Clinical Correlations Interval 3 Flashcards
Stabbing in 4th intercostal space, just left of sternal border, distended neck
Cardiac Temponade
Kussmaul’s Sign
Distention of veins of the neck during inspiration
Atherosclerosis: what is it and where do coronary arteries anastamose?
Artery wall thickens due to accumulation of fatty materials
End-arteries: arteries that do not anastamose. Abstruction of these would cause necrosis
RCA and LCX anastamose
PDA and LAD anastamose (LAD travels around apex)
Fracture of the 10th rib: what organ was likely affected
Spleen! Sits at ribs 9-11. 10th rib lies along the long axis of the spleen
A chronic duodenal ulcer might rupture which artery?
Gastroduodenal artery, which decends posterioraly to the 1st part of the duodenum
What is a common site for ischemic bowel infarction?
Splenic flexure (point where transverse colon becomes the descending colon)
Ischemic bowel infarction means that the blood supply was cut off. The splenic flexure is where the middle colic and left colic arteries anastamose
Where is McBurney’s point and what is it’s significance?
McBurney’s point is 1/3 of the way from the ASIS to the umbilicus. It is where there is pain due to appendicitis.
There is also pain at the lower splanchnic T10 dermatome: the umbilicus
Name two types of problems that can cause appendix pain
- Fecalith: stool obstructs the appendix (adult)
2. Hyperplasia of the lymphatic tissue (kids)
Name the boarders of the heart
Right border: right atrium, SVC, IVC
Left border: left ventricle and left auricle
Inferior border: juncture between anterior surface and diaphragmatic surface. Mainly right ventricle
Superior border: left and right atria and the ascending aorta, pulmonary trunk and SVC
Where would you put your fingers on a person to approximate the normal surface projection of the heart and pericardial sac
Place your fingers on the sternal angle, the xiphisternal joint and the apex impulse
Myocardial infarction
Myocardial infarction (heart attack) results from localized avascular necrosis of cardiac muscle cells caused by prolonged ischemia
Usually due to LAD occlusion. Less commonly the RCA and LCX occlusion
Symptoms:
Sudden, severe pain beneath the sternum
Treatment:
Open up the stenosed vessel ASAP
AV block
In complete block, atria and ventricular contraction become dissociated and these chambers beat independently
Angina Pectoris
Severe chest pain
-T1-T4/5 refer pain to left arm and thorax
What is Beck’s Triad?
- Hypotension
- Muffled heart sounds
- Increased central venous pressure
Suggests cardiac tamponade
What is the anatomic reason trans-esophageal echocardiography can provide excellent cardiac images?
This can image the great vessels, heart valves, both atria, atrial septum and coronary arteries
The thoracic esophagus is located directly behind the left atrium and is separated from the heart only by pericardium. Thus, the ultrasound beam only has to go a few mm, instead of through your entire chest
Where in the chest wall should you place a stethoscope to hear valve sounds?
Aortic: right 2nd intercostal space at the sternal margin
Pulmonic: left 2nd intercostal space at the sternal margin
Mitral: left 5th intercostal space at the cardiac apex
Tricuspid: left 5th intercostal space at the sternal margin
What anatomic structures are currently used to bypass obstructed coronary arteries?
Saphenous vein segments (superficial veins in the leg)
Right and left internal thoracic arteries
Radial arteries (on arm)
What physiologic aberrations can occur if papillary muscle rupture occurs after an acute myocardial infarction?
Mitral or tricuspid regurgitation
At what point in the cardiac cycle the 2 coronary ostia receive blood?
Coronary ostia are the aortic sinuses that mark the beginning of the coronary artery ???????
During diastole, when the aortic valves are closed
Danger of tachycardia
Tachycardia is a fast heart rate, it impinges on diastole, shortening the time of coronary flow
What is the significance of accessory spleens?
10% of the population has accessory spleens
In the surgical removal of the spleen, an accessory spleen may enlarge and result in failure of the primary splenic issue to resolve. These must be removed along with the primary spleen
These are often found in the hilum of the spleen or adjacent to the pancreatic tail, in the gastrosplenic ligament, greater omentum, or splenorenal ligament
What is a Kocher maneuver?
The point is to expose structures in the retroperitoneum behind the duodenum and the pancreas
- Peritoneum is incised at the right edge of the 2nd portion of the duodenum
- The 2nd portion of the duodenum and the head of the pancreas are reflected left
- this exposes structures in the retroperitoneum
3. The duodenum and pancreatic head are moved, allowing for surgery on a bleeding ulcer (for example)
What is the surgical significance of the marginal artery of Drummond?
The marginal artery is formed when the ascending and descending branches of the SMA and IMA anastamose
This is an important source of collateral blood supply to the colon if the SMA, IMA or their branches are blocked
What is the anatomic usefulness of the coronary sinus in biventricular cardiac pacemakers?
The RV, LV and RA are paced due to dysynchronos contraction due to heart failure
Introduce a lead transvenously into the coronary sinus and advance the tip into the epicardial vein on the lateral wall of the LV to pace the heart
Bradycardia
Leads to decreased perfusion of vital organs (ventricles beat slowly)
What is cardiac temponade?
Fluid in the pericardiac cavity that compresses the chambers of the heart
Consequences:
- Decreased venous return and reduced cardiac output
- Heart chambers are compressed
- Neck veins are distended
- Thin-walled atria cannot fill
Treatment:
1. Pericardiocentesis at the left xiphocostal angle
Danger of surgical appendix removal? (appendectomy procedure)
The iliohypogasatric nerve may be lesioned. This would cause a weakening of the anterior abdominal wall, causing a direct hernia
Atrial Fibrillation
Chaotic atrial heart beat
This can cause a clot within the left atrium
