Anatomy of the heart Flashcards
1
Q
where is the pericardium and the heart located
A
middle mediastinum
2
Q
what does the hilum (root) of the lung contain
A
pulmonary artery main bronchus pulmonary vein pulmonary lymphatic vessels, brochopulmoanary lymph nodes pulmonary nerves (visceral afferents)
3
Q
what is the pericardium
A
tough fibrous sac enclosing the heart
4
Q
what nerves descend across the lateral borders of the pericardium
A
phrenic nerves
keep diaphragm alive
5
Q
what is the main motor nerve supply to the diaphragm
A
phrenic nerves
6
Q
what are the 3 layers of the pericardium
A
fibrous pericardium (outermost)
parietal serous pericardium (in contact with fibrous pericardium)
visceral serous pericardium (in contact with heart)
7
Q
what is the function of the space between the parietal and visceral serous pericardium
A
filled with fluid acts as lubricant to allow smooth muscle contraction
8
Q
what is the anterior surface of the heart covered by
A
epicardium - secretes pericardial fluid lubricant
9
Q
what is another name for the visceral serous pleura
A
epicardium
10
Q
what is haemopericardium and what condition can it cause
A
pericardial cavity fills with blood
pressure around the heart prevents cardiac contraction = CARDIAC TAMPONADE
11
Q
how do you treat haemopericardium
A
pericardiocentesis - drain fluid (blood from the pericardial cavity)
12
Q
where is the needle inserted in pericardiocentesis
A
via infrasternal angle and directed superposteriorly (not through lungs!)
13
Q
what is the transverse pericardial sinus
A
space in pericardial cavity poserosuperiorly
lies posterior to the ascending aorta and pulmonary trunk
14
Q
why is the transverse pericardial sinus so vital
A
surgeons use this sinus to identify and isolate the great vessels for cardiopulmonary bypass (in open heart surgery)
15
Q
where is the transverse pericardial sinus located
A
behind aorta and pulmonary trunk but infront of SVC
16
Q
what are the 3 clinically important surface of the heart
A
anterior (sternocostal) surface
base (posterior) surface
inferior (diaphragmatic) surface
17
Q
what are the 4 clinically important surfaces of the heart
A
right (mostly right atrium)
left (mostly left ventricle)
inferior (mostly right ventricle)
superior (mostly great vessels)
18
Q
where is the apex located
A
most lateral and inferior part of the heart
5th intercostal space mid clavicular line
19
Q
where does cardiomegaly shift the apex beat to
A
left
20
Q
what are the 3 branches from right to left of the aortic arch
A
1) brachiocephalic trunk (branches into right subclavian artery and right common carotid artery)
2) left common carotid artery
3) left subclavian artery
21
Q
what does the SVC branch off into
A
right BCV (right subclavian and right IJV) left BCV
22
Q
what nerve lies anterior to the lung root
A
phrenic nerve
23
Q
what nerve lies posterior to the lung root
A
vagus nerve
24
Q
what is the extension of the right atria called
A
right auricle
25
how does blood leave the right ventricle
via pulmonary trunk which branches into right pulmonary arteries (superior and inferior) and left pulmonary arteries (superior and inferior)
26
what are the 3 parts of the aorta
ascending
arch
descending
27
what does the coronary groove indicated
surface marking of tricuspid valve
| boundary between right atrium and right ventricle
28
what does the anterior inter ventricular groove indicate
boundary between the 2 ventricles
29
what artery does the coronary groove contain
right coronary artery
30
what artery does the anterior inter ventricular groove contain
branch of the left coronary artery
31
what chamber covers most of the area of the back of the heart
left atrium
32
what does the inter-atrial groove indicate
boundary between 2 atria
33
what does the posterior inter-ventricular groove indicate
boundary between 2 ventricles on diaphragmatic surface of the heart
34
what does the posterior inter-ventricular groove contain
an artery and a vein
35
what vein is responsible for draining venous blood from the intercostal spaces into the SVC
azygous vein
36
what arteries supply the epicardium and myocardium with its own oxygenated blood
coronary arteries
37
what is the prominent venous drain in the atrioventricular groove posteriorly that receives deoxygenated blood from most cardiac veins
coronary sinus
38
where do coronary vessels lie
deep to epicardium embedded in adipose tissue
39
what is the first branch of the aorta
coronary arteries which arise from the ascending aorta
40
what are the 2 branches of the right coronary artery
right marginal artery
| posterior inter ventricular artery
41
what are the 4 branches of the left (main stem coronary artery)
Circumflex artery
left anterior descending (anterior interventricular artery)
left marginal artery
diagonal branch
42
what chamber does the coronary sinus drain into
right atrium
43
