Cardiac-Pulmonary System Flashcards
What does the thorax include?
-Pulmonary system
-Cardiovascular system
Boundaries of thoracic cage
Anterior: sternum (manubrium, body of sternum, xiphoid process)
Lateral: 12 pairs of ribs + costal cartilages
Posterior: thoracic vertebrae (T1-T12)
What is the sternal angle?
Manubriosternal joint
Which aperture enables communication between the thorax and upper limb, head, neck?
Superior thoracic aperture
Which aperture enables communication between the thorax and abdomen?
Inferior thoracic aperture
Which structure closes the inferior thoracic aperture?
Respiratory diaphragm
Which structures travel through the STA?
Enter thorax via STA:
-Esophagus
-Trachea
-Major tributaries of super vena cava
Exit thorax via STA:
-Major branches of aorta
Which structures travel through ITA?
Enter thorax via ITA:
-inferior vena cava
Exit thorax via ITA:
-esophagus
-aorta
Which compartments make up the thoracic cavity?
Pulmonary cavities:
-bilateral compartments
-contain lungs and pleurae
Mediastinum:
-contains all other thoracic viscera, including heart and structures that generally conduct air, blood and food
Boundaries of mediastinum
Superior: superior thoracic aperture
Anterior: sternum + costal cartilage
Posterior: bodies of T1-T12
Inferior: diaphragm
Where does the superior mediastinum and inferior mediastinum differentiate?
Sternal angle at T4 and T5
What does the superior mediastinum contain?
-Great vessels and branches or tributaries
-Esophagus
-Trachea
What does the middle inferior mediastinum contain?
-Heart
-Pericardium
-Roots of great vessels
What does the posterior inferior mediastinum contain?
-Thoracic (descending) aorta
-Esophagus
-Azygos and hemi-azygos vein and tributaries
Function of lungs
-Oxygenate blood by bringing venous blood in proximity with inspired air
Boundaries of pulmonary cavities
Superior: root of the neck (just superior to rib 1)
Lateral: thoracic wall
Medial: mediastinum
Inferior: diaphragm
What is the lateral surface of the lungs called?
costal surface (close contact with ribs)
What is the base of the lung called?
diaphragmatic surface (close contact with diaphragm)
Main differences between left lung and right lung?
-Size
-Number of lobes
-Fissures
-Notches
Lobes in right lung
-Superior lobe
-Middle lobe (most anterior)
-Inferior lobe
Lobes in left lung
-Superior lobe
-Inferior lobe
Fissures in right lung
-Oblique fissure
-Horizontal fissure
Fissures in left lung
-Oblique fissure
Notches in left lung
-Cardiac notch
-Lingula
Cardiac notch
-Accommodates apex of heart
-Superior to lingula
Lingula
-Thing, tongue-like process extending below cardiac notch
-Expands during respiration
What is the medial surface of the lung called?
Mediastinal surface
Hilum
-Wedge-shaped area
-Structures forming the root of the lung enter/exit the lung through the hilum
Structures of the root of the lung and their positioning
-Bronchi - middle (L); posterior (R)
-Pulmonary arteries - superior
-Pulmonary veins - anterior/inferior
-Nerves
-Lymphatic vessels
Pulmonary ligaments
-Double layer of pleura
-Anchors lung
-Accommodates respiration
Why are lungs isolated to their own pulmonary cavities?
To isolate them from each other if something goes wrong
Grooves on right lung
-Groove for esophagus (posterior/superior to inferior)
-Groove for arch of azygos vein (arched part of the groove)
-Groove for azygos vein (inferior/posterior)
-Groove for superior vena cava (anterior)
Which lobes do the grooves of the right lung sit in?
Superior lobe: groove for esophagus
Inferior lobe: groove for arch of azygos vein and groove for azygos vein
Middle lobe: groove for superior vena cava
Grooves for the left lung
-Groove for arch of aorta (superior)
-Groove for descending aorta (posterior and inferior)
Are the grooves on the left lung close to the notches?
No they are posterior to the notches
Where does the trachea bifurcate into primary bronchi?
Sternal angle
Which bifurcations exist from the trachea?
-Left and right side
-Primary bronchi
-Secondary bronchi
Where does the primary bronchi enter lung?
Hilum
Parietal pleura
-Lines pulmonary cavity; adheres to thoracic wall, mediastinum, diaphragm
Visceral pleura
-Adheres to external surface of lungs
How do the parietal and visceral pleura connect?
They are continuous with one another at the hilum of the lung
Where is the pleural cavity?
Space between the visceral and parietal pleura
What are the 4 parts of the parietal pleura?
