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anatomy psc2018 > cardiovascular system > Flashcards

cardiovascular system Flashcards

1
Q

what is the heart and what does it do?

A
  • self adjusting double pump
  • propels blood around 2 circulatory systems
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2
Q

what 2 systems does the heart pump blood around?

A

pulmonary and systemic

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3
Q

what is the heart formed from?

A
  • myocardium (specialised cardiac muscle)
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4
Q

what does myocardium contraction allow?

A
  • blood to be pushed out the chambers
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5
Q

what does myocardium relaxation allow?

A
  • blood to flow or be pushed into heart
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6
Q

what is contraction of ventricles known as?

A

systole

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7
Q

what is relaxation of ventricles known as?

A

diastole

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8
Q

why is pulmonary circulation pumped at low pressure?

A
  • not much force required to send blood distance through lungs from right to left heart
  • high pressure would force fluid out into blood - lead to drowning
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9
Q

what are the properties of the blood pumped from lungs to right ventricle?

A
  • very low oxygen concentration
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10
Q

where does blood go after leaving right ventricle?

A
  • through pulmonary trunk which divides to give left and right pulmonary arteries
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11
Q

what does systemic mean?

A

affects whole body

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12
Q

where does the systemic circulation feed in to?

A
  • in and out all organs apart from the lungs
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13
Q

what is the origin of systemic circulation?

A

left ventricle

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14
Q

where does the systemic circulation terminate?

A

right atrium

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15
Q

what type of pressure does systemic circulation operate at?

A
  • high pressure
  • force needed to perfuse all tissues
  • blood has larger distance to travel from left to right heart
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16
Q

is the supply to organs rich or poor in oxygen?

A

rich

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17
Q

is the blood supply returning to the heart rich or poor in oxygen?

A

poor

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18
Q

where does the thorax lay?

A

sits superiorly in trunk of body

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19
Q

what is the function of the thoracic cage?

A
  • protects contents of thorax
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20
Q

what is thoracic cage made up of?

A

ribs, costal cartilage, sternum (anteriorly), thoracic vertebrae (posterior)

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21
Q

what are the components of the thoracic cage?

A
  • superior and inferior thoracic aperture
  • sternum
  • costal cartilage
  • ribs
  • thoracic vertebrae
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22
Q

what are the 3 regions of the thoracic cavity?

A
  • mediastinum
  • left pleural cavity
  • right pleural cavity
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23
Q

what is the mediastinum?

A
  • central compartment of thoracic cavity
  • situated between lungs
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24
Q

what is mediastinum superior to?

A

superior thoracic aperture

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25
Q

what is mediastinum inferior to?

A

diaphragm

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26
Q

what is mediastinum anterior to?

A

sternum and costal cartilages

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27
Q

what is the mediastinum posterior to?

A

thoracic vertebrae

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28
Q

what does the mediastinum consist of?

A
  • hollow visceral structures joined by loose connective tissue
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29
Q

what is the sternal angle?

A
  • the joint between the manubrium (top) and the body (middle) of sternum
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30
Q

where is the thoracic plane ‘drawn’?

A

horizontal plane drawn from sternal anal to level between T4 and T5

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31
Q

what 2 compartments does the thoracic plane split the mediastinum into?

A
  • superior mediastinum
  • inferior mediastinum
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32
Q

what is the inferior mediastinum further divided into?

A
  • anterior
  • middle
  • posterior
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33
Q

drawings

A
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34
Q

what features does the superior mediastinum contain?

A
  • oesophagus
  • trachea
  • neurovasculature: arch of aorta, superior vena cava, phrenic nerves, vagus nerves, thoracic duct, sympathetic chains
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35
Q

what features does the anterior mediastinum contain?

A
  • mainly consists of fat and the thymus
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36
Q

what does the middle mediastinum contain?

A
  • contains the heart and pericardium
  • contains root of great vessels, phrenic nerves, vagus nerves
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36
Q

what does the posterior mediastinum contain?

A
  • descending aorta and branches
  • oesophagus
  • thoracic duct
  • azygos system of veins
  • sympathetic chains
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37
Q

what structure features in both inferior and superior mediastinum?

A

oesophagus

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38
Q

what is the azygos system of veins?

A
  • H shaped configuration of the azygos, hemiazygos and accessory hemiazygos veins
  • drains the posterior thoracic wall
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39
Q

what are the sympathetic chains?

A
  • external to spinal column
  • adjacent to vertebral bodies
  • paired structure (one on each side of body)
  • also known as sympathetic trunk
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40
Q

what is the thoracic duct?

A
  • main lymphatic vessel for return of chyle/lymph to systemic venous system
  • drains lymph from both lower limbs, abdomen, left hemithorax, left upper limb, left side of face and neck
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41
Q

what is the thymus?

A
  • T cell producing lymphoid organ
  • plays role in development of immune system (maturation of T cells)
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42
Q

what is the phrenic nerve?

A
  • paired nerve
  • supplies the diaphragm
  • comes from nerve roots C3. 4 and 5
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43
Q

what is the vagus nerve?

A
  • tenth cranial nerve (CNX)
  • paired
  • provides bulk of parasympathetic input to gastrointestinal system and heart
  • complex mixed sensory, motor and parasympathetic nerve
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44
Q

what is the pericardium?

