Anatomy of the Heart I & II

Question 1

pericardium:

pericardial sac: ___

posterior to ___ & ___

anterior to ___

composed of two portions: ___ & ___

Answer 1

fibroserous sac that encloses the heart & roots of the great vessels

body of sternum, 2nd - 6th ribs

T5 - T8

fibrous pericardium, serous pericardium

Question 2

fibrous pericardium:

firmly attached infererioly to ___ & anteriorly to ___ via ___

blends superiorly w/ ___

the ___ nerves & the ___ vessels are embedded in its surface & pass in ___ of the roots of the lungs

functions: ___

Answer 2

central tendon of diaphragm, sternum, sternopericardial ligaments

outer coats of the great vessels passing through it

phrenic, pericardiophrenic, front

anchors the heart & limits distention

Question 3

serous pericardium:

___ layered ___ sac

parietal layer (parietal pericardium):

• inner lining of the ___
• reflected around the ___ to become continuous with the ___

visceral layer (visceral pericardium, epicardium):

• closely applied to the ___
• potential space exists b/n the ___ & ___ layers which contains a small amount of ___ fluid

function: ___

Answer 3

double, serous

fibrous pericardium
roots of the great vessels, visceral pericardium

heart
parietal, visceral, lubricating serous

lubricates the moving surfaces of the heart

Question 4

sinuses:

located on the ___

consist of enlargements of the ___ created by ___

Answer 4

posterior surface of the heart

pericardial cavity, reflections of the serous pericardium around the vessels

Question 5

transverse sinus:

space b/n the ___ & the ___

passage from the ___ to the ___

Answer 5

aorta/pulmonary trunk, superior vena cava

right, left side of the pericardial cavity

Question 6

oblique sinus:

___ rather than a passageway created by ___

lies ___

Answer 6

cul-de-sac, reflections of the serous pericardium around the six major veins entering the heart

behind the left atrium

Question 7

surface of heart: apex:

location: ___

points ___

found in ___

Answer 7

tip of left ventrical

anteriorly, inferiorly, & to the left

left 5th intercostal space, approximately 8-10 cm from the midline

Question 8

surface of heart: sternocostal surface

Answer 8

mostly right atrium & right ventricle

small part of left ventricle

Question 9

surface of heart: diaphragmatic surface

Answer 9

mostly left ventrical

smaller part of right ventricle

Question 10

surface of heart: base

Answer 10

mostly left atrium

smaller portion of right atrium (most superior part of the heart)

Question 11

right border of heart

Answer 11

SVC
right atrium
IVC

Question 12

left border of heart

Answer 12

arch of aorta
pulmonary trunk
left auricle
left ventricle

Question 13

superior border of heart

Answer 13

great vessels

Question 14

inferior border of heart

Answer 14

right ventricle

part of left ventricle

Question 15

right atrium:

partially divided internally into two main parts by the ___

smooth muscular ridge commencing on ___ just in front of ___& extending ___

cavity posterior to the crista terminals is the ___ which receives the ___ & has ___ walls

walls of anterior half of atrium, including auricle, are ridged by the ___ (comb-like) which fan out from the crista terminalis into the auricle

Answer 15

crista terminalis

roof of atrium, opening of the superior vena cava, downward to the anterior lip of the inferior vena cava

sinus venarum, superior & inferior vena cava, smooth

pectinate muscles

Question 16

right atrium: atrium proper

Answer 16

anterior half of chamber including right auricle

Question 17

right atrium: sulcus terminalis

Answer 17

position of the crista terminalis is represented on the surface of this groove which extends between the superior & inferior vena cava

Question 18

openings into the right atrium: superior vena cava

Answer 18

opens into the superior, posterior, part of the right atrium

Question 19

openings into the right atrium: inferior vena cava

Answer 19

opens into the inferior, posterio part of the right atrium almost in line w/ the SVC

contains a non-functioning valve of embryonic importance

Question 20

openings into the right atrium: coronary sinus

Answer 20

opens into the right atrium b/n the orifice of the inferior vena cava & the right atrioventricular orifice

contains a non-functioning valve (Thebesian valve) of embryonic origin

Question 21

openings into the right atrium: right atrioventricular orifice

Answer 21

lies anterior to the orifice of the IVC, guarded by the tricuspid valve

Question 22

right atrium: fossa ovalis:

depression in the ___

marks the location of the ___

has a prominent upper margin called the ___

Answer 22

interatrial septum just above the opening of the inferior vena cava

embryonic foramen ovale (aperture for right to left shunting of embryonic blood)