what separates the hearts left and right side
septum
44
what is the 2 parts of the septum
interatrial septum
| interventricular septum
45
what is an atrial septal defect
hole in the intertribal septum
46
what is a ventricular septal defect
hole in inter ventricular septum
47
what does a septal defect result in
mixing of arterial and venous blood in the heart so results in hypoxaemia
48
what are the 3 openings in the right atrium
opening of the coronary sinus
opening of the SVC
opening of the IVC
49
where do the coronary arteries origionate
ascending aorta
| right and left aortic sinuses
50
what is the name of the depression In the right atrium
oval fossa
51
what separates the muscle bands of the auricle wall and the smooth atrial muscle
crista terminalis
52
what are the 4 heart valve
tricuspid valve
mitral (bicuspid) valve
aortic valve
pulmonary valve
53
what are the 3 cups of the tricuspid valve
anterior
posterior
septal
54
what valves create the first heart sound (LUB)
tricuspid
| mitral
55
what allows valves to close and resist opening to high pressure
tendinous cords
| papillary muscle
56
what cardiac muscle attach to the chamber walls
papillary muscles
57
what valves create the second heart sound
pulmonary valve
| aortic valves
58
describe the structure of pulmonary and aortic valves
pockets act to catch blood when it starts to reflux when the pockets fill valve closes
59
what are the cusps of the mitral valve
anterior and posterior
60
what is the function of the moderator band (septomarginal trabecular) in the ventricles
carries fibres of the right bundle branch to the papillary muscle of the anterior cusps - ensures all the cusps of the valve close at the same time
61
what is the function of the fibrous cardiac skeleton
facilitates electrical conduction by acting as an insulator
62
artery can be mobilised from its attachment to the sternum, sectioned inferiorly and anastomosed to a coronary artery, distal to an occlusion (in coronary artery bypass grafting). what is the artery
the inter thoracic artery
63
what lies above the aortic valves
the Ostia of left and right coronary arteries
64
what is the crux of the heart
junction of all 4 chambers
65
where do the sympathetic and parasympathetic nerves reach the heart
at the cardiac plexus
66
what are the 2 types of visceral afferent nerves
- pain fibres travel to spinal cord alongside sympathetic fibres
- visceral reflex afferent from baroreceptors
67
what do the visceral reflex afferent from baroreceptors travel in
vagus nerve CNX
68
how do sympathetic nerve fibres get from CNS to Organ
Impulse travels from CNS along presynaptic fibre to the sympathetic chain where they ganglion is and then synapse with the post synaptic fibre which carries impulse to the organ
69
where is the ganglion of sympathetic nerve fibres
in the sympathetic chain
70
what is the neurotransmitter of the sympathetic presynaptic neurone
acetylcholine
71
what is the neurotransmitter of the sympathetic postsynaptic neurone
noradreneline
72
where do the sympathetic presynaptic fibres exit the spinal cord and what happens next
T1-L2
THORACOLUMBAR OUTPUT
then either: 1) go into the ganglion of that level and synapse 2) travel superiorly in sympathetic chain to another ganglion and synapse or 3) travel inferiorly in sympathetic chain to another ganglion and synapse
73
what name is given to the sympathetic post synaptic fibres that travel to heart and lungs
cardiopulmonary splanchnic nerves
74
where do cardiopulmonary splanchnic nerves travel to
they travel from their synapse in the sympathetic chain to the cardiac plexus
75
what fibres travel to the cardiac plexus
sympathetic fibres
parasympathetic fibres
visceral afferent fibres
76
how do parasympathetic signals travel from the CNS to the Organ
Excitation will travel from CNS along the presynaptic fibre to the parasympathetic ganglion synapse on the surface of the heart then along the postsynaptic fibre to the organ
77
where is the parasympathetic ganglion synapse located
on the organ eg on the heart hence why postganglionic fibres are short and pre ganglionic fibres are long
78
what is the parasympathetic presynaptic neurotransmitter
acetylcholine
79
what is the parasympathetic post synaptic neurotransmitter
acetylcholine
80
what nerves carry the presynaptic parasympathetic fibres to the heart where the synapse is
Vagus nerves
81
are pelvic splanchnic nerves sympathetic or parasympathetic
parasympathetic
82
are abdominopelvic splanchnic nerves sympathetic or parasymapathetic
sympathetic
83
what type of spinal outflow do parasympathetic nerves show
Craniosacral
84
I have a sharp stabbing pain that is well localised. What type of pain is this
Somatic: muscular, joint, bony, intervertebral disc, fibrous pericardial, nerve
85
I have a dull aching nauseating pain that is poorly localised. What is causing my pain?
