Cardiopulm anatomy (camtasi + class) Flashcards
What are the 4 chambers of the heart?
2 chambers to pump blood to lungs: R atria/ventricle
2 chambers to pump blood to body: L atria/ventricle
Why is left side muscle mass so much thicker?
Arterial pressure on left is higher so it has to push against more pressure than the right side so it has more mass.
What is the skeleton of the heart?
Consists of annuli fibrosi: four firmly connected, fibrous connective tissue rings (2 “coronets’; 2 rings)
Rigid attachment for:
myocardial fiber bundles; Pulmonary, aortic, and atrioventricular valves
Separates myocardial fibers of atria from those of ventricles
What are the external features of the heart?
Base, apex, diaphragmatic surface, sternocostal surface
What forms the base, apex, diaphragmatic surface, and sternocostal surface?
Base: Posterior aspect of heart
Formed largely by the left atrium (about in the mid line) along with a narrow portion of the right atrium.
Apex: Blunt descending projection formed by left the ventricle
Diaphragmatic surface: formed largely by the left ventricle along with narrow portion of the right ventricle.
Sternocostal surface: composed largely of the right atrium and right ventricle along with narrow portion of the left ventricle
What are parts of the right atrium?
auricle, crista terminalis, fossa ovalis, opening of coronary sinus, valve of IVC, SVC, IVC, right AV valve
What are characteristics of the auricle?
Corresponds to primitive atrium of embryonic heart; contains pectinate muscles
What are characteristics of the crista terminalis?
Junction of rough pectinate muscles vs smooth interior of the sinus venarum
Superior end marks location of sinoatrial node
What are characteristics of fossa ovalis?
Fossa ovalis (oval depression): Marks site of the embryonic foramen ovale through which blood passes from right atrium to left atrium before birth
What are characteristics of opening of coronary sinus?
Opening of coronary sinus: Site of venous blood that has passed through the cardiac muscle
What does valve of IVC, SVC, IVC, and AV valve do?
Valve: In embryonic heart, directs blood from inferior vena cava through foramen ovale and into left atrium (also call eustachian valve)
SVC: Large superior opening in the sinus venarum that brings poorly oxygenated blood from head and upper limbs
IVC: Large inferior opening in the sinus venarum that brings poorly (low) oxygenated blood abdomen and lower limb
Right AV valve:
Site of blood flow out of right atrium
What are the cusps of the tricuspid valve?
Anterior, posterior, septal
What can be found in the right ventricle?
Cusps of the tricuspid valve: anterior, posterior and septal cusps (leaves) of the AV valve
Papillary muscles: anterior (largest), posterior (smallest), and septal in right ventricle; according to location of their bases off the walls of the ventricle
Chordae tendineae: fibrous strands connecting papillary muscles to cusps (normally 2) of atrioventricular valves
Pulmonary valve
What is the role of the papillary muscles?
Muscles and chorda tendineae attached to AV valve cusps.
Contract during systole
Prevents blood from regurgitation back into atria
May rupture
What are characteristics of left atria?
Pulmonary veins: 2 right and 2 left pulmonary veins carry oxygenated blood into the left atrium
Smooth-walled part: derived from incorporation of pulmonary veins
Fossa ovale: slight depression in the interatrial wall
Left AV valve: Blood exits into the left ventricle through the mitral valve
What are characteristics of mitral valve?
Has anterior and posterior cusps
Closes at beginning of systole (part of lub sound)
What is mitral valve prolapse?
Everts into the left atrium when the left ventricle contracts during systole.
Although relatively common and often benign, it may produce chest pain, shortness of breath, and cardiac arrhythmia.
What type of prolapse is more common?
Mitral valve (systemic) prolapse is more common than tricuspid valve (pulmonary) prolapse Reason: Left ventricle contracts at higher pressure
What are characteristics of left ventricle?
Wall 2 to 3 times thicker than right ventricle
Mitral valve cusps: anterior and posterior cusps (leaves) of the AV valve
Papillary muscles: only ant and post papillary muscles
Chordae tendineae: fibrous strands connecting papillary muscles to each cusps of the mitral valve
Aortic valve: allows blood to exit the left ventricle past the 3 semilunar cusps of the aortic valve leading to the ascending aorta
What are characteristics of the pulmonary valve?
