Cardiology Flashcards
What are the boundaries of the mediastinum
Superior thoracic aperture
Diaphragm
Anterior - sternum
Posterior - thoracic vertebrae
Above what is the superior mediastinum
Sternal angle (inferior border)
What are the three parts of the inferior mediastinum and what are contained in each
Anterior - nothing
Middle - heart and roots of GV
Posterior - descending aorta
What is contained in the superior mediastinum
The arotic arch and GV
What are the two layers of the pericardium
Fibrous pericardium
Serous pericardium
Describe the fibrous pericardium and its function. What is it continuous with?
Tough external part
Continuous with central tendon of the diaphragm
Prevents the heart from overdialating
What does the fibrous pericardium continue with superiorly
Tunica adventitia (perivascular CT)
How is the fibrous pericardium attached to the sternum
Sternopericardial L.’s
What is the internal layer of the fibrous pericardium
Parietal layer of serous pericardium
What layer covers the heart
The visceral layer of serous pericardium which is also the epicardium
What is the visceral layer of serous pericardium mainly composed of
Mesothelium
Define the pericardial cavity
Potential space between parietal and visceral serous pericardium that contains a small amount of pericardial fluid which helps heart beat freely
Define the transverse pericardial sinus
Transverse passage in the serous pericardium between aorta and pul. Trunk and the great veins of the heart
How is the transverse pericardial sinus formed
Formed in the primordial heart when the primordial atrial and venous ends come together
Define the oblique pericardial sinus
The passage in the serous pericardium between the veins of the heart
Why does the oblique pericardial sinus form
From vein expansion
What A. Supplies the pericardium and what V. Empties it
The pericadiacophrenic A. And V.
What is the sensory and motor N.’s of the
Sensory - phrenic N.
Motor - sympathetic trunks
Define the LUB
1st sound heard
Blood from atria to vent.
closing of the AV valves
Define the dub
2nd sound
Ventricles expel blood
Closing of semi-lunar valves
What are the three layers of the heart and what are they made up of
- Epicardium - most superficial made up of visceral serous pericardium/mesothelium
- Myocardium - middle layer of thick spiraling muscles
- Endocardium - thin internal layer of endothelial cells
When ventricles contract, what type of motion do they make
A wringing motion, tightening the spiral muscles
How does heart contract in general
From apex to base and base to apex
What is the cardiac muscle anchored to
The fibrous skeleton of the heart
What is the fibrous skeleton of the heart made up of
Dense collagenous fibers
What does the fibrous skeleton o f the heart surround
All four valves with a ring
What are the three functions of the fibrous skeleton of the heart
- Attachment points for myocardium
- Attachment point for cuspid valves
- Provides insulation for electrical conduction
What part specifically of the fibrous skeleton provides insulation for. Electrical conduction
The membranous part of the interarterial and interventricular septum
What forms the apex
The inferolateral part of the LV
What are the three surfaces of the heart and what occupies them
- Sertnocostal - RV
- Diaphragmatic - LV and RV
- Pulmonary - RA and LV respectively
What are the 4 borders of the heart and what occupies them
- Right - RA
- Inferior - RV
- Left - LV
- Superior - R and L atria
What separates the RA and the RV and what does it transmit
R atrioventricular Groove with RCA
What separates the LA from the LV and what is with it
L atrioventricular groove with the coronary sinus
What separates the LV and RV on the anterior aspect and what runs with it
Anterior interventricular groove with the anterior interventricular A. (LAD) and the great cardiac V.
What separates the Lv and RV on the posterior side and what runs with it
Posterior interventricular groove with the posterior interventricular A. And the middle cardiac V.
Define the sulcus terminalis
External vertical groove corresponding to the internal crista terminalis
What do the sulcus terminalis (external) and crista terminalis (internal) divide
Divides the sinus vernaum and the pectinate muscle from each other within the RA
Define the ligamentum arteriosum
The embryological remnant of the ductus arteriosus
Is a connection between the pulmonary trunk and the Aortic Arch
Define the sinus venarum
Smooth muscle of the RA
What empties into the sinus Venarum
IVC/SVC/Coronary sinuses
Define pectinate M.