A

membrane that covers the heart

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45
Q

where is the pericardium positioned?

A

within the middle mediastinum of the thorax

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46
Q

what 2 layers does the pericardium consist of?

A
  • outer fibrous layer
  • inner thin serous layer
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47
Q

what is the structure of the fibrous/outer layer?

A
  • continuous with great vessels adventitia (aorta and pulmonary trunk)
  • blended inferiorly with central tendon of diaphragm
  • rigid structure
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48
Q

what is the structure of the serous pericardium?

A
  • contained within the fibrous pericardial sac
  • analogous to the pleural membrane
  • double layer
  • lubricating fluid between layers to reduce friction caused by heart contraction
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49
Q

what are the two layers of the serous pericardium?

A
  • visceral layer (epicardium) -> inner layer of serous pericardium
  • parietal layer -> outer layer that lines the fibrous pericardium
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50
Q

what are the 4 functions of the pericardium?

A
  1. protection from infection
  2. fixes the heart in the mediastinum and limits its motion
  3. lubrication
  4. prevents rapid overfilling of the heart
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51
Q

how does the pericardium protect the body from infection?

A
  • fibrous later serves as physical barrier between muscular body of heart and adjacent organs prone to disease
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52
Q

how does the pericardium fix the heart in position?

A
  • its attached to the diaphragm, sternum and outer layer of great vessels to fix heart in place
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53
Q

how does the pericardium allow lubrication?

A
  • serous pericardium and small amount of serous fluid within pericardial cavity reduces friction between heart and surrounding structures
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54
Q

how does the pericardium prevent rapid overfilling of the heart?

A
  • fibrous layer of pericardium prevents heart from increasing in size too rapidly
  • places physical limit on potential organ size
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55
Q

what is cardiac tamponade?

A
  • where blood or fluid accumulates the pericardium
  • causes compression of the heart, preventing the ventricles from expanding fully and impeding its blood supply
  • potentially fatal
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56
Q

what is cardiac tamponade a result of?

A
  • pericarditis caused by either a bacterial or viral infection
  • trauma where damage to heart/vessels causes pericardium to fill with blood
  • end stage lung cancer, heart surgery, dissecting aortic aneurysm
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57
Q

what is the treatment of cardiac tamponade?

A
  • immediate hospitalisation where pericardiocentesis is performed where fluid is drained from pericardium to reduce pressure
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58
Q

define pericarditis

A

inflammation of pericardium

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59
Q

how does dissection of aortic aneurysm occur?

A
  • when tear occurs in inner layer of bodys main artery
  • blood rushes through tear causing inner and middle layers of aorta to split
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60
Q

what is acute myocardial infarction?

A
  • life threatening condition that occurs when blood flow to the heart muscle is abruptly cut off (heart attack)
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61
Q

what is pericardiocentesis?

A
  • a procedure done to remove fluid that has built up in the sac around the heart (pericardium)
  • done using needle and small catheter to drain excess fluid
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62
Q

what are the great vessels of the right side of the heart?

A
  • superior vena cava
  • inferior vena cava
  • pulmonary tank
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63
Q

what is the function of the superior vena cava?

A
  • brings deoxygenated blood to right atrium from systemic circulation superior to heart
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64
Q

what is the function of the inferior vena cava?

A
  • brings deoxygenated blood to right atrium from systemic circulation inferior to the heart
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65
Q

what is the function of the pulmonary trunk?

A
  • exits the right ventricle
  • takes deoxygenated blood to the lungs
  • bifurcates into right and left pulmonary arteries
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66
Q

what are the great vessels of the left side of the heart?

A
  • pulmonary veins
  • aorta
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67
Q

what is the function of the pulmonary veins?

A
  • they enter the left atrium on posterior aspect of heart
  • carry oxygenated blood from pulmonary circulation
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68
Q

what are the 4 pulmonary veins?

A
  • left superior and left inferior
  • right superior and right inferior
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69
Q

what is the function of the aorta?

A
  • leaves the heart
  • carries high pressure
  • carries oxygenated blood to the body in systemic circulation
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70
Q

what forms the anterior (sternocostal) surface?

A
  • formed mostly from the right ventricles
  • surface is related anteriorly to sternum and ribs
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71
Q

what forms the inferior (diaphragmatic) surface?

A
  • mostly the left ventricle, partly from the right ventricle
  • related inferiorly to centre of diaphragm
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72
Q

what forms the left (pulmonary) surface?

A
  • mostly by the left ventricle
  • related laterally with left lung
  • occupies a depression in lung known as cardiac impression
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73
Q

where is the base of the heart located?

A
  • on the posterior aspect
  • directed towards vertebrae T6-9
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74
Q

what forms the base of the heart?

A
  • from left and right atrium
  • extends from bifurcation of pulmonary trunk superiorly to atrioventricular groove (depression between atrium and ventricle on each side of heart) inferiorly
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75
Q

where does the apex of the heart lie?

A
  • posterior to 5th intercostal space in midclavicular line
  • directed antero-inferiorly and to the left
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76
Q

what are the 4 borders of the heart?

A
  • right
  • inferior
  • left
  • superior
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77
Q

what is the right border formed by?

