Anatomy - Thoracic Cavity: The Heart Part 1 Flashcards
12 components of the superior mediastinum?
- SVC2. L/R brachiocephalic veins3. Aortic arch + 3 branches4. Thoracic duct5. Trachea6. Esophagus7. Thymus8. L/R Vagus nerve9. L recurrent laryngeal nerves10. L/R phrenic nerves11. L/R pulmonary arteries12. Ligamentum arteriosum
3 components of anterior inferior mediastinum?
- Thymus2. Lymph nodes3. Connective tissue
5 components of middle inferior mediastinum?
- Pericardium2. Heart3. Roots of great vessels4. Arch of the azygos vein5. Main bronchii
8 components of posterior inferior mediastinum?
- Esophagus2. Thoracic aorta3. Azygos system of veins4. Hemiazygos5. Vagus nerve6. Symphathetic trunks7. Thoracic splanchnic nerves8. Thoracic duct
What are the 11 physiological systems?
- Integumentary2. Skeletal3. Muscular4. Nervous5. Endocrine6. CV7. Lymphatic8. Respiratory9. Digestive10. Urinary11. Reproductive
Are all 11 physiological systems found in the mediastinum?
YUP
Anterior border of mediastinum?
Sternum
Posterior border of mediastinum?
Vertebral column
Superior border of mediastinum?
Thoracic aperture
Inferior border of mediastinum?
Diaphragm
Lateral borders of mediastinum?
Lungs
In which parts of the mediastinum do we find the same structures?
ALL
Incidence of CVD?
1:5 males and females
What is the leading cause of morbidity and mortality in the US and other developed countries? For how long has this been going on?
Congenital and acquired heart diseasesSince 1900 (except 1918)
How many deaths per year in the US due to some sort of heart disease?
1 million
What % of sudden deaths are due to heart disease?
90%
What % of sudden cardiac deaths occur in men?
75%
Who are the main victims of cardiac deaths?
Males between 45 and 64 (90%)
Do women die more of breast cancer or heart disease?
Heart disease: 1:4 vs 1:9 (develop it)
How many Americans have 1 or more types of CVD?
Over 60 million
Does CVD claim more lives each year than the next 6 leading causes of death combined?
YUP (almost 10,500 more)
What 5 things did the Greeks think they knew about the heart in 280 B.C.?
- 4 main vessels: arteries and veins2. Heart has 2 sides3. Right side was the only one to hold blood and did not pump4. Left side contained intelligence5. Valves were present at the root of great vessels
When was the heart recognized as a pump?
270 B.C.
What 3 variables contribute to the development of heart disease?
- Aging2. Disease3. Lifestyle
What can red wine reduce the risk of?
- CVD2. Alzheimer’s3. Cancer
How often does the heart beat in an average adult?
70 times/min at rest
Does the heart beat faster or slower in marathon runners?
Slower: 50 times/min at rest
What quantity of blood does the heart pump every day?
1800 gallons
Is the heart heavier in men or women? By how much?
Heavier in men: 300 g vs 250-275 g
What are the 4 components of the CV system?
- Heart2. Vascular system 3. Volemia4. Pulmonary microcirculation
Is the vascular system open or closed?
CLOSED
What is the volemia portion of the CV system?
The blood volume that fills up the vascular system at a given pressure
What is the pulmonary microcirculation of the CV system?
A gas-exchange system between the blood and the surround environment
What are the 2 layers of the pericardial sac?
- Fibrous pericardium2. Serous pericardium
What is the fibrous pericardium?
The outermost layer of the pericardium made of tough connective tissue
What attaches to the fibrous pericardium superiorly, inferiorly, and anteriorly?
- Superiorly: tunica adventitia of SVC2. Inferiorly: central tendon of diaphragm 3. Anteriorly: posterior surface of the sternum
What is the main function of the fibrous pericardium?
Protect the heart from sudden over filling
What are the 2 layers of the serous pericardium? Describe each.
- Parietal: outer layer lining the inner surface of the fibrous pericardium2. Visceral: inner layer covering the external surface of the heart
Which other organs have a 2 layers membrane (visceral and parietal)?
Lungs (pleura)
What is another name for the visceral serous pericardium?
Epicardium
Is there a space between the 2 layers of the serous pericardium?
