Cardio Flashcards
Thoracic duct ascending enters where and empties into ?
enters the aortic hiatus and empties into the left subclavian vein.
IVC is from from which veins?
Right and left common iliac veins at the level of L4 and L5. The IVC returns venous blood to the heart from the
lower extremities, portal system, and abdominal and pelvic viscera.
At the level of L1, the renal veins and arteries originate where
aorta
the IVC is anterior to right renal artery and right to the aorta
SVC is formed from
Left and right brachiocephalic veins
Right-sided endocarditis involving the tricuspid valve commonly occurs in IV drug users and is most often due
S.aureus
infective endocarditis can cause tricuspid regurgitation, which is
identified as
an early systolic murmur best heard over the left lower sternal border that is accentuated by
inspiration.
The right and left main coronary arteries arise directly from the root of the aorta and provide the blood supply
to the heart. The left main coronary artery divides
Left anterior descending (LAD) and circumflex
coronary arteries, which supply most of the anterior and left lateral surfaces of the heart.
In 85-90% of
individuals, the right coronary artery gives rise to
the posterior descending artery and right marginal branch of right coronary artery.
These patients are said to
have right dominant coronary circulation. In approximately 10% of patients, the posterior descending artery
arises from the circumflex branch of the left main coronary artery; these patients have left dominant
circulation.
The posterior descending artery of right supplies
most of the inferior wall of the left ventricle, which forms
the diaphragmatic surface of the heart. The right coronary artery also gives rise to the SA and AV nodal
arteries in most patients.
The LAD of left coronary artery normally supplies
anterior 2/3 of the interventricular septum (septal
branches}, the anterior wall of the left ventricle (diagonal branches}, and part of the anterior papillary muscle.
The most common cause of coronary sinus dilatation
is elevated right-sided heart pressure secondary to pulmonary artery
hypertension.
The coronary sinus serves as the endpoint of venous drainage from the coronary blood supply_ Since it
contains deoxygenated blood it drains into
the right atrium
Since the coronary sinus communicates freely with
the right atrium, it will become dilated by
any factor that causes dilatation of the right atrium.
Aortic dissection often occurs in patients with hypertension. Such patients might have
elevated
left heart pressures
This patient presents with progressive dyspnea and orthopnea (cough when lying down). His chest x-ray
shows cardiomegaly (heart> 1 hemithorax in size), increased vascular shadowing (alveolar edema) in a
“batwing” peri-hilum pattern, and blunting of the costophrenic angles (pleural effusions). These findings are
characteristic of
Left acute ventricular heart failure
acute left ventricular failure,
result from increased left atrial and ventricular filling pressure
(increased preload).
This increased pressure is transmitted to the pulmonary capillaries, causing fluid
transudation into the pulmonary interstitial and alveolar spaces (cardiogenic pulmonary edema).
Common triggers for acute heart failure include
myocardial infarction, severe hypertension, arrhythmias (eg,
atrial fibrillation), and drug use (eg, cocaine). Patients with acute heart failure complain of cough, dyspnea,
and fatigue, which can rapidly become more severe
Chest examination from acute heart failure usually reveals
crackles and sometimes wheezing
(cardiac asthma) due to edema of the bronchial airways
The chest x-ray can also show from acute heart failure show
Kerley B lines,
short horizontal lines situated perpendicularly to the pleural surface that represent edema of the interlobular
septa.
Acute respiratory distress syndrome (ARDS) results from
endothelial injury and leakage of
fluid from capillaries.
ARDS has what onset? and looks like what on chest X ray?
has an acute onset and is characterized by bilateral patchy airspace disease on chest
x-ray. It is caused by an inciting factor such as sepsis, aspiration, pneumonia, or trauma.
ARDS can be
distinguished from cardiogenic pulmonary edema by t
he absence of jugular venous distension and
cardiomegaly.
chest x-ray in idiopathic interstitial fibrosis (referred to histologically as usual interstitial
pneumonia) shows?
reticular, net-like, opacities involving the lung bases. Most patients present with slowly
progressive dyspnea and a nonproductive cough.