A
  • right atrium
  • extends from superior to inferior vena cava
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78
Q

what is the inferior border formed by?

A
  • roughly horizontal
  • formed mostly by the right ventricle
    -small contribution by left ventricle
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79
Q

what is the left border formed by?

A
  • left ventricle
  • superior portion formed by auricular appendage of left atrium
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80
Q

what is the superior border formed by?

A
  • both atria
  • aorta and pulmonary trunk arise from this border
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81
Q

where does superior vena cava enter heart?

A
  • right side of superior border
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82
Q

what is the sternal angle?

A
  • joint between manibrium of the sternum and the sternal body
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82
Q

what is the position of the superior border of the heart?

A
  • reaches third costal cartilage on right side of sternum
  • and second intercostal space on left side of sternum
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83
Q

what is the position of the right margin of the heart?

A
  • extends from right third costal cartilage to near the right sixth costal cartilage
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84
Q

what is the position of the left margin of the heart?

A
  • descends lateral from the second intercostal space to the apex
  • located near the midclavicular line in 5th intercostal space
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85
Q

what is the position of the lower margin of the heart?

A
  • extends from sternal end of right 6th costal cartilage to apex in 5th intercostal space
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86
Q

what are the different layers of the heart?

A
  • epicardium
  • myocardium
  • endocardium
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87
Q

what does the epicardium consist of?

A
  • layer of connective tissue
  • provides protective layer over the heart
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88
Q

what does the myocardium consist of?

A
  • myocytes or cardiac muscle cells
  • muscular component of heart wall
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89
Q

what does the endocardium consist of?

A
  • epithelium and connective tissue fibres that line heart and cover heart valves
  • continuous with endothelial lining of blood vessels
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90
Q

what are the features of cardiac muscle?

A
  • straited muscle
  • not under voluntary control
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91
Q

what does cardiac muscle contraction rely on?

A
  • sliding filament mechanism between thick and thin muscle filaments of sarcomeres
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92
Q

what is the difference between cardiac and skeletal muscle?

A
  • cardiac muscle cells = highly branched, interconnecting network of fibres
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93
Q

why are cardiac muscle cells interconnected?

A
  • allows heart to operate as functional syncytium
  • whole heart contracts when one part is electrically stimulated
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94
Q

what physically divides the cardiac cells?

A
  • sarcolemma (around fibrils)
  • intercalated discs (between the cells)
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95
Q

what do intercalated discs separate?

A
  • sarcoplasm of adjacent cardiac muscle cells
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96
Q

what allows the discs to be held together?

A
  • action of desmosomes
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97
Q

what are desmosomes?

A
  • specialised structure of cell membrane that allows adhesion to anchor neighbouring cells together
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98
Q

what do intercalated discs allow to pass through?

A
  • electrical excitation between the cells through gap junctions
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99
Q

what is the fibrous skeleton of the heart?

A
  • where the cardiac muscle is anchored to for support
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100
Q

what is the fibrous skeleton made up of?

A
  • dense collagen (network forms 4 fibrous rings to surround valve openings)
  • 2 fibrous trigones (triangles that lie between rings)
  • provides membranous parts of interatrial and inter ventricular septa
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101
Q

what is the purpose of the fibrous skeleton?

A
  • prevents valve openings from collapsing or distending
  • provides base for attachment for leaflets and cusps of valves
  • forms electrical barrier between atria and ventricles preventing contraction together
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102
Q

what are the 4 chambers of the heart?

A
  • right atrium
  • right ventricle
  • left atrium
  • left ventricle
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103
Q

where do the atria lie?

A
  • superior to the ventricles
  • separated by intertribal septum
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104
Q

what does the right atrium fill with?

A
  • deoxygenated blood from systemic circulation
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105
Q

what does the left atrium fill with?

A
  • oxygenated blood from pulmonary circulation
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106
Q

where does blood move once in atria?

A

to the ventricles

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107
Q

which ventricle is more muscular and why?

A
  • left
  • has to pump blood around whole body
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108
Q

what divides the ventricles?

A
  • inter ventricular septum
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109
Q

what are the atria?

A
  • thin walled chambers that receive blood from circulatory system
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110
Q

which circulation drains into left atrium?

A
  • pulmonary circulation
  • through pulmonary veins
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111
Q

where does the systemic circulation drain into?

A
  • right atrium
  • through superior and inferior vena cava
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112
Q

is ventricular filling active or passive?

A
  • passive
  • because atria don’t contract until the end of diastole
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113
Q

what is essential during exercise?

A
  • line up of atrial contraction and speed up of ventricular filling
  • allows increased rate of ventricular contraction
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114
Q

what are the features of the right atrium?

A
  • atrioventricular orifice (right)
  • atrioventricular node
  • crista terminalis
  • fossa ovalis
  • interatrial septum
  • opening of coronary sinus
  • pectinate muscles
  • right auricle
  • sinoatrial node
  • sulcus terminalis
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115
Q

what is the atrioventricular orifice (right)?

A
  • the aperture in which blood flows from the right atrium to the right ventricle
  • where the tricuspid valve is positioned
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116
Q

what is the atrioventricular node?

