ANATOMY - thorax p2 Flashcards
what level does the SVC enter the RA?
at level 3rd rib
where do the pulmonary aa receive blood from and where does it send it to?
deoxy blood from the RV –> lung
which valve separates the pulmonary aa and the RV?
pulmonary valve
at what spinal level does the pulmonary aa/trunk split into the R + L pulmonary aa
T5/6
where do the pulmonary vv receive blood from and where does it send it to?
oxy blood from the lungs –> LA on the posterior surface
what structure is in between the L + R pulmonary vv?
oblique pericardial sinus
where does the IVC receive blood and where does it drain into?
blood from all structures inf to diaphragm –> inferior portion of the RA
at what spinal level does the IVC enter the pericardium?
T8
what are the 5 surfaces of the heart
ant - RV
post - LA
inf - LV + RV
R pulmonary - RA
L pulmonary - LV
what are the 4 borders of the heart?
R - RA
inf - LV + RV
left - LV
sup - RA/LA/ great vessels
another name for coronary sulcus
atrioventricular groove
what important structure is contained within the coronary sulcus
RCA
what forms pericardial sinuses?
because of how the pericardium folds around the great vessels
where is the transverse pericardial sinus?
posterior the ascending aorta + pulmonary trunk
anterior to the SVC
superior to the LA
what does the transverse sinus separate and what is its surgical use
separates the aa from the vv
used to ligate the aa of the heart during a CABG
which 3 vv drain into the RA
SVC
IVC
Coronary vv
where is the R auricle within the RA?
anteromedially
role of the R auricle?
increases the capacity of the heart
what divides the inferior surface of the RA into 2?
crista terminalis
what 2 parts does the division of the RA by the crista terminalis make?
Sinus veranum (posterior to crista)
Atrium proper (anterior to crista)
where does the sinus veranum receive blood from
SVC + IVC
wall smooth or rough - sinus veranum
smooth
embryological origin sinus veranum
sinus venosus
wall smooth or rough - atrium proper
rough
name of the oval shaped depression in the interatrial septum
fossa ovalis
what is the fossa ovalis a remnant of?
foramen ovale
how does an atrial septal defect cause HF?
L –> R shunt –> LV overload –> pulm HTN –> RVH –> RHF
where is the L auricle>
superior aspect of the LA
inferiorly, what is the LA divided into?
inflow portion + outflow portion
which vessels does the inflow portion of the LA receive blood from?
pulmonary vv
what structure is the inflow portion of the LA derived from and how does it affect its surface
derived from pulmonary vv
hence smooth surface
what type of mm is the outflow portion of the LA?
pectinate mm
what structure divides the RV into the inflow and outflow sections?
supraventricular crest
name of the irregular ridges on the inflow portion of the RV
trabecula carnae
what are the 3 types of the trabeculae carnae
ridges
bridges (cont R bundle branches)
Pillars (papillary mm)
what are the pillar trabeculae carnae attached to
chordae tendinae + tricuspid valves (presents prolapse)
another name for the outflow portion of the RV
conus arteriosus
embryological origin conus arteriosis
bulbus cordis (smooth walled)
difference between the superior and inferior interventricular septum
sup - membranous and thinner, part of the fibrous skeleton
inf - muscular, same thicness as the LV
what structure lines the inflow portion of the LV
trabeculae carnae
+ 2 papillary mm (attach to mitral valve)
another name for outflow portion of the LV
aortic vestibule
embryonic origin aortic vestibule
bulbus cordis
smooth walled
what is tetralogy of Falot?
VSD
overriding aorta - dexoy blood into aorta
pulnary valve stenosis
RVH
(R –> L shunt)
what are the 4 aspects of the conductive system of the heart?
SAN
AVN
AV ‘bundle of His’
Purkinje gfibres
conducting system from SAN to contraction
1) AP created by SAN
2) wave of excitation spreads across the atria via gap junctions to contract
3)wave reaches AVN where signal is delayed
4) signal then is conducted in bundle of His in interventricular septum
5) bundle of His and Purkinje fibres spread waves across the ventricles –> contraction
where is the SAN?
upper RA at the junction where the SVC enters
sympathetic inn of the SAN –>
incr firing rate –> incr HR
parasymp inn of the SAN –>
decr firing rate –> decr HR
where is the AVN
in the atrioventricular sinus, near the opening of the coronary sinus
how long is the AVN delay? what is the significance of it
120ms
to that the atria can fully eject
where is the Bundle of HIs?
