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IBI Test 2 > B3.085 Heart and Mediastinum > Flashcards

B3.085 Heart and Mediastinum Flashcards

1
Q

pericardium

A

the sac of connective tissues that encloses the heart and first portion of the great vessels

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2
Q

2 parts that makes up the pericardium

A

fibrous

serous

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3
Q

2 anatomical regions of serous pericardium

A

visceral - on heart itself (epicardium)

parietal - forms the inner surface of the wall of the pericardial sac

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4
Q

fibrous pericardium

A

tough
indistensible
outer portion
fuses with adventitia of great arteria and veins 2-4 cm above the heart
can grow slowly to accommodate an enlarging heart

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5
Q

adventitia

A

outermost connective tissue

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6
Q

serous pericardium

A 
closed sac
covers heart (visceral) and inner surface of fibrous pericardium (parietal)
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7
Q

when do the visceral and parietal layers of serous pericardium become continuous?

A

at roots of great vessels

form a closed cavity

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8
Q

how much fluid is in the pericardial cavity?

A

20 (15-50) mL

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9
Q

what is the purpose of fluid in the cavity?

A

heart can move freely as it beats in a very low friction environment
prevent rubbing against other structures

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10
Q

where is pericardial fluid produced?

A

visceral pericardium

an ultrafiltrate of plasma

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11
Q

pericardial sinuses

A

transverse

oblique

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12
Q

transverse pericardial sinus location

A

passageway between R and L sides of pericardial cavity
anterior to SVC
posterior to ascending aorta and pulm trunk
superior to pulm veins and left atrium

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13
Q

oblique pericardial sinus location

A

blind pocket
dorsal to L atrium
formed by pericardial reflections surrounding the pulm veins and SVC and IVC

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14
Q

most dependent (lowest) portion of the pericardial sac when a patient lies supine

A

oblique pericardial sinus

leaking bypasses may result in extra fluid here post surgery

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15
Q

cardiac tamponade

A

compression of heart due to rapid accumulation of fluid in the pericardial sac
prevents chambers from expanding fully
limits ability to pump blood

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16
Q

what amt of fluid can cause elevated intrapericardial pressures?

A

80 mL

if slowly progressive, can reach 2 L in extreme cases

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17
Q

classic indications of cardiac tamponade

A

jugular venous distention
distant heart sounds
hypotension with dyspnea

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18
Q

where can you see jugular venous distention?

A

external jugular vein on top of sternocleidomastoid muscle

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19
Q

why can you see JVD?

A

no valves within the vein
ultimate connection to right atrium
blood can get backed up

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20
Q

pericardiocentesis

A

removal of excess fluid from pericardial sac
18G spinal tap needle
20-80 cc syringe
performed with US guidance

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21
Q

where do you place the needle in pericardiocentesis

A

just to the left of the xiphoid process
angled 45 deg
pointing towards medial edge of left scapula

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22
Q

pericarditis

A

inflammation of the pericardial sac lining due to viral or bacterial infections

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23
Q

pain associated with pericarditis

A 
remains substernal
some referred pain to back and shoulders
rarely radiates down arm
worsens when lying down (opposite of MI pain)
worsens when inhaling deeply
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24
Q

why does pain worsen when laying down or breathing?

A

flattening of diaphragm elongates sac causing it to rub against heart

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25
Q

what is pericardial rub

A

serous layer of pericardium becomes rough (secondarily due to viral infections)
friction and vibrations may occur
specific for acute pericarditis

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26
Q

how does pericardial rub sound

A

squeaky leather
scratchy, grating
left lower sternum border
louder with forced expiration

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27
Q

what supplies blood to the pericardium

A

pericardiophrenic artery and vein

runs with phrenic nerve on external surface of fibrous pericardium

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28
Q

what innervates the pericardium

A

phrenic nerve

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29
Q

diastole

A

heart fills with blood

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30
Q

systole

A

heart contracts and pumps blood

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31
Q

S1 sound

A

closing of atrioventricular valves (simultaneously)

beginning of systole

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32
Q

S2 sound

A

closing of aortic and pulmonary valves

beginning of diastole

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33
Q

base of heart

A

posterior aspect

largely the left atrium and a narrow portion of the right atrium

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34
Q

apex of heart

A

blunt descending projection of left ventricle

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35
Q

diaphragmatic surface of heart

A

formed by left ventricle and a narrow portion of the right ventricle

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36
Q

sternocostal surface of heart

A

right atrium and right ventricle

narrow portion of left ventricle

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37
Q

obtuse margin

A

left margin
rounded left side
left ventral and small extent of left auricle

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38
Q

acute margin

A

inferior border
where sternocostal and diaphragmatic surfaces meet
formed by right ventricle

