- runs along atrioventricular groove - 12% cases continues and gives off posterior descending artery - has branches called obtuse marginal Aa

- runs in right atrioventricular groove - 88% of the time it runs around to become posterior descending artery

- toward left - listen here for CHF - medial to midclavicular line at: - -5th intercostal space in supine - -6th in standing - 4th in obese/pregnant

- loose serous sac around heart - parietal and visceral layers - lubricates moving parts and holds heart in place

- top, central chest - at rib 3

- 2/3 on left side - Rotated: left ventricle toward anterior/axilla

- increased amount of fluid in pericardium - especially after MI - causes discomfort &/or decreased venous return

- muscle layer of heart - thickness in proportion of work done - Left ventricle thickest

- valves between L & R atria - normally closes at birth

- outside surface of heart - shiny red

- inner most layer of heart - shiny and smooth

- (create their own action potential) - SA/AV nodes - Bundle of His - Purkinje Fibers

- Left Anterior Descending Artery - Circumflex Artery

- Right Dominant=posterior Descending Artery from RCA (80%) - Left Dominant=Posterior Descending Artery from LCA--Circumflex Artery (5%)

Cardiac Anatomy Flashcards by Chaeli Greco

Circumflex Artery

runs along atrioventricular groove
12% cases continues and gives off posterior descending artery
has branches called obtuse marginal Aa

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RCA

runs in right atrioventricular groove

- 88% of the time it runs around to become posterior descending artery

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Part of blood from right ventricle goes _____ but most goes _____
(baby in utero)

through pulmonary trunk to lungs

- through ductus arteriosus to descending aorta to rest of body and placenta

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Heart Apex

toward left
listen here for CHF
medial to midclavicular line at:
-5th intercostal space in supine
-6th in standing
4th in obese/pregnant

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Pericardium

loose serous sac around heart
parietal and visceral layers
lubricates moving parts and holds heart in place

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Heart Size

2 clenched fists

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Heart Base

top, central chest

- at rib 3

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Heart Location

2/3 on left side

- Rotated: left ventricle toward anterior/axilla

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pericarditis

increased amount of fluid in pericardium
especially after MI
causes discomfort &/or decreased venous return

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Myocardium

muscle layer of heart
thickness in proportion of work done
Left ventricle thickest

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Foramen Ovale

valves between L & R atria

- normally closes at birth

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Epicardium

outside surface of heart

- shiny red

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Endocardium

inner most layer of heart

- shiny and smooth

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Prenatal Oxygenation of Blood

-occurs across placenta, not the lungs

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At birth, decreased pressure in R atrium and increase pressure in left atrium cause______

closing of the foramen ovale

- anatomical closure by 2-3 months

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Arterial Supply to Heart

-LCA & RCA

branch from base of aorta

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Patent foramen ovale

-pathology causing foramen ovale to remain open
-results in R to L shunt
(blood flows from R atrium to L atrium)

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Sarcoplasmic Reticulum of Myocardium

less developed so the heart muscle relies on extracellular Ca++

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Autorhythmic Cells

(create their own action potential)
SA/AV nodes
Bundle of His
Purkinje Fibers

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Action Potential of Autorhythmic Cells

slowly depolarizes until threshold met

- due to slow leak of Na+ into cell that then opens long lasting Ca++ gates

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Ductus Arteriorsus After Birth

closes w/n 15-72 hours
due to increased arterial O2 saturation
Anatomic closure in 2-3 weeks

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Coronary Flow Pattern

when heart muscle gets blood flow

L & R atria and R ventricle get blood supply to during systole
L ventricle gets blood during diastole (b/c pressure too high during systole)

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Divisions of LCA

Left Anterior Descending Artery

- Circumflex Artery

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Heart Dominance

Right Dominant=posterior Descending Artery from RCA (80%)

- Left Dominant=Posterior Descending Artery from LCA–Circumflex Artery (5%)

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Part of blood from right atria goes to the______ & other 1/2 goes to the _____ (baby in utero)

- right ventricle | - left atrium via foramen ovale

Patent Ductus Arteriosus

-failure of ductus arteriosus to close -due to hypoxia -causes L to R shunting (blood from aorta to pulmonary artery)

