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A&P 2 > Anatomy of the Heart > Flashcards

Anatomy of the Heart Flashcards

1
Q

where does the apex of the heart rest during maximal inspiration

A

fibrous tendon of the diaphragm

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2
Q

how does the phrenic nerve innervate the diaphragm

A

pierces the diaphragm and innervates it from beneath

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3
Q

what might irritatoin of the pericardial sac to?

why?

A

cause referred pain in the C3, 4, 5 dermatomes

-phrenic nerve also traverses the pericardial sac

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4
Q

where are the heart and esophagus located in the mediastinum

A

heart is in the middle mediastinum and esophagus is in the post mediastinum

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5
Q

what is the boundary btwn the sup and middle mediastinum?

A

manubrium-sternal junction and 4-5 intervertebral disk

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6
Q

where does the post mediastinum run from?

A

T5-T12

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7
Q

where are the esophagus and descending aorta located

A

post mediastinum

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8
Q

what is located at T8? T10? T12?

A

inf vena cava
esophagus and vagus
descending aorta

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9
Q

what are the layers of the sac (pericardium)

A

outer, thick fibrous layer

inner serous layer

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10
Q

what is the structure and role of the pericardium?

A

simililar to pleura and peritoneal lining

  • protects the organ and lines the body wall
  • fluid btwn layers
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11
Q

what kind of cells are in the serous layer?

what do they produce?

A

monolayer of mesothelial cells which produces a small amount of fluid

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12
Q

what does the pericardial cavity contain

what kind of tissue is aggregated here

A

small amount of fluid which lubricates the heart as it contracts

brown adipose tissue

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13
Q

the outer fibrous coat loosely is around the heart and on the outer surface of the great vessels except the what?

A

inf vena cava

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14
Q

what does each layers of the double inner serous coat do

A

one layer is closely adherent to the heart and the other lines the inner surface of the outer coat w/ the intervening space being filled w/ pericardial fluid

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15
Q

what does brown fat in the serous space provide? how does it differ from white adipose tissue

A

energy source and heat

white is only for energy storage

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16
Q

what is a cardiac tamponade

what may one experience from this?

A

too much fluid btwn the serous layers in the pericardial sac

-may experience mechanical compression of the heart, restricting its movements

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17
Q

why is brown fat cool to have in the serous space

A

having heat generating material next to the heart is helpful in spreading warmth throughout the body

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18
Q

when may pericardidtis appear

A

after bypass surgery in which the pericardial sac has been cut to reveal vessels

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19
Q

what may the inflammation from pericarditis produce?

A

an exudate, which is an ultrafiltration of plasma

-the exudate is called the pericardial effusion

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20
Q

what are the 5 layers of heart tissue

A
  1. epicardium
  2. sub-epicardium
  3. myocardium
  4. sub-endocardium
  5. endocardium -lines atrium or ventricles
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21
Q

what does sub-epicardium contain

A

arteries, veins, coronary sinus

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22
Q

what does sub-endocardium contain

A

veins, nerves, purkinje fibers

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23
Q

which layer of the heart is most prone to ischemia (lack of blood flow) and infarctions (necrosis as a result of ischemia)

A

sub-endocardium

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24
Q

why can an infarction of the sub-endocardium cause a lot of damage

A

purrkinje fibers spread the electrical signals from the SA/VA nodes
-may damage the electrical conduction system, requiring a pacemaker

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25
Q

why is the sub-endocardium more prone to ischemic damage

A

bc there is no blood flow during systole in subendocardium

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26
Q

what is the ligamentum arteriosum?

A

remains of ductus arteriosus(bypassed the lungs) btwn pulmonary trunk and aortic arch

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27
Q

what is the conus arteriosis

A

fetal structure which gives rise to the pulmonary trunk

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28
Q

what is the blood flow within the heart

A

sup and inf vena cava, RA, RV, pulmonary trunk, pul arteries, lungs, LA, LV, aortic valve, body

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29
Q

what is tricuspid and what is bicuspid

A

tricuspid: pulmonary valve (RV to PA), aortic valve (LV to aorta), AV valve (RA to RV)
bicuspic: mitrial (LA to ventricle)

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30
Q

when does the descending aorta pierce the diaphragm?

when does it branch into the common iliac arteries?

A

T12

L4

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31
Q

what does the external iliac go under? what does it become?

A

under the inguinal ligament and becomes the femoral artery

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32
Q

what does the internal iliac nourish

A

pelvic region

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33
Q

where does the common iliac vein join the inf vena cava?