-Cervical
-Costal
-Diaphragmatic
-Mediastinal
What are the costodiaphragmatic recesses?
-Pleural-lined spaces between the ribs (thoracic wall) and diaphragm
How do the costodiaphragmatic recesses acommodate respiration?
-They serve as extra space for the lungs to move into during inspiration
What are the boundaries of the middle mediastinum?
Superior: sternal angle
Lateral: mediastinal pleura
Inferior: diaphragm
Pericardium
-Double walled, fibroserous sac that covers the heart and roots of the great vessels
-Two layers: fibrous pericardium and serous pericardium
Layers and characteristics of the pericardium
Fibrous pericardium:
-tough, external layer
Serous pericardium:
-Parietal layer: lines internal surface of fibrous pericardium
-Visceral layer: adheres to surface of heart
Are the parietal and visceral layers of the serous pericardium continuous with one another? If so, where?
Yes, at the great vessels
What is the space between the parietal and visceral layers of serous pericardium? What does it contain?
Pericardial cavity:
-contains fluid secreted by serous pericardium that allows for frictionless movement of heart
What is the fibrous pericardium continuous with?
-Tunica adventitia of great vessels: external layer of a blood vessel
-Central tendon of the diaphragm
Function of the fibrous pericardium
-Holds heart in place
-Limits expansion of the heart
______ side of the heart receives venous blood
Right
_______ side of the heart receives arterial blood
Left
Arterial blood
Well-oxygenated
Venous blood
Poorly-oxygenated
What are the receiving chambers of the heart?
Atrium
What are the discharging chambers of the heart?
Ventricles
Which chambers of the heart are visible from the anterior view?
RA
RV
LV
Which chambers of the heart are visible from the posterior view?
LA
LV
RA
What do the SVC and IVC do?
-Bring poorly oxygenated blood into the heart
-Pushes blood into the right atrium
-Upper body blood (SVC) and lower body blood (IVC)
From left to right, what are the major vessels of the heart?
P A S
Pulmonary trunk
Aorta
Superior vena cava
In anatomical position, how do the SVC and IVC align?
In a sagittal plane
In posterior view of the heart, which major vessels can you see?
Left and right pulmonary arteries
Aorta
Pulmonary veins
SVC and IVC
On the medial view of the right lung, which pulmonary artery is superior? Same with the left one.
The right one.
The left one.
At the level of the sternal angle, which structures bifurcate?
Aorta:
-Ascending aorta becomes the arch of the aorta
Pulmonary trunk:
-Bifurcates into pulmonary arteries at sternal angle
Azygos vein:
-Azygos vein becomes the arch of the azygos vein
Trachea:
-Trachea bifurcates into primary bronchi
SVC:
-Left and right brachiocephalic veins become the SVC
Which great vessels are associated with the right atrium?
-Superior vena cava
-Inferior vena cava
Which great vessels are associated with the right ventricle?
Pulmonary trunk
Which great vessels are associated with the left atrium?
Pulmonary veins
Which great vessels are associated with the left ventricle?
Aorta
Which chamber forms the base of the heart? What is the positioning?
Left atrium: mostly posterior
Which chamber forms the apex of the heart? What is the positioning?
Left ventricle: antero-lateral, left
What are the surfaces of the heart? Which chambers form these surfaces?
-Anterior (sternocostal) surface: right ventricle
-Inferior (diaphragmatic) surface: mainly left ventricle, but partly right ventricle
-Right pulmonary surface: right atrium
-Left pulmonary surface: left ventricle
Borders of the heart
Superior:
-Right atrium
-Left atrium
Inferior:
-Right ventricle
-Left ventricle
Left:
-Left ventricle
Right:
-Formed by right atrium, extends between SVC and IVC
The right atrium forms the:
-Right pulmonary surface
-Right border
-Superior border
The right ventricle forms the:
-Diaphragmatic surface
-Sternocostal surface
-Inferior border
The left atrium forms the:
-Base of the heart
-Superior border
The left ventricle forms the:
-Diaphragmatic surface
-Left pulmonary surface
-Inferior border
-Left border
To place an isolated heart in anatomical position, ensure:
-Apex of heart is pointing left
-SVC is on the right, aorta in middle, pulmonary trunk on left
-SVC and IVC align in sagittal plane
-Pulmonary veins are posterior
What are the walls of the right atrium?
-Sinus venarum
-Interatrial septum
-Pectinate muscles
Sinus venarum
-Smooth posterior wall of right atrium only
-Denotes interatrial septum
Interatrial septum
Wall between right and left atria
Fossa ovalis
-Remnant from fetal circulation
-Right atrium
-Oval impress on sinus venarum
-Bypass pulmonary circulation
Where is the fossa ovalis in relation to the IVC?