LAD

- runs along interventricular groove | - branches into diagonals

Venous Drainage

- most veins drain into coronary sinus to R atrium | - Thebesian Vv drain directly into L & R ventricles

Collateral Circulation

- Amount determined by birth - collaterals available if arterial supply hindered - Ischemia-->opening of collaterals -(takes 8-24 hours)

Action Potential from ______ to cause heart contraction

- SA node - AV node - Bundle of His - Purkinje Fibers

Cardiac Muscle Fibers

- striated - cells in series with intercalated discs - less developed sarcoplasmic reticulum - innervated by autonomic NS - ventrical myocardium similar to type I fibers but have more mitochondria

Depolarization/contraction of heart from _____ to allow ____

- bottom to top | - allow ventricle to squeeze out blood

Heart Muscle Depolarization from____

Na+ in

Heart Muscle Repolarization from _____

K+ out

Heart Sounds

- S1, S2 (normal) | - S3, S4 (abnormal)

M1 & T1 Sounds

- 2 components of S1 sound | - when mitral valve closes slightly before tricuspid

A2 and P2 Sounds

- 2 components of S2 | - when aortic valve closes slightly before pulmonic valve

S3 sound pattern

- Lub Dub-ub - 1 2-3 -VOLUME PROBLEM (CHF)

Myocardium action potential plateau from:

Na+ in allows Ca++ into cell so lots of (+) going in while less (+) going out (K+)

S3 & S4 sounds due to:

loss of ventricular compliance

Fiber types of ventricles

type I but more mitochondria

Heart Impulse Pathway

1. SA Node 2. Bachman's Bundle & Internodal Tracts 3. AV Node 4. Bundle of His 5. L/R Bundle Branches 6. Purkinje Fibers

Internodal Tracts

-deliver impulses directly from SA node to AV node

- "Lub" - 1st heart sound - Loudest at Apex - 2 components (M1, T1) - Sound from closure of AV valves

- "Dub" - 2nd heart sound - 2 components (A2, P2) - Loudest at Aortal Area - Sound from closure of semilunar valves

S3 sound occurs in

middle 1/3 of diastole

S4 Sound Pattern

- "du-lub dub" - 4-1 2 - mechanical problem

S4 abnormal if:

- there is resistance to ventricular filling | - like with CAD, hypertensive cardiac disease, pulmonic disease, history of MI or CABG

S4 normal in:

-trained athlete with left ventricular hypertrophy | LVH

S3 indicates:

loss of ventricular compliance | -key for CHF diagnosis

- caused by vibrations in ventricles as it switches from rapid diastolic filling to passive distention - VENTRICULAR GALLOP - Heart over apex (pt in lateral decubitus; with bell) - Key diagnosis of CHF

Key Diagnosis of CHF

-S3 heart sound

- during 2nd phase of diastole due to atrial contraction - ATRIAL GALLOP - Heard over apex (pt in left lateral decubitus; bell) - heard before S1

Ventricular Gallop

Atrial Gallop

Left Ventricular Diastole

-pressure in L atrium > pressure in L Ventricle so Mitral valve is open

Isovolumic Systole

- Mitral & Aortic Valve closed - mitral closed and aorta yet to open - (pressure increased in ventricle)

QRS Complex

EKG of ventricular contraction

Isovolumetric Diastole

-aortic and mitral valves closed -aortic closed, mitral yet to open (pressure decreased in ventricle)

Autorhythmic Cells depolarize due to:

Ca++ in

Autorhythmic Cells repolarize due to:

K+ out

SA Node

- top of R atrium - pacemaker (depolarizes fastest) - 70-80/min

AV Node

- 40-60/min | - becomes pacemaker if SA damaged

Bachman's Bundle

delivers impulse from R to L atrium

Bundle of His and Purkinje fibers

20-40/min

Circumflex and marginal Aa supply:

- Superior and marginal portions of L ventricle - Part of Post L Ventricle - L Atrium - SA Node (in 40% of people)

SA Node blood supply

- Circumflex/Marginal Aa (40% of people) | - RCA (60%)

AV Node Blood Supply

- LAD/Diagonals (10% of people) | - RCA (90%)

RCA Supplies

- most of R ventricle - part interventricular septum - R atrium - part posterior L ventricle - inferior surface of L ventricle - SA Node (60%) - AV Node (90%)