B3.085 - Intro to Anatomy of Heart Flashcards
What is the oblique pericardial sinus
lowest (most dependent) part of pericardial sac when a patient lies on ones back.
Blind pocket dorsal to left atrium formed by pericardial reflections surrounding pulmonary veins and s/i VC
What is cardiac tamponade
compression of the heart due to rapid accumulation of fluid in the pericardial sac. Prevents chambers from expanding fully limiting stroke volume.
What are classic indications of cardiac tamponade
Jugular venous distention
Distant heart sounds
Hypotension with dyspnea
What is pericardiocentesis
Removal of excess fluid from pericardial sac with 18G spinal tap needle
Used to treat cardiac tamponade
How is a pericardiocentesis done
With US, needle placed just left of xyphoid angled 45 degrees towards head while pointing towards medial edge of left scapula
What is pericarditis
inflammation of the pericardial sac lining typically due to viral or bacterial infections
What is a non infectious cause of pericarditis
malignancy
Describe pain due to pericarditis
Remains substernal and worsens upon lying down or when inhaling deeply
What is pericardial rub indicative of
acute pericaditis
what is pericardial rub
if the serous layer of pericardium becomes rough it induces friction and vibrations
What is S2 due to
closing of the aortic and pulmonary valves
What is S1 due to
Closing of the atrioventricular valves
What valves can you listen to on the body
A -Aortic
P - Pulmonary
T - Tricuspid
M - Mitral
Where can you hear the aortic valve best
right of sternum at 2nd IC space
Where can you hear Pulmonary valve best
left of sternum at 2nd IC space
Where can you hear the tricuspid valve best
left of sternum at 5th IC space
Where can you hear the mitral valve best
left side at 5th IC space at midclavicular line
What is the clinical relevance of the fibrous skeleton of heart
if its stretched the heart valves often fail
How do you close the left atrial appendage
Placing an implant designed to close off appendage
What are papillary muscles
restrict valve cusp movement during ventricular systole to prevent blood from regurgitating back in
What happens when papillary muscles rupture
sometimes in MI, leads to AV valve dysfunction or insufficiency. Regurgitation of blood is often a consequence
How can regurgitation of a valve present clinically
as a diastolic murmur
What is left ventricular hypertrophy produced by
chronic hypertension or aortic valve stenosis
What does volume overloading cause
ventricular hypertrophy and chamber dilation
What happens when the mitral valve everts into the left atrium when left ventricle contracts
mitral valve prolapse
what can mitral valve prolapse cause
mitral valve regurgitation
Why is mitral valve prolapse more common than tricuspid valve prolapse
the left ventricle contracts at higher pressure
What can cause mitral valve regurgitation
rupture of chordae tendineae or papillary muscles
how do the aorta and pumonary trunk end up in relation to eachothers position in the body
Aorta slightly posterior
pulmonary anterior
what is the most common congenital abnormality
bicuspid aortic valve
what are complications of a bicuspid aortic valve
more likely to cause aortic valve stenosis than a normal tricuspid aortic valve
what is “right dominant distribution”
posterior interventricular artery arising from the right coronary artery
What is left dominant distribution
circumflex branch of LCA gives off posterior interventricular
what is balanced distribution
when both right and left coronary arteries supply the posterior interventricular artery
what are the top 3 sites of coronary artery blockage
- Anterior descending
- Base of right coronary artery
- left circumflex branch
what is CABG
coronary artery bypass graft
how is CABG performed
distal end of internal thoracic artery is attached to the existing coronary artery distal to the blockage
What are additional arteries and veins harvested for graft
radial artery
Great saphenous vein
Where does most blood passed through the coronary arteries return ot venous circulatory system
coronary sinus (most) anterior cardiac veins (less)
what is the SA node
initiates heartbeats
Where is the SA node located
in the right atrial wall at superior end of sulcus terminalis near SVC
what is the SA node stimulated by
sympathetic cardiac nerves
What is the SA node decreased by
parasympathetic cardiac nerves
what do ANF/ANP do
affect blood volume
ANP acts on kidney to increase sodium and water excretion to reduce blood volume
where is the AV node located
inferior aspect of the intraatrial septum near the opening of the coronary sinus
ischemia to what artery can fuck up SA and AV node
right coronary artery
blockage of what artery can cause loss of ventricular contractions
LAD
if pacemaker cells in ventricles are not stimulated by SA node what happens
spontaneous contraction at slower pace
Where are pacemakers generally inserted
under the skin on anterior chest wall inferior to clavicle while leads are threaded through the venous system down SVC and over to site of SA
sympathetic nerves that innervate heath have cell bodies where
in sympathetic chain ganglia from C4 down to T5
What is ischemic pain caused by
inadequate blood flow is carried back to CNS through afferents that run with sympathetic nerves and enter synapse within the spinal cord at C4 to T5
major signs of MI in women
chest pain or discomfort nausea, lightheadedness, tired pain in jaw, nack or back pain in arm or shoulder SOB
What are signs of MI in men
chest pain or discomfort in arm or shoulder
SOB
what is the basis of referred pain caused by
convergence of afferent nerves from both viscera and soma onto same dorsal horn neuron
There is convergence of both somatic and visceral afferents onto nerves in same dorsal horn nerve in spical cord such that
heart pain may be perceived as chest or left arm pain
What is a thymoma
tumors of the thymus
The brachiocephalic veins are formed by union of what
subclavian and internal jugular veins
What is the sternal angle
where the trachea bifurcates into the right and left main bronchus
Where does the esophagus pass through the diapragm
esophageal hiatus at T10
How do you remember the hiatuses
8- I - Inferior VC
10- Esophageal
12-Aortic
I 8 10 Eggs At Noon
Where does the phrenic nerve arise from
C3, C4, C5
The phrenic nerve transmit referred pain from diaphragm, pericardium, abdominal cavity and mediastinal pleura back to what dermatones
C3, C4, C5 where they present as neck pain
where can pain from the diaphragm be referred to
T7, 8, 9,10 anteriorly, and T11, 12 posteriorly or C3,C4, C5
Which nerve is the vagus nerve
10th cranial
