marginal branch

A

Travels from the heart’s inferior margin towards the apex

79
Q

Describe Atrio-ventricular branch

A

Small branch supplying AV Node

80
Q

Describe Posterior interventricular branch

A

Comes from RCA as it travels along the diaphragmatic surface/ base of the heart.

Lies in the posterior interventricular sulcus

81
Q

RCA supplies ?

A

RA and RV

82
Q

Right marginal artery supplies ?

A

RV and Apex

83
Q

Left marginal artery supplies ?

A

LV

84
Q

Left anterior descending artery supplies?

A

RV, LV and Interventricular septum

85
Q

Left circumflex artery supplies?

A

LA and LV

86
Q

Explain Coronary dominance

A

Determined by origin of posterior descending artery (PDA), which supplies the posterior 1/3 of the interventricular septum

87
Q

SA and AV nodes are supplied by?

A

RCA in 69% and 90 % of cases respectively

NB: The circumflex branch of the LCA sometimes supplies these structures instead.

88
Q

What is the coronary sinus?

A

Large venous structure located in the coronary sulcus on the posterior surface of the heart

89
Q

Coronary sinus collects and empties venous blood from?

A

Great, middle, small and posterior cardiac veins directly into the right atrium

90
Q

Coronary veins

A
  • Great cardiac ( anterior interventricular) vein
  • Middle cardia (posterior interventricular) vein
  • Posterior cardiac vein
  • Small cardiac vein
  • Anterior cardiac veins
  • Smallest cardiac veins
91
Q

Begins at the apex of the heart
Ascends in the anterior interventricular sulcus alongside the anterior interventricular artery (LAD) Continues onto the base/diaphragmatic surface of the heart, where it travels in the coronary sulcus alongside the circumflex branch of the LCA
It gradually enlarges to form the coronary sinus

Which vein is that?

A

Great cardiac (anterior interventricular) vein

92
Q

Begins at the apex of the heart
Ascends in the posterior interventricular sulcus alongside the posterior interventricular artery (PDA) towards the coronary sinus

Which vein is that ?

A

Middle cardiac (posterior interventricular) vein

93
Q

Lies on the posterior surface of the LV just to the left of the middle cardiac vein
It either enters the coronary sinus directly or joins the great cardiac vein

Which vein is that?

A

Posterior cardiac vein

94
Q

Lies on the posterior surface of the LV just to the left of the middle cardiac vein
It either enters the coronary sinus directly or joins the great cardiac vein

Which vein is that?

A

Small cardiac vein

95
Q

Arise on the anterior surface of the RV, cross the coronary sulcus and enter the anterior wall of the RA

Which vein is that?

A

Anterior cardiac veins

96
Q

Drain directly into the cardiac chambers. Most numerous in the RA and RV

Which vein is that ?

A

Smallest cardiac veins

97
Q

What nodes and networks initiate and coordinate contraction ?

A

SA NODE

AV NODE

AV BUNDLE (left and right branches)

PURKINJE FIBRES

98
Q

Features of SA node

A
  • Cardiac pacemaker

* Located in the right atrium near the SVC entrance

99
Q

Features of AV node

A
  • Located near opening of coronary sinus

* Demarks the beginning of AV bundle

100
Q

Features of AV bundles

A

• Travels along the interventricular septum before forming R and L bundle branches, which travel towards the apex

• NB - The right bundle branch enters the septo-marginal trabecula to reach the anterior papillary muscle before
dividing into Purkinje fibres – smaller terminal branches which spread excitation impulses through the ventricles

101
Q

Key features of cardiac conduction system

A
  1. Unilateral pathway of excitation/contraction
    - Co-ordinated myocardial contraction
  2. Large conduction branches are insulated
    - Decreasing inappropriate stimulation
    of myocardial tissue
102
Q

Cardiac conduction is initiated where ?

A

Sinoatrial node - SAN

103
Q

What regulates heart rate, force of contraction and cardiac output ?

A

Autonomic nervous system = sympathetic and parasympathetic

Via cardiac plexus

104
Q

How is the desired innervation effect reached in the heart?

A

Branches of mixed nerves supplying the heart via the cardiac plexus affect the conduction system, coronary blood vessels, and atrial and ventricular musculature to achieve their desired effect

105
Q

Explain sympathetic innervation of the heart

A

Sympathetic chain: T1 – T4, sometimes T5 too

→ cervical cardiac & thoracic cardiac nerves
- cardiac plexus
→ branches to the SA & AV nodes & directly to myocardium

= ↑ rate & force of contraction

106
Q

Explain Parasympathetic innervation

A

Sympathetic chain: T1 – T4, sometimes T5 too
→ cervical cardiac & thoracic cardiac nerves

  • cardiac plexus
    → branches to the SA & AV nodes & directly to myocardium

= ↓ rate & force of contraction

107
Q

Explain Visceral innervation

A

Afferent fibres pass through cardiac plexus and return to CNS via sympathetic trunk and vagal cardiac branches

     = Alterations in BP and blood chemistry
108
Q

Why does Referred pain occurs?

A

Referred pain occurs because the brain cannot distinguish between sensory input from visceral sensory neurons within the ANS (supplying heart) and spinal nerves from the somatic nervous system (supplying skin sensation)

109
Q

What is the angle of Louis ?

A

Sternal angle

110
Q

Listen 2nd ICS, right sternal border for?

A

Aortic valve

111
Q

Listen 2nd ICS, left sternal border for?

A

Pulmonary valve

112
Q

Listen 5th ICS, mid-clavicular line (APEX) for?

A

Mitral valve

113
Q

Listen 4th ICS, right sternal border for?

A

Tricuspid valve

114
Q

The left atrium and ventricle drain into?

A

RIGHT jugulo-subclavian junction

115
Q

The right atrium and ventricle drain into?

A

The LEFT jugulo-subclavian junction

116
Q

AP imaging of the heart

A

Heart appears enlarged (cardiomegaly) and heart details are difficult to visualise Mediastinum appears widened

117
Q

PA imaging of the heart

A

Heart is not magnified and markings are well delineated

Mediastinum is not widened

118
Q

What is a Coronary Angiogram?

A

Method of visualising blood flow through the coronary arteries

A radio-opaque contrast (dye) is injected into the blood vessel (using a catheter) and XR images are taken to see how the dye moves through the artery

119
Q

What is a Percutaneous Coronary Intervention (coronary angioplasty)?

A

Involves using a balloon to widen a stenosed or occluded artery. A stent is left in place to prevent recurrence

120
Q

How is Myocardial Infarction (MI) developed?

A

Occlusion&raquo_space; Reduced blood (and oxygen) supply to myocardium&raquo_space; myocardial necrosis

121
Q

Uses of Cardiac CT

A

Evaluation of coronary arteries

Presence of cardiac masses

Aortic abnormalities
- e.g. aortic dissection

Pericardial disease
- e.g. pericarditis

122
Q

Uses of MRI in the heart?

A

To assess heart perfusion, for scarring, anatomic defects or masses. Can also assess the function of cardiac chambers and valves

CARDIO - RESP BLOCK (13 decks)

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