limbus fossa ovalis

Question 23

right ventricle:

communicates w/ the ___ via the ___ & w/ the ___ via the ___

partially divided into ___ & ___ by the smooth muscular crest ___

Answer 23

right atrium, right atrioventricular orifice, pulmonary trunk, pulmonary orifice

inflow tract (posterior), outflow tract (anterior), supraventricular crest

Question 24

right ventricle: outflow tract

has a funnel-shaped surface appearance & is called the ___ or ___

internal walls are ___

Answer 24

infundibulum, conus arteriosus

smooth

Question 25

right ventricle: inflow tract behind the ___ contains prominent fleshy ridges called ___ which give rise to column-like or nipple-like projections called ___

Answer 25

crista supraventricularis trabeculae carnae, papillary muscles

Question 26

right ventricle: three sets of papillary muscles named according to the location of their bases: ___ from the apex of each papillary muscle, several fibrous cords extend to the cusps of the tricuspid valve: ___

Answer 26

anterior, posterior, septal chordae tendinae

Question 27

right ventricle: anterior papillary muscle

Answer 27

most constant & most prominent

Question 28

right ventricle: septal papillary muscle

Answer 28

may be absent, in which case, the chordae tendinae spring directly from the wall of the septum

Question 29

right ventricle: posterior papillary muscles

Answer 29

there may be several small ones

Question 30

right ventricle: papillary muscles & chordae tendinae

Answer 30

prevent eversion of the atrioventricular valve into the atrium during ventricular systole

Question 31

right ventricle: tricuspid valve (right atrioventricular valve): composed of ___ bases of the cusps are secured to the ___

Answer 31

anterior, posterior, & septal cusps fibrous ring of the heart

Question 32

right ventricle: septomarginal trabeculae (moderator band)

Answer 32

specialized trabeculae carnae running from the interventricular septum to the base of the anterior papillary muscle carries right branch of the bundle of His to the anterior papillary muscle

Question 33

right ventricle: pulmonary valve composed of ___ one cusp is ___ placed, the other two are situated to the ___ & named accordingly center of the free margin of each cusp: ___ thin margins on each side of the above: ___ in the "pocket" of each cusp is a ___ of the pulmonary trunk the cusps attach along the ___ of each sinus backflow of blood during ___ fills the sinuses & causes ___ preventing ___

Answer 33

three delicate cup-shaped cusps (valvules) anteriorly, right & left posteriorly nodule lunula "sinus" or dilation curved, inferior margins ventricular diastole, approximation of the edges of the cusps, regurgitation of blood

Question 34

left atrium: similar to the right with ___, but there is ___ posterior portion which receives the ___ has ___ walls anterior wall & left auricle contain ___ as in the right atrium in contact posteriorly w/ the ___ through the ___ & ___

Answer 34

two internal sections, no definite line of demarcation four pulmonary veins, smooth musculi pectinati esophagus, oblique sinus, pericardium

Question 35

left ventricle: walls are approximately ___ as thick as the right ventricle the ___ are not as well developed as those of the right ventricle the ___ is the outflow tract of the left ventricle & corresponds to the ___ of the right ventricle

Answer 35

three times trabeculae carnae aortic vestibule, conus arteriosus

Question 36

left ventricle: interventricular septum (two portions)

Answer 36

thick muscular portion (pars muscularis) thin membranous portion (pars membranacea) - above the muscularis & close to the atrioventricular orifices

Question 37

left ventricle: mitral valve guards the ___ two cusps: ___ & ___ anterior cusp is ___ & intervenes b/n the ___ & ___ two large ___ muscles (anterior & posterior) attach to the free margins of the valve cusps by ___ each muscle is attached by ___ to ___ cusps

Answer 37

left atrioventricular orifice anterior & posterior larger, atrioventricular, aortic orifices papillary, chordae tendinae chordae tendinae, both

Question 38

left venctricle: aortic valve guards the ___ contains ___ cusps similar to those of the ___ arranged w/ one lying ___ & left & right ___ cusps sinuses are located ___ as in the pulmonary cusps the right & left coronary arteries arise from the right & left ___ the posterior aortic sinus lacks a ___, so the posterior sinus & cusp are referred to as the ___

Answer 38

aortic orifice three, pulmonary valve posteriorly, anterior above the bases of the cusps aortic sinuses coronary artery, noncoronary sinus & cusp