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39
Q

right margin

A

superior vena cava
right atrium
inferior vena cava

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40
Q

coronary culcus

A

separates atria from ventricles

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41
Q

where to listen to heart valves

A 
A-aortic
P-pulmonary
T-tricuspid
M-mitral
L to R across chest
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42
Q

aortic valve auscultation area

A

right of sternum

2nd intercostal space

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43
Q

pulmonary valve auscultation area

A

left of sternum

2nd intercostal space

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44
Q

tricuspid valve auscultation area

A

left of sternum

4th or 5th intercostal space

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45
Q

mitral valve auscultation area

A

left side at 5th intercostal space

midclavicular line

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46
Q

clinical relevance of fibrous skeleton of heart

A

if it becomes stretched, heart valves often fail

50% of aortic valve insufficiency is due to aortic root (skeleton) dilation

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47
Q

right atrium walls

A

larger and thicker than left atrium

1-4 mm

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48
Q

sinus venarum of right atrium

A

smooth region derived from incorporation of right horn of sinus venosus

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49
Q

auricle of right atrium

A

R. atrial appendage

corresponds to primitive atrium of embryonic heart, contains pectinate muscles

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50
Q

pectinate muscles of right atrium

A

ridges of myocardium

only in atrium, not ventricles

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51
Q

crista terminalis of right atrium

A

junction of rough pectinate muscles vs smooth interior of the sinus venarum

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52
Q

fossa ovalis of right atrium

A

marks site of embryonic foramen ovale through which blood passes from right atrium to left atrium before birth

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53
Q

opening of coronary sinus

A

site of venous blood return that has passed through cardiac muscle

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54
Q

valve of inferior vena cava

A

in embryonic heart, directs blood from IVC through foramen ovale and into left atrium

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55
Q

SVC

A

large superior opening in the sinus venarum that brings poorly oxygenated blood from the head and upper limbs

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56
Q

IVC

A

large inferior opening in the sinus venarum that brings poorly oxygenated blood from the abdomen and lower limbs

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57
Q

right atrioventricular orifice

A

site of blood flow out of right atrium into right ventricle

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58
Q

right ventricle wall thickness

A

4-8 mm

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59
Q

right atrium volume

A

75-80 mL

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60
Q

right ventricle volume

A

120 +20 mL

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61
Q

cusps of tricuspid valve

A

anterior, posterior, and septal cusps

leaves of the AV valve

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62
Q

trabeculae carnae

A

irregular muscular elevations on the inner wall of the ventricle

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63
Q

papillary muscles

A

anterior, posterior, and septal in RV
according to location of their bases off the walls of the ventricle
variable in number

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64
Q

chordae tendineae

A

fibrous strands connecting papillary muscles to cusps of AV valves

65
Q

septomarginal trabecula

A

trabecula carnea that conveys right branch of AV bundle to anterior papillary muscle

66
Q

conus arteriosus

A

smooth walled outflow tract to pulmonary trunk

separated from ventricle proper by supraventricular crest

67
Q

pulmonary valve

A

allows blood to exit the right ventricle and into the pulm trunk past the 3 semilunar cusps

68
Q

left atrium volume

A

55-65 mL

69
Q

left atrium location in body

A

posterior chamber

anterior to esophagus

70
Q

pulmonary valves

A

2 right and 2 left pulm veins carry oxygenated blood into the L atrium

71
Q

smooth walled part of LA

A

derived from incorporation of pulm veins

72
Q

fossa ovale of LA

A

slight depression in the interatrial wall

73
Q

rough walled part of LA

A

derived from embryonic atrium; contains pectinate muscles

74
Q

left atrial appendage/auricle

A

often closed in patients w atrial fibrillation due to concern about clot formation

75
Q

AV orifice

A

blood exits into the L ventricle through the mitral valve

76
Q

watchman device

A

closes left atrial appendage

patients w atrial fibrillation on blood thinners

77
Q

left ventricle volume

A

125 + 15 mL

78
Q

left ventricle wall thickness

A

8-14 mm

2-3x thicker than RV

79
Q

mitral valve cusps

A

anterior and posterior cusps of the AV valve

80
Q

trabeculae carneae of LV

A

irregular muscular elevations on inner wall of the vetricle

81
Q

papillary muscles in LV

A

only anterior and posterior papillary muscles

82
Q

chordae tendineae in LV

A

fibrous strands connecting papillary muscles to each cusp of the mitral valve

83
Q

aortic valve

A

allows blood to exit the LV past the 3 semilunar cusps of the aortic valve
leads to the ascending aorta

84
Q

function of papillary muscles and chorda tendineae

A

restrict valve cusp movement during ventricular systole

prevent blood from regurgitating back into atrial chamber

85
Q

papillary muscle rupture

A

can happen as a complication of MI
leads to AV dysfunction
regurgitation can present as a diastolic murmur

86
Q

cause of left ventricular hypertrophy

A

chronic hypertension or aortic valve stenosis (pressure overloads)

87
Q

effect of volume overloading

A

aortic or mitral valve regurgitation = LV hypertrophy and chamber enlargement

88
Q

result of aortic valve insufficiency

A

blood regurgitation

89
Q

what is mitral valve prolapse

A

mitral valve everts into the left atrium when the left ventricle contracts during systole

90
Q

result of mitral valve prolapse

A

common and often benign

can develop into mitral valve regurgitation —chest pain, cardiac arrhythmia, SOB

91
Q

why is mitral valve prolapse more common than tricuspid valve prolapse?

