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CardioRespiratory Year 1 > Anatomy of the Heart and Coronary Arteries > Flashcards

Anatomy of the Heart and Coronary Arteries Flashcards

1. Trace the flow of blood through the heart and identify the great vessels 2. Describe the arrangement and the main features of the chambers of the heart 3. Explain the anatomy and the perfusion of the coronary arteries 4. Describe the functional anatomy of the valves of the heart

1
Q

what is the function of the pericardium

A
  • Fixes the heart in the mediastinum and limits its motion
  • Protection from infections coming from other organs such as lungs
  • Prevetns over dilation of the heart where the volume is overloaded
  • Lubrication
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2
Q

what kind of tamponede can be accommodated by the pericardium

A
  • Chronic tamponade - happens over a slow period of time

- Heart can accommodate 1.5L until you see the symptoms of cardiac tamponade

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3
Q

What does pericardial effusion lead to

A

Cardiac tamponade

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4
Q

what is used to salivate cardiac tamponade

A 
Pericardiocentisis 
there are 3 types these are the 
- subxiphoid 
- parasternal 
- apical
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5
Q

What are the heart wall layers

A

Epicardium - visceral layer of the serous pericardium
Myocardium
Endocardium

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6
Q

Describe the myocardium

A
  • the is the heart muscle itself
    – Cardiac muscle fibers
    – Arranged in bundles
    – Squeezes blood out of heart
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7
Q

Describe the endocardium

A
  • continuous with the endothelium (lines chambers and valves)
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8
Q

What are the landmarks of the heart

A

Coronary sulk
Anterior interventricular sulcus
Posterior interventricular sulcus

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9
Q

where is the coronary sulci

A
  • atrioventricular sulcus is what it is sometimes called

- it is between the atrium and the ventricle

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10
Q

where is the anterior interventricular sulci

A

between the right and left ventricle

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11
Q

Where is the posterior interventricular sulci

A

between the right and left ventricle

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12
Q

describe the structure of the atriams

A 
Right atrium 
-	Superior and inferorir vena cava 
-	Right auricle 
Left atrium 
-	4 pulmonary veins 
-	Left auricle
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13
Q

Describe the structures of the ventricles

A

Rigth ventricle
• 2/3 anterior
• Pulmonary trunk

Left ventrilce

  • Apex (left border)
  • Inferior surface (2/3 posterior)
  • Aorta
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14
Q

How does cardiac tamponade happen

A
  • there is accumulation of fluid which increases pressure this compresses the cardiac chambers and prevents the diastolic filling of both of the ventricles
    this ….
  • in the left ventricle reduces stroke volume and cardiac output leading to hypotension/shock and reflexive tachycardia
  • in the right ventricle it increases Venus pressure and causes pulmonary congestion leading to rales, or it affect systemic pressure increasing jugular Venus pressure
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15
Q

describe the coronary arteries

A
  • right and left coronary arteries

- supply the atria and ventricles

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16
Q

What is the arterial supply to the heart

A

Coronary arteries

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17
Q

Describe the structure fo the right atria

A

Made up of
- fossa ovalis - this is originally from the fetus and is the shunt that pushed blood from the right atria to the left atria to bypass the lungs which did not function at this time
- pectinate muscles- These are used to protect the wall during filling
- crista terminalis - divides the posterior and anterior wall of the atria
- sinus vernarum - receives the deoxygenated blood from the cornary sinus and vena cava, and forms the intertribal sputum
- coronary sinus - this is the part of the heart muscle itself and it drains part of the deoxygenated blood into the right atria – not all deoxygenated blood comes from the vena cava
POSTERIOR WALL IS SMOOTH

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18
Q

Describe the structure of the right ventricle

A
  • Tricuspid valves are between the atria and ventricle these allow the deoxygenated blood to flow from the atria to the ventricles
  • there are 3 leaflets that make up the tricuspid valves they are called papillary muscles and the 3 of them are called, septal papillary muscled, posterior papillary muscles and anterior papillary muscles
  • the papillary muscles extend from the walls and help anchor the chorodae tendineae preventing t
  • chorodae tendineae - prevent the inversion of the valves into the right atria
  • Tubercular cancer - help papillary muscles contract, prevent inversion, prevent chambers from sticking together
  • septomarginal trabecular- rungs from the septum to the margin and is the short cut for nerve fibres on the right hand side
  • Interventricular septum - carries the AV bundle of His
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19
Q