Directly superior
Pectinate muscles
Rough anterior wall of:
-Right atrium
-Left atrium
Right auricle
Outpouching of atrium
Openings of the right atrium
-Opening of SVC
-Opening of IVC
-Opening of coronary sinus
-Right atrioventricular orifice
What guards the right AV orifice?
The tricuspid (right AV) valve
Walls of the right ventricle
-Trabeculae carneae
-Interventricular septum
Trabeculae carneae
Rough muscular wall of:
-right ventricle
-left ventricle
Interventricular septum
-Wall between right and left ventricles
Components of the tricuspid valve
-Right AV orifice
-Cusps (3)
-Tendinous cords
-Papillary muscles (3)
-Septomarginal trabecula (moderator band)
What does the tricuspid valve inhibit?
Regurgitation of blood into right atria during right ventricular contraction
What does the septomarginal trabecula do?
-Contains part of the conducting system of the heart
-Coordinates contraction of papillary muscles
Valves in the right ventricle
-Tricuspid valve
-Pulmonary semilunar valve
Components of the pulmonary semilunar valve
-3 cusps
What does the pulmonary semilunar valve do?
-Prevents regurgitation of blood into right ventricles during right left atrial contraction
Left auricle
Outpouching of atrium
Walls of the left atrium
-Pectinate muscles
Openings of the left atrium
-Openings of pulmonary vein
-Left AV orifice
Semilunar depression
-Left atrium
-Location of fossa ovalis
What is the left AV orifice guarded by?
Bicuspid (mitral/left AV) valve
What are the components of the bicuspid valve?
-Cusps (2)
-Tendinous cords
-Papillary muscles
Valves of the left ventricle
-Bicuspid valve
-Aortic semilunar valve
Components of the aortic semilunar valve
3 cusps
Walls of the left ventricle
-Trabeculae carneae *much thicker than right ventricle for systemic circulation
In a superior view of the valves with the atria removed, what are the positioning of all four valves?
posterior: pulmonary semilunar valve
middle: aortic semilunar valve
left: bicuspid valve (two cusps)
right: tricuspid valve (three cusps)
What valves are open during diastole?
Bicuspid and tricuspid valves
What valves are open during systole?
Pulmonary and aortic semilunar valves
Diastole
Ventricular relaxation:
-semilunar valves are closed to prevent regurgitation of blood into ventricles during atrial contraction
Systole
Ventricular contraction:
-bicuspid and tricuspid valves are closed to prevent regurgitation of blood into atria during ventricular contraction
Muscles comprising the walls of and/or found within the atria:
Pectineate
Muscles comprising the walls of and/or found within the ventricles:
Trabeculae carneae
Papillary muscles
Valves associated with the right atrium:
Tricuspid
Valves associated with the right ventricle:
Tricuspid
Pulmonary valve
Valves associated with the left atrium:
Bicuspid
Valves associated with the left ventricle:
Bicuspid
Aortic valve
Direction of blood flow, starting from the upper/lower limbs
- IVC/SVC
- Right atrium
- Tricuspid valve
- Right ventricle
- Pulmonary valve
- Pulmonary trunk
- Pulmonary arteries
- Lungs
- Pulmonary veins
- Left atrium
- Bicuspid valve
- Left ventricle
- Aortic valve
- Aorta
- Body
When blood is flowing into the atrium from the ventricle, what structure is damaged?
Bicuspid valve (left side) or tricuspid valve (right side)
What component of the bicuspid valve is damaged most often?
The cusps are misshaped leading to leaky valve
When there is adipose tissue on the heart, is the visceral layer of the serous pericardium removed or present?
Present
What are the two grooves on the heart? Which way do they run?
Atrioventricular: more horizontally
Interventricular: more vertically
What are the two main arteries of the heart? What physically divides them?
Right coronary artery and left coronary artery
The pulmonary trunk
What are the branches of the right coronary artery? What are their travel paths?
First branch: sino-atrial artery
-Ascends up heart, heading towards SVC
-Deep to right auricle
Second branch: right marginal artery
-Travels towards the apex of the heart along the inferior border
Third branch: posterior interventricular artery
-descends posteriorly in the interventricular groove
-anastomoses with anterior interventricular artery
What is the travel path of the right coronary artery?
-Travels along the atrioventricular groove, deep to the right auricle, from anterior, along the right side, to the posterior
What is the travel path of the left coronary artery?
