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LSS Anatomy of the Thorax > anatomy of the heart and organisation of nerves in the thorax > Flashcards

anatomy of the heart and organisation of nerves in the thorax Flashcards

1
Q

where is the mediastinum located

A

in between the two pleural cavities of the lungs

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2
Q

sections of the mediastinum

A

anterior, posterior, superior, inferior, middle

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3
Q

what is the pericardium within the middle of the mediastinum

A

fibroserous sac surrounding heart and its great vessels

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4
Q

what 2 layers does the pericardium consist of

A

fibrous and serous

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5
Q

what 2 parts does the serous section consist of

A

parietal and visceral

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6
Q

what does the parietal section line

A

fibrous

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7
Q

what does the visceral section adhere to

A

heart

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8
Q

what are the two pericardial sinuses - important clinically to limit outflow of heart

A

transverse and oblique (where serous visceral reflects back on itself to become parietal layer)

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9
Q

what does the transverse pericardial sinus do

A

separates arteries from veins

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10
Q

what is the oblique pericardial sinus formed by

A

reflection onto pulmonary veins of heart

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11
Q

stages of pericardial sinuses formation - from vertical to bending in 2

A

primordial heart tube in pericardial sac → primordial tansverse pericardial sinus → heart loops ventrally → primordial arterial and venous ends of the developing heart brough together, forming transverse pericardial sinus; veins expand and pericardial reflection carried out around them to form oblique pericardial sinus

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12
Q

what are the two circuits of the heart

A

pulmonary and systemic

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13
Q

inflow of right atrium

A

blood returns bia superior and inferior venae cavae (body) and coronary sinus (heart)

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14
Q

inflow of left atrium

A

blood returns via pulmonary veins

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15
Q

outflow of right ventricle

A

outflow to pulmonary trunk

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16
Q

outflow of left ventricle

A

outflow to ascending aorta

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17
Q

significance of right atrium

A

AVN tricuspid valve, crista terminalis, musculi pectinati, valve of IVC, valve of coronary sinus (main drainage veins from coronary to heart), opening of coronary sinus

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18
Q

significance of left atrium

A

mitral valve, small window between right atrium - bypassed in foetus; left auricle, pulmonary veins, valve of foramen (fossa) ovale (permits blood to go right atrium to left atrium and bypass lungs in foetus)

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19
Q

siginificance of right ventricle

A

conus arteriosus, septal papillary muscle, septomarginal trabecula, posterior papillary muscle, trabeculae carneae, anterior papillary muscle, chordae tendineae (heart strings, embedded by papillary muscles - stops backflow), pulmonary valve

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20
Q

significance of left ventricle

A

mitral valve anterior cusp, chordae tendineae, anterior papillary muscle, trabeculae carneae (net), posterior papillary muscle, mitral valve posterior cusp; 2 aortic sinuses have holes (coronary aortic sinuses) for coronary arteries

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21
Q

more common variation in coronary arteries; MI - blood issue causing ischaemia; cardiac arrest: not due to ischaemic - electrical

A

right dominant coronary artery; posterior interventricular branch arises from right coronary artery; marginal; circumflex

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22
Q

less common variation in coronary arteries

A

left dominant coronary artery; posterior interventricular branch arises from left coronary artery

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23
Q

coronary veins

A

follow arteries, drain into coronary sinus (IVC of heart - bringing back deoxygenated blood from heart)

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24
Q

sections of the conducting system

A

SAN, Bachmann’s bundle, AVN, His bundle, left posterior bundle, right bundle, Purkinje fibres

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25
Q

pathway of conduction

A

excitation begins in SAN → spreads across atria causing contraction → concurrently wave stimulates AVN → travels through bundle of His → travels along bundle branches, through Purkinje fibres, causing ventricular contraction

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26
Q

MRI of heart

A

braciocephalic vein → SVC → right atrium → pulmonary artery → pulmonary vein → left heart → aorta

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27
Q

functional divisions of CNS

A

somatic (skin and skeletal muscles), autonomic (organs, smooth muscle, glands)

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28
Q

somatic spinal nerves: wher do motor go

A

only to skeletal muscle - cannot function without them

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29
Q

somatic spinal nerves: where do sensory go

A

body wall, not viscera

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30
Q

somatic spinal nerves: what might segmental nerves combine to form

A

plexi, supplying specialised areas (cervical, brachial, lumbosacral)

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31
Q

structure of plexi

A

diagram from slide 24; ventral (efferent), dorsal horn, grey, white matter, ramus (division of mixed spinal cord of back and everything else) vs root (not mixed)

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32
Q

define dermatome

A

area of skin supplied by single spinal nerve on one side or from single spinal cord level (not vertebral levels) (segmented); T4 is nipple

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33
Q

define myotome

A

part of skeletal muscle supplied by single spinal nerve on one side or from single spinal cord level

34
Q

how many pairs on intercostal nerves are there

A

11 (+ 1 subcostal)

35
Q

what types of nerves are present in intercostal nerves

A

mixed, so sensory and motor

36
Q

what do intercostal nerves supply

A

intercostal spaces

37
Q

spinal/segmental nerves

A

anterior primary rami

38
Q

lateral cutaneous branch

A

anterior and posterior

39
Q

anterior cutaneous branch

A

medial and lateral

40
Q

where are phrenic nerves (in front of lung root (vagus behind), motor to diaphragm, sensory to pleura, diaphragm, peritoneum, pericardium) derived from