Yes, but it’s a potential space with a tiny amount of fluid to lubricate it (secreted by the serous membrane) and does not become a true space unless there is a pathology
Why are we asked to hold our breath during X-rays?
Because the fibrous pericardium is bound to the diaphragm and the heart will not be accurately depicted if we are breathing (aka the diaphragm is moving)
Which is more common: AP or PA?
PA
What is the potential space between the 2 serous pericardial layers called?
Pericardial cavity
What are 5 possible causes of pericardial pathological conditions?
- Pericarditis 2. Pericardial effusion3. Cardiac tamponade 4. Cardiomegaly5. Hemopericardium
What is pericarditis? 2 possible causes?
Inflammation of the pericardium1. Virus2. Bacteria
What is pericardial effusion?
Pericardial cavity becomes a real space with fluid build-up
What is cardiac tamponade?
Heart compression due to pericardial effusion or hemopericardium
What is hemopericardium? Treatment?
Blood fills up pericardial cavityTreatment: pericardiocentesis (draining)
What does the suffix “-itis” mean?
Inflammation
How do bacteria or viruses reach the pericardial space?
Piece of fascia extends from base of the skull to the thorax
What is a common cause of bacterial pericarditis? How can this be avoided?
Oral surgeryProphylactic antibiotics
What are 3 potential causes of cardiac tamponade?
- Ruptured aortic aneurism2. Ruptured myocardial infarct 3. Penetrating injury
Can any blood born pathogen have potential access to the pericardial sac?
YUP
What are the 5 signs of cardiac tamponade?
- Elevated venous pressure 2. Distended neck veins 3. Distant heart sounds4. Patient in variable degrees of shock5. Decreased arterial and pulse pressures
What does pathognomic mean?
Characteristic for a particular disease
Is the elevated venous pressure a pathognomic sign of cardiac tamponade?
YUP
Is the decrease arterial and pulse pressures a pathognomic sign of cardiac tamponade? What does this mean?
NOPEUnreliable for diagnosis
What is pulse pressure?
The difference between the systolic and diastolic pressure readings
Where exactly is pericardiocentesis performed? Why? Other name for this area?
Bare area of the pericardium = Larrey’s area => just inferior to the 5th rib (5th intercostal space) about 1 inch to the left of the sternumNo lung overlying this area
What is an aneurysm? Vessels in which this is most commonly found? Long-term consequence?
Excessive sac-like localized enlargement of a vessel due to vessel weakeningMost commonly found in abdominal aorta and carotid arteries LT consequence: bursting due to gradual worsening of the weakening of the wall
What is a ruptured myocardial infarct?
TBD
What does “in extremis” mean?
In extreme circumstances; especially: at the point of death
How does venous pressure increase during cardiac tamponade?
Linearly
What is jugular venous distention called? When is this observed?
Kussmaul’s sign During inspiration, when the venous pressure in the jugulars is supposed to decline
What are the 4 signs of pericarditis?
- Atypical chest pain2. High-pitched friction rub3. Effusion (mimics cardiac tamponade)4. Exudate associated with acute disease
To where can the fluid in the pericardial space drain to?
Two cardiac sinuses = spaces created by the reflections of the serous pericardium
Where are the borders of the 2 cardiac sinuses?
Where the visceral pericardium extends off the surface of the heart to become continuous with the parietal pericardium
What are the 2 cardiac sinuses? Where is each located?
- Oblique pericardial sinus: formed by reflections onto the pulmonary veins: inferior to the level of the pulmonary veins, posterior to the heart2. Transverse pericardial sinus: separates arteries from veins, superior to the level of the pulmonary veins, posterior to the pulmonary trunk/ascending aorta between them and the SVC
Are the 2 cardiac sinuses connected?
NOPE
How is one of the cardiac sinuses exploited during bypass surgery?
The location of the transverse one is exploited as a surgical clamp is introduced into the space and blood flow of the aorta/pulmonary trunk is stopped momentarily before great vessels are connected to the bypass machine
Describe the heart borders in the anatomical position.
- Right border: right atrium2. Anterior border: right ventricle3. Left border: left ventricle
Can one see the left atrium from the anterior view of the heart in anatomical position?
NOPE (very very small portion)
Why does the heart need its own blood supply instead of just using the blood inside of it?
Because its walls are so thick that the blood does not have time to diffuse across the heart tissue
Are the roots of the great vessels inside the pericardium?
YUP