down the membranous portion of the IV septum
what are the purkinje fibres?
sub-endocardial plexus of conduction cells
which energy form are Purkinje fibres abundant in
glycogen
where are the Purkinje fibres?
in the subendocardial surface of ventricle walls
what are the 3 layers of the heart wall?
endocardium, myocardium, epicardium
what cell types make up the endocardium
CT
simple swuamous ep
what is the name of the single sheet of cells making up the parietal layer of the pericardium?
mesothelium
what is the fibrous layer of the pericardium continuous with
centra tendon of the diaghragm
what material makes up the fibrous pericardium and what is its function (and danger)
connective tissue
prevents rapid overfilling of heart
liable to tamponade, especially the right)
what type of muscle is the myocardium
involuntary striated muscle
what does the connective tissue of the epicardium do
secretes pericardial fluid into pericardial cavity
what is the outer surface of the epivardium lined by
simple squamous ep = mesothelium
where is the subendocardial layer of the heart
in between the endocardium + pericardium
where is the subepicardial layer of the heart
in between myocardium + epicardium
what is the pericardium
fibroserous, fluid filled sac which surrounds the body of the heart and the roots of the great vessels
layers of the pericardium (+ how to remember)
Farty Priya Shits Viscously
Fibrous
Parietal
Serous fl/space
Visceral
what are the punctiosn of the pericardium (4)
fixes heart in the mediastinum + limits motion
prevents overfilling of heart
lubrication - reduces friction
protection from infection
innervation of the pericardium
C3-5 phrenic nn
what are the 2 AV valves
tricuspid
mitral
what are the 2 semi-lunar valves
aortic
pulmonary
when do the AV valves close?
start of ventricular contraction/systole –> 1st heart sound
where is the tricuspid valve
between the RA+RV
name of the 3 tricuspid valve csusps
ant, septal, post
where is the mitral valve?
between LA + LV
name of the 2 mitral valve cusps
ant + post
why dont the AV valves prolapse into the atria?
supported by chordae tendinae which are attached to papillary muscles
when do the semi-lunar valves close?
at the beginning of ventricular diastole aka 2nd heart sound
where is the pulmonary valve?
between RV + pulmonary trunk
name of the 3 pulmonary valve cusps
L, R, ant
where is the aortic valve?
betw LV + aorta
what are the 3 aortic valve cusps called
R, L, post
where do the R+ LCA originate from?
L + R aortic sinuses
how do the aortic sinuses fill with blood?
blood recoils during diastole –> fills sinuses –> coronary aa –> myocardium
what structure do most of the coronary vv drain into to for blood to reach the RA?
coronary sinus
what are the 4 main venous tributaries of the heart
great cardiac vv
small cardiac vv
middle cardiac vv
post cardiac vv
great cardiac vv - route back to the coronary sinus
apex of the heart –> ascending in ant interventricular groove –> cuves to L –> post surface of heart –> enlarges to become coronary sinus
small cardiac vv - route back to coronary sinus
anterior surface of heart in groove between RA + RV –> post to coronary sinus
middle cardiac vv - route back to coronary sinus
apex of heart in post interventricular groove –> coronary sinus
post cardiac vv - route back to coronary sinus
post surface LV –> on left to middle cardiac vv –> coronary sinus
inferior MI - where on ECG + which aa occluded
II, III , AVF
RCA
anteroapical MI - where on ECG + which aa occluded
V3+4
distal LAD
anteroseptal MI - where on ECG + which aa occluded
V1/2 LAD
anterolateral MI - where on ECG + which aa occluded
I
avL
V5/6
circumflex
true post MI - where on ECG + which aa occluded
tall R V1
RCA
RCA - which region of heart supplied + subsequent venous drainage
RA, SAN, AVN, post part IV septum
small and middle cardiac vv
R marginal aa - which region of heart supplied + subsequent venous drainage
RV
Apex
small and middle cardiac vv
post interventricular aa - which region of heart supplied + subsequent venous drainage
RV
LV
post 1/3 IVS
l post ventricular vv
L coronary aa - which region of heart supplied + subsequent venous drainage
LA, LV
IVS
AV bundles
great cardiac vv
LAD - which region of heart supplied + subsequent venous drainage
RV, LA, ant 2/3 IVS
great cardiac vv
L marginal aa - which region of heart supplied + subsequent venous drainage
LV
L marginal + great cardiac vv
Circumflex aa - which region of heart supplied + subsequent venous drainage
LA +LV
great cardiac vv
structures in close proximity to medial surface L lung (4)
heart
arch aorta
thoracic aorta
oesophagus
structures in close proximity to the medial surface of the R lung (5)
oesophagus
heart
IVC
SVC
azygous vv
how many lobes Left lung
2
how many lobes right lung
3
where doe sthe horizontal fissure of the lung extend between
horizontally from stenrum at level 4th rib to meet oblique fissure
where does the oblique fissure extend between?