A

anterior rami of spinal nerves C3, 4, 5

41
Q

what type of nerve are phrenic nerves

A

somatic, so no autonomic function or visceral distribution

42
Q

what do phrenic motor fibres supply

A

skeletal muscle of diaphragm

43
Q

what do phrenic sensory fibres supply

A

central diaphragm, its plueral covering, mediastinal pleura, pericardium, peritoneum on inferior surfacr of central diaphragm

44
Q

what to motor autonomic nerves innovate

A

cardiac muscle, smooth muscle, glands

45
Q

what do sensory autonomic nerves innovate

A

visceral organs

46
Q

what 2 divisions are autonomic nerves divided into

A

sympathetic (T1 to L2) and parasympathetic (cranial nerves 3, 7, 9, 10 and S2 to S4)

47
Q

sympathetic outflow from spinal cord

A

emerge from spinal cord at sympathetic ganglia; follow somatic nerves to periphery; eosophagus plexus (heart) and prevertebral plexus (abdominal and pelvic viscera)

48
Q

what sections of neurone do all autonomic motor pathways involve

A

preganglionic and postganglionic neurones; intermediolateral horn present T1 to L2 as sympathetic cell bodies present there)

49
Q

where do pathways to body wall synapse

A

in ganglia of sympathetic trunk; can go up or down before synapsing depending where going to; postganglionic neurones to heart not in chain

50
Q

where do pathways to viscera synapse

A

in unpaired ganglia

51
Q

what does the trunk do

A

takes fibres up or down; rami (grey-unmyelinated, white-myelinated); won’t synapse will synapse outside of chain in heart; to brain synapse in chain but not same level

52
Q

function of sympathetic trunks (T1 to L2)

A

distribute sympathetic nerves to smooth muscle and glands, body wall synapse in ganglia of trunks, viscera synapse in unpaired ganglia, bring pain fibres back to CNS from viscera

53
Q

significance of fibres from lower T5-T12

A

reach abdomen in bundles called spanchnic nerves

54
Q

5 sets of nerves containing parasympathetic fibres

A

oculomotor (III) cranial nerves, facial (VII) cranial nerves, glossopharyngeal (IX) cranial nerves (all head and neck), vagus (X) cranial nerves (most important as supplies viscera of thorax and most of abdomen), sacral (S2-S4) spinal nerves

55
Q

sympathetic nerves to lungs and heart

A

mainly from T2-T4, passing through cervical and upper thoracic ganglia or sympathetic trunk

56
Q

where are many of the synapses of sympathetic nerves to lungs and heart

A

in micro-ganglia in pulmonary and cardiac plexuses rather than in trunk ganglia

57
Q

pulmonary plexuses

A

left vagus nerve, right vagus nerve, anterior pulmonary plexus, posterior pulmonary plexus

58
Q

effect on bronchioles of sympathetic nerves

A

dilate

59
Q

effect on bronchioles of parasympathetic (vagus) nerves

A

constrict

60
Q

cardiac plexuses

A

superficial cardiac plexus, deep cardiac plexus

61
Q

effect of sympathetic efferents on heart rate and force of contraction

A

increase heart rate and force of contraction

62
Q

effect of parasympathetic efferents (vagus) on heart rate and diameter of coronary arteries

A

decrease heart rate via pacemaker tissue and constrict coronary arteries

63
Q

what do sympathetic afferents relay

A

pain sensations from heart

64
Q

what do parasympathetic afferents (vagus) relay

A

blood pressure and chemistry information from heart

65
Q

where does vagus nerve arise from and leave skull through

A

arises from medulla and leaves skull through jugular foramina

66
Q

where does the vagus nerve descend in the neck

A

posterolateral to common carotid artery

67
Q

where does left vagus cross

A

anterior to aortic arch then posterior to left lung root

68
Q

where does right vagus pass

A

posterior to right lung root

69
Q

where do both vagi form a plexus

A

round oesophagus

70
Q

what do the vagi separate to form

A

anterior and posterior oesophageal/gastric nerves

71
Q

oesophageal plexus: sympathetic afferents relay

A

pain sensations from oesophagus

72
Q

oesophageal plexus: parasympathetic afferents (vagus) sense

A

normal physiological information from oesophagus

73
Q

what are the branches to chest and abdomen

A

parasympathetic, with large sensory (enteroceptor) content from gut and lungs

74
Q

difference between parasympathetic and sympathetic

A

parasympathetic provide no autonomic supply to body wall (e.g. arterioles and sweat glands)

75
Q

recurrent laryngeal branch of vagus nerve

A

not parasympathetic - runs back up neck to supply most skeletal muscles of larynx

76
Q

vagi in posterior mediastinum

A

mainly right vagus contributes to oesophageal plexus; nerves also acquire many sympathetic fibres

77
Q

vagi in posterior mediastinum: inferior continuation

A

posterior oesophageal nerve, taking right vagal fibres through diaphragm to abdominal viscera

78
Q

vagi in posterior mediastinum: left vagus

A

provides fibres to oesophageal plexus then continues as anterior oesophageal nerve

79
Q

intrinsic nerves of oesophagus

A

plexus of ganglia and axons within oesophageal wall coordinates activity; can be up/down regulated by autonomic nerves; part of enteric nervous system

80
Q

positions of phrenic and vagus nerves and sympathetic trunks in superior mediastinum

A

slide 42

LSS Anatomy of the Thorax (25 decks)

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