A
  • the electrical relay station between the atria and ventricles
  • located in the posteroinferior region of the interatrial septum near the opening of the coronary sinus
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117
Q

what is crista terminalis?

A
  • means terminal crest
  • the origin of the pectinate muscles
  • the sulcus terminalis (on the external surface) acts as a surface marking for the internal crista terminalis
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118
Q

what is the fossa ovalis?

A
  • embryological remnant of the foramen ovale (hole between the 2 atria in a foetal heart)
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119
Q

what is the interatrial septum?

A
  • the fibromuscular wall between the left and right atrium
  • where the fossa ovalis and AV node is located
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120
Q

what is the opening of the coronary sinus?

A
  • the main cardiac vein
  • where the deoxygenated blood drained from the heart returns to the heart’s circulation
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121
Q

what are the pectinate muscles?

A
  • meaning comb like
  • parallel ridges in the wall of the atrium
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122
Q

what is the right auricle?

A
  • also known as right atrial appendage
  • muscular pouch the acts to increase capacity of atrium
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123
Q

what is the sinoatrial node?

A
  • pacemaker of heart
  • located in posterior wall of right atrium
  • inferolateral to opening of superior vena cava
    -along superior part of crista terminalis
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124
Q

what is the sulcus terminalis?

A
  • shallow depression marking point of fusion between venous part of right atrium and true right atrium
  • crista terminalis sits on internal surface of this structure
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125
Q

what are the features of the right atrium?

A
  • atrioventricular orifice (right)
  • fossa ovalis
  • interatrial septum
  • left auricle
  • pectinate muscles
126
Q

what is the left auricle?

A
  • known as left atrial appendage
  • muscular pouch that acts to increase capacity of atrium
127
Q

what are the pectinate muscles?

A
  • comb like
  • parallel ridges in wall of atrium
  • sparse in left atrium
128
Q

what are the ventricles?

A
  • thick walled muscular chambers which propel blood around pulmonary and systemic circulation
129
Q

which ventricle is more muscular?

130
Q

why is this side more muscular?

A

more force is required to create higher pressure needed for tissue perfusion in systemic circulation

131
Q

how are the muscle fibres arranged in ventricles?

A
  • so ventricular contraction progresses upwards in spiral from apex of heart
  • towards vessels leading out the ventricles
132
Q

what are the papillary muscles extensions of?

A
  • muscle of ventricular wall in left and right ventricles
133
Q

where are the papillary muscles attached?

A
  • to mitral and tricuspid valves via inextensible papillary tendons (chordae tendineae)
134
Q

what occurs to papillary muscles during systole?

A
  • they contract and prevent valves from inverting as result of high pressures created in contracting ventricle
135
Q

what does back flow of blood cause?

A
  • damage to atria wall and valves
  • would reduce efficiency of ventricular contraction in pumping blood into pulmonary and systemic circulations
136
Q

what are the features of the right ventricle?

A
  • atrioventricular orifice (right)
  • atrioventricular valve (tricuspid)
  • chordae tendineae
  • conus arteriosus
  • interventricular groove
  • interventricular septum
  • moderator band
  • papillary muscles
  • pulmonary valve
  • trabeculae carneae
137
Q

what is the atrioventricular orifice?

A
  • aperture in which blood flows from right atrium to right ventricle
  • tricuspid valve positioned here
138
Q

what is the atrioventricular valve (tricuspid)?

A
  • valve sitting in atrioventricular orifice
  • has 3 cusps
  • prevent reflux of blood into right atrium
139
Q

what is the chordae tendineae?

A
  • meaning tendinous cords
  • heart strings
  • attach to cusps of atrioventricular valves and to the papillary muscles of ventricle
  • act to hold valves in place and prevent reflux
140
Q

what is the conus arteriosus?

A
  • anterosuperior region of right ventricle from which the pulmonary trunk arises
141
Q

what is the inter ventricular groove?

A
  • the groove or sulcus on external surface of heart
  • demarks the division between the two ventricles
142
Q

what is the inter ventricular septum?

A
  • fibromuscular wall between right and left ventricles
143
Q

what is the moderator band?

A
  • thick muscular structure that arises from the interventricular septum and ends at right anterior papillary muscle
  • acts as shortcut for electric impulses from right bundle tract
144
Q

what are the papillary muscles?

A
  • nipple like
  • muscles extend from ventricular walls
  • attached to chordae tendineae
  • contract and pull on these chords which prevent prolapse of atrioventricular valve cusps
  • in right ventricle there are anterior, posterior and septal papillary muscles
145
Q

what is the pulmonary valve?

A
  • semilunar valve between the right ventricle and pulmonary trunk
146
Q

what is the trabeculae carneae?

A
  • meaning meaty ridges
  • irregular muscles columns found on internal surface of ventricles
147
Q

what are the features of the left ventricle?

A
  • aortic valve
  • atrioventricular orifice (left)
  • atrioventricular valve (bicuspid/mitral)
  • chordae tendineae
  • inter ventricular groove
  • inter ventricular septum
  • papillary muscles
  • trabeculae carneae
148
Q

what is the aortic valve?

A
  • semilunar valve between left ventricle and aorta
149
Q

what is the atrioventricular orifice (left)?