Obstructive pulmonary diseases such as asthma and chronic obstructive pulmonary disease
are associated with
hyperinflated lungs and a flattened diaphragm.
The diagnosis of pneumothorax is confirmed
by the presence of a white visceral pleural line on
chest x-ray. Pulmonary vessels are not visible beyond the visceral pleural boundary. The mediastinum is
often shifted away from the affected side.
When the left anterior descending artery (LAD) alone is occluded by an atherosclerotic plaque what is the preferred bypass?
the left internal
mammary artery (left internal thoracic artery) is the preferred vessel for bypass grafting because it has
superior short- and long-term patency rates compared to saphenous vein grafts.
For cases in which there
are multiple coronary arteries or vessels other thani the LAD requiring revascularization, what graft is preferred?
saphenous vein grafts
are routinely used.
The great saphenous vein is located
superficially in the leg and is the longest vein in the body
Course for saphenous vein
It courses
superiorly from the medial foot, anterior to the medi’al malleolus, and up the medial aspect of the leg and
thigh. In the proximal anterior thigh 3-4 centimeters inferolateral to the pubic tubercle, the great saphenous
vein dives deep through the cribriform fascia of the saphenous opening to join the femoral vein. Surgeons
commonly access the great saphenous vein in the medial leg or at its point of origin in the upper thigh near the
femoral triangle. The femoral triangle is bordered by the inguinal ligament superiorly, sartorius muscle
laterally, and adductor longus muscle medially.
The popliteal artery and vein course centrally
through the popliteal fossa together with the tibial
nerve. Common medical problems that occur in the popliteal fossa include popliteal artery aneurysms, which
account for the majority of peripheral artery aneurysms, and synovial (Baker) cysts, which are commonly
associated with arthritis.
The small saphenous vein can be
found at the lateral aspect of the foot. This vein courses
posteriorly to drain into the popliteal vein.
A penetrating injury at the left sternal border in the fourth intercostal space (level of the nipple) will pass
through the following layers:
1 . Skin and subcutis
2. Pectoralis major muscle
3. External intercostal membrane
4. Internal intercostal muscle
5. Internal thoracic artery and veins
6. Transversus thoracis muscle
7. Parietal pleura
8. Pericardium
9. Right ventricular myocardium
The pulmonary trunk could be pierced by a penetrating injury to the which intercostal space?
second intercostal space at
the left sternal border
The left ventricle composes the left lateral aspect of the heart. A stab wound in which intercostal space?
fourth
intercostal space in the midclavicular line could potentially strike the left ventricle, but only after passing
through the bulk of the left lung.
The inferior vena cava passes through the right side of the central tendon of the diaphragm at the
level of TS. A stab wound to the ?
to the back to the immediate right of the vertebral bodies could strike the IVC
A penetrating injury at the left sternal border in the fourth intercostal space would puncture
the anterior surface
of the heart. The right ventricle composes most of the heart’s anterior surface.
It is important to know that the right ventricle composes the majority of the anterior surface of the heart. The
left lung would not be punctured by a stab wound in this location
In MVA, the most commonly injured is?
the most common site of injury is the
aortic isthmus, which is the connection between the ascending and descending aorta distal to where the left
subclavian artery branches off the aorta.
the right brachiocephalic artery is a common site for
aortic aneurysm
The IVC filter is designed to prevent
the travel of deep vein thrombosis from the legs to the lung vasculature.
Inferior vena cava filter is used to prevent pulmonary embolism in patients who have contraindications to
anticoagulation.
This abdominal computed tomography (CT) scan for IVC filter is taken at the level of
s taken at the level of L2. The bilateral
kidneys are viewed in section; the inferior pole of the right lobe of the liver is noted on the left side of the above
image anterior to the right kidney and posterolateral to the large bowel.