Question 39

cardiac skeleton: consists of ___ which forms the ___ four fibrous rings provide ___ the rings help reduce ___

Answer 39

fibrous connective tissue, central support of the heart attachment for the valvules & cusps of the heart vavles & the bundles of atrial & ventricular muscle fibers excessive valve stretching & give origin to the myocardial muscle bundles

Question 40

physiological significance of cardiac skeleton: the ___ are attached to the upper borders of the rings the ___ are attached to the lower borders of the rings therefore, the two sets of muscle bundles are ___ except through the ___

Answer 40

atrial bundles ventricular bundles electrically separated, specialized conducting system

Question 41

right coronary artery: arises from the ___ & emerges on the ___ runs through the ___ b/n the ___ & ___

Answer 41

right aortic sinus, right side of the pulmonary trunk right coronary sulcus, right atrium, right ventricle

Question 42

right coronary artery: branches sinuatrial nodal branch: ___ right marginal branch (___): ___ AV nodal branch: ___ posterior interventricular branch (___) - ___

Answer 42

usually given off from atrial branch near the origin of RCA acute marginal, supplies right border given off at crux of the heart posterior descending artery (PDA), runs in the posterior interventricular sulcus

Question 43

summary of right coronary artery supply

Answer 43

``` right atrium right ventricle (most) part of left ventricle (diaphragmatic surface) posterior 1/3 of IV septum SA & AV nodes (most of the time) ```

Question 44

left coronary artery: arises from the ___ & emerges on the ___ shortly after its origin usually while it is still behind the left auricle, it branches into the ___ & ___

Answer 44

left aortic sinus, left side of the pulmonary trunk anteior interventricular branch (left anterior descending (LAD)), circumflex branch

Question 45

left coronary artery: anterior interventricular artery

Answer 45

descends toward the apex in the anterior interventricular sulcus

Question 46

left coronary artery: circumflex artery: runs to the left in the ___ b/n the ___ & ___ & then continues onto the ___ usually doesn't reach the ___, but when it does, it may give rise to the ___

Answer 46

left coronary sulcus, left auricle, left ventricle, posterior of the heart posterior interventricular sulcus, posterior interventricular artery

Question 47

left coronary artery: left coronary dominance

Answer 47

approximately 10% of cases the left coronary artery (by way of the circumflex branch) gives rise to the posterior interventricular artery

Question 48

left coronary artery: branches of the circumflex artery

Answer 48

left marginal branch (obtuse marginal) - supplies left border SA & AV nodal branches (occasionally)

Question 49

summary of left coronary artery supply

Answer 49

``` left atrium left ventricle (most) part of right ventricle anterior 2/3 of IV septum including the bundle of His SA & AV node (occasionally) ```

Question 50

cardiac veins: coronary sinus: lies in the ___ receives ___

Answer 50

left coronary sulcus from the left margin of the heart to its orifice in the right atrium most of the veins of the heart

Question 51

cardiac veins: great cardiac vein: lies in the ___ & passes ___ becomes continuous w/ the ___ after receiving the ___

Answer 51

anterior interventricular sulcus, upward & to the left in the left coronary sulcus coronary sinus at the left margin of the heart, oblique vein of the left atrium

Question 52

cardiac veins: middle cardiac vein: runs in the ___ empties into the ___

Answer 52

posterior interventricular sulcus coronary sinus on posterior surface of heart

Question 53

cardiac veins: small cardiac vein: parallels the ___ passes in the ___ & drains into the ___

Answer 53

right marginal artery right coronary sulcus to the posterior of the hear, coronary sinus

Question 54

cardiac veins: anterior cardiac veins arise on the ___, pass across the ___, & penetrate the ___

Answer 54

anterior surface of the right ventricle right coronary sulcus anterior wall of the right atrium directly

Question 55

cardiac veins: least cardiac veins (venae cordis minimis): minute veins in the ___ that empty directly into the ___ most numerous in the ___ & least numerous in the ___

Answer 55

muscular walls of the heart, cardiac chambers wall of the right atrium, wall of the left ventricle

Question 56

cardiac plexus: diffuse network of ___ extending in front of the ___ to the ___ receives ___ input

Answer 56

delicate nerve fibers trachea aortic arch, pulmonary trunk, & ligamentum arteriosum both sympathetic & parasympathetic

Question 57

sympathetic cardiac branches: three cervical cardiac nerves

Answer 57

superior cervical - from superior cervical ganglion middle cervical - from middle cervical ganglion inferior cervical - from inferior cervical ganglion

