CARDIOLOGY - Anatomy, Surgery and Trauma Flashcards
What is the pericardium
Double-walled fibrous membrane enclosing heart and roots of great vessels
What is the function of the fibrous pericardium
Protects heart against sudden overfilling
What is the pericardial cavity?
Potential space between visceral and parietal layers of pericardium
Through which sinus do the aorta and pulmonary trunk leave the pericardium?
Transverse pericardial sinus
Through what sinus do the SVC,IVC and pulmonary vv enter the heart?
Oblique pericardial sinus
Aa supply to the pericardium
Pericardiophrenic aa
Vv drainage of pericardium
Pericardiophenic vv
Nn supply to pericardium
phrenic nn C3-5
CNX
Sympathetic trunk
Where is the apex of the heart
Anterior to the left
Post to L ICS 5
Where is the base of the heart
Posterior
LA with bit of RA
Ant to T6-9
What are the 4 surfaces of the heart?
Anterior (Sternocostal) - RV
Diaphragmatic (inf) - LV + RV
Left pulmonary - LV
R pulmonary - RA
What are the 4 borders of the heart
R - RA
Inf - RV
L - LV
Sup - RA/LA + great vessels
Which heart chamber forms most of the base of the heart
LA
Which heart chamber forms the R border of heart
RA
Where does the con sinus receive blood from
Cardiac vv
What does the con sinus become
Sinus venarum
What part of the heart does the LV form
Apex and L surface
What level is the mitral valve at
4th CC
What level is the aortic valve at
3rd ICS
Where do you auscultate for: aortic valve:
2nd ICS, R sternal edge
Where do you auscultate for: pulmonary valve
2nd ICS - L sternal edge
Where do auscultate for: Tricuspid valve
5th ICS L sternal edge
Where do you auscultate for: Mitral valve
5th ICS MCL
Where does the R coronary aa arise from?
Coronary sulcus
Where does the L coronary aa arise from?
Aortic sinus of ascending aorta
Where do the great, middle and small cardiac vv empty?
Coronary sinus
Where does the anterior cardiac vv empty?
RA
Sympathetic innervation of heart
Accelerator nn
Parasympathetic innervation of heart
CNX
What is the ‘lub’ sound
Blood being transferred from atrai to ventricles
What is the ‘dub’ sound
Ventricles contract and expel blood from heart
When is a median sternotomy incision used for?
Ops on heart and aortic arch
When is a anterolateral thoractomy incision used?
Access to RHS heart
When is a posterior throacotomy incision used?
For access to distal aortic arch and descending thoracic aorta
When is a bilateral transverse throacotomy used?
for H-L transplant
What is the main complications of Cardiopulmonary bypass
Clotting within machine
Which artery is most commonly used as a conduit in CABG
L internal mammary aa
Complications CABG (7)
MI Bleeding Arrhythmias Stroke Tamponade Aortic dissection Resp/systemic complications
Example of man made heart valve names
Ball-in-cage
Bileaflet
What must be coprescribed with man-made valves?
Warfarin
How to tell if a patient has a manmade heart valve
Can hear clicking from bedside
Which type of prosthetic valve is more prone to degenerative failure?
Tissue valve
What Ix must all patients with blunt chest trauma have
CHX (supine)
Sign of cardiac tamponade CXR
Rounded heart border
What is a myxoma
Common myocardial tumour
What conditions does myxoma mimic?
Infective endocarditis
Mitral stenosis
Ix myxoma
Echo
mx myxoma
Excise
What is constrictive pericarditis due to?
Pericardial inflammation (e.g. due to RA/trauma/radiotherapy)
Signs constrictive pericarditis
Pulmonary/systemic congestion
Mx constrictive pericarditis
excise whole pericardium
`Why are ball in cage valves not really used anymore
Due to high risks of clot –> stroke
Click replacing 1st heart sound =
Mitral valve replacement
Click replacing 2nd heart sound =
Aortic valve replacement
What is TAVI and when is it used
Transcatheter aortic valve replacement
Through femorals up to aorta
Balloon opened + valve implanted
For high risk patients with aortic stenosis
Prognosis TAVI
Unsure as new but lower rate of infective endocarditis and clots
What % of prosthetic valves –> infective endocarditis
2.5%