A

left ventricle contracts at higher pressure to pump blood throughout the body than the right ventricle which only needs to pump blood to the lungs

92
Q

discuss the development of aorta and pulmonary trunks from a single outflow track

A

aorta ends up slightly posterior and has a posterior cusp
pulmonary trunk ends up anterior and has an anterior cusp
both have L and R cusps

93
Q

when is blood flow into coronary arteries the greatest

A

during diastole
opposite of most arteries in the body
max blood flow when cardiac tissue is most capable of receiving blood

94
Q

bicuspid aortic valve

A

most common congenital heart anomaly
1-2% of pop
males 2x more affected
if calcification occurs, more likely to cause aortic valve stenosis than a normal tricuspid aortic valve

95
Q

result of stenosis of aortic valve

A

excessive turbulence

long term can cause ascending aortic aneurysmal

96
Q

right coronary artery

A

origin: right aortic sinus
distribution: right atrium, SA and AV nodes, posterior portion in IV septum

97
Q

artery to sinoatrial node

A

present in 60% of pop

origin: right coronary artery
distribution: SA node and pulm trunk

98
Q

right marginal artery

A

origin: right coronary artery
distribution: right ventricle and apex

99
Q

post interventricular (posterior descending)

A

origin: right coronary artery
distribution: right and left ventricles and IV septum

100
Q

AV node artery

A

origin: right coronary artery (80% of the time)
distribution: AV node

101
Q

left coronary artery

A

origin: left aortic sinus
distribution: left atrium and ventricle, IV septum, AV bundle, and AV node (20% of the time)

102
Q

artery to sinoatrial node

A

present in 40% of population

origin: left coronary artery
distribution: SA node and left atrium

103
Q

artery to IV (left anterior descending)

A

origin: left coronary artery
distribution: right and left ventricles, IV septum

104
Q

lateral diagonal branch

A

origin: LAD
distribution: left ventricle (anterior)

105
Q

circumflex

A

origin: left coronary artery
distribution: left atrium and ventricle
distribution: left atrium and ventricle

106
Q

left marginal

A

origin: left circumflex
distribution: left border of left ventricle

107
Q

what does the right coronary artery supply?

A 
RA
most of RV
diaphragmatic surface of LV
posterior 1/3 of AV septum
SA node in 60% of people
AV node in 80% of people
108
Q

what does the left coronary artery supply?

A 
LA
most of LV
anterior 2/3 of AV septum
AV bundles
SA node in 40% of people
AV node in 20% of people
109
Q

right dominant distribution

A

80% of people

posterior IV artery arises from right coronary artery

110
Q

left dominant distribution

A

10% of population

circumflex gives off posterior IV artery

111
Q

balanced distribution

A

10% of population

both R and L coronary arteries supple the posterior IV artery

112
Q

3 most common sites of artery occlusion on the heart

A
  1. 40-50% LAD, widowmaker
  2. 30-40% right coronary
  3. 15-20% left circumflex
113
Q

coronary artery bypass surgery

A

CABG

bypass of coronary artery blockage

114
Q

most typical format of CABG

A

distal end of internal thoracic artery is attached to existing coronary artery distal (downstream) of blockage

115
Q

additional arteries or veins used in CABG

A

radial artery from arm
great saphenous vein from leg
attached to ascending aorta and distal to blockage

116
Q

cardiac veins

A

most blood passed through the coronary arteries returns to the venous circulatory system at the RA through either the coronary sinus (most) or by anterior cardiac veins

117
Q

coronary sinus

A

direct continuation of great cardiac vein
lies in posterior part of coronary sulcus and opens into RA
receives all cardiac veins except anterior cardiac veins and smallest cardiac veins

118
Q

great cardiac vein

A

beside anterior IV artery

119
Q

middle cardiac vein

A

alongside posterior IV artery

120
Q

small cardiac vein

A

along acute margin of RV

parallels right marginal artery

121
Q

anterior cardiac veins

A

2 or 3 small veins that drain sternocostal surface of RV directly into RA

122
Q

what is the SA node

A

initates heartbeats

collection of specialized cardiac cells

123
Q

where is the SA node

A

right atrial wall at superior end of sulcus terminalis near SVC

124
Q

rate of contraction of SA node

A

stimulated by sympathetic cardiac nerves

decreases when stimulated by parasympathetic cardiac nerves

125
Q

atrial natriuretic factor/peptide

A

made by right atrial cardiac cells
affect total blood volume
acts on kidney to increase sodium and water excretion to reduce blood volume