Right, left, anterior
Forced closed by pressure and elastic recoil in pulmonary trunk during relaxation of right ventricle
Part of S2 dub sound at end of systole
What are characteristics of aortic valve?
Right, left, posterior
Right and left coronary arteries open into right and left aortic sinuses
Blood flows into coronary arteries after valves have closed as result of elastic recoil of aorta and great vessels
Part of S2 sound
What are the layers of the pericardium?
Serous pericardium (parietal and visceral): secretes fluid, 20-30 ml
Fibrous pericardium: tough, fibrous outer portion; fuses with diaphragm adventitia of great arteries and veins, inelastic
Visceral pericardium: layer surrounding and attached to heart
What is the pericardial blood supply?
Pericardiophrenic artery and vein: phrenic nerve on external surface
Phrenic nerve: innervates pericardium, carry afferents from pericardium
What is pericardial friction rub?
If the serous layer of the pericardium becomes rough, typically secondarily due to viral infections, then friction and vibrations (sounds) may occur with each cardiac cycle.
Pericaridal rub may sound like squeaky leather and may be widespread.
When is blood flow to coronary arteries greatest? Why?
Greatest during diastole because there is blood pooling from the aorta and the back flow will automatically go into the coronary arteries
What are landmarks/characteristics of cardiac venous system?
Coronary sinus: Direct continuation of great cardiac vein, Lies in posterior part of coronary sulcus and opens into right atrium, Receives all cardiac veins except anterior cardiac veins and smallest cardiac veins
Great cardiac vein: lies beside anterior interventricular artery.
Middle cardiac vein: lies next to posterior interventricular artery.
Small cardiac vein: runs along acute margin of right ventricle, paralleling right marginal artery.
Anterior cardiac veins: comprise two (or three) small veins that drain sternocostal surface of right ventricle directly into right atrium.
Most numerous in right atrium
What makes up the S1 heart sound?
Right AV/Tricuspid (ant, post, septal cusps)
Allows blood to flow from atrium to ventricle during diastole
Closes at beginning of systole
Shuts so there is no back flow
Explain the lub dub of the heart sounds.
First sound ("lub"): coincides with closure of AV valves at start of systole
Second sound ("dub"): produced by closure of aortic and pulmonary valves at end of systoleWhat are bronchopulmonary segments?
Include bronchi, pulmonary arteries, with pulmonary veins draining segment near by.
Can be surgically removed while leaving rest of lung intact
Important for postural drainage
What are the bronchial arteries and veins?
The bronchi have small arteries that supply oxygenated blood to the bronchial tree.
2 on the left come off the descending aorta
1 on the right comes off the 3rd posterior intercostal artery
What are characteristics of the lungs?
Organs of respiration for oxygenation and removal of CO2.
Each have own pleural cavity
They are light, spongy, elastic organs that change in size with each breath
Collapse (due to elastic fibers) just as chest wall tends to retain normal shape (keeps them inflated).
The elasticity of the lung is counter balanced by the muscles and structural elements of the thoracic cage and the negative pressure in the pleural space.
What is a pneumothorax? symptoms?
Result of traumatic injury to wall of lung.
Infection causing hole in lung which allows air to be pulled into the pleural space
Air (or gas) is in pleural cavity
Elasticity of lung causes it collapse on itself towards the hilum
Symptoms: chest pain, respiratory distress, and tachycardia
What is a hemothorax?
accumulation of blood in pleural space
Typically caused by injury to an intercostal vessel versus laceration of parenchema
What is hydrothorax?
Excessive accumulation of fluid, other than blood within the pleural space.
CHF
Infection of lung
What are clinical manifestations of pneumothorax?
Lung collapse from trauma: MVA, GSW, penetration of object
What are clinical manifestations of atelectasis?
Collapse, compression (hydrothorax), obstruction (tumor)
What will imaging show for atelectasis?
X-ray will show opaque area.
Lung collapse x-ray will show: elevation of hemi diaphragm on affected side, shift of mediastinum toward affected side, decreased in size of rib interspaces over affected hemi diaphragm
What is treatment for atelectasis?
breathing techniques, spirometry, airway clearance