A
  • aperture in which blood flows from left atrium to left ventricle
  • where bicuspid (mitral) valve is positioned
150
Q

what is the atrioventricular valve (bicuspid/mitral)?

A
  • has two cusps
  • prevent reflux of blood into left atrium
151
Q

what would happen without heart valves?

A
  • contraction of wall surrounding ventricles would send blood forwards to pulmonary artery and backwards into aorta
152
Q

what are atrioventricular valves?

A
  • between atria and ventricles (prevent back flow of blood during systole)
153
Q

what do the AV valves consist of?

A
  • leaf shaped cusps
154
Q

what does increased pressure in ventricles cause?

A
  • cusps to form tight seal together in systole
155
Q

what do the papillary muscles and chordae tendineae ensure?

A
  • proper closure of valves and prevents inversion of blood
156
Q

what are the semilunar valves?

A
  • valves between ventricles and great vessels
  • prevent back flow of blood during diastole
157
Q

where dow the aortic valve exist between?

A
  • left ventricle and aorta
158
Q

what does the semi lunar valve consist of?

A
  • three cusps shaped like pockets
159
Q

what are aortic sinuses?

A
  • spaces behind the aortic valves
160
Q

what does the lub heart sound correspond to?

A

closure of atrioventricular valves

161
Q

what does the dub heart sound correspond to?

A

closure of semilunar valves

162
Q

???? heart sound stuff

163
Q

what does abnormal heart sounds detect?

A
  • something wrong with valves
164
Q

what is a heart murmur caused by?

A
  • blood leaking through incompletely closed or excessively narrowed (stenosed) valve
165
Q

how does the blood flood occur through systemic and pulmonary circulation?

A
  1. deoxygenated blood from inferior and superior travels through superior vena cava

???? look at slides

166
Q

what does the cardiac cycle refer to?

A
  • pattern of contraction and relaxation of heart during one complete heartbeat
167
Q

what is contraction of heart known as?

168
Q

what is relaxation of heart known as?

169
Q

what does contraction take place due to?

A
  • intrinsic conducting system within the heart
170
Q

what is the intrinsic conducting system?

A
  • made up of specialised cardiac muscle cells
  • they initiate a heartbeat
  • contraction of cardiac muscle pumps blood through and out the heart
171
Q

what is the extrinsic conducting system controlled by?

A
  • nerves
  • controls heart rate, contraction force etc.
172
Q

what does the hearts electrical tissue consist of?

A
  • two nodal tissues (sinoatrial node and atrioventricular node)
  • conductive fibres
  • myocardium
173
Q

what is the sinoatrial node?

A
  • pacemaker of heart
  • its repeated automatic depolarisation sets the rhythm of the heartbeat
174
Q

what is the structure of the SA node?

A
  • cluster of cells
  • situated on posterior wall of right atrium
175
Q

what is the rate of SA firing modified by?

A
  • autonomic input (sympathetic increasing heart rate, parasympathetic decreasing heart rate)
176
Q

what happens once impulse reaches AV node?

A
  • passes along main conductive bundle of His
  • through insulating annulus fibrosus
  • down inter ventricular septum of heart where it bifurcates into right and left bundle branches
177
Q

what are the structures of the bundles now?

A
  • narrow, slow conducting fibres
  • terminate at extensive network of Purkinje fibres
178
Q

what are Purkinje fibres?

A
  • fast conducting fibres
  • they spread impulse throughout ventricular myocardium
  • causes upward wave of contraction
179
Q

what is the purpose of the moderator band?

A
  • in right ventricle
  • provides shortcut for electric impulses of right bundle branch from inter ventricular septum to anterior papillary muscle of right ventricle
180
Q

what is the process of movement to cause contraction after SA node depolarisation?

A
  1. internal tract allows synchronised contraction of both atria and conduction to AV node
  2. AV node receives impulse and transmits signal to ventricles via bundle of His
  3. bundle of His transmits signal down inter ventricular septum, splits in two
  4. left and right bundle branches transmit AP to Purkinje fibres
  5. allows contraction from apex base of heart
180
Q

what is an electrocardiogram?

A
  • diagnostic tool
  • measures electrical activity of the heart
181
Q

what can you measure using ECG?

A
  • activity and direction of electrical impulses in heart
182
Q

what is the P wave?

A
  • atrial depolarisation
183
Q

what is the QRS complex?

A
  • represents conduction of impulse through inter ventricular septum
  • ventricular depolarisation
  • atrial repolarisation
184
Q

what does the T wave represent?

A
  • ventricular depolarisation
  • end of cardiac cycle
185
Q

where do the coronary arteries arise?

A
  • superior to the cusps of aortic valve
  • from aortic sinuses
186
Q

what are the 3 sinuses of the aortic valve?

A
  • posterior aortic sinus
  • left aortic sinus
  • right aortic sinus
187
Q

where does the right coronary sinus arise from?

A
  • right aortic sinus
188
Q

where does the left coronary artery arise from?

A
  • left aortic sinus
189
Q

where doesn’t have an artery arise from?

A
  • posterior aortic sinus
190
Q

what does the left coronary artery supply?

A
  • left atrium
  • most of left ventricle
  • some of right ventricle
  • anterior part of inter-ventricular septum
  • SA node
191
Q

what does the left coronary artery divide into?

