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Cardiopulmonary > Cardiopulmonary Anatomy > Flashcards

Cardiopulmonary Anatomy Flashcards

1
Q

Describe the mediastinum

A
  • Central compartment of thoracic cavity b/w 2 pulmonary cavities
  • Superior part is above T4-T5
  • Inferior part is divided into anterior, middle, & posterior
  • Pericardium & its contents constitute the middle mediastinum
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2
Q

Describe the pericardium

A
  • Closed sac with two layers
  • Fibrous layer: tough external layer that protects the heart against sudden overfilling
  • Serous layer: parietal and visceral layer
  • Pericardial cavity: b/w the serous layers that contains a thin film of fluid that enables the heart to move/beat in a frictionless environment
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3
Q

Describe a cardiac tamponade (heart compression)

A
  • Extensive pericardial effusion doesn’t allow full expansion of the heart limiting the amount of blood the heart can receive which reduces cardiac output
  • Potentially lethal condition bc heart volume is increasingly compromised by the fluid outside the heart but inside the pericardial cavity
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4
Q

If the increase in fluid is rapid as little as _______ml of fluid can result in tamponade

A
  • 200ml
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5
Q

Describe the role/importance of the fibrous skeletal of the heart

A
  • Used as an anchor for cardiac muscle fibers
  • Provides attachment for leaflets and cusps of valves
  • Forms electrical “insulator” separating conduction of impulses in atria from ventricles
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6
Q

What are the nerve supply of the pericardium

A
  • Phrenic nerve (C3-C5): primary sources of sensory/pain fibers with pain referring to C3-C5 dermatomes of the ipsilateral supraclavicular region
  • Vagus nerve
  • Sympathetic trunks of vasomotor
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7
Q

List the order of circulation through the heart from right to left

A
  • Venous systemic circulation (less O2)
  • Vena Cavae (less O2)
  • R Atrium (less O2)
  • R ventricle (less O2)
  • Pulmonary circulation (both/reoxygenation)
  • L Atrium (O2)
  • L ventricle (O2)
  • Arterial systemic circulation (O2)
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8
Q

Describe the role/importance of the R Atrium

A
  • Receives venous blood from SVC (enters at 3rd costal cartilage), IVC (enters at 5th costal cartilage), & coronary sinus
  • Sinus centrum: smooth, thinned wall
  • Pectinate muscles: rough, muscular anterior wall
  • Interatrial septum separates the atria and has the oval fossa which is a remnant of the oval foramen & its valve in the fetus
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9
Q

Describe the R ventricle role/importance

A
  • Conus arteriosus: superior, leads to pulmonary trunk
  • Trabecular carneae: irregular muscular elevations
  • Tricuspid valve: guards R AV Orifice
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10
Q

where do the anterior, posterior, and septal cusps of the tricuspid valve attach to

A
  • Fibrous ring of orifice
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11
Q

Describe the role/importance of the tricuspid valve

A
  • Attached to corresponding papillary muscles via chordae tendinae
  • Prevents regurgitation of blood from the R ventricle back into the R atrium during ventricular systole
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12
Q

Describe the pulmonary valve role/importance

A
  • Semilunar valve with 3 cusps: no tendinous cords for support
  • Situated at the apex of the conus arterioles at the level of the L 3rd costal cartilage
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13
Q

What 2 valves are semilunar valves

A
  • Pulmonary
  • Aortic
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14
Q

How to semilunar valves work/role

A
  • After relaxation of the ventricle the elastic recoil of the wall of the pulmonary trunk or aorta forces the blood back toward the heart
  • Cusps snap closed like an umbrella caught in the wind as they catch the reversed blood flow
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15
Q

Describe the blood flow/relationship between the R atrium and R ventricle

A
  • Inflow of blood into R ventricle enters posteriorly
  • When the ventricle contracts the outflow of blood into the pulmonary trunk leaves superiorly and to the L
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16
Q

Describe the structures of the interior of the L atrium

A
  • 4 pulmonary veins (2 superior, 2 inferior) entering the smooth posterior wall (valveless entry)
  • Slightly thicker wall than R atrium
  • Interracial septum that slopes posteriorly to the R
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17
Q

