Anatomy - Thoracic Cavity: The Heart Part 2 Flashcards
Does the heart beat faster or slower in marathon runners?
Slower: 50 times/min at rest
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
What are the 4 components of the CV system?
- Heart2. Vascular system 3. Volemia4. Pulmonary microcirculation
What are 5 possible causes of pericardial pathological conditions?
- Pericarditis 2. Pericardial effusion3. Cardiac tamponade 4. Cardiomegaly5. Hemopericardium
How do bacteria or viruses reach the pericardial space?
Piece of fascia extends from base of the skull to the thorax
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 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
How does venous pressure increase during cardiac tamponade?
Linearly
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
Which coronary artery is called the widow maker?
LAD
What is a common complication of coronary ischemia? How fast does this occur?
Ischemic necrosis of the heart (tissue death)Within 20-30 min after occlusion+ cardiac tamponade
What is the clinical presentation of myocardial ischemia?
- Angina pectoris = pressure, discomfort, or feeling of choking in the left chest that radiates to the left shoulder and arm as well as the neck, jaw/teeth, abdomen, and back (referred pain)2. Shortness of breath3. Nausea/vomiting4. Perspiration5. Weakness, collapse, coma
Where does MI usually begin? Why?
In the subendorcardium because most poorly perfused region of the ventricular wall
What is the patency of vein grafts?
7 to 9 years
What are the 3 treatments for myocardial ischemia?
- Coronary artery by-pass surgery2. Percutaneous transluminal angioplasty3. Stents
Describe coronary artery by-pass surgery.
The internal thoracic artery (right or left) or the radial artery (right or left) or the great saphenous vein (right or left) are used as graft to create an alternate path for blood to flow around the occluded coronary artery.
What needs to be done if the great saphenous vein is used during coronary artery by-pass surgery?
Reverse the direction of the vein since it has valves OR turn it inside out
Where is the great saphenous vein found?
The thigh
Which has better long-term results: coronary artery by-pass surgery using the great saphenous vein or the internal thoracic artery? Why?
Internal thoracic artery, because:1. Arterial grafts so do not have valves2. Better match size 3. Easy to harvest 4. Low vasoconstrictor sensitivity and high vasodilator sensitivity
Describe percutaneous transluminal angioplasty.
Method in which a deflated balloon catheter is placed in the vessel blockage and inflated to crush the blockage to re-establish circulation
What is saphenous vein graft disease? Treatment?
Complication after coronary artery by-pass surgery where the vein presents a diffuse and friable plaque and often a thrombusTreatment: stents
Describe how stents are used in the coronary arteries. When is this often done?
Stent often coated with anticoagulants is inserted using a catheter in the femoral artery and placed at the site of blockage to help the vessel stay patent (usually during the angioplasty intervention)
What is a major complication of stents? Who does this often happen to?
If the patient has an accident he will bleed very quickly (usually to death) because of the anticoagulants on the stent and orally taken Elderly who fall a lot or have another type of surgery
What % of coronary circulation returns to the heart via the coronary sinus?
95%
Symptom of LA enlargement
Trouble swallowing (drink fluids to help)
What does the SVC drain?
Body above diaphragm, excluding the heart, lumbar azygos, and hemiazygos veins
What does the IVC drain?
Body below diaphragm
What 2 factors propel blood from atria to ventricles?
- Gravity2. Contraction
What is the correct sequence of valvular opening and closing? Start at beginning of systole.
Mitral valve closing => tricuspid valve closing => pulmonary valve opens => aortic valve opens => aortic valve closes => pulmonary valve closes => tricuspid valve opens => mitral valve opens => mitral valve closing => tricuspid valve closing => …
What is a heart block? Treatment?
Damage to either the AV node or AV bundle causing the ventricles to beat slower than the atria Treatment: pacemaker
What is cardiopulmonary congestion? What is it a feature of? Symptom?
Blood fills up in the lungsFeature of left heart failureSymptom: trouble breathing, especially when they lay down and systemic hypoperfusion
What can it mean when a patient intuitively grabs onto something to support them while standing?
Left heart failure
Signs of right heart failure?
SYSTEMIC CONGESTION and PULMONARY HYPOPERFUSION: 1. Cyanotic patients = blue 2. Bilateral jugular vein distention 3. Enlarged liver4. Ascites 5. Pitting edema on legs, ankles, and feet
Where does fluid go during systemic hyperperfusion?
Serosal cavities:1. Pleura = pleural effusion2. Pericardium = pericardial effusion3. Peritoneal cavity = ascites
Purpose of pericardial cavity? What to note?
Thought to provide a smooth surface for the heart to work against but persons congenitally born without one do not seem to have cardiac difficulties
Location of SA node on external surface of the heart?
Sulcus terminalis cordis (or terminal sulcus)
What sensations are consciously perceivable from the heart?
- Ischemia2. Pressure
Is the heart sensitive to cutting or changes in temp?
NOPE
What forms the superior border of the heart?
Both atria
What structure forms the anterior wall of the LV?
IV septum
Describe placement and insertion of a pacemaker. Complication?
Pacemaker is placed within the subcutaneous tissue over the pectoralis major and travels to pierce the axillary vein right below the clavicle, lateral to the subclavius muscle (as far as possible in the axillary vein from it) => subclavian vein => left brachiocephalic vein => SVC => RA => lies on RV wall After many years of shoulder movement, subclavius muscle stresses and breaks the wire causing the pacemaker to fail.
What could an atrial septal defect lead to over many years?
Pulmonary HT due to enlargement of pulmonary trunk and RV
Consequence of patient ductus arteriosus?
Pulmonary HT