Describe the structure of the left atria

A
  • Smooth posterior and anterior walls

- no pectinate muscles and crest terminalis

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20
Q

Describe the structure of the left ventricle

A
  • Mitral valve - 2 cusps and 2 papillary muscles
  • anterior cusps and posterior cusps
  • anterior papillary muscles and posterior papillary muscles as there are only 2 leaflets
  • trabecuae crane
  • chord tendineae
  • Arctic semilunar valves
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21
Q

Describe the semilunar cusps of the aortic valves

A
  • there are three cusps these are the right, posterior and left semilunar cusps
  • only the right and left semilunar cusps have coronary arteries leading into them as there is only a right and left coronary artery.
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22
Q

Describe what happens to the cusps in the semilunar valves during systole and diastole

A
  • cusps fold over the openings of the coronary artery when systole is taking place as coronary circulation is not filled with blood but when diastole is happening the cusps are open and allow blood from the coronary artery supply to go into the ventricle
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23
Q

what do the aortic sinuses do in the semilunar cusps

A
  • allow the opening of the coronary arteries
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24
Q

What are the other names for the left coronary artery

A
  • Left main stem or trunk
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25
Q

What does the Left coronary artery branch into

A
  • divides into two
    main branches are the circumflex and the anterior interventricular (LAD)
  • The circumflex has a branch called the left marginal
  • anterior interventricular has a branch called lateral
26
Q

What are the two main left coronary arteries

A
  • Circumflex

- Anterior interventricular

27
Q

What does the right coronary artery divide into

A
  • Posterior interventricular (posterior descending PDA)

- Has right marginals that branch of it

28
Q

where do the right coronary artery and left coronary artery touch

A

between the anterior interventricular and posterior interventricular

29
Q

How do you tell dominance

A
  • Look at the posterior interventricular artery, and if it comes from the right coronary artery then the heart is right dominant, if it comes from the circumflex artery which is part of the left coronary artery then the heart is left dominant
30
Q

Describe blood flow to the bundle of his

A
  • the left coronary artery supplies the anterior section and makes up 2/3rds of the blood supply
  • the right coronary artery supplies the posterior section and makes up 1/3rd of the total blood supply
31
Q

what supplies both nodes in the heart

A

Right coronary artery supplies both the SA and AV nodes

32
Q

What is Occlusion

A

A blockage or closure of a blood vessel

33
Q

what is the number 1 site of occlusion leading to MI

A

left coronary artery and the LAD part of the left coronary artery

34
Q

what is the effect of occlusion

A

MI

35
Q

what are the sites of occlusion

A
  • LAD of LCA (40-50%)
  • RCA (30-40%)
  • Circumflex of LCA (15-20%(
36
Q

What does occlusion do

A
  • damages the conducting system
  • LAD lead to septal branches which supply AV bundles damaging the bundle of HIS
  • RCA supplies both SA and AV nodes - affects the nodes
  • Heart block this leads to bradycardia
37
Q

What are the views of the coronary angiogram

A
  • left anterior oblique
  • Right anterior oblique
  • Anterior posterior
38
Q

What do coronary veins do

A
  • collect the waste from the cardiac muscles
  • drains into the coronary sinus on the posterior surface of the heart
  • this coronary sinus empties into the right atrium
39
Q

Describe the fibrous skeleton of the heart

A
  • it is dense connective tissue that surrounds the AV and outflow vessel valves
  • surrounds the openings of the valves
40
Q

Describe the function of the fibrous skeleton of the heart

A
  • supports/anchors the valves and keeps the patent
  • prevents the overstretch of valves
  • insertion point of cardiac muscle bundles
  • electrical insulator between atria and ventricles, keep nerve impulses separate
41
Q

What are the two atrioventricular valves

A
  • Tricuspid valve (right hand side)

