B4-082 Chest Wall Heart Flashcards
muscles that lie deep to the breast
- pectoralis major
- pectoralis minor
- serratus anterior
[…] fascia surrounds the pectoralis major
pectoral
[…] fascia surrounds the pectoralis minor
clavipectoral fascia
- potential space located between breast and pectoral fascia
- allows some degree of movement of the breast
retromammary space
location of the breast
- lateral border of sternum to mid axillary line
- 2-6th ribs
artery that supplies medial mammary branches
internal thoracic
artery that supplies lateral mammary branches
lateral thoracic
artery that supplies lateral mammary and lateral cutaneous branches
posterior intercostal
nerves that supply the breast
anterior and lateral cutaneous branches of 4-6th intercostal nerves
the nerves that supply the breast travel in
pectoral fascia
lymphatic supply to nipple, areola and lobules
subareolar lymphatic plexus
lymphatic supply to lateral quadrent
axillary lymph nodes
lymphatic supply to medial quadrant
parasternal lymph nodes
lymphatic supply to inferior quandrant
abdominal lymph nodes
flow of lymph through the lateral quadrant
- pectoral nodes
- central nodes
- apical nodes
- clavicular nodes
- subclavian lymphatic trunk
- thoracic or right lymphatic trunk
lactiferous ducts
note: lobules of mammary glands
suspensory ligaments
nipple
lactiferous sinus
in the autonomic nervous system, the pre synaptic cell body is in the […], while the post-synaptic cells body is in an […]
CNS; autnomic ganglion
one presynaptic fiber synapses with multiple post synaptic fibers provides
amplification of response
fight or flight
sympathetic
preganglionic fibers located from T1-L2/3
sympathetic
- paravertebral ganglia
- superior, middle, and inferior cervical ganglia
- prevertebral ganglia
sympathetic
postganglionic cell bodies are in the sympathetic gangle and
the axons continue to target organ
- short preganglionic fibers
- long postganglionic fibers
sympathetic
rest and digest
parasympathetic
preganglionic fibers located in nuclei in brainstem or sacral spinal chord
parasympathetic
preganglionic fibers in the parasympathetic system travel with which cranial nerves?
3, 7, 9, 10
include ciliary, pterygopalatine, otic and submandibular ganglion and ganglion found in the target organ
parasympathetic ganglia
long preganglionic fibers
short postganglionic fibers
parasympathetic
preganglionic neurotransmitter
acetylcholine
post ganglionic NT in PSNS
acetylcholine
postganglionic NT in SNS
NE
alpha and beta receptors
SNS
nicotinic and muscarinic receptors
PSNS
sympathetics destined for the heart are located in the
- intermediolateral cell column
- lateral horn of the spinal chord
sympathetic preganglionic fibers leave the spinal chord at
- ventral root
- mixed spinal nerve
- ventral ramus
- white ramus
- paravertebral ganglion
- superior, middle or inferior ganglion
sympathetic postganglionic fibers travel through the [….] to the heart
cardiac plexus
parasympathetics destined for the heart are located in the
brainstem
preganglionic parasympathetic fibers travel
with cranial nerve X
the parasympathetic preganglionic fibers will travel through the […] and synapse with the parasympathetic ganglion in the heart
cardiac plexus
SNS effect on SA node
increase rate
PSNS effect on SA node
decrease rate
SNS effect on atrial wall
increase contractility
PSNS effect on atrial wall
decrease contractility
SNS effect on AV node
increase speed of conduction
PSNS effect on AV node
decrease speed of conduction
SNS effect on ventricular wall
increase contractility
PSNS effect on ventricular wall
no effect
located on the aorta near the ligamentum arteriosum
superficial cardiac plexus
located on the bifurcation of the trachea
deep cardiac plexus
contain:
* postganglionic sympathetic fibers
* preganglionic parasympathetic fibers
* visceral afferent
cardiac plexus
visceral afferents that detect pain are detecting
ischemia
metabolic products
substernal chest pain
angina
MI symptoms in men
- nausea
- jaw, neck, back pain
- pain/pressure in chest
- SOB
MI symptoms specific to women
- upper back pain
- pain/pressure in lower chest or upper abdomen
- fainting
- indigestion
- extreme fatigue
3 types of referred pain
- visceral afferents
- one branch of a nerve to another
- phrenic nerve to shoulder
knee pain felt in hip is an example of
referred pain
one branch of the femoral nerve to another
embryologic origin due to migration of the septum transversum
referred pain
phrenic nerve to shoulder
identify the heart sound
closure of mitral and tricuspid valves
s1
identify the heart sound
start of systole
s1
identify the heart sound
closure of semilunar valves
s2
identify the heart sound
- ventricular filling
- normally in kids, disappers with age
s3
identify the heart sound
- atrial contraction
- not normally heard
s4
where to auscultate the aortic valve?
right 2nd intercostal space, just to the right of the sternum
where to auscultate the pulmonary valve?
left 2nd intercostal space, just to the left of the sternum
where to auscultate the mitral valve?
apex of the heart, 5-6th intercostal space at mid clavicular line
where to auscultate tricuspid valve?
5th intercostal space, left of sternum
occurs between the “lub” and the “dub”
systolic murmur
- can be early (following the “dub”)
- can be late (preceding the “lub”)
diastolic murmur
a systolic murmur indicates
- aortic or pulmonary stenosis
- mitral or tricuspid regurgitation
an early diastolic murmur indicates
pulmonary or aortic regurgitation
late diastolic murmur indicates
tricuspid or mitral stenosis
normal direction of flow through a narrow orifice
stenosis
retrograde flow due to inadequate valve closure
regurgitation
- late diastolic murmur
- heard in left 4-5 intercostal space
- low pitched
- rumbling
mitral stenosis
- systolic murmur
- heard at apex of heart
- soft
- blowing
- pansystolic
mitral regurgitation
- systolic murmur
- heard in right 2nd intercostal space
- cresendo-decresendo
- harsh
aortic stenosis
- early diastolic murmur
- heard in left 3rd intercostal space
- high pitched
- blowing
aortic regurgitation
- systolic murmur on left side of sternum
- harsh
- pansystolic
interventricular septal defect
- systolic murmur
- left 2nd intercostal space
2
- pulmonary stenosis
- tetrology of Fallot
- continuous murmur heard in left 2nd intercostal space
- continuous
- rumbling
patent ductus ateriosus