Cardiac Anatomy

Question 1

Normal or abnormal?

Answer 1

Abnormal

• globular shaped heart from pericardial fluid

Question 2

Normal or abnormal?

Answer 2

Normal

Question 3

Describe what you are examining on a chest x-ray:

• Heart:
• Mediastinum:

Answer 3

• 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

Question 4

Identify the structures:

Answer 4

Question 5

What are the clinical signs for cardiac tamponade?

Answer 5

• 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

Question 6

Where are the Heart Valve Sounds on Surface Anatomy?

Answer 6

All Patients Take Meds

1. Aortic Semilunar Valve –
   
   • Intercostal space 2, right of sternum
2. Pulmonary Semilunar Valve –
   
   • Intercostal space 2, left of sternum
3. Tricuspid Valve –
   
   • just lateral to body of sternum @ below rib 5
4. Mitral Valve –
   
   • apex of heart at intercostal space 5

Question 7

Identify the Structures

Answer 7

Question 8

Identify the Structures

Answer 8

1. Right brachiocephalic
2. Right subclavian
3. Right common carotid
4. Left common carotid
5. Left subclavian
6. Right coronary

Question 9

What are the major arteries for finding a pulse?

Answer 9

• Superficial Temporal Artery
• Common Carotid Artery
• Brachial Artery
• Femoral Artery
• Dorsalis Pedis Artery
• Popliteal Artery
• Radial Artery
• Subclavian Artery
• Facial Artery

Question 10

**Pericardium and Heart: **

• **Layers: **
• **Nerves: **
• **Sinuses: **

Answer 10

• Layers
  
  1. Visceral layer of serous pericardium
  2. Parietal layer of serous pericardium
  3. 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
  
  1. Transverse sinus ⇒ open sac and runs btwn great arteries and pulmonary veins; of surgical importance
  2. Oblique sinus ⇒ recess of pericardial cavity ends in cul‐desac surrounded by the pulmonary veins

Question 11

Layers of the pericardium from superficial to deep:

Answer 11

1. Fibrous pericardium
2. Parietal layer of the serous pericardium
3. Visceral layer of the serous pericardium
   
   • outer layer of the epicardium

Question 12

When injecting contrast into the arteries of the heart, how would you ensure that the contrast enters the anterior interventricular artery? Why?

Answer 12

• 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

Question 13

• Anterior Interventricular Artery (LAD) travels with _____ _______
• R. Marginal branch of R. Coronary travels with _____ _______
• Posterior Interventricular Artery travels with _______ _______

Answer 13

• 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.

Question 14

Describe the route blood takes through the heart, starting with deoxygenated blood from the body and head.

Answer 14

Question 15

What helps keep the tricuspid and mitral valves tightly closed?

Answer 15

• chordae tendinae
• anterior and posterior papillary muscles
• moderator band (tricuspid valve)
  
  • not so much for strength, rather, it helps conduct the electrical signals

Question 16

What are the general hemodynamics of the heart as it moves from diastole to systole?

Answer 16

1. closure of the aortic and pulmonary valves ⇒ beginning of diastole
2. atrial contraction during final moments of diastole
3. closure of the AV valves (tricuspid and mitral) ⇒ systole begins very soon afterwards
4. opening of the aortic and pulmonary valves during systole

Question 17

Diastole or Systole?

Answer 17

Systole

Question 18

Diastole or Systole?

Answer 18

Diastole

Question 19

What are the different ways to repair a heart valve?

Answer 19

1. Porcine valve
2. Ball and cage valve
3. Tilting disk valve

Question 20

When do the coronary arteries perfuse the heart?

Answer 20

during DIASTOLE

Question 21

Wigger’s Diagram (fill in the blanks)

Answer 21

Question 22

Describe Cardiac Innervation:

Answer 22

1. Cardiac Plexus near tracheal bifurcation & ligamentum arteriosum
2. Parasympathetic – motor control over HR and SV
3. Sympathetic – postganglionic fibers come from upper chain ganglia to heart (3 cervical & T1‐T5)
4. Afferents enter spinal cord T1‐T5
5. 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

Question 23

Dermatomes for Cutaneous Innervation of the Upper Limb:

Answer 23

Question 24

Electrical Conduction System of the Heart (PQRST intervals):

1. SA node corresponds with ⇒
2. AV node corresponds with ⇒
3. Common AV bundle (of His) corresponds with ⇒

Answer 24

1. SA node corresponds with ⇒ PR interval
2. AV node corresponds with ⇒ QRS complex
3. Common AV bundle (of His) corresponds with ⇒ ST segment

Question 25

Which structure of the heart can **compress the esophagus**, if hypertrophied?

Answer 25

**left atrium**

Question 26

What are common coronary artery obstructions that can cause clinical manifestations?

Answer 26

1. Anterior interventricular branch (LAD) 2. Right coronary artery 3. Left circumflex branch 4. Left coronary artery 5. Posterior interventricular branch

Question 27

What is cardiac output? What does it correlate with?

Answer 27

* **Cardiac output = amount of blood pumped by the heart** (L/min) * **Reflection of LV function**

Question 28

What can **decrease CO**?

Answer 28

1. Cardiomyopathy/MI 2. Pulmonary disorders 3. Endocrine disorders 4. Hematological disorders 5. Surgery/anesthesia 6. Shock 7. Allergic response 8. Medications

Question 29

What can **increase CO**?

Answer 29

**SEEdS** 1. **S**epsis 2. **E**xercise 3. **E**ndocrine **d**isorders 4. **S**hunts

Question 30

What are common causes of heart failure?

Answer 30

* Coronary Atherosclerosis * Myocardial Infarction * Hypertension * Myocarditis * Toxins (e.g., alcohol) * Idiopathic / Genetic

Question 31

What are _risk factors_ that can lead to coronary artherosclerosis, MI and eventually heart failure?

Answer 31

* Hyperlipidemia * Hypertension * Diabetes * Smoking * Aging

Question 32

Systolic HF vs. Diastolic HF PV loops:

Answer 32

Question 33

What are two mechanisms for heart failure?

Answer 33

* **Inadequate CO** * **Tissue Congestion**

Question 34

Signs and Symptoms of Heart Failure: Right vs. Left Heart * **Inadequate CO:** * **Tissue Congestion:**

Answer 34

* **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**