Describe L atrial appendage & atrial fibrillation

A

-

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18
Q

Describe the structures of the interior of the L ventricle

A
  • Walls are 2-3x thicker than R ventricle
  • Walls mostly covered with mesh of trabeculae carneae more numerous/finer than R ventricle
  • Conical cavity longer than R ventricle
  • Double leaflet mitral valve that guards the L AV orifice
  • Aortic orifice on the R posterosuperior aspect where the ascending aorta begins
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19
Q

Describe the role/relationship b/w the L atrium and L ventricle

A
  • L AV orifice: Orifice which the L atrium discharges O2 blood it receives from the pulmonary veins into the left
  • L ventricle outflow tract: aortic vestibule = smooth, nonvascular, superoanterior outflow part; leads from ventricular cavity to aortic orifice & aortic valve
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20
Q

Describe the role/importance of the mitral valve

A
  • L AV valve
  • Posterior to sternum at level of 4th costal cartilage
  • Each cusps receives tendinous cords from more than one papillary muscle
  • Cords become taut just before/during systole to prevent cusps from being forced into L atrium
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21
Q

Describe the aortic valve

A
  • Semilunar (3 cusps)
  • Posterior to L aspect of sternum at level of 3rd intercostal space (obliquely oriented)
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22
Q

Which valves are open versus closed during diastole

A
  • Mitral & tricuspid valves are OPEN allowing ventricular filling
  • Pulmonary & aortic valves are CLOSED (“Dub”)
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23
Q

Which valves are open versus closed during systole

A
  • Mitral & tricuspid valves are CLOSED (“Lub”)
  • Pulmonary & aortic valves are OPEN allowing pulmonary & systemic circulation
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24
Q

What structures does the R coronary artery supply

A
  • R atrium
  • most of R ventricle
  • part of the L ventricle (the diaphragmatic surface)
  • part of the IV septum, usually the posterior third
  • SA node (in approximately 60% of people)
  • AV node (in approximately 80% of people)
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25
Q

What structures does the L coronary artery supply

A
  • L atrium
  • most of the left ventricle
  • part of the right ventricle
  • most of the IVS (usually its anterior two thirds), including the AV bundle of the conducting system of the heart, through its perforating IV septal branches
  • SA node (in approximately 40% of people)
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26
Q

What are the branches of the R coronary artery

A
  • Sino-Atrial (SA) Nodal Branch
  • Atrioventricular (AV) Nodal Branch
  • Right Marginal Branch
  • Posterior Interventricular Branch (Posterior Descending Artery)
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27
Q

What are the branches of the L coronary artery

A
  • Circumflex Branch
  • Anterior Interventricular Branch (Left Anterior Descending (LAD) AKA “Widow Maker”
  • Left Marginal Branch
  • Posterior Interventricular Branch
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28
Q

How is the heart primarily drained

A
  • Mainly by veins that empty into the coronary sinus and partly by small veins that empty into the right atrium
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29
Q

Describe the coronary sinus

A
  • It’s the main vein of the heart, is a wide venous channel that runs from left to right in the posterior part of the coronary sulcus
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30
Q

What is the correct order of conduction through the heart

A
  • SA node: pacemaker (~70 bpm)
  • AV node: secondary pacemaker (40-60 bpm)
  • Atrioventricular bundle of His: bridge b/w atrial & ventricular myocardium
  • R bundle
  • L bundle
  • Subendocardial branches (AKA Purkinje fibers): penetrate the myocardium & stimulate muscle contraction form the apex upward toward the base of the heart in a “wringing” action
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31
Q

What is the normal pacing ability of the SA node at rest

A
  • 60-100 bpm
32
Q

What is the main function of the AV node during each cardiac cycle

A
  • To slow down the cardiac impulse to mechanically allow time for the ventricles to fill
33
Q

Describe the P-wave on EKG/ECG

A
  • Represent atrial depolarization and mechanical atrial contraction
  • In sinus rhythm a p-wave precedes each QRS complex
34
Q

Describe the PR interval on EKG/ECG

A
  • From the start of the P-wave to the start of the Q-wave
  • Represents the time taken for electrical activity to move b/w the atria & ventricles
  • AV node delays conduction of impulse from atria shown as the isoelectric line following the P-wave before the QRS complex
35
Q

Describe the QRS complex on EKG/ECG

A
  • Represents depolarization of the ventricles caused by the R/L bundle branches
  • Seen as three closely related waves on the ECG
36
Q

