Block 3 - Heart Flashcards
1
Q
what generally drives the heart blood pump
A
cardiac muscle tissue, creates pressure
2
Q
where does the heart sit
A
middle mediastinum of thoracic cavity
3
Q
what is the superior boundary of the thoracic cavity
A
root of neck / first ribs
4
Q
what is the anterior boundary of the thoracic cavity
A
sternum
5
Q
what is the lateral boundary of the thoracic cavity
A
ribs and intercostal spaces
6
Q
what is the posterior boundary of the thoracic cavity
A
vertebral column
7
Q
what is the inferior boundary of the thoracic cavity
A
diaphragm
8
Q
what are the subdivisions of the thoracic cavity
A
pulmonary cavities and mediastinum
9
Q
what is contained within the pulmonary cavities
A
pleurae and lungs
10
Q
what is contained in the mediatinum
A
pericardium and heart, other respiratory / digestive organs
11
Q
what are the subdivisions of the mediastinum
A
superior
interior: anterior, middle, posterior
12
Q
what is the boundary between the superior and inferior mediastinums
A
sternal angle at T4-T5
13
Q
what divides the anterior middle and inferior mediastinums
A
pericardium
14
Q
how does the heart sit in relation to the midline
A
base at midline, 2/3 of mass to the L
15
Q
what is the pericardium
A
tough dense membrane that makes a sac for the heart
16
Q
what are the 4 main purposes of the pericardium
A
protects and confines heart, anchors heart in mediastinum, protects heart from infections, lubricates heart
17
Q
how does the pericardium modulate stretch of the heart
A
accommodates diastole while restricting excessive dilation
18
Q
how does the pericardium anchor the heart in the mediastinum
A
fused superiorly to the great vessels leaving the heart, fused inferiorly to the diaphragm
19
Q
what role does the diaphragm play in heart pumping
A
when diaphragm moves during respiration the heart moves too which facilitates movement of blood by the heart
20
Q
what are the two layers of the pericardium
A
fibrous pericardium, serous pericardium
21
Q
what innervation does the fibrous pericardium recieve
A
general sensory from phrenic n
22
Q
what is the fibrous pericardium
A
outer most layer of heart lining, dense, strong, inelastic
23
Q
what is the serous percardium
A
inner layer of pericardium deep to fibrous, consists of two membranous layers and pericardial cavity
24
Q
what are the two layers of the serous pericardium
A
parietal serous pericardium, visceral serous pericardium reflected on the heart / part of heart wall
25
what is the innervation of the parietal serous pericardium
general sensory from phrenic n
26
what is the innervation of the visceral serous pericardium
visceral sensory cardiac autonomic plexus
27
what is the epicardium composed of
visceral serous pericardium and underlying adipose tissue
28
what is the pericardial cavity
space between parietal and visceral serous pericardium filled with pericardial fluid
29
what is the function of pericardial fluid
prevents friction between serous layers
30
what is the blood supply to the pericardium and diaphragm
pericardiacophrenic a/v
31
what is pericarditis
acute or chronic inflammation of the pericardium
32
what can be auscultated with pericarditis
rubbing of serous layers
33
what is pericardial effusion
buildup of pericardial fluid that can lead to cardiac tamponade
34
what is cardiac tamponade
compression of heart preventing full expansion
35
describe the chamber organization of the heart
four total chambers
two superior atria with receive blood from lungs / body
two inferior ventricles with recieve blood from atria and push blood to lungs and body
36
describe the valve organization of the heart
four total major valves
two atrioventricular valves with separate artia / ventricles. tricuspid (right) separates RA and RV. bicuspid (left, mitral) separates LA and LV.