- Bicuspid (mitral) (left hand side)

42
Q

Describe the mechanism of action of the atrioventricular valves

A
  1. AV valves open and this allows blood to flow from the atria into the ventricles when ventricular pressure is lower than atrial pressure
    - this occurs when the ventricles are relaxed, chord tendineae are slack and papillary muscles are relaxed
  2. AV valves close to prevent back flow of the blood into the atria
    - this occurs when the ventricles contract pushing the valve cusps closed, the chord tendinae are pulled tightt and papillary muscles contract to pull cords and prevent cusps from everting
43
Q

What are the semilunar valves

A
  • Aortic

- pulmonary

44
Q

How many cusps do semilunar valves have

A

3

45
Q

describe the mechanism of action of semilunar valves

A
  • Prevent back flow from the aorta and pulmonary trunk into the ventricles
  • passive action
  • systole of ventricles opens the valves
  • diastole of ventricles causes blood pressure to lower, this back flow fills cusps and this closes the valve - coronary artery takes the blood
46
Q

what valves shut in Lub

A
  • Mitral (bicuspid)
  • Tricuspid
    then systole happens
47
Q

What valves shut in Dub

A
  • aortic
  • pulmonary
    then diastole happens
48
Q

what sound does the heart make

A

lub dub

49
Q

what are the two cardiac muscle fibres that the heart forms

A
  • atrial network

- ventricular network

50
Q

Describe how the conducting system works

A
  • Cardiac muscle fibres form 2 networks via gap junctions at intercalated discs to allow the nerve impulses
51
Q

what separates the two conducting networks

A
  • Separated by a fibrous skeleton - this means that there is no gap junction between the atria networks and the ventricle network of muscles
52
Q

How does the atrial network work

A
  • cell to cell impulses

- it is circular

53
Q

How does the ventricular network work

A
  • conducting fibres in the conducting system (bundle of his)

- spiral

54
Q

Describe how the nodes regulate the cardiac cycle

A
  1. Sino-atrial node this is the pacemaker, it generates 70-80 impulses per minute causing the atria to contract
  2. the impulses pause 0.1 seconds at the atrio-ventricualr node so the ventricles have time to fill
  3. the atrioventricular bundle connects the atria to the ventricle
  4. the atrioventricular bundle branches conduct the impulses through the interventricular septum
  5. the pukinje fibres stimulate the contractile cells of both ventricles starting at apex and moving superiorly
55
Q

What plexus innervates the heart

A
  • supplied by the cardiac plexus
56
Q

Where is the cardiac plexus

A
  • Lies anterior to the bifurcation of the trachea and posterior to the arch of the aorta
  • Fibres extend from the plexus to the coronary vasculature and to components of the conducting system of the heart (especially SA node)
57
Q

What does the cardiac plexus contain

A
  • Parasympathetic (from vagus)
  • sympathetic (from the sympathetic trunk)
  • General visceral afferents (GVA)
58
Q

What is the pathway of the parasympathetic system to the heart

A
  • reticular formation in the medulla in the cardioinhibitory centre
  • vagus nerve which goes to the SA and AV nodes
  • causes node to become more permeable, potassium moves out and the cell hyper polarises meaning that it takes longer to reach an action potential and contract reducing the force of contraction and the heart rate
59
Q

What is the pathway of the sympathetic system

A

reticular formation int he medulla in the cardioacceleratory centre

  • the preganglionic sympathetic neurones in the thoracic spinal cord
  • postganglionic sympathetic neurones to SA and AV node and to coronary vascular smooth muscle
60
Q

What are the two centres in the medulla

A

Cardioinhibitory

cardioacceleatory

61
Q

describe the method of the referred pain

A
  • when pain is caused by ischaemia and damage to cardiac muscle
  • this stimulates visceral sensory enrage endings in the myocardium
  • the general visceral afferent nerve fibres ascend to the CNS through the cardiac branches of the sympathetic trunk
  • organ and skin pain fibres travel to the spinal cord together
  • pain not felt in heart but referred
  • pain felt in T1-T4

CardioRespiratory Year 1 (28 decks)

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