Rough muscle of the RA
Define the interatrial septum
Wall between the two atria
What is the passage called from the RA to the RV
R atrioventricular orifice
What valve guards the R atrioventricular orifice
The tricuspid valve
What attaches to the cusps of each AV valve (muscle and tendon)
The chordae tendonae which are attached to papillary muscles
What cusps do the anterior, posterior, and septal papillary muscles attach to respectively
Anterior
Posterior
Septal
Define trabecula carnae
The rough muscle region of the RV and LV
The papillary muscles are attached to what part of the RV
Trabecula carnae
Define the septomarginal trabeculum and its function
Part of the trabecula carnae
Transmits the RBB to the anterior papillary M.
Define the conus arteriosus
Smooth walled part of RV which leads into the pulmonary trunk
What valve leads to the pulmonary trunk/arteries
Pulmonary semilunar valve
What is smooth muscle walls called in the LA
Sinus venarum
What contains the pectinate M.’s in the LA
The left auricle
What is the passage from the LA to the LV called and what guards it
The left atrioventricular orifice guarded by the mitral (bicuspid) valve
What is the rough and smooth muscle wall regions of the LV called
Rough - trabeculae carnae
Smooth - aortic vestibule
What does the interventricular septum house
The AV Bundle, LBB, RBB
Where are the purkinjie fibers and LBB and RBB located
Endocardium, V. Deep
What is the division between the superior and inferior mediastinum
Transverse thoracic plane
When is widening of the mediastinum noted
Observed after trauma to the chest after a laceration to the great vessels
Malignant lymphoma
Hypertophy due to CHF
What space is used for a cross clamping of the aorta and pulmonary trunk in a bypass surgery
Transverse pericardial sinus
What is pericarditis
Inflammation of the pericardium which can cause a friction rub
Define pericardial effusion
Fluid from the pericardial capillaries leaks into the pericardial space, compressing the heart
Define cardiac tamponade and what can it result from
Due to accumulation of fluid in the pericardial space
Can result from pericardial effusion, pneumo, MI, or pneumopericardium
Define a pericardiocentesis and the procedure itself
Draining of fluid from the pericardial sac
Large-bore needle is inserted into the 5th or 6th ICS near the sternum or via the xiphocostal angle
Define dextrocardia and what causes it
Misplacement of the heart to the right instead of the left
Caused by misfolding of the embryonic heart tube to the left
Define isolated dextrocardia and dextrocardia with situs inversus
Which one is more serious?
ID = just heart switched
ID w/SI = transposition of abdominal viscera as well
ID is more serious
What part of the adult heart represents the primordial atrium
Right auricle
The coronary sinus is a derivative of what
Sinus venous
The foramen ovale closes when
The baby takes its first breath, causing back pressure in the left atrium to increase, closing the shunt
A patent foramen ovale is called what
Atrial septal defect
A patent foramen ovale that is serious can cause what
Hypertrophy of the R atrium and R ventricle
What does a VSD cause
Blood flow between Ventricles and cardiac hypertrophy
Where is cardiac percussion perfomed
3rd, 4th, and 5th ICS
Define valvular heart stenosis
Failure of the valve to open fully which slows blood flow into the chamber
Define valvular heart insufficiency
A failure of the valve to close completely usually due to scaring on the cusps
Both stenosis and insufficiency can produce what
Turbulence and audible murmurs
What is the cause of insufficiency
Acutely - by a pathology of the valve structure itself
Chronically - by scaring or retraction
What is the cause of stenosis
A result of a valve abnormality and is always a chronic process
Define a prolapsed mitral valve
An insufficient valve with one or both leaflets enlarged and floppy, causing it to extend back into the atrium during systole
What occurs due to a mitral valve insuddiciency
Blood regurgitates into the left atrium during systole
Usually seen in young females
Define pulmonary valve stenosis
The valve cusps are fused together
Define infundibular pulmonary stenosis
The conus arteriosus is underdeveloped
What do pulmonary valve stenosi cause
A restricted RV outflow
Define pulmonary valve incompetence
Results in a back-rush of blood under high pressure into the RV during diastole
What is the most frequent valve stenosis
Aortic valve stenosis
What is the result of aortic valve stenosis
Left ventricular hypertrophy
What does aortic valve insufficiency cause
Back-rush of blood into the left ventricle, producing a heart murmur and a collapsing pulse
The ligamentum arteriosum travels from where to where
From the superior aspect of the pulmonary trunk to the inferior concave border of the aortic arch
What did the ductus arteriosus do
Shunted blood from the pulmonary trunk to the aorta to bypass the lungs
What N. Loops around the ligamentum arteriosum
The left recurrent laryngeal N. Of the Vagus N.
Where does the electrode of a pacemaker implanted
In the trabecula carnae of the RV