A
  • anterior interventricular branch (left anterior descending branch)
    -smaller circumflex branch
192
Q

where does the anterior inter ventricular branch supply?

A
  • anterior walls of both ventricles
  • trails down anterior surface heart along inter ventricular groove towards apex of heart
193
Q

where does the circumflex supply?

A
  • supplies left ventricle
  • supplies SA node in 40% of people
  • passes along coronary (atrioventricular) groove on left border of heart to posterior surface
  • gives off left marginal artery which runs on left border of heart
194
Q

where does the right coronary artery supply?

A
  • right atrium
  • most of right ventricle
  • some of left ventricle
  • posterior IV septum
  • SA node (in 60% of population)
195
Q

what does the right coronary artery give off near its origin?

A
  • ascending sinoatrial node branch that supplies SA node
196
Q

where does the right coronary artery descend?

A
  • in right atrioventricular groove
  • gives off marginal branch at right margin of heart
  • supplies right border of heart
197
Q

what does the right coronary artery give off at the crux of the heart?

A
  • large posterior inter ventricular branch
  • descends in posterior inter ventricular groove
198
Q

what is the crux of the heart?

A
  • zone of junction of interartrial and inter ventricular septa, atrioventricular valves and 4 chambers of heart
199
Q

what is venous drainage?

A
  • network of cardiac veins drain deoxygenated blood from heart tissue and deposits in the coronary sinus
  • this drains directly into right atrium
200
Q

how is myocardial infarction caused?

A
  • by blocked/severely restricted coronary artery
  • myocardium becomes ischaemic
200
Q

what is myocardial infarction?

A
  • heart attack
201
Q

what does ischaemic mean?

A
  • deficient supply of blood due to obstruction of inflow of arterial blood
202
Q

what does severe ischaemia lead to?

A
  • tissue death due to lack of oxygen
202
Q

what is the definition of infarct?

A
  • area of tissue death due to local lack of oxygen
203
Q

what is the most common location for ischaemia to occur?

A
  • left anterior descending artery
204
Q

what are the symptoms of myocardial infarction?

A
  • chest pain
  • nausea
  • sweating
  • jaw pain
  • syncope (fainting)
  • pressure in chest
  • left arm or shoulder pain
  • dyspnea (shortness of breath)
  • neck pain
205
Q

what are the ways of diagnosing myocardial infarction?

A
  • ECG (reviews electrical activity)
  • blood test (looks for markers of heart muscle damage)
  • imaging (assess structure and function of heart)
206
Q

what is the treatment of myocardial infarction?

A
  1. primary percutaneous intervention (PCI)
  2. thromolytics / fibrinolytics
  3. coronary artery bypass graft
207
Q

what is primary percutaneous intervention (PCI)?

A
  • angioplasty (widen the blocked vessel using a stent)
  • blocked vessel accessed through artery in groin
208
Q

what is thrombolytics / fibrinolytic?

A
  • medicines used to break down blood clots
209
Q

what is the coronary bypass graft?

A
  • blood vessel from elsewhere in body is attached above or below blockage
  • blood can divert around blocked artery
210
Q

what is the cardiovascular system made up of?

A
  • heart
  • blood vessels
  • blood
211
Q

what is the pulmonary circulation?

A
  • deoxygenated blood travels through pulmonary arteries to the lungs
  • oxygenated blood returns to heart through pulmonary veins
212
Q

what is the systemic circulation?

A
  • oxygenated blood travels through arteries to peripheral structures to supply with nutrients
  • venous (deoxygenated) blood returns to heart
213
Q

what is the vascular system talking about?

A
  • blood vessels of the human body
214
Q

what is the structure of the vascular system?

A
  • great vessels emerging from heart split into smaller arteries
  • they branch to form arterioles
  • they branch into lots of capillaries
  • capillaries converge to form venules
  • venues converge to form veins
215
Q

what are arterioles?

A
  • narrow high resistance vessels
  • diameter of 0.1 - 0.5 mm
216
Q

what are capillaries?

A
  • site of diffusion of nutrients and waste between blood and tissues
217
Q

what are capillaries?

A
  • thin walled
  • oxygen and nutrients from blood enter organs and tissues
  • take waste away from tissues
  • oxygen exchanged for co2 and waste
218
Q

what blood vessels have a three layered wall?

A
  • arteries
  • arterioles
  • venules
    -veins
219
Q

what does the wall consist of?

A
  • tunica intima (inner)
  • tunica media (middle)
  • tunica adventitia (outer)
220
Q

what does the intima consist of?

A
  • single sheet of endothelial cells resting on thin layer of connective tissue
  • layer is mechanically weak but barrier to plasma proteins
  • secretes vasoactive products
221
Q

what does the media consist of?

A
  • layer of smooth muscle of varying thickness
  • matrix of elastin and collagen
  • supplies mechanical strength, elasticity and contractile power to vessel
222
Q

what does the adventitia consist of?

A
  • connective tissue with no distinct outer border
  • main role is to tether vessels loosely in place
  • contains vasa vasorum in large arteries
223
Q

what is the vasa vasorum?