two semilunar valves which allow blood to exit to the lungs and body. pulmonary right ventricle to lungs. aortic left ventricle to body / aorta
37
describe the septal organization of the heart
two septums
interatrial septum between atria continuous with interventricular septum between ventricles
38
what are the four main heart surfaces
anterior (sternocostal), pulmonary (right and left), base, diaphragmatic
39
what does the anterior heart surface cover
mostly RV, some LV
40
what does the pulmonary heart surface cover
right RA, left LA
41
what does the base heart surface cover
LA
42
what does the diaphragmatic heart surface cover
most LV, some RV
43
what is the base heart surface associated with
where pulmonary veins return blood from lungs
44
what is the diaphragmatic heart surface associated with
pericardium fused to diaphragm
45
what are the 5 heart borders
superior, right, left, inferior, apex
46
what structure is the superior heart border associated with
adjacent to atria, where great vessels enter and leave the heart
47
what structure is the left heart border associated with
LV and Laur
48
what structure is the right heart border associated with
RA
49
how is the apex heart border oriented
anterior, inferior, left
50
what structure is the inferior heart border associated with
ventricles
51
what are auricles
muscular pouches of the atria which increase volume capacity of the atria
52
what are the two sulci of the heart
coronary, anterior interventricular
53
where is the coronary sulcus and what structure is it associated with
between atria and ventricles and run circularly, related to fibrous skeleton of heart
54
where is the anterior interventricular sulcus and what structure is it associated with
between RV and LV, formed by pulling from interventricular septum
55
what are the three layers of the heart wall, outer to inner
epicardium, myocardium (bulk), endocardium
56
what is the epicardium composed of
visceral serous pericardium (mesothelium - single layer of cells) and fibroelastic and adipose tissues, neurovasculature for myocardium
57
between what heart wall layers does heart vasculature run
deep to epicardium in sulci, superficial to myocardium
58
what is the myocardium composed of
cardiac muscle tissue (cardiomyocytes) and fibroblasts
59
how does thickness of the myocardium vary by region
atria thinner, ventricles thicker
60
what is the endocardium composed of
endothelium - single layer of squamous endothelial cells that line interior surface of blood vessels
61
how does the number of mitochondria in cardiac muscle tissue related to other tissues
larger and more due to high metabolic activity
62
what are intercalated discs
complex structures in cardiac muscle tissue that connect adjacent cells and form junctions between cells so they don't separate under strain of pumping blood
63
what are the two components of intercalated discs
desmosomes - anchors
gap junctions - protein channels
64
what is the purpose of gap junctions
facilitate electrical communication between cells
65
what is functional syncytium
collective unit of cells which is critical for synchronous contraction and autorhythmicity of cardiac muscle cells
66
what does it mean to be autorhythmic
self excitable for rhythmic wave contractions over whole organ
67
trace the pulmonary circulation loop
deO2 blood in RV, pulmonary trunk and arteries, reach lungs, unload CO2 pick up O2, pulmonary veins, O2 blood in LA to LV
68
trace systemic circulation loop
O2 blood in LV, exit through aorta, all regions of body except lungs, vins, vena cavae, RA, deO2 in RV
includes coronary circulation
69
what type of blood does the RA receive and from where
deO2 venous blood from vena cavae and coronary sinus
70
what type of blood does the RV receive and from where
deO2 blood from RA through right AV valve
71
what type of blood does the LA receive and from where
O2 blood form pulmonary veins
72
what type of blood does the LV receive and from where
O2 blood from LA through left AV valve
73
where does the RV send blood
through pulmonary semilunar valve to pulmonary trunk to lungs
74
where does the LV send blood
through aortic semilunar valve to aorta to body
75
what and where is the sinus venarum
smooth portion on posterior lateral wall of RA, superior and inferior vena cavae openings
76
what are where are the pectinate mm
on anterior wall of RA and in L aur, parallel muscle columns
77
what and where is the crista terminalis
runs from opening of SVC to IVC in RA which separates sinus venarum form pectinate mm
78
what and where is the sinu-atrial (SA) node
cluster of cells that set the sinus rhythm, on crista terminalis in RA
79
what comes through the coronary sinus opening and what chamber is it in
RA, cardiac veins drain blood from heart wall
80
what and where is the interatrial septum
medial aspect of RA and LA that separates the two
81
what and where is the fossa ovalis
shallow depression in interatrial septum remnant of the foramen ovale that closed shortly after birth
82
what are trabeculae carnae
bumpy inner wall of ventricles, formed by myocardium, contract during systole with the myocardium