Describe the ST segment on EKG/ECG

A
  • Starts at the end of the S-wave and ends at the start of the T-wave
  • An isoelectric line that represents the time b/w depolarization & repolarization of the ventricles (i.e. contraction)
37
Q

Describe the T-wave on ELG/ECG

A
  • Represents ventricular repolarization
  • Seen as a small wave after the QRS complex
38
Q

Describe the RR interval on EKG/ECG

A
  • Starts at the peak of one R wave and ends at the peak of the next R wave
  • Represents the time b/w 2 QRS complexes
39
Q

Describe the QT interval on EKG/ECG

A
  • Starts at the beginning of the QRS complex & finishes at the end of the T-wave
  • Represents the time taken for the ventricles to depolarize & then repolarise
40
Q

At what points during a normal EKG does the atria and ventricles activate

A
  • Just before the P-wave the ventricles fill passively
  • ~the end of the P-wave the atria contracts to eject up to 20% of the end diastolic ventricular volume (atrial kick)
  • Shortly after onset of the QRS complex a period of isovolumic ventricular contraction begins
  • Ventricular ejection coincides with the early portion of the ST segment
41
Q

What are the 5 areas that heart auscultations are best heard from

A
  • Aortic area: second intercostal space close to the sternum on the right of the sternum
  • Pulmonary area: second intercostal space to the left of the sternum
  • 3rd L intercostal space: murmurs of both aortic and pulmonary origin are best heard here
  • Tricuspid area: located at the lower-left sternal border, approximately the fourth to fifth intercostal space
  • Mitral area (apex of heart): located in the fifth left intercostal space, medial to the midclavicular line
42
Q

Describe the cardiac plexus

A
  • Formed by both sympathetic & parasympathetic fibers going towards the heart & visceral afferent fibers conveying reflexive/nocioceptiive fibers from the heart
  • Located on posterior aspect of ascending aorta & pulmonary trunk
  • Fibers extend from the plexus to the coronary vessels & to the SA node
43
Q

What does sympathetic stimulation influence in the heart

A
  • C2-T4 ganglia
  • Triggers release of catecholamines (epinephrine & norepinephrine)
  • Increased heart rate
  • Increased impulse conduction
  • Increased force of contraction
  • Increased blood flow through the coronary vessels to support the increased activity
44
Q

What does parasympathetic stimulation influence in the heart

A
  • Vagus nerve (CN X)
  • Triggers release of acetylcholine
  • Slows the heart rate
  • Reduces the force of the contraction
  • Constricts the coronary arteries, saving energy between periods of increased demand
45
Q

List the great vessels that connect to the cardiopulmonary system

A
  • Brachiocephalic veins (R & L): L is 2x as long as R
  • Superior vena cava
  • Inferior vena cava
  • Pulmonary trunk: pulmonary arteries (less O2)
  • Pulmonary veins (O2 rich)
  • Ascending aorta: coronary arteries
  • Arch of aorta: brachiocephalic trunk (R common carotid artery & R subclavian artery), L common carotid artery, & L subclavian
46
Q

What is the role/purpose of the thoracic wall

A
  • Protect vital organs from external forces
  • Resist neg. internal pressures generated by elastic recoil from the lungs/inspiratory movements
  • Provide attachment/support for the upper limbs
  • Provide anchoring attachment of many muscles that move/maintain position of the upper limbs
47
Q

Describe the 3 different types of ribs

A
  • True (vertebrosternal) ribs: 1-7 ribs, attach directly to the sternum through thrown costal cartilages
  • False (vertebrochondrral) ribs: 8-10 ribs, cartilages are connected to the cartilage of the rib above them
  • Floating (vertebral, free) ribs: 11-12 ribs, rudimentary cartilages of these ribs do not connect even indirectly to the sternum but instead end in the posterior abdominal musculature
48
Q

What is the purpose of the costal cartilage

A
  • Contributes to the elasticity of the thoracic wall
  • For ribs 1-10 they anchor the anterior end of the rib to the sternum
49
Q

Describe the main landmarks/anatomy of the strenum

A
  • Jugular Notch: at the level of the inferior border of the body of T2 vertebra
  • Manubrium: lies at the level of the bodies of T3 and T4 vertebrae
  • Sternal Angle (Angle of Lous): lies at the level of the T4–T5 IV disc
    marks the level of the 2nd pair of costal cartilages
  • Body of the Sternum: lies anterior to the right border of the heart and vertebrae T5–T9
  • Xiphisternal Joint: the level of the inferior border of T9 vertebra
50
Q