Visceral (organ): heart/great vessels, trachea, oesophagus, abdominal viscerae
86
what is radiating pain and where does it typically radiate to
somatic pain in centre of chest which also spreads outwards to upper limbs, back or neck along affected dermatome
87
what is referred pain and where is it typically felt
pain ONLY at site remote from area of tissue damage in chest: upper limbs, back and neck
88
what are the 5 different types of chest pain
- somatic
- visceral (organ)
- radiating
- referred
- acute vs chronic
89
if you are painfully prodded in T5 dermatome where will sensitisation reach conciousness
cerebral cortex
90
what anatomical feature separates the frontal and parietal lobe
central sulcus
91
what is the somatosensory region of the brain where APs arrive from the body wall and consciousness of pain is registered
Postcentral gyrus of parietal lobe
92
what is the somatomotor region of the brain where APs originate to bring about contraction of the body wall skeletal muscle
precentral gyrus of frontal lobe
93
what is the sensory homunculus
area of cerebral cortex where sensitisation from different body wall structures reach consciousness
94
give examples of sharp (somatic) central chest pain sources
```
Herpes Zoster (shingles)
bone, muscle, joint
parietal pleura and fibrous pericardium
```
95
describe the pain associated with shingles (Herpes Zoster)
reactivation of dormant virus in posterior root ganglia
pain anywhere in dermatome
pain preceeds blisters
96
what presentation does shingles have in the T4/5 dermatome
central chest pain
97
what bone/joint/muscle pain can be felt as central chest pain
pectoralis or intercostal strain
dislocated costochondral joint
costovertebral joint inflammation
slipped thoracic intervertebral disc
98
what type of pain is associated with pleurisy and pericarditis
sharp stabbing central chest pain
well localised
somatic
99
where are dull visceral central chest pain sources
```
tracheal
aorta (ruptured aneurysm of aortic arch)
heart (angina/MI)
abdominal visceral (gastritis, pancreatitis, hepatitis)
oesophagitis
```
100
what are the 4 subdivisions of the mediastinum
Superior mediastinum = above sternal angle
anterior = sternum
middle = heart and diaphragm
posterior = vertebral column and posterior of heart
101
how can the vagus nerve be found on from the right side of the mediastinum
on lateral aspect of trachea goes over oesophagus and through diaphragm
102
what lies behind the oesophagus and arches over the top of the lung into the SVC
azygous vein
103
what is another name for the descending aorta
thoracic aorta
104
how can the left vagus nerve be found
courses over aortic arch
105
how can the recurrent laryngeal branch of the left vagus be found
it hooks under ligaments arteriosum
106
what is the ligamentum arteriosum
remnant ductus arterioles connecting PT to arch of aorta
107
where does the thoracic duct lie posteriorly
between azygous and oesophagus
| DUCK between 2 GOOSE (azygoose and oesophagoose)
108
where do visceral afferent action potentials pass
bilaterally to the thalamus and hypothalamus then diffuse areas of the cortex
109
what do visceral (pain) afferents travel alongside
sympathetic motor nerves to organs except enter via posterior roots as do somatic sensory fibres from body wall this is what causes confusion as to where pain comes from
110
how do pain signals travel from the organs to the brain
via visceral pain afferents
111
at what spinal cord level do the visceral afferent enter the sympathetic trunk and spinal cord from the heart
cervical ganglia and T1-T5 spinal nerves)
112
what is visceral radiating pain
pain is still dull in nature at organ although felt in dermatome pattern
113
How does radiating pain arise if from the heart radiation is to the dermatome supplied by the spinal cord levels at which cardiac visceral afferents enter spine
bilaterally to cervical and upper thoracic dermatomes
114
how does referred pain arise
due to afferent (sensory) fibres from soma and afferent sensory fibres from viscera (visceral afferens) entering the SPINAL CORD AT SAME LEVEL
brain chooses to belie the pain signal from the organ are coming from the soma
115
define myocardial infarction
irreversible death (necrosis) of part of the myocardium due to occlusion of its arterial blood supply
116
what are the 3 types of MI
Anterior MI
Inferior MI
Anteriolateral MI
117
occlusions of what coronary arteries cause an anterior MI
Right coronary arter
left coronary artery
anterior inter ventricular artery
118
where does the left coronary artery sit
in left atrioventricular groove between the pulmonary trunk and left auricle
119
in most people what coronary arteries supply myocardium
right coronary arteries
120
what are the 4 sites of coronary atherosclerosis
1. anterior interventricualr branch of LCA
2. Right Coronary Artery
3. Circumflex branch of LCA
4. Left (main stem coronary artery)
121
what arteries are replaced in a triple bypass
Anterior Interventricular artery
RCA
circumflex artery
122