83
what and where are the papillary mm
muscles in ventricles that contract slightly before ventricular contraction to increase tension of chordae tendinae while ventricular pressure is high
84
what are the three papillary mm and how are they names
anterior, posterior, septal, based on wall attachment
85
what and where are chordae tendinae
fibrous string like structures that attach to apex of papillary mm and cusp of AV valves in ventricles. prevent inversion of AV valve into atrium
86
what and where is the septomarginal trabecula
base of ventricular septum to anterior papillary m, conducts electrical impulses to anterior papillary m / R side of conduction system to heart
87
what and where is conus arteriosis
cone shaped tube in RV that connects the RV to the pulmonary trunk
88
describe the structure of the right AV valve (cusps, orifice, connections)
three cusps: anterior, posterior, suptal
orifice surrounded by ring of fibrous skeleton
cordae tendinae attach to the free edges of cusps
89
describe the structure of the left AV valve (cusps, orifice, connections)
two cusps: anterior, posterior
surrounded by ring of fibrous skeleton
chordae tendinae attach to the free edges of cusps from anterior and posterior papillary mm
90
describe the structure of the pulmonary valve
3 cusps: anterior, right, left
associated sinuses with each cusp
91
describe the structure of the aortic valve
3 semilunar valves: posterior, right, left
associated sinuses with each cusp
92
what is the fibrous skeleton of the heart
runs deep in heart walls, framework of deep collagen that forms septa / 4 rings surrounded each AV valve
93
what is diastole
relaxation and filling with blood
94
what is systole
contraction
95
what valves are open and closed in ventricular diastole
AV vales open, semilunar valves closed
96
what valves are open and closed in ventricular systole
av valves closed, semilunar valves open
97
what happens during ventricular diastole
all chambers fill, higher pressure in atria forces blood into low pressured ventricles, semilunar valves close with pressure in aorta and pulmonary trunk, coronary aa fill
98
what happens during ventricular systole
av valves close with pressure in ventricles, atrial filling, semilunar valves open and ventricular contraction
99
what happens in atrial systole
atria contract, AV vale open, SL closed, remaining 1/4 of ventricles fill
100
what are the 3 regions of the aorta
ascending, arch, descending
101
where do the coronary arteries branch from
ascending aorta
102
where do coronary aa carry blood
O2 blood to heart muscle
103
what are the three aortic sinuses
right coronary, left coronary, non-coronary
104
during what part of the cardiac cycle do the coronary aa fill
diastole
105
where do the coronary aa run, generally
coronary sulcus and interventricular sulci
106
what are the 4 branches of the right coronary a
anterior: SA nodal, right marginal
posterior: AV nodal, posterior interventricular
107
where does the SA nodal br of the right coronary a supply
supplies SA node in superior crista terminalis in RA
108
where does the right marginal br of the right coronary a run
along inferior border of heart to apex
109
where does the AV nodal br of the right coronary a supply
AV node located in inferior posterior of interatrial septum
110
where does the posterior interventricular br of the right coronary a supply
posterior walls of ventricle and interventricular septum
111
where does the left coronary a arrise
in ascending aorta posterior to pulmonary trunk
112
what are the branches of the left coronary a
anterior interventricular br, circumflex br, left marginal a
113
where does the anterior interventricular br of the left coronary a run and supply
runs in anterior interventricular sulcus, supplies anterior wall of ventricle in anterior portion of interventricular septum / majority of supply to IV septum
114
where does the circumflex br of the left coronary a run
wraps around heart in coronary sulcus
115
where does the left marginal a run
along L margin of heart to apex
116
what is an arterial anastomosis and what is the function
communication between 2+ arteries / vasculatures to provide alternate routes for blood flow to divert if a blockage occurs
117
how is heart dominance determined
by arterial supply to crux of heart
R dominent: RCA supplies crux
L dominent: LCA supplies crux
co dominent: both
118
what is the crux of the heart
meeting point of interventricular and coronary sulci
119
what are the clinical differences in a left dominent heart
the circumflex br of the LCA wraps to crux, gives off AV nodeal br and posterior interventricular br
majority of ventricular walls and all of interventricular septum are supplied solely by left coronary a
no more anastomoses between left and right coronary aa
120
what are the two systems of cardiac v
greater system and smaller system
121
how and where does the greater system of cardiac vv drain
into RA through coronary sinus
122
what are the two components of the greater system of cardiac vv
coronary sinus, anterior cardiac vv
