AP01 Topography of the Heart and Great Vessels

Question 1

Where do the umbilical arteries pass from?

Answer 1

internal iliac arteries

Question 2

what proportion of the blood from the umbilical vein passes through the liver?

Answer 2

1/2

Question 3

how does blood from the umbilical vein pass through the liver?

Answer 3

via the portal sinus and ductus venosus

Question 4

what happens to blood entering the right atrium in the foetus?

Answer 4

bypasses the lungs and enters the left atrium via the foramen ovale.

Question 5

what happens to the blood from the right ventricle in the foetus?

Answer 5

some goes to the lungs, most goes to the aorta via the ductus arteriosus

Question 6

what is PDA?

Answer 6

Patent Ductus Arteriosus

Question 7

what proportion of the blood in the descending aorta goes to the umbilical arteries?

Answer 7

40-50%

Question 8

what does the right recurrent laryngeal wrap around?

Answer 8

the right subclavian artery

Question 9

what is the ligamentum arteriosum?

Answer 9

artefact of the ductus arteriosus

formed 3 weeks After birth

Question 10

what is the function of the fibrous pericardium?

Answer 10

resists overexpansion of the heart

Question 11

what is the pericardium attached to?

Answer 11

diaphragm
mediastinal pleura laterally
sternum anteirorly
moulds around anterior surface of great vessels posteriorly

Question 12

what is normally used to measure pericardial pressure?

Answer 12

right atrial pressure

Question 13

what marks the superior border of the mediastinum?

Answer 13

the sternal angle of louis / trans-thoracic plane

Question 14

what is the clinical significance of the transverse sinus?

Answer 14

go under the aortic arch and behind the pulmonary trunk to clamp off the vessels

Question 15

where is the oblique sinus?

Answer 15

gap behind the left atria anterior to the oesophagus

Question 16

what would happen to heart rate if you damaged the vagus nerve?

Answer 16

inability to decrease heart rate so tachy

Question 17

what would happen if you damaged sympathetic supply to the heart?

Answer 17

brady

Question 18

what is the pathway of sympathetic afferents from the heart?

what is their function?

Answer 18

afferents to upper thoracic and lower cervical ganglia

feedback on blood pressure, pain sensation

Question 19

what is the pathway of sympathetic efferents to the heart?

what is their function?

Answer 19

cardiac nerves from the lower cervical and upper thoracic ganglia

increases heart rate and force of contraction of myocardium

Question 20

what is the pathway of parasympathetic afferents from the heart?

what is their function?

Answer 20

vagal cardiac nerves

provide feedback on blood pressure

Question 21

what is the parasympathetic efferent pathway to the heart?

what is its’ function?

Answer 21

vagus nerve

reduces rate and force of contraction, vasoconstricts coronary arteries

Question 22

where is the superficial cardiac plexus?

Answer 22

below the aortic arch and between the aortic arch and pulmonary trunk

Question 23

where is the deep cardiac plexus?

Answer 23

between aortic arch and carina

Question 24

How does parasympathetic innervation negotiate the cardiac plexus?

Answer 24

provided by the Vagus only, preganglionic fibres reach the heart and synapse with ganglia in the cardiac plexus and the walls of the atria

Question 25

How does sympathetic innervation negotiate the cardiac plexus?

Answer 25

fibres from the sympathetic trunk reach the plexus via cardiac nerves preganglionic fibres from the upper thoracic spinal chord synapse in the lower cervical and upper thoracic ganglia

Question 26

What are the 3 main functions of sympathetic innervation of the heart?

Answer 26

increases heart rate increases contraction force fight / flight

Question 27

What are the 4 features of normal heart X-rays?

Answer 27

cardiothoracic ratio < 50% upper zone of vessels smaller than lower one lungs are clear costophrenic angles well defined

Question 28

How can you tell a CXR is PA?

Answer 28

retracted scapulae and smaller heart appearance

Question 29

How does an angiogram work?