inferior border of the lung in a superopost direction
what are the 3 surfaces of the lungs
costal, mediastinal + diaphragmatic
what are the 3 borders of the lugns
anterior, inferior, posterior
what is the anterior border of the lung
convergence of the mediastinal + costal surfaces
name of the notch of the L lung anterior border
cardiac notch
contents of the root of the lung (6)
bronchus, PA, 2 PV, bronchial vessels, pulmonary plexus nn, lymhatic vessels
through what do structures enter and leave the lung?
via the hilum
bronchial tree from trachea to alveoli
trachea
-> L + R bronchus
–> hilum where divides into lobar bronchi - 1 supplies 1 lobe
–> segmental vronchi (each provides air to 1 broncho-pulmonary segment)
–> conducting bronchioles
–> terminal bronchioles
–> respiratory bronchioles which cont alveoli
aa/vv supply to the lungs
bronchial aa + vv
bronchial aa are a branch of
thoracic aorta
R bronchial vv drains into
azygous vv
L bronchial vv drains into
accessory azygous vv
parasymp contribution + function pulmonary plexus
CN X
stims secretions, bronchial glands
contraction of SM
VD of pulmonary vessels
symp contribution + function pulmonary plexus
symp trunks
relaxation of SM
VC of pulmonary vessels
visceral afferent contribution pulmonary plexus
pain impulses to the sensory ganglion CNX
LN drainage lung parenchyma
superificial/subpleural plexus —> tracheobronchial LN (at bifurfaction) –> L + R bronchomediastinal trunks
LN drainage lung root
deep plexus –> tracheobronchial LN (at bifurcation)
–> L + R bronchomediastinal trunks
where does the trachea extend between
lower border cricoid cartilage –> sternal angle
what mm supports the free ends of the tracheal rings
trachealis mm
lining trachea
ciliated pseudostratified columnar ep + goblet cells
name of bifurcation of the trachea
carina
inn trachea
rec laryngeal nn CNX
aa supply trachea
tracheal branches inf thyroid aa
vv drainage trachea (3)
brachiocephalic, azygous + accessory hemiazygous vv
which bronchus is shorter, wider and descends more vertically?
right bronchus
what 2 structures are sup and post to L main bronchus
sup = arch aorta
post = thoracic aorta + esophagus
nn supply bronchi
pulmonary branches CNX
aa supply bronchi
branches bronchial aa
vv supply bronchi
bronchiole vv
what cartilage do the bronchioles contain
none
instead of goblet cells, what cells do the bronchioles have? (+ their fct)
club cells
prodc surfactant lipoprotein - prevents airways sticking during expiration
cell type alveoli
simple squamous epithelium
how many alveoli in the adult lungs
300 million
where are the visceral and parietal pleura continuous with eachothoer?
at the hilum of the lungs
which is thicker - parietal or visceral pleura
parietal
what are the 4 sections of the parietal pleura
cervical
costal
mediastinal
diaphragmatic
what does the cervical parietal pleura cover
lines extension of the pleural cavity into neck
what does the costal parietal pleura cover
covers inner aspects of the ribs, costal cartilages, intercostal mm
what dose the mediastinal parietal pleural cover
lateral mediastinal area
what does the diaphragmatic parietal pleura cover
sup surface of the diapgragm
aa supply parietal pleural
intercostal aa
nn supply parietal pleura
phrenic + intercostal nn
to what sensation is the parietal pleura sensitive to
pressure
pain
temperature
aa supply visceral pleura
bronchial aa
inn visceral pleura
autonomic mm from pulmonary plexus
what sensation is the visceral pleura sensitive to?
stretch only
what forms the pleural recesses?
where opposing surfaces of the parietal pleura touch
what are the 2 pleural recesses?
costodiagrapgmatic (between costal pleura + diaphragmatic pleura)
costomediastinal - behind sternum
clinical importance of pleural recesses?
pleural effusions can form here
