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SF3 > Anatomy of the heart: Gilland > Flashcards

Anatomy of the heart: Gilland Flashcards

1
Q

What is the fold difference between the atria and ventricles?

A

The atria and ventricles can pump side by side for 2-3 billion cycles while maintaining a 4 to 8 fold difference in the systemic/pulmonary pressures

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2
Q

What maintains the seperation of the two circuits (pulmonary and systemic)?

A

The integrity of atrial and ventricular septa

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3
Q

Efficient pumping mechanism depends on what?

A

Depend on controlled spreading of myocyte excitation initiated at the SA pacemaker and relayed to the ventrciles by the cardiac conduction system

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4
Q

What regulates cardiac activity?

A

Vagal and Sympathetic interaction with myocardium and intrinsic cardiac neurons

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5
Q

Normal Aortic pressure

A

120/80 mm Hg

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6
Q

What is the distribution of blood in the body?

A

Heart - 15%

Brain - 15%

Liver - 10%

Intestine - 25%

Kidney - 20%

Skin ,skeletal, trunk, limbs - 25%

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7
Q

What is the anterior, inferior, and superior attachment of the pericardium?

A

Anterior - to fascia on deep surface of sternum

Inferiorly - to the central tendon of the diaphragm

Superiorly - to the great vessels

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8
Q

What is the fibrous pericardium?

A
  • a tough conical collagenous, with small elastic fibers, cloak encasing the heart.
  • Base is attached to the diaphragm
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9
Q

The lower portion of superior vena cava, aorta, and pulmoary trunck are encased in what?

A

Encased in pericardium

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10
Q

What provides innervation to the pericardium and diaphragm?

A

Phrenic nerve

(C3-C5)

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11
Q

Pericardial Cavity

A

potential space between parietal and visceral pericardua

Contains smal amount of pericadial fluid

(15-50mL)

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12
Q

What are the serous pericardial layers?

A

Parietal pericardium

Visceral pericardium (epicardium)

exude pericardial fluid which reduces friction during heart motion

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13
Q

Parietal PEricardium

A

shiny inner surface

Fused with fibrous pericardium

SENSITIVE TO PAIN

(innervation from afferent fibers of the phrenic nerve)

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14
Q

Pericardial pain is referred to where?

A

Referred to supraclavicular skin on the same side

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15
Q

Visceral pericardium (epicardium)

A

forms outer surface of heart

Covers myocardium and epicardial fat

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16
Q

Endocarium is made up of what?

A

squamous epithelium continuos with endothelium of arterial and venous system

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17
Q

What are the two spaces where fliud can collect within the pericardial cavity?

A

Oblique pericardial sinus

Transverse pericardial sinus

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18
Q

What is Cardiac tamponade?

A

Accumulation of fluid in pericardial space, whether from bleeding, over production of pericardial fluid or other causes results in increased pericardial pressure and eventual progressiely reduced ventricular filling.

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19
Q

Do you develop cardiac tamponade with slow accumulaiton of fluid?

A

Not initally

Slow accumulation of fluid can allow for stretching of pericardum, with build up of a liter of fluid before even getting Tamponade

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20
Q

Rapid accumulation, as with severe bleeding, allows no time for stretching of the pericardium. What this lead to?

A

Tamponade can occur with as liitle as 100 mL of fluid

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21
Q

Cardiac Tamponade results in what?

A

Pulmonary Edema

Shock

Death

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22
Q

When you orient the heart, Ventricles are _____ and Atria are ____.

A

Ventricles anterior

Atria posterior

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23
Q

What does the coronary sulcus seperate?

A

Seperate atria muscle from ventricle muscle

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24
Q

What forms most of the inferior surace of the heart?

A

Right ventricle

Sits on Central tendon

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25
Q

Which three structures are oriented along a verticle line in anatomical position?

A

Superior vena Cava

Right Atrium

Inferior Vena Cava

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26
Q

What is the purpose of the fibrous skeleton of the heart?

A
  • Provides a strong framework for attachment of cardiac muscle fibers
  • physically seperate atrial and venricular myocardia and blocks the spread of myocardial excitation across the atrioventricular border (coronary sulcus)
  • support all 4 heart valves by provideing anchoring rings and also forms fibrous ribs in the semilunar valves
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27
Q

The fibrous skeleton comprise of what three things?

A

Fibrous rings

Fibrous trigones

Membranous portion of interventricular septum (septum membranacecum)

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28
Q

Fibrous rings

A

(partial)

around valves (anunuli fibrosi) and extension into semilunar leaflets

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29
Q

Fibrous trigones

A

between aortic valve and atrioventricular valves (trigone fibrosa)

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30
Q

What are the 4 openings in the Right atrium?

A

Superior vena cava

Inferior vena cava

coronary sinus

anterior cardiac sinus

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31
Q

right ventricle expansion (RV diastole) does what?

A

Sucks blood from R. Atrium, SVC, IVC, and Coronary SInus

32
Q

Contraction of the R atrium (systole) is known to what the ventricle?

A

“Top Off”

It is the final volume before ventricular systole (contraction)

33
Q

What anchors the valves?

A

They are anchored by a surrounding fibrous ring known as annulus

34
Q

During ventricular systole, attachment to the tendinous cords and papillary muscles prevents what?

A

Prolapse of the valve leaflets into the right atrium by arresting the leaflets exactly in contact with one another

35
Q

If the cusps do not meet precisely during slosure they will leak. This is know as?