Describe the sternocostal joints

A
  • Synchondrosis of 1st rib: costal cartilages articulate with the manubrium by means of a thin dense layer of tightly adherent fibrocartilage interposed b/w the cartilage & manubrium
  • 2-7th ribs articulate with the sternum at synovial joints with fibrocartilaginous articular surfaces on both the chondral & sternal aspects allowing movement during respiration
51
Q

The head of the rib articulates with

A
  • Superior costal facet of the corresponding vertebra (ex: 7th rib and T7)
  • Inferior costal facet of the vertebra superior to it (ex: 7th rib and T6)
  • Adjacent intervertebral (IV) disc uniting the 2 vertebrae
52
Q

Where do the 3 main costotransverse ligaments pass through

A
  • Costotransverse lig: passes from the neck of the rib to the transverse process
  • Lateral costotransverse lig: passes from the tubercle of the rib to the tip of the transverse process; strengthening the anterior & posterior aspects of the joint
  • Superior costotransverse lig: a broad band that joins the crest of the neck of the rib to the transfers process superior to it
53
Q

How does the thoracic wall move during inspiration/expiration

A
  • Inspiration: increases in intrathoracic volume/diameter -> decreased intrathoracic pressure -> air is drawn into lungs
  • Expiration: decreased intrathoracic volume -> increased intrathoracic pressure with concurrent decrease in intra-abdominal pressure -> elastic recoil of lungs -> expelling air
54
Q

How do the ribs move during inspiration/expiration

A
  • Pump handle: elevation/depression of the sternal ends of the ribs/sternum in the sagittal plane; increases A-P dimensions of thorax
  • Bucket handle: elevation/depresion of the lateral most portions of the ribs in the transverse plane; increases transverse dimensions of thorax
55
Q

Describe the muscles used for respiration

A
  • External/internal intercostal activation is primarily isometric; their role is mostly for forced respiration and to support the intercostal space
  • Diaphragm is the primary muscle of inspiration
  • Expiration is passive unless exhaling against resistance
  • Elastic recoil of the lungs & decompression of abdominal viscera expel previously inhaled air
56
Q

What is flail chest

A
  • Multiple rib fxs that allow the anterior/lateral thoracic wall to move freely
  • Loose segment of wall moves paradoxically (inward on inspiration & outward on expiration)
  • Extremely painful & impairs ventilation therefor affecting oxygenation of the blood
  • During tx the loose segment may be internally fixed w/plates or wires to prevent movement
57
Q

What does a chest tube remove

A
  • Removes air, blood, serous fluid, and/or pus from the pleural cavity
58
Q

Describe how a chest tube is placed

A
  • Short incision at 5th or 6th intercostal space in midaxillary line
  • Tube can be directed superiorly or inferiorly for fluid drainage
  • Extracorporeal end of tube is connected to an underwater drainage system with controlled suction to prevent air from being sucked back into the pleural cavity
59
Q

What muscles are used during inspiiration

A
  • Serratus posterior superior to elevate the superior 4 ribs
  • Serratus posterior superior to depress the inferior ribs
  • These muscles may have more of a proprioceptive function during inspiration
60
Q

What muscles are used during forced expiration

A
  • Transverse thoracis
  • Transverse abdominis
  • Intercostales interni (interosseous fibers)
  • Obliquus externus abdominis
  • Rectus abdominis
61
Q

What is tripod breathing

A
  • Hands on knees breathing
62
Q

Describe the structure of the diaphragm

A
  • Double domed musculotensinous partition separating the thoracic and abdominal coavities
  • R dome is higher than L due to presence of the liver
  • Chief muscle of inspiration
  • Pericardium lies on the central part of the diaphragm depressing it slightly
63
Q

Describe the important ligaments of the diaphragm

A
  • Central tendon
  • Median arcuate ligament: units them as it arches over the anterior aspect of the aorta forming the aortic hiatus; fascia covering the posts major
  • Lateral arcuate ligament: covers the quadrates lumborum
  • Caval opening: inferior vena cava & branches of R phrenic nerve
  • Esophageal hiatus: esophagus & vagus nerve trunks
  • Aortic hiatus: aorta & thoracic duct
64
Q