A

at about the same level the ciliac artery bifurcates

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34
Q

why can the venous system keep the iliac vein open on the left side?
what happens on the right side

A
  • enough negative pressure in the venous system to keep the vein open
  • right side, the artery (right common illiac) crosses the vein
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35
Q

why can venous pressure be compromised during pregnancy

A

bc of increased abdominal pressure, left artery and vein are compressed against the body wall side by side.
-right artery presses on the vein, compromising venous return resulting to venous stasis

-greater/sooner on RIGHT

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36
Q

in venous drainage into the RA, where do internal jugular veins end

A

subclavians

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37
Q

what is the anterior wall of the RA made of? what is the ridge along the lateral side of the RA called?

A

pectinate muscles

crista terminales

38
Q

why is the arrangement of trabeculae carnae good

A

good for generating significant force w/o much muscle weight

39
Q

where is the SA node located

A

on the post wall of the R

-close to entry point of SVC

40
Q

what is the fossa ovalis the remnant of

-when does this clsoe

A

of the foramen ovale-fetal opening btwn the right and left atrium which floses/fibroses upon the 1st breath

41
Q

how are the walls of the right and left ventricles compared

A

wall of left is twice as thick as the right

42
Q

what happens in RV failure

A

RV works harder to pump blood through the lungs and consequently there’s pressure backup into the RA and vena cavas

-caused by lung disease

43
Q

what do valves have on all sides? what is in the middle?

A

endocardium on all sides

fibrous tissue in the middle

44
Q

what edema? what happens when standing and lying down

A

venous system begins to leak fluid

-when standing, fluid acculmulates in lower lets, when lying down, it redistributes

45
Q

how is chordae tendinae and papillary muscles connected

A

one papillary muscle has linkages (also made of endocardium and fibrous tissue) to 2 separate valves

46
Q

how many papillary muscles are on the left and right

A

2 on left and 3 on right

47
Q

what is trabeculae carnae

A

muscle lining the ventricles

48
Q

papillary muscles are an extension of what

A

myocardium

49
Q

how is blood flow back to the atria prevented

A

a split second before the ventricles contract, papillary muscles contract, so valvle leaflets can be tightly held closed against the pressure from ventricle contraction

50
Q

in what disesases does mitrial valve prolapse occur

A

marfan syndrome
graves disease
hypertension

51
Q

what happens in mitral valve prolapse

A

some blood in the LV gets regurgiated/squirted back into the LA
-audibly detectable as a heart murmur

52
Q

how do poeple w/ marfan syndrome look like `

A

tall, long limbs, long and thin fingers

-thin women w/ minor chest wall deformities, scoliosis

53
Q

what causes marfan syndrome

A

dominant mutation in the fibrillin-1 gene

-found in elastic/non elastic fibers in connective tissues

54
Q

where is fibrillin-1 found in

A

elastic/non elastic fibers in connective tissues

55
Q

what are patients more prone to when they have marfan syndrome

A

lung problems (spont pneumothroax), aortic dilation or aortic aneurysm, scoliosis, eye problems

  • subluxation (dislocation) of the cyrstalline lens (lens suspended from ciliary body by elastic fibers) in one or both eyes (ectopia lentis) occurs in 80% pts
  • nearsightedness
  • astig
56
Q

when does mitral stenosis occur

A

occurs following group A beta hemolytic streptococcal (GABHS) paryngitis in children-rheumatic fever

57
Q

what is the problem in mitral stenosis

what can this cause

A

problem getting blood into the left ventricle
-fast, turbulent blood flow btwn left atria and ventricle

  • can cause left atrial fibrillation bc atrium must work much harder to get blood into the ventricle
  • fluid may be backed up into the lungs leading to respiratory distress and pulmonary edema
58
Q

what did pathologic examination of the mitral valve in mitral stenosis reveal

A

scarring: proliferation of fibroblasts and macrophages

59
Q

what do the serum of the patients with mitral stenosis from strep throat, leading to rheumatic fever contain

A

antibodies which cross-react w/ myocardial tissue

  • antibodies to type 5 streptococcal M protein
  • cross react w/ myosin in myocardial tissue
60
Q

why can different parts of the heart fail?