126
Q

where is the AV node

A

inferior aspect of the intraatrial septum near the opening of the coronary sinus

127
Q

artificial cardiac pacemakers

A

can substitute for SA, AV or AV bundle
generates electrical impulses
implanted under the skin on the anterior chest wall just inferior to the clavicle
leads are threaded through venous system to the site of SA or near apex (to replace AV)

128
Q

sympathetic innervation of the heart

A

cervical and thoracic sympathetic ganglia

cell bodies from C4 to T5

129
Q

parasympathetic innervation of the heart

A

vagus CN

cranial nerve X

130
Q

discuss cardiac referred pain

A

afferent innervation to the heart returns to CNS with sympathetic nerves that innervate upper thoracic wall and medial side of left upper extremity

131
Q

heart attack pain in men

A

chest
left arm/shoulder
SOB

132
Q

heart attack pain in women

A 
chest
nausea
jaw, neck, back pain
left arm.shoulder
SOB
133
Q

thymoma

A

tumors of the thymus

rarecan grow and affect the trachea, SVC, and occasionally other structures

134
Q

great veins in superior mediastinum

A

internal jugular - blood from head and neck
subclavian - blood from arm
brachiocephalic - IJ + S

135
Q

SVC

A

left (longer) and right (short, vertical) brachiocephalic veins together
returns to RA
receives arch of the azygos vein

136
Q

great arteries

A

aorta

pulmonary arteries

137
Q

3 parts of the thoracic aorta

A
  1. ascending
  2. arch
  3. descending
138
Q

ascending aorta

A

begins w pericardial sac at the aortic valves and ascends behind sternum to sternal angle

139
Q

arch of the aorta

A

lies behind manubrium in front of trachea

140
Q

descending aorta

A

begins at sternal angle and descends just anterior to vertebral bodies

141
Q

where does the trachea bifurcate

A

sternal angle of Lewis

T4-T5

142
Q

esophagus

A

enters superior mediastinum at a position between trachea and vertebral column
passes through diaphragm at T10

143
Q

3 diaphragm openings

A

IVC - T8
esophageal hiatus - T10
aortic hiatus - T12

144
Q

phrenic nerve

A

arises from C3,4,5
innervate diaphragm
remain anterior to root of lungs in thorax
refer diaphragm pain to neck

145
Q

cranial nerve X (vagus)

A

major parasympathetic nerve supplying all thoracic organs and upper 2/3 of abdominal organs

146
Q

right vagus location

A

enters superior mediastinum on right side of trachea
passes posterior to the right brachiocephalic vein and IVC
descends along posterior of esophagus

147
Q

left vagus location

A

enters superior mediastinum by descending along the left surface of the arch of the aorta
stays posterior to root of the lung
descends along anterior of esophagus

148
Q

recurrent laryngeal nerves

A

control voice box in neck

both right and left vagus

149
Q

right recurrent laryngeal nerve

A

runs under the right subclavian artery

comes off vagus at T1

150
Q

left recurrent laryngeal nerve

A

runs under the arch of the aorta lateral to the ligamentum arteriosus
comes off the vagus at T4-T5

151
Q

autonomic plexuses of the thorax

A

cardiac, pulmonary, and esophageal
mixed plexuses that contain both sympathetic and parasympathetic fibers
T1-T5 contribute

152
Q

thoracic splanchinic nerves

A
  1. greater = T5-T9
  2. lesser = T10-T11
  3. least = T12
153
Q

thoracic duct

A

begins in abdomen as cisterna chili (L1-L2)
receives lymph from both sides of the thoracic cavity and abdominal cavity and both lower limbs
empties into the junction of the left subclavian and left IJ veins

154
Q

location of thoracic duct

A

between azygos vein and descending thoracic aorta

anterior to thoracic vertebral bodies

155
Q

chylothorax

A

lymph in pleural cavity

>50% come from malignant etiologies

156
Q

azygos system of veins

A

drains blood from the thoracic wall

connects to both IVC and SVC

157
Q

hemizygos

A

vein on the inferior aspects along the left side of thoracic vertebrae

158
Q

accessory hemizygos

A

vein on the superior aspect of the left side of the thoracic vertebrae

159
Q

pancoast syndrome

A

apical bronchogenic carcinoma of the lung can impinge on adjacent anatomical structures
-can cause Horners (ptosis, myosis, and anhydrosis)
neurovascular compromise of the arm

IBI Test 2 (10 decks)

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