-travels deep to the left auricle, along the left side of the heart, along the interventricular and atrioventricular grooves
What are the branches of the left coronary artery? What are their travel paths?
First branch: Circumflex branch of of the LCA
-travels in atrioventricular groove, goes posterior, deep to the coronary sinus
Second branch: left marginal artery
-technically a branch of the circumflex branch of the LCA
-travels along the interventricular groove to the apex of the heart
Third branch: anterior interventricular artery
-travels along the interventricular groove on the anterior aspect of the heart
-anastomoses with posterior interventricular artery
Coronary sinus
-located within atrioventricular groove on posterior aspect of heart
-receives venous blood from most veins of the heart
Which chamber is the coronary sinus within?
Right atrium
What are the four cardiac veins?
-Great cardiac vein
-Middle cardiac vein
-Small cardiac vein
-Anterior cardiac veins
Travel path of great cardiac vein
-Main branch off of coronary sinus
-Travels in AV groove to the anterior IT groove
-Travels with the anterior interventricular artery
Travel path of middle cardiac vein
-Travels in the posterior IT groove
-Travels with the posterior interventricular artery
Travel path of small cardiac vein
-Travels with the right coronary artery and right marginal artery in the AV groove
-Starts posterior and travels along inferior border
Travel path of the anterior cardiac veins
-Bring venous blood directly into right atrium
-Jumps over RCA in AV groove
Borders of the superior mediastinum
Superior: superior thoracic aperture
Inferior: sternal angle
Lateral: mediastinal pleura
Anterior: sternum
Posterior: T1-T4
Organization of contents of superior mediastinum from anterior to posterior
Veins
Arteries
Trachea
Esophagus
Lymphatic vessels
At which level do the right and left brachiocephalic veins converge?
Deep to rib 1 costal cartilage
What do the brachiocephalic veins converge to form?
SVC
Which tributaries of the SVC are apart of the superior thoracic aperture?
-Right and left brachiocephalic veins
-Posterior intercostal veins
-Arch of the azygos vein
Which tributaries of the SVC converge in the neck?
Right and left subclavian veins, and right and left internal jugular veins
Which parts of the aorta are in the superior mediastinum?
-Arch of the aorta
-Brachiocephalic trunk
-Left common carotid artery
-Left subclavian artery
What compartment of the mediastinum is the ascending aorta in?
Middle
Which parts of the aorta are in the neck?
Right subclavian artery and common carotid artery
What is the ligamentum arteriosum?
-Remnant from fetal circulation
-Bypass the lungs so prevents blood from entering pulmonary artery and deposits it in the aorta
Which structure is similar to the ligamentum arteriosum?
Fossa ovalis
Why is the superior mediastinum the only compartment that the trachea is in?
Because it bifurcates into the primary bronchi at the sternal angle
What is the esophagus’ positioning in relation to the trachea and aorta?
-Travels posterior to trachea in the superior mediastinum
-In the posterior mediastinum, the aorta crosses over the esophagus posteriorly
What are the venous angles?
The angles at which the right/left subclavian vein and right/left internal jugular veins converge to form the right and left brachiocephalic veins
What other vessels are present at the venous angles?
-Right lymphatic duct
-Lymphatic trunk (right)
-Thoracic duct (left)
Boundaries of the posterior mediastinum
Superior: sternal angle
Inferior: diaphragm
Posterior: bodies of T5-T12 vertebrae
Anterior: fibrous pericardium/diaphragm
What is the “blue side” of the posterior mediastinum? “red side”?
Blue side: contains veins
Red side: contains arteries
Organization of the posterior mediastinum from anterior to posterior
-Esophagus
-Arteries
-Veins
-Lymphatic trunks
Which part of the aorta is located in the posterior mediastinum?
Thoracic (descending aorta)
Order of the parts of the aorta, from most proximal to most distal.
Ascending aorta
Arch of the aorta
Thoracic (descending aorta)
Bronchial arteries
Esophageal arteries
Posterior intercostal arteries
At which opening does the thoracic aorta become the abdominal aorta?
Aortic hiatus
What parts of the azygos vein are in the posterior mediastinum?
Azygos vein
Accessory azygos vein
Hemi-azygos vein
Which veins bring blood from intercostal spaces to the azygos vein?
Posterior intercostal veins
Which part of the azygos vein is more superior on the left side of the body?
Accessory azygos vein
Which part of the lymphatic vessels are in the posterior mediastinum?
Lymphatic trunks and thoracic duct
Where does the azygos vein exit the posterior mediastinum?
Superiorly: sternal angle (becomes the arch of the azygos)
Inferiorly: aortic hiatus