where are Coronary Artery Bypass Grafts anastomosed
proximal to ascending aorta
123
what arteries are usually used in CABG
radial artery
great saphenous vein
internal thoracic artery by pedicle
124
what coronary arteries are linked with the conducting system of the heart (beside the SAN and AVN)
right coronary arteries
125
how is the superior and inferior mediastinum
line from sternal angle (manubrium above and sternum below) goes to transverses thoracic plane between sternal angle and T4/5
126
what is thoracic outlet syndrome
compression of vascular and brachial plexus of thoracic inlet bounded by ribs 1, T1 vertebra and jugular notch
127
what does the diaphragm separate
thoracic and abdominal cavity
128
what is contained in the anterior mediastinum (area betweens sternum and fibrous pericardium) of adult
adipose tissue
129
what is contained in the anterior mediastinum (area betweens sternum and fibrous pericardium) of child
thymus gland producing T cells in prepubescent childhood
130
what does the middle mediastinum contain
```
pericardium
heart
parts in great vessel: ascending aorta, pulmonary veins, inferior part of SVC
superior part of IVC
pulmonary trunk & pulmonary arteries
```
131
what part of aorta is confined in the posterior mediastinum
descending
132
what part of the aorta is in the superior medistinum
arch of aorta
133
what structures are in the posterior medistinum
```
oesophagus (behind trachea)
vagus nerve
trachea + 2 main bronchi
thoracic duct
azygous vein
sympathetic chains
```
134
where does the trachea bifurcate
level of sternal angle so is in superior mediastinum
135
where do the vagal trunks from the vagal plexus pass through
diaphragm with the the oesophagus onto the stomach
136
function of azygous vein
covneys blood from intercostal veins/intercostal space of chest wall to SVC
can be ruptured in trauma
137
function of thoracic duct
carries lymph to left venous angle
138
what does the azygous vein cross over
root of the lung posteriorly to drain into SVC
139
4 parts of aorta
ascending
arch
thoracic
abdomina
140
what does the aorta become after passing through the diaphragm
no longer thoracic aorta becomes abdominal aorta
141
what is the aortic hiatus
opening in the diaphragm where thoracic artery becomes abdominal artery
142
what are the 5 branches from the thoracic aorta
```
bronchial arteries
oesophageal arteries
mediastinal arteries
pericardial arteries
phrenic arteries
```
143
what does the right lymphatic duct drain into
right venous angle
144
what does the thoracic duct drain lymph into
left venous angle
| much more drainage than right lymphatic drug drainage
145
how does lymph drain from lungs
1) bronchopulmonary/hilar lymph nodes surround main bronchus, lymph drains here
2) lymph drain into tracheobrachial lymph nodes around the bifurcation of the trachea
3) lymph then either drain into right lymphatic duct or thoracic duct
146
what makes up the left venous angle
internal jugular vein and subclavian vein which forms brachial cephalic vein
147
how can pulmonary metastases spread
via lymphatics
148
In some patients where does left inferior lobe drain into
right lymphatic duct (usually drains into thoracic duct)
149
how can the thoracic duct be identified
by cisterns chyli: swollen start if thoracic duct in abdomen
150
what does the right vagus nerve sit on
trachea passes posteror to lung root
151
how can the left vagus nerve be identified
arches over the aorta, one branch that supplies larynx goes under ligamenum arteriosum (recurrent laryngeal branch of left vagus nerve)
152
what is the ligament arteirosum
embryological structure, remnant ductus arteriosus
153
what structures are located in superior mediastinum from anterior to posterior
```
brachiocephalic veins (jugular vein + subclavian) + SVC
arch of aorta
trachea
oesophagus
thoracic duct
```
154
what nerves are in the superior mediastinum from lateral to medial
phrenic nerves
vagus nerves
recurrent laryngeal nerves
155
what are central veins
subclavian, brachiocephalic, internal jugular, SVC, IVC, iliac, femoral veins that have the same pressure as the right atrium
156
what is the most lateral nerve
phrenic
157
at 45 degrees what is the max the JVP should be
no more then 3cm superior to sternal angle (angle of Louis)
158
where can the right recurrent laryngeal nerve be found
hook under right subclavian artery (NOT enter chest)
159
where can the left recurrent laryngeal nerve be found
hooks under the arch of the aorta (does enter the chest)
160
what is the phrenic nerve somatic sensory to
supplies somatic motor diaphragm
somatic sensory to: pericardium, mediastinal parietal pleura, diaphragmatic parietal pleura, diaphragmatic parietal peritoneum
161
if a patient presents with right shoulder tip pain what structure can this be due to
diaphragm (due to shared nerves)
162
if a patient presents with right shoulder tip pain what structure can this be due to
diaphragm (due to shared nerves)
163
2 main nerves of superior mediastinum
phrenic and vagus nerve
