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c2 > applied anatomy of the heart > Flashcards

applied anatomy of the heart Flashcards

1
Q

what are the borders of the heart?

A
  • Upper right: 3rd costal cartilage
  • Upper left: left 2nd costal cartilage
  • Lower right: 6th costal cartilage
  • Lower left: 5th intercostal space midclavicular line
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2
Q

what is the cardiac plexus made up of?

A

vagus nerve
sympathetic nerves
general visceral afferent nerves

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3
Q

where does the vagus feed into the heart and what effect does it have on the heart?

A

feeds into the SAN

parasympathetic - slows down HR

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4
Q

where do sympathetic nerves from the heart enter the spinal cord?

A

T1-T5

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5
Q

what effect do sympathetic nerves have on the heart?

A

increase the rate of firing

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6
Q

where do general visceral afferents feed into?

A

spinal levels T1-T5

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7
Q

where is referred heart pain felt and why?

A

dermatomes T1-T5

brain can’t differentiate between GVA and somatic nerves bc they enter the spinal cord at the same spinal level

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8
Q

what are the branches of the right coronary artery?

A

posterior interventricular/descending artery

marginal branch

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9
Q

what are the branches of the left coronary artery?

A

circumflex branch
left marginal branch of circumflex artery
left anterior descending

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10
Q

what artery supplies the SAN?

A

right coronary artery

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11
Q

what artery supplies the AVN?

A

right coronary artery

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12
Q

what arteries supply the bundle branches?

A

interventricular (descending) arteries

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13
Q

what is a right dominant heart?

A

posterior descending artery is supplied by the RCA which supplies the myocardium of the inferior 1/3 of the interventricular septum

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14
Q

what is a left dominant heart?

A

PDA supplied by the LCA. All of the IV septum supplied by the LCA

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15
Q

what is the risk in a left dominant heart?

A

LCA blockage means both bundle branches have their blood supply cut off

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16
Q

what happens as a result of bundle branch block?

A
  • bundle branch becomes ischaemic
  • doesnt conduct impulses properly
  • use altered pathways for depolarisation (cardiac myocytes conduct the impulses instead of using the bundle branches)
  • slows impulse speed
  • prolongs QRS
  • loss of ventricular synchrony
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17
Q

what are the 3 most common places for stenosis of coronary arteries?

A

left anterior descending
right coronary artery
circumflex artery

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18
Q

how long does it take for severe ischaemia to register on an ECG?

A

minutes

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19
Q

how many electrodes and perspectives are there on an ECG?

A

10 electrodes

12 perspectives

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20
Q

how many chest leads are there and how many perspectives do they provide?

A 
6 chest leads
6 perspectives (horizontal plane)
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21
Q

how many limb leads are there and how many perspectives do they provide?

A

4x limb leads

6x perspectives

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22
Q

what leads give a lateral view of the heart?

A

I, aVL, V5 and V6

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23
Q

what leads give an anterior view of the heart?

A

V3, V4

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24
Q

what leads give a septal view of the heart?

A

V1, V2

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25
Q

what leads give an inferior view of the heart?

A

II, III and aVF

26
Q

what leads correspond with the right coronary artery?

A

main artery on the inferior surface

leads II, III, aVF

27
Q

what leads correspond with the left anterior descending artery?

A

main artery on the anterior surface

V3, V4

28
Q

what leads correspond with the circumflex?

A

main artery on the lateral surface

I, aVL, V5, V6

29
Q

where are the heart valves located?

A

o Aortic – upper right 3rd costal cartilage
o Pulmonary – upper left 2nd costal cartilage
o Tricuspid – lower right 6th costal cartilage
o Mitral – lower left 5th intercostal space midclavicular line

30
Q

where do you auscultate the heart valves?

A

o Aortic – right 2nd intercostal space
o Pulmonary – left 2nd intercostal space
o Tricuspid – 6th intercostal space
o Mitral – 5th intercostal space midclavicular line

31
Q

what causes the characteristic lub dub noises of the heart?

A 
o	Lub (S1) when mitral valves and tricuspid close (systole)
o	Dub (S2) when aortic and pulmonary valves close (diastole)
32
Q

what 2 things can go wrong with the heart valves?

A

stenosis

regurgitation

33
Q

what is stenosis?

A

when the valves dont open properly

34
Q

what is regurgitation?

A

when the valves dont close properly

35
Q

what type of murmur is mitral regurgitation?

A

systolic murmur

36
Q

what causes mitral regurgitation?

A

Mitral valve doesn’t close properly – can hear when blood passes back through valve into the atria

37
Q

what does mitral regurgitation sound like?

A

pansystolic

often louder in late systole

38
Q

where is mitral regurgitation heard?

A

heard at the apex

39
Q

what is the most common form of valvular heart disease?

A

mitral regurgitation

40
Q

what type of murmur is aortic stenosis?

A

systolic murmur

41
Q

why do you hear turbulence in aortic stenosis?

A

as blood has to be pushed through stenotic aortic valve

42
Q

describe the different severities of aortic stenosis throughout systole and why this occurs

A

less severe in early systole
more severe in late systole
bc time taken to generate pressure to pass through stenotic valves

43
Q

where is aortic stenosis heard?

A

right second intercostal space

44
Q

what does mitral stenosis sound like?

A

rarely produces a soft rumbling diastolic murmur

45
Q

what does aortic regurgitation sound like?

A

complex and often absent

46
Q

what are the further complications of aortic regurgitation?

A

decreased cardiac output bc of regurgitation
elevates preload and afterload
LVH - typically very dilated

47
Q

what causes change in heart size

A
  • changes based on workload

- workload can be physiological (athletes, pregnancy) or pathological (valvular disease, atrial fibrillation)

48
Q

define preload

A

volume of blood in ventricles at the end of diastole

49
Q

define afterload

A

resistance ventricle must overcome to circulate blood

50
Q

what does preload increase in?

A

hypervolemia, valve regurgitation, heart failure

51
Q

what does afterload increase in?

A

(chronic) hypertension, vasoconstriction, valve (aortic) stenosis, outflow stenosis

52
Q

what is concentric hypertrophy?

A

hypertrophic growth of a hollow organ without overall enlargement – walls thicken, and capacity/volume are reduced

53
Q

how does concentric hypertrophy occur?

A

increased afterload bc of aortic stenosis or chronic hypertension
increased resistance
wall thickness increases to overcome resistance - new sarcomeres

54
Q

what are the disadvantages of wall thickness increasing?

A

compliance is reduced (stiff)

ventricular filling is compromised (diastolic dysfunction)

55
Q

what is eccentric hypertrophy?

A

dilation of the left ventricular chamber (normal response to healthy exercise)

56
Q

what causes eccentric hypertrophy?

A

o Aortic and mitral regurgitation
o Systolic dysfunction (loss of cardiac inotrophy)
o Volume overload (hypervolaemia due to ventricular or renal failure)
o Others eg alcohol cocaine

57
Q

what causes atrial enlargement?

A

in response to mitral or tricuspid valve pathology

58
Q

what is atrial remodelling?

A

any persistent change in atrial structure

59
Q

what is the link between atrium size and the risk of atrial fibrillation and why?

A

larger the atrium the higher the risk of AF bc you’re disrupting the electrical conduction pathways

60
Q

how is atrial fibrillation diagnosed?

A

absent P waves on an ECG
reduced cardiac output
thrombi and syncope

61
Q

how is left atrium enlargement seen on an x-ray?

A

seen as a double density over the right atrium

62
Q

how is left ventricular enlargement seen on an x-ray?

A

heart looks like a boot

c2 (37 decks)

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