123
what are the three main tributaries of the coronary sinus
great cardiac v, middle cardiac v, small cardiac v
124
where does the great cardiac v run and drain
runs in anterior IV sulcus
drains anterior aspect of heart wall
125
where does the middle cardiac v run and drain
runs in posterior IV sulcus
drains diapragmatic surface of heart into coronary sinus
126
where does the small cardiac v run
runs in inferior margin of heart
runs with R marginal a
127
what does the anterior cardiac vv drain
drains R wall of RV, goes into heart wall in R aur to drain into RA
128
what is the main component of the smaller system of cardiac vv
small cardiac vv
129
what do the small cardiac vv drain
subendocardial myocardium into each of the chambers
130
what is myocardial ischemia
reduced blood flow to the myocardium
131
what is myocardial infarction
death of an area of myocardium due to lack of blood flow
132
what is ventricular fibrillation
uncoordinated contraction of ventricles
133
what is coronary artery disease
atherosclerotic plaque builds up in coronary aa and causes myocardial ischemia (less blood = less O2)
134
what are risk factors for coronary a disease
smoking, hypertension, diabetes, high cholesterol, obesity, age, etc
135
what is the number 1 site for occlusion in CAD
anterior IV br
136
what is coronary artery bypass grafting (CABG)
grafting a new vessel to the heart to bypass a blockage
137
what is percutaneous transluminal coronary angioplasty and stenting
catheter placed in artery and passed through to coronary aa, balloon is deployed to widen arteries. stent / wire mesh is placed to keep weakened vessels open
138
what is the fibrous skeleton of the heart
complex framework of dense colalgen fibers
139
what are the functions of the fibrous skeleton
separates atria from ventricles, structural support, anchor for valves, prevents over-stretching, electrical insulation
140
describe electrical insulation by the fibrous skeleton
important for independent contraction of atria and ventricles, does not conduct electricity
141
what is depolarization
excitement / contraction - passage of electrical current through heart muscle
142
what is the purpose of the SA node
pacemaker of the heart ~100bpm
143
what is the purpose of the AV node
delays impulse from SA node until ventricles are filled
144
what is the purpose of the AV bundle
R/L bundle branches spread across IV septum
145
what do the R and L bundle branches innervate
interventricular septum
146
what is the septomarginal trabecula
shortcut for part of the R bundle, keeps depolarization of ventricles synchronous
147
what are perkinje fibers
specialized fibers from the R / L bundle brs that assist in completion of depolarization of the heart muscle
148
what does interruption of the cardiac conduction system cause
cardiac arrest
149
what is the purpose of extrinsic control of the heart conduction system
depress / slow the SA node from 100 bpm
150
what is the general function of the cardiac autonomic plexus, does it receive sympathetic or parasympathetic input
extrinsic control of heart, both
151
what is the innervation of the parasympathetic input to the cardiac autonomic plexus and what do afferent and efferent fibers receive and control
cardiac br of vagus n
efferent: decrease HR and constrict coronary a
afferent: sense HR
152
what is the innervation of the sympathetic input to the cardiac autonomic plexus and what do afferent and efferent fibers receive and control
cardiac br from sympathetic trunk
efferent: increase HR and dilate coronary a
afferent: pain
153
describe the neurons synapses and course for the sympathetic input to the cardiac autonomic plexus
presynaptics: arise from T1-T4/5 levels, enter sympathetic chain and synapse at inferior cervial - T4 ganglia
postsynaptics: leave the chain, cardiac nn
154
where are the superficial and deep parts of the cardiac plexuses located
superficial: concavity of aortic arch
deep: tracheal bifurcation deep to heart
155
what is bradychardia
too slow HR
156
what is tachycardia
too fast HR
157
what is atrial fibrilation
quivering / irregular contraction of heart wall
158
what is heart sound S1 caused by
AV valves close (beginning of v systole) "lub"
159
what is heart sound S2 caused by
semilunar valves close (diastole) "dub"
160
what are the primary heart sounds
"lub" "dub" S1 and S2
161
what are the secondary heart sounds
S3 S4 not usually heard
162
what is heart sounds S3 caused by
blood turbulence during ventricular filling
163
what is heart sounds S4 caused by
blood turbulence during atrial systole
164
what is the order of heart sounds 1-4
S4 S1 S2 S3
165
what is a heart murmer
abnormal sounds, benign in children, valve disorders in adults
166
where would you place a stethoscope to auscultate the aortic valve
Right 2nd IC space
167
where would you place a stethoscope to auscultate the pulmonary valve
left 2nd-3rd IC
168
where would you place a stethoscope to auscultate the tricuspid valve
left 4th-5th IC, variable
169
where would you place a stethoscope to auscultate the bicuspid valve
left 5th IC along mid clav line