A
  • small blood vessel network
  • responsible for nourishing the media
224
Q

what else do larger vessels sometimes contain?

A
  • nociceptive sensory fibres
  • sympathetic nerve plexi
225
Q

what are the different types of blood vessels?

A
  • elastic arteries
  • conduit (muscular) arteries
  • arterioles
  • capillaries
  • arteriovenous anastomosis
  • veins and venules
226
Q

what are the characteristics of elastic arteries?

A
  • diameter 1-2cm
  • tunica media rich inelastic
  • distensible walls
227
Q

what happens to elastic artery walls in systole?

A
  • expand to receive stroke volume of ventricular ejection
228
Q

what happens to elastic artery walls in diastole?

A
  • recoil
  • creates almost constant flow in more distal tissues
229
Q

what is the blood pressure created by elastic recoil called?

A
  • diastolic blood pressure
230
Q

what are the examples types elastic arteries?

A
  • aorta
  • pulmonary artery
  • iliac arteries
231
Q

what are the characteristics of conduit (muscular) arteries?

A
  • diameter 0.1-1cm
  • tunica media thicker relative to lumen of vessel
  • media contains more smooth muscle (prevents collapse at sharp bends eg. elbow)
  • highly innervated by autonomic nervous system (can contract/relax)
232
Q

what is the main function of muscular arteries?

A
  • limitation of blood loss in major trauma
233
Q

what are examples of conduit (muscular) arteries?

A
  • radial, cerebral and coronary arteries
234
Q

what are the characteristics of arterioles?

A
  • diameter <0.1 cm
  • narrow lumen
  • large numbers
  • proximal and distal
235
Q

what are proximal arteries?

A
  • many smooth muscle layers
  • richly innervated by sympathetic (vasoconstrictor) nerve fibres)
236
Q

what are distal arterioles?

A
  • closer to capillaries
  • have 1-3 layers of smooth muscle
  • poorly innervated by sympathetic fibres
237
Q

what is the main function of arterioles?

A
  • main site of blood flow regulation to tissues
238
Q

what are the characteristics of capillaries?

A
  • diameter 0.004-0.007cm
  • wall contains single layer of endothelial cells
  • very numerous
239
Q

what is the blood pressure like at capillaries?

A
  • very low
  • slowest movement
  • allows exchange of nutrients, gases and waste
240
Q

what are the three different types of capillaries?

A
  • continuous (intercellular cleft, basement membrane, endothelial layer)
  • fenestrated (fenestrations)
  • sinusoid (incomplete basement membrane, intracellular gap)
241
Q

what are the characteristics of arteriovenous anastomosis?

A
  • diameter 0.02-0.135cm
  • only found in few tissues (skinned nasal mucosa)
  • wide ‘shunt vessel’ that bypasses capillary beds
  • richly innervated with sympathetic nerve fibres
242
Q

what is the function of arteriovenous anastomosis in the nasal mucosa?

A
  • help to warm inspired air
243
Q

what is the function of arteriovenous anastomosis in the skin?

A
  • temperature regulation
244
Q

what are the characteristics of veins and venules?

A
  • diameter 0.05-0.2 cm (venules), >0.2cm (veins)
  • venules and veins only differ in size and number
  • thin tunica media composed of smooth muscle and collagen
  • easily distended
  • often collapse
  • in limbs, tunica intima have valves to prevent back flow
247
Q

how resistant are veins and venules to flow?

248
Q

why are they also called capacitance vessels?

A
  • they often contain up to 2/3s circulating blood at any one time
249
Q

what are many veins innervated by?

A
  • sympathetic (vasoconstrictor) nerve fibres
  • makes smooth muscle contract and displace blood from this ‘reservoir’ of blood in veins during physiological stress
250
Q

what is the general appearance of arteries vs veins?

A
  • arteries = rounded
  • veins = more irregular, often collapsed
251
Q

what is the pressure of arteries vs veins?

A
  • arteries = high
  • veins = low
252
Q

what is the relative oxygen concentration of arteries vs veins?

A
  • arteries = higher in systemic, lower in pulmonary
  • veins = lower in systemic, higher in pulmonary
253
Q

which has valves present?

254
Q

what is hypertension?

A
  • high blood pressure
  • causes increased probability of coronary thrombosis, stroke and renal failure
255
Q

what are the two forms of hypertension?

A
  • primary (essential, most common)
  • secondary
256
Q

what is the cause of primary hypertension?

A
  • unknown
  • evidence of hereditary factor
  • linked somewhat to smoking, obesity and western diet
257
Q

what is the cause of secondary hypertension?

A
  • occurs in 5% of cases
  • caused secondary to primary hypertension or by a specific abnormality in one of the organs/systems of body
258
Q

what are the treatments?

A
  • antihypertensive drugs
  • lifestyle changes are first line treatment
259
Q

what drugs are used to treat?

A
  • beta blockers
  • ACE inhibitors
  • calcium antagonists
  • diuretics
260
Q

what is the first line of management in hypertension?

A
  • stopping smoking
  • lose weight
  • exercise regularly
  • avoid stress
  • reduce salt in diet
261
Q

what is the aorta?

A
  • largest artery in the body
  • comes from left ventricle
  • carries oxygenated blood
262
Q

what 4 parts can the aorta be divided into?