Question 58

sympathetic cardiac branches: thoracic cardiac nerves

Answer 58

from upper four or five thoracic ganglia of the sympathetic trunk

Question 59

sympathetic cardiac branches: sympathetic fibers of plexus are all ___ preganglionic fibers for all of the sympathetic cardiac nerves arise in the ___

Answer 59

postganglionic upper four or five thoracic segments of the spinal cord

Question 60

sympathetic cardiac branches: functions

Answer 60

accelerate heart rate increase force of heart beat dilate the coronary arteries

Question 61

parasympathetic cardiac branches: arise from the ___

Answer 61

vagus nerves

Question 62

parasympathetic cardiac branches: two cervical cardiac nerves arise from the ___

Answer 62

superior cervical & inferior cervical vagus nerves in the neck

Question 63

parasympathetic cardiac branches: several thoracic cardiac branches arise from ___

Answer 63

either the vagal trunks or from the recurrent laryngeal branches of the vagus

Question 64

parasympathetic cardiac branches: parasympathetic fibers of the plexus originating from the vagi are ___ & synapse w/ ___ within the ___

Answer 64

preganglionic small ganglia plexus or in the walls of the heart

Question 65

parasympathetic cardiac branches: functions

Answer 65

decrease the heart rate reduces the force of contraction constricts the coronary arteries

Question 66

afferent (sensory) fibers of the plexus: visceral afferents from the heart join the ___ & pass along the ___ the vagal afferents are concerned w/ ___ the afferents in the sympathetic cardiac nerves are concerned w/ ___

Answer 66

cardiac plexus, sympathetic & vagal cardiac branches cardiac reflexes the conduction of pain sensations from the heart

Question 67

afferent (sensory) fibers of the plexus: cardiac afferents conducting "pain" the fibers travel from the heart w/ ___ fibers to spinal cord levels ___ all pain afferents enter the ___ of the ___nerves (the same spinal cord segments giving rise to ___ efferent fibers)

Answer 67

sympathetic, T1 - T5 dorsal roots, upper four or five thoracic, preganglionic

Question 68

afferent (sensory) fibers of the plexus: cardiac afferents conducting "pain" because visceral afferent fibers concerned w/ ___ terminate in the ___ of the same spinal cord segments as ___ in upper thoracic spinal nerves, the pain of ___ may be "referred" along the dermatomes supplied by these upper thoracic spinal nerves the patient often interprets pain along the ___ (dermatomes T1 & T2) & the ___ (dermatomes T2 - T5)

Answer 68

cardiac pain, dorsal horns, somatic afferents, angina pectoris ulnar border of the upper limb, upper part of the thorax

Question 69

conducting system of the heart: components

Answer 69

sinuatrial node atrioventricular node atrioventricular bundle (of His)

Question 70

conducting system of the heart: sinuatrial node (Pacemaker): structure location

Answer 70

crescent-shaped structure (5-8 mm in length), occupying whole thickness of the wall of the right atrium located on the anterior lip of the superior vena cava orifice near the top of the crista terminalis

Question 71

conducting system of the heart: atrioventricular node: embedded in the ___ close to the ___ it rests on the ___ close to the attachment of the ___ within the septum, the node extends ___ its cells continue anteriorly into the ___

Answer 71

interatrial septum, opening of the coronary sinus fibrous atrioventricular ring, septal cusp of the tricuspid valve forward from the opening of the coronary sinus atrioventricular bundle

Question 72

conducting system of the heart: atrioventricular bundle: commences as the forward continuation of the ___ the only connection b/n the ___ the bundle runs downward & forward into the ___ & then ___ where it divides into ___

Answer 72

atrioventricular node myocardium of the atria & ventricles membranous, muscular interventricular septa, right & left bundle branches

Question 73

conducting system of the heart: atrioventricular bundle: the right bundle branch runs beneath the ___ & enters the ___ to supply the ___ & then breaks up into fine fibers which supply the remainder of the ___ the left bundle follows a similar course beneath the ___ in the ___, but breaks up into branches which reach the ___ along several ___ the fine terminal branches of each bundle end in ___ of specialized conducting cells called ___ which are continuous with ___ muscle fibers

Answer 73

endocardium septomarginal trabecula papillary muscles right ventricle endocardium left ventricle ventricular wall trabeculae carnae subendocardial plexus Purkinje fibers ventricular myocardial