Cardiac Anatomy Flashcards
Normal or abnormal?
Abnormal
- globular shaped heart from pericardial fluid
Normal or abnormal?
Normal
Describe what you are examining on a chest x-ray:
- Heart:
- Mediastinum:
- Heart:
- Cardiac size
- Pulmonary vessels
- Width of the adult heart should be < half the greatest thoracic diameter, measured from inside the rib cage at its widest point near the level of the diaphragm
- Mediastinum:
- Hilar structures
- Position of trachea
- Aortic arch
Identify the structures:
What are the clinical signs for cardiac tamponade?
- Neck veins distended
- Distant heart sounds
- Venous pressures elevated
- Decreased arterial and pulse pressures often exist
- Patient in variable degrees of shock or in extremis
Where are the Heart Valve Sounds on Surface Anatomy?
All Patients Take Meds
-
Aortic Semilunar Valve –
- Intercostal space 2, right of sternum
-
Pulmonary Semilunar Valve –
- Intercostal space 2, left of sternum
-
Tricuspid Valve –
- just lateral to body of sternum @ below rib 5
-
Mitral Valve –
- apex of heart at intercostal space 5
Identify the Structures
Identify the Structures
- Right brachiocephalic
- Right subclavian
- Right common carotid
- Left common carotid
- Left subclavian
- Right coronary
What are the major arteries for finding a pulse?
- Superficial Temporal Artery
- Common Carotid Artery
- Brachial Artery
- Femoral Artery
- Dorsalis Pedis Artery
- Popliteal Artery
- Radial Artery
- Subclavian Artery
- Facial Artery
**Pericardium and Heart: **
- **Layers: **
- **Nerves: **
- **Sinuses: **
-
Layers
- Visceral layer of serous pericardium
- Parietal layer of serous pericardium
-
Fibrous pericardium
- thick connective tissue layer
- Pericardial cavity is between visceral and parietal serous pericardium
-
Nerves: Phrenic n.
- travel lateral to fibrous ericardium as they descend thru mediastinum
-
Sinuses
- Transverse sinus ⇒ open sac and runs btwn great arteries and pulmonary veins; of surgical importance
- Oblique sinus ⇒ recess of pericardial cavity ends in cul‐desac surrounded by the pulmonary veins
Layers of the pericardium from superficial to deep:
- Fibrous pericardium
- Parietal layer of the serous pericardium
- Visceral layer of the serous pericardium
- outer layer of the epicardium
When injecting contrast into the arteries of the heart, how would you ensure that the contrast enters the anterior interventricular artery? Why?
- left coronary artery branches into the left circumflex artery and anterior interventricular artery (also known as the left anterior descending artery [LAD]).
- Therefore, contrast would be injected into the left coronary artery to ensure that it enters the anterior interventricular artery
- Anterior Interventricular Artery (LAD) travels with _____ _______
- R. Marginal branch of R. Coronary travels with _____ _______
- Posterior Interventricular Artery travels with _______ _______
- Anterior Interventricular Artery (LAD) travels with Great Cardiac v.
- R. Marginal branch of R. Coronary travels with Small Cardiac v.
- Posterior Interventricular Artery travels with Middle Cardiac v.
Describe the route blood takes through the heart, starting with deoxygenated blood from the body and head.
What helps keep the tricuspid and mitral valves tightly closed?
- chordae tendinae
- anterior and posterior papillary muscles
- moderator band (tricuspid valve)
- not so much for strength, rather, it helps conduct the electrical signals
What are the general hemodynamics of the heart as it moves from diastole to systole?
- closure of the aortic and pulmonary valves ⇒ beginning of diastole
- atrial contraction during final moments of diastole
- closure of the AV valves (tricuspid and mitral) ⇒ systole begins very soon afterwards
- opening of the aortic and pulmonary valves during systole
Diastole or Systole?
Systole
Diastole or Systole?
Diastole
What are the different ways to repair a heart valve?
- Porcine valve
- Ball and cage valve
- Tilting disk valve
When do the coronary arteries perfuse the heart?
during DIASTOLE
Wigger’s Diagram (fill in the blanks)
Describe Cardiac Innervation:
- Cardiac Plexus near tracheal bifurcation & ligamentum arteriosum
- Parasympathetic – motor control over HR and SV
- Sympathetic – postganglionic fibers come from upper chain ganglia to heart (3 cervical & T1‐T5)
- Afferents enter spinal cord T1‐T5
- Referred pain – painful sensation mediated by visceral afferent fibers that enter the spinal cord at a particular level is referred to the somatic dermatome corresponding to that vertebral level
Dermatomes for Cutaneous Innervation of the Upper Limb:
Electrical Conduction System of the Heart (PQRST intervals):
- SA node corresponds with ⇒
- AV node corresponds with ⇒
- Common AV bundle (of His) corresponds with ⇒
- SA node corresponds with ⇒ PR interval
- AV node corresponds with ⇒ QRS complex
- Common AV bundle (of His) corresponds with ⇒ ST segment
Which structure of the heart can compress the esophagus, if hypertrophied?
left atrium
What are common coronary artery obstructions that can cause clinical manifestations?
- Anterior interventricular branch (LAD)
- Right coronary artery
- Left circumflex branch
- Left coronary artery
- Posterior interventricular branch
What is cardiac output?
What does it correlate with?
- Cardiac output = amount of blood pumped by the heart (L/min)
- Reflection of LV function
What can decrease CO?
- Cardiomyopathy/MI
- Pulmonary disorders
- Endocrine disorders
- Hematological disorders
- Surgery/anesthesia
- Shock
- Allergic response
- Medications
What can increase CO?
SEEdS
- Sepsis
- Exercise
- Endocrine disorders
- Shunts
What are common causes of heart failure?
- Coronary Atherosclerosis
- Myocardial Infarction
- Hypertension
- Myocarditis
- Toxins (e.g., alcohol)
- Idiopathic / Genetic
What are risk factors that can lead to coronary artherosclerosis, MI and eventually heart failure?
- Hyperlipidemia
- Hypertension
- Diabetes
- Smoking
- Aging
Systolic HF vs. Diastolic HF PV loops:
What are two mechanisms for heart failure?
- Inadequate CO
- Tissue Congestion
Signs and Symptoms of Heart Failure:
Right vs. Left Heart
- Inadequate CO:
- Tissue Congestion:
-
Inadequate Cardiac Output
- Fatigue
- Cool extremities
- Mental obtundation
- Organ dysfunction (kidneys, liver)
-
Tissue Congestion (due to elevated diastolic pressures)
- Shortness of breath (dyspnea) - LH
- Swelling of legs (pedal edema) - RH
- Swelling of abdomen (ascites) - RH