A
  • ascending
  • arch
  • descending / thoracic
  • abdominal
263
Q

what is the ascending aorta?

A
  • left and right coronary arteries branch from here
  • supply the heart
264
Q

what is the aortic arch?

A
  • arches overdo left side
  • gives off 3 branches which supply head, neck and upper limbs
265
Q

what is the first branch that’s given off?

A
  • brachiocephalic trunk
266
Q

what does the brachiocephalic trunk divide into?

A
  • right subclavian artery
  • right common carotid artery
267
Q

what are the other branches given off aortic arch?

A
  • left common carotid artery
  • left subclavian artery
268
Q

what are common carotid arteries?

A
  • at level of C3
  • divide into internal and external carotid arteries
269
Q

what does the internal carotid artery supply?

270
Q

what does the external carotid artery supply?

A
  • neck, face and scalp on its respective side
271
Q

what are the subclavian arteries?

A
  • below the clavicle
272
Q

what is the subclavian artery a major supply to?

A
  • arm
  • thoracic wall
  • shoulder (on respective side)
  • neck (on respective side)
273
Q

what does the subclavian artery become in the upper limb?

A
  • axillary
  • brachial artery
274
Q

what do the brachial artery and axillary provide?

A
  • arterial branches throughout the upper limb
275
Q

what are the two major arteries in the forearm?

A
  • ulnar
  • radial arteries
276
Q

what is the descending/thoracic aorta?

A
  • sits left of vertebral column in thorax
  • gives off branches that supply structures of thorax
277
Q

what does the descending/thoracic aorta supply?

A
  • oesophagus
  • lungs
  • thoracic wall muscles
  • pericardium
  • superior surface of diaphragm
278
Q

what is the abdominal aorta?

A
  • passes through diaphragm at level of T12
279
Q

what does the abdominal aorta supply?

A
  • abdomen
  • pelvis
  • lower limb
    includes coeliac trunk, superior mesenteric artery, renal arteries, inferior mesenteric artery
280
Q

what does the abdominal aorta split into?

A
  • two common iliac arteries
  • they travel towards pelvis and lower limb
281
Q

what is the coeliac trunk?

A
  • first unpaired branch of abdominal aorta
282
Q

what does the coeliac trunk supply?

A
  • structures of abdomen
  • stomach
  • liver
  • gallbladder
  • pancreas
  • spleen
283
Q

what is the location of the coeliac trunk?

A
  • comes off abdominal aorta at vertebral level of T12
284
Q

what is the superior mesenteric artery?

A
  • second unpaired branch of abdominal aorta
285
Q

what does the superior mesenteric artery supply?

A
  • structures of abdomen
  • most of small intestine
  • proximal portion of large intestine
286
Q

what is the location of the superior mesenteric artery?

A
  • comes off at vertebral level of L1
287
Q

what are the renal arteries?

A
  • paired branches of the abdominal aorta
288
Q

what do the renal arteries supply?

289
Q

what is the location of the renal arteries?

A
  • come off at vertebral level of L1/L2
290
Q

what is the inferior mesenteric artery?

A
  • third unpaired branch of abdominal aorta
291
Q

what does the inferior mesenteric artery supply?

A
  • hindgut structures of the abdomen (distal portion of large intestine
292
Q

what is the location of the inferior mesenteric artery?

A
  • comes off at vertebral level of L3
293
Q

where do common iliac arteries form from?

A
  • bifurcation of abdominal art at vertebral level of L4
294
Q

what does the common iliac artery split into?

A
  • internal iliac
  • external iliac artery
295
Q

what does the internal iliac artery supply?

A
  • structures of pelvic cavity and perineum
296
Q

what does the external iliac artery supply?

A
  • lower limb on respective side
297
Q

what does the external iliac artery continue as?

A
  • femoral artery
298
Q

where do capillaries drain into?

A
  • venules
  • venules then drain to veins
299
Q

what are the largest veins that drain into heart?

A
  • superior and inferior vena cava
300
Q

in which direction is venous drainage?

A
  • blood travelling towards the heart
301
Q

what do veins have instead of branches?

A
  • tributaries
302
Q

what are the superior vena cava tributaries?

A
  • internal jugular vein
  • subclavian vein
  • brachiocephalic vein
303
Q

which tributary of superior vena cava drains most the blood out of head and neck?

A
  • internal jugular vein
304
Q

what does the subclavian vein drain?

A
  • upper limb
305
Q

what do the internal jugular and subclavian veins join to form?

A
  • brachiocephalic vein
306
Q

what does the azygous system drain?

A
  • posterior thoracic wall
  • drains into superior vena cava
307
Q

what are the tributaries of the inferior vena cava?

A
  • common iliac veins
  • renal veins
  • lumbar veins
  • hepatic veins
308
Q

what do the common iliac veins drain?

A
  • structures of lower limb and pelvis
309
Q

what is the portal venous system?

A
  • collection of veins that drain into the liver before draining the IVC
310
Q

where do the portal venous system veins originate from?

A
  • digestive organs within the abdomen
311
Q

what happens to the blood filtered by the lungs?

A
  • its returned to the heart via hepatic veins and IVC

anatomy psc2018 (8 decks)

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