Cardio Flashcards
Where should the apex beat sit
5th intercostal space midclavicular line
What are the layers of the pericardium
Fibrous pericardium
Parietal pericardium
Visceral pericardium
(Pericardial cavity between the parietal and visceral)
Where is a needle placed in a pericardiosentisis
Inserted via the infrasternal angle and directed superoposteriorly to aspirate the fluid
Where is the transverse pericardial sinus
Posterior to the aorta and pulmonary trunk
What is the surgical use of the pericardial sinus
The transverse pericardial sinus is used to identify and isolate the great vessels for cardiopulmonary bypass
State the surfaces of the heart
Anterior surface (Sternocostal) Base surface (posterior) Inferior surface (diaphragmatic)
Name the heart borders
Right heart border: Right atrium
Left heart border: Left ventricle
Inferior heart border: Right ventricle
Superior heart border: Great vessels
The interatrial septum surface location
Shown by the interatrial groove
The interventricular septum surface location
Anterior interocentricular groove (Left anterior descending artery runs in this groove)
Define the coronary sulcus
The groove formed between the atrium and the ventricles
Name the 8 named coronary arteries
Right coronary artery (atrioventricular groove) - Right marginal artery - Posterior intraventricular artery Left coronary artery - Circumflex artery - Left marginal artery - Left anterior descending artery -- Lateral branch
Name the major coronary vein
The coronary sinus (Runs in the atrioventricular groove)
What structures are notable within the right atrium
Oval fossa
Opening of coronary sinus
Crista terminalis
Where do the coronary arteries stem from
The ascending aorta just superior to the aortic valve
How many cusps does the pulmonary valves have
Anterior
Right
Left
How many cusps does the aortic valve have
Right
Left
Posterior
What is the aortic sinus
The space within the aortic valve cusps that the coronary arteries arise from
How many cusps does the mitral valve have
Anterior
Posterior
How many cusps does the tricuspid valve have
Anterior
Posterior
Septal
What is the moderator band
Formal name septomarginal trabecula
Carries fibres of rigth bundle branch to the papillary muscle of the anterior cusp
Describe the innervation to the heart
Sympathetic nerves, parasymapthic nerves and visceral afferents reach the heart via the cardiac plexus
Describe the sympathetic chain
Runs of the posterior wall of the chest lateral to the spine
Which areas of the spinal nerve level affect the heart
T1 to L2/L3
Thoracolumbar
How do nerves from the sympathetic chain reach the organs
Travel from CNS to sympathetic chain (ganglionic fibre)
Ganglia from the spinal chain travel to organs (postganglionic fibre)
These move to the cardiac plexus in the case of the heart
Define cardiopulmonary splanchnic nerves
The sympathetic supply from the sympathetic chain to the heart and lungs
Define cardiac plexus
The cardiac plexus is collection of sympathetic fibers, parasympathetic fibers and visceral afferent fibers
Neurotransmitter of sympathetic heart supply
ACh to the chain
NA from the chain
Neurotransmitter of the parasympathetic heart supply
ACh to and from the chain
How do parasymapthetics reach the heart
CNS sends presynaptic fibres to ganglion to synapse to a fibre to the organ (ganglion often in the organ)
Define pain
An unpleasant sensation in response to a stimulus
List features of somatic pain
Sharp
Stabbing
Localized
List features of visceral pain
Dull
Aching
Nauseating
Diffuse
Explain the general path of a somatic pain to the brain
Peripheral receptors sense the stimuli which is carried to the spinal nerve
From the spinal nerve it is carried by the dorsal root ganglion
This travels up the spinal cord to the brain
What is the central sulcus of the brain
The fold between the frontal lobe and parietal lobe
What is the lateral fissure of the brain
Lateral line across the lateral aspect of the brain above the temporal lobe and inferior to the parietal and frontal lobe
Define the anatomical divisions of the mediastinum
Inferior below the sternal angle
Anterior, thymus and lymph nodes are here
Middle, the heart is located here
Posterior, the thoraxic aorta oesophagus and trachea are here
Superior above the sternal angle contains the great vessels
How is visceral pain carried from the thorax
The cardiopulmonary splanchnic nerves carry both the symathetic nerves and visceral pain
Define radiating pain
Pain that spreads from the area causing it
This is often across dermatomes
Define referred pain
Pain that is present far from a distant site only
Due to afferent fibres from soma entering at the same point as visceral
Define myocardial infarction
Irreversible death of part of the myocardium due to occlusion of the arterial blood supply
(Area of infarct due to the area of the occlusion)
Define left and right co-dominance
Co-dominance is the idea that the heart is supplied by the left and right vessels
(A vessel runs through the intraventricular grooves)
State in descending order the 4 most common places for coronary artery occlusion
Anterior interventricular branch
Right coronary artery
Circumflex branch
Left coronary artery
Define CABG
A coronary artery bypass graft
A graft often from the great saphenous vein (large in the leg) is anastomosed proximaly to the ascending aorta to supply the occluded area
Explain the anatomy of the blood supply to the conducting system of the heart
SAN branch from right coronary artery near its origin
AVN branch from right coronary artery near its branch to the posterior intraventricular artery
What is the blood supply to the interventricular septum
The left anterior descending artery
Minorly the posterior interventricular artery
Contence of the anterior mediastinum
Thymus
Contence of the middle mediastinum
The heart
The parts of the great vessels
Contence of the posterior mediastinum
The azygous vein upon the right side Sympathic chain Thoracic duct Thoracic aorta Oesophagus The trachea and the 2 main bronchi The vagus nerve
Anatomy of the azygous vein
The azygous vein arches anteriorly superior to the lung root to drain to the SVC
Sits just posterior to the oesophagus
Intercostal veins from the posterior chest wall drain here
Anatomy of the aorta
The ascending aorta imediatly from the heart (Coronary arteries from it)
The arch of the aorta (3 branches for it)
The thoracic aorta
Ends at the T12 level through the aortic hiatus of the diaphragm
Name the mediastinal branches from the aorta
The coronary arteries
The brachiocephalic trunk
The left common carotid artery
The left subclavian artery
Branches from the thoracic aortas anterior surface
- Bronchial
- Oesophageal
- Mediastinal
- Pericardial
- Phrenic
The lateral branches are the posterior intercostal arteries
Where does the thoracic duct drain into
Into the left and right venous angle respectivly
What does the right thoracic duct drain
Half the face and thorax (right side) and the right arm
Lymphatic drainage of the lungs
The tracheo-bronchial lymph nodes are around the tracheal bifrication
The bronchopulmonary lymph nodes surround the main bronchus at the lung base
At what point are there no more sympathetic fibres in the vagus
After the branch of the left recurrent laryngeal nerve
Where does the phrenic nerve pass through the diaphragm
At the level of T8 at the IVC hiatus
What is the ligamentum arteriosum
A vessicle reminant connecting the first part of the aortic arch and the descending aorta
Where is the left recurrent laryngeal nerve
Branches from the left vagus nerve
Looped around the arch of the aorta
Where is the right recurrent laryngeal nerve
Branches from the right vagus nerve
Looped around the right subclavian artery