Describe the motor and sensory innervation of the diaphragm

A
  • Entire motor supply is from R/L phrenic nerves
  • Pain and proprioception to the diaphragm is mostly from the phrenic nerves
  • Peripheral parts of the diaphragm receive sensory supply from the intercostal nerves & subcostal nerves
65
Q

What is the role of sympathetic fibers on the lungs versus parasympathetic

A
  • Sympathetic: inhibitory to the bronchial muscle (bronchodilator) and inhibitory to the alveolar glands of the bronchial tree
  • Parasympathetic: motor to the smooth muscle of the bronchial tree (bronchoconstrictor); secretory tot eh glands of the bronchial tree (secretomotor)
66
Q

What is pleura

A
  • Each pulmonary cavity(right and left) is lined by apleural membrane(pleura) that also reflects onto and covers the external surface of the lungs occupying the cavities
67
Q

Describe the two pleural that surround the lungs

A
  • Visceral: invests all surfaces of the lungs; provides the lung with a smooth slippery surface, enabling it to move freely on the parietal pleura
  • Parietal: lines the pulmonary cavities; consists of 3 parts -> costal, mediastinal, & diaphragmatic and the cervical pleura
68
Q

What is the main function of the lungs

A
  • To oxygenate the blood by bringing inspired air into close relation with the venous blood in the pulmonary capillaries
  • Lungs are elastic & recoil to ~1/3 their size when the thoracic cavity is opened
69
Q

What are the features of the right lung

A
  • 3 lobes: superior, middle, inferior
  • Larger and heavier than L lung but is shorter and wider bc the diaphragm sits higher
70
Q

What are the features of the left lung

A
  • 2 lobes: superior and inferior
  • Anterior border has a deep cardiac notch consequent to the deviation of the apex of the heart to the L side
71
Q

What is the hilum of the lung

A
  • It’s a hedge-shaped area on the mediastinal surface of each lung through which the structures forming the root of the lung pass to enter or exit the lung
  • Pulmonary arteries, pulmonary veins, bronchial vessels, & bronchi
72
Q

Describe the trunk and branches of the tracheobronchial tree

A
  • Trachea is the trunk and bifurcates at the level of the sternal angle into main bronchi (one for each lung)
  • R main bronchus: wider & shorter and runs more vertically then the L as it passes directly to the hilum of the lung
  • L main bronchus: passes inferolaterally inferior to the arch of the aorta & anterior to the esophagus & thoracic aorta to reach the helium of the lung
73
Q

Each main (primary) bronchus divides into secondary lobar bronchi which are

A
  • 2 on L and 3 on R, each of which supplies a lobe of the lung
  • Each lobar bronchus divides into several tertiary segmental bronchi that supply the bronchopulmonary segments
74
Q

Describe the structure/importance of the bronchioles

A
  • 20-25 generations that eventually end as terminal bronchioles (smallest conducting bronchioles)
  • Lack cartilage in their walls
  • Conducting bronchioles transport air. but lack glands or alveoli
  • Each terminal bronchiole gives rise to several generations of respiratory bronchioles with scattered, thin walled outpocketings (alveoli) that extend from their lumens
  • Each respiratory bronchiole gives rise to 2–11alveolar ducts, each of which gives rise to 5–6 alveolar sacs
  • Alveolar ductsare elongated airways densely lined with alveoli, leading to thealveolar sacs,into which clusters of alveoli open.
75
Q

What is the basic structural unit of gas exchange in the lung

A
  • Pulmonary alveolus
76
Q

What is the correct order of the pulmonary circulation

A
  • R/L pulmonary arteries carry low-O2 blood to the lungs for O2
  • Lobar arteries (less O2)
  • Segmental arteries (less O2)
  • Pulmonary capillary beds within alveolar walls (mixed blood)
  • Segmental veins (O2 rich)
  • Lobar veins (O2 rich)
  • Superior & inferior pulmonary veins on each side carry O2 rich blood from corresponding lobes of each lung to the L atrium of the heart
77
Q

What does elevation versus depression of the ST segment on an EKG/ECG indicate

A
  • ST elevation = MI
  • ST depression = heart ischemia

Cardiopulmonary (18 decks)

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