Answer 29

cathetier through a radial or femoral artery, which is then fed through to the start of the coronary artery, then a contrast media is used

Question 30

What drains into the right atrium?

Answer 30

superior, IVC | coronary sinus

Question 31

What are the portions of the right atrium?

Answer 31

``` sinus venarum (smooth) divided by the crista temrinalis atrium proper (rough) ```

Question 32

What is the artefact of the foramen ovale?

Answer 32

fossa ovalis

Question 33

What are the portions of the right ventricle?

Answer 33

inflow - trabeculae carnae divided by the supraventricular crest outflow conus arteriosus

Question 34

What are the 3 features of trabeculae carnae?

Answer 34

ridges bridges pillars

Question 35

What feature is different about the left ventricle compared to the right?

Answer 35

outflow portion is the aortic vestiblae

Question 36

What are the muscles of the atria?

Answer 36

pectinate muscle

Question 37

What is the function of the papillary muscles?

Answer 37

the DO NOT CLOSE AV valves the pressure in the ventricle does they prevent the valve from prolapsing

Question 38

Where do the pulmonary arteries divide?

Answer 38

T5 -T6

Question 39

What is the only bicuspid valve?

Answer 39

Mitral

Question 40

What are AV valves supported by?

Answer 40

chordae tendinae, connected papillary muscles (1 per cup)

Question 41

What are the branches of the Left coronary artery on the anterior surface?

Answer 41

Left Anterior Descending (Diagonal branch off this) | Left Marginal Artery

Question 42

What is the posterior branch of the left coronary artery?

Answer 42

left circumflex

Question 43

What are the anterior branches of the right coronary artery?

Answer 43

sinoartrial node branch | right marginal artery

Question 44

What structure is at the meeting point between circumflex and posterior interventricular arteries?

Answer 44

Coronary Sinus (venous drainage)

Question 45

What are the tributaries of the coronary sinus?

Answer 45

``` great cardiac vein left marginal vein left posterior ventricular vein middle cardiac vein small cardiac vein ```

Question 46

What proportion of people are right or left dominant for the posterior interventricular artery?

Answer 46

80% right 10% left 10% codominant

Question 47

Where does the sinoatrial node artery come from?

Answer 47

RCA (60%) | circumflex (40%)

Question 48

Name the 3 sulci of the heart

Answer 48

``` coronary sulcus (divides atria from the ventricles) anterior and posterior interventricular sulci ```

Question 49

What are the layers of pericardium?

Answer 49

fibrous pericardium serous pericardium separated by serous fluid

Question 50

What innervates the pericardium?

Answer 50

phrenic nerve

Question 51

What branches off the ascending aorta?

Answer 51

left and right coronary arteries

Question 52

What branches off the aortic arch?

Answer 52

brachiocephalic trunk left common carotid left subclavian

Question 53

What branches off the thoracic aorta?

Answer 53

``` bronchial arteries mediastinal arteries oesophageal arteries pericardial arteries superior phrenic arteries intercostal and subcostal arteries ```

Question 54

What are the branches and their vertebral levels of the abdominal aorta?

Answer 54

``` T12 inferior phrenic arteries T12 coeliac artery L1 SMA L1 middle suprarenal L1-L2 renal L2 Gonadal L3 IMA L4 median sacral artery L1-L4 Lumbar arteries (4 pairs) ```

Question 55

What are the branches of the common iliac arteries?

Answer 55

external iliac | internal iliac

Question 56

What are the branches of the internal iliac arteries?

Answer 56

anterior and posterior branches

Question 57

WHat are the branches of the anterior internal iliac arteries?

Answer 57

``` umbilical obturator inferior vesicular / vaginal uterine middle rectal inferior pudendal inferior gluteal ```

Question 58

What are the branches of the posterior internal iliac arteries?

Answer 58

superior gluteal | lateral sacral