A

bc of a direct myocardial infarction as opposed to some systemic disease

61
Q

how can a pt with atherosclerosis (plaque build up in vessels) lead to left ventricular failur

A

leads to increased peripheral vascular resistance

  • LV works much harder which leads to hypertrophy, weakening the mucsle
  • left heart failure inevitably leads to right failure leading to death
62
Q

what do right and left coronary arteris arise from

A

right coronary artery arises from an aortic sinus

left coronary artery arises from left post sinus

63
Q

where is the apex of the heart located

A

5th intercostal space ~9cm left of the sternum

-roughly aligned w/ the xiphoid process of the sternum

64
Q

where are th eopenings for the coronary artiers

A

at the base of the (right) ant and left post aortic valves

65
Q

what grooves do the left coronary artery and right coronary artery lie in

A

left: interventricular groove
right: coronary groove

66
Q

when do the left and right coronary artiers fill

A

during diastole (relaxation)

67
Q

what are symptoms of a heart attack

A 
crushing chest pain
anxiety
difficulty breathing
nausea, vomiting
sweating
pallor
68
Q

what is atherosclerosis

A

a disease of large and medium muscular arteries w/ several indications:

  • endothelial dysfunction
  • vascular inflammation
  • clotting: buildup of lipids, Ca, and cellular debris in the tunica intima
69
Q

what is arteriosclerosis

A

similar to atherosclerosis but w/o fatty plaque buildup

70
Q

what can happen if atherosclerosis comes on slowly

why can a fast blockage be more dangerous

A

collateral branches of coronary arteries (few) may sprout around the clot
-a fast blockage can be more dangerous bc there are normally so few branches

71
Q

what can be used in a coronary artery bypass graft

A

internal mammary vessels

72
Q

in coronary bypass surgery, what can some stents (tubular support) be coated w/

-what can happen when uncoated

A

compounds which inhibit cellular proliferation and inflammation
-with uncoated stents, vessels may revert to original level of blockage w/in a year

73
Q

what is an angina

A

referred pain as a result of an exertional decrease in blood flow to the heart
-not a heart attack

74
Q

what does the coronary sinus open up into

where does it lie

A 
right atrium 
coronary groove (alone coronary artery)
75
Q

what are cardiac muscles linked by

why

A

gap junctions

-as a result, electrical excitement will discharge across many cardiac muscle cells

76
Q

what is the bundle of His (atrioventricular bundle)

A

connects SA Node to the AV node

  • SA node in RA
  • AV node is in RA but close to the valve leading into the RV
77
Q

what are the left and right bundle branches located? what are they made of

A

interventricular system

made of purkinje fibers: specilaized cardiac muscle cells which look like nerves
-conducting elements for the electrical current

78
Q

what does an SA Node produce

how is it related to the AV node

A

autorhythmic function
-beats on its own

-must faster than AV node (~80 beats per min vs 40 bpm) purkinje is 20bpm

79
Q

what is important for both atria to work in series

A

discharge of SA node permeates both right and left atria muscle cells
-slight dysfunction btwn them could lead to rapid draining of blood from the lungs

80
Q

what ist he preferential pathway for the SA node

A

bachman’s bundles

81
Q

where are the purkinje fibers located? what happens here often?

A

interventricular septum

-infarct

82
Q

what will myocytes do to the electrical current as it comes down to the tip of the heart

A

as electrical current comes down to the tip of the heart, it curves back up, moving the purkinje fibers into the cardiac myocytes
-myocytes will activate it in a particular pattern

83
Q

how do ventricles contract after electrical discharge from the tip of the ventricles upward towards the valves

A

from the bottom (apex) up in a twisting fashion

-as though blood is being rung out toward the valve

84
Q

where does the great cardiac vein run in

A

ant interventricular sulcus

85
Q

what is the moderator band

A

a band of muscular tissue which contains the purkinje right bundle branch (conveys right branch of the AV bundle)

86
Q

where does the moderator band extend from

A

from the interventricular septum across the lumen of the RV to the papillary muscles

87
Q

what does the moderator band ensure

A

the 2 ventricules contract at the same time

88
Q

what dermatomes are invovled with the innervation of the heart
what nerves innervate the heart

A

T1 and sometimes T2 dermatomes

T1 and T2 nerves (sympathetic innervation)

89
Q

where are the sympathetic ganglia near

what are parasympathetic ganglia near

A

the CNS origin, not the organ being innervated

close to the organ being innervated

90
Q

what are the sympathetic ganglia that send post-ganglionic fibers to innervate the heart?

A

superior cervical ganglion and T2 ganglion

91
Q

what are cardiac plexi

A

ganglia that are close to or w/in the heart

  • superfial
  • deep
92
Q

what does the cardiac skeleton, the reinforced fibrocartilaginous “skeleton” do?
where is it located

A

helps to support the heart when it contracts

-around the location of the valves, absorb pressure when the muscle contracts (points of greatest stress)

A&P 2 (8 decks)

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