A

Regurgitation

36
Q

Failure of a valve to open widely during ventricular diastole is known as?

A

Valve stenosis

37
Q

Why is the septomarginal trabecula (moderator band) so important?

A

Holds conduction fibers

38
Q

What is the purpose of the nodule on the aortic cusps?

A

reinforcement in the center of the edge of each cusps.

The three nodules meet in the middle where the valves close.

39
Q

When do the aortic valves open and close?

A

Open: When left ventricular pressure exceeds aortic pressure

Close: when ventricular pressure drops

40
Q

Majority of valve replacements involve which two valves?

A

Mitral and aortic valve

41
Q

Disruptonof the conduction system of the heart leads to what?

A

Arrythmogenic heart

42
Q

What is hypertrophic cardiomyopathy?

A

Thickning of the walls and reduction of volume in the ventricles

43
Q

Dilated Cardiomyopathy

A

Left ventricle enlarged with thin walls

44
Q

What forms the pacemaking cells and distribution structures that defines the spatiotemporal pattern of cardiac excitation?

A

Special Myoepithelial Cells

45
Q

What blocks conduction from atrium to ventricle?

A

Fibrous tissue in coronary groove

46
Q

Where does the Right bundle branch run and terminate as?

A

Runs along moderator band and anterior papillary muscles and terminate as purkinje fibers

47
Q

Spread of excitation through atria and to the AV node may result from what?

A

Largely from ordinary atrial myocyte excitaiton

There are also internodal and Bachmann’s fibers

48
Q

Where does the excitation of the AV node first occur?

A

In the apex of the heart

49
Q

Where does the Left bundle branch run?

A

run down septal wall and then fans out on papillary muscles nad extends fibers throughout apical region

50
Q

What initates the cardiac cycle?

A

Myogenic activity inthe SA node

51
Q

What modulates the cardiac cycle?

A

Sympathetic and Parasympathetic input modulates

Modulate rate, force, and output

52
Q

The autonomic nerves and ganglion cells act on what?

A

Nodal tissues

conduction bundles and terminal fibers

coronary vessels

directly on the atrial and ventricular musculature

53
Q

Sympathetic activity _______ the heart and _______ the coronary arteries

A

Accelerates

dilates

54
Q

Parasympathetic (vagus) activity ____ the heart and _____ the coronary arteries

A

Slows

Constricts

55
Q

Are the vagal cardiac nerve pre or post ganglionic?

A

PREGANGLIONIC parasympathetic fibers

56
Q

Are the sympathetic cardiac nerves pre or post ganglionic?

A

POSTGANGLIONIC fibers

57
Q

All of the cardiac branches of the vagus and all the sympathetic branches contain both affernt and efferent fibers except?

A

The Cardiac branch of the Superior Cervical Sympathetic Ganglion is entirely EFFERENT

58
Q

What are the three vagal cardiac nerves?

A

Superior cervical vagal cardiac nerve

Inferior Cervical Vagal Cardiac Nerve

Thoracic Vagal Cardiac NErve

59
Q

The autonomic cardiac nerve supply the heart by way of ?

A

By way of the cardiac plexus

This is located on the posterior surface of the aortic arch and pulmonary trunk/arteries, immediately anterior to the bifurcation of the trachea.

60
Q

What is the coronary plexus?

A

extension of the cardiac plexus along the coronary arteries

61
Q

What is the pulmonary plexus?

A

vagal and sympathetic fibers innervate the bronchial tree and visceral pluera

62
Q

The largest group of cardiac ganglia are located near where?

A

The SA node and AV nodes

63
Q

Where are the smaller groups of cardiac ganglia located?

A

Upper part of the left atrium

Interatrial septum

junctions of atria and auricles

base of the great vessels

base of teh ventricles

64
Q

Which areas of the heart are devoid of cardiac ganglia?

A

Right atrial free wall

atrial appendages

trunk of great vessels

most of the venricular myocardium

65
Q

Majority of the neurons in cardiac ganglia are local circuit neurons which synapse where?

A

on other ganglia

66
Q

What does it mean when the heart is Left dominant?

A

PAD is coming of the Left coronary artery instead of the Right coronary arter

also if there is no Right coronary artery the branches are all coming off the left coronary artery

67
Q

What does it mean when the heart is balanced?

A

Right coronary artery braches into right marginal and Posterior Interventricular brach

Left coronary artery branches into circumflex and LAD

68
Q

What does it mean when the heart is right dominant?

A

The circumflex artery instead of coming off the left is now coming off the right. Right coroanry artery also has PAD and Right marginal. Only branch on Left coronary artery is LAD

69
Q

Where along the large coronary arteries are collaterals located?

A

The heart does not have much collaterals but there is anastamosis along the distal end of the coronary arteries branches. This allows for some bidirectional flow between main branches.

70
Q

Are the anastamosis in the heart sufficient to provid colateral pathways around large coronary blocks?

A

NO

71
Q

The great cardiac vein becomes what?

A

THe coronary sinus

72
Q

Where does the anterior cardiac vein drain into?

A

Right atrium

73
Q

What are Thebsian veins?

A

Thees are the smallest cardiac veins.

Located mostly in right atrium and ventricle

74
Q

When coronary blood flow greatest?

A

During ventricular diastole, especially for the left coronary artery

75
Q

When does flow drop? Peak?

A

Drops to zero as systole begins

Peaks at the beginning of diastole when the ventricles relax

SF3 (15 decks)

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