Clinically relevant anatomy of the heart Flashcards
Where is the phrenic nerve?
Descending across the lateral borders of the pericardium
Where is the pericardial cavity?
Between the 2 layers of serous pericardium
What is the anterior surface of the heart covered by?
Epicardium
What does the epicardium do?
Secretes pericardial fluid into pericardial cavity
What happens if the pericardial cavity fills with blood?
The pressure around the heart can prevent cardiac contraction (cardiac tamponade)
What is it called when the pericardial cavity fills with blood?
Haemopericardium
What does parietal mean?
Something in contact with body walls or organs
What is the epicardium also known as?
Visceral serous pericardium
3 layers of the pericardium?
Fibrous pericardium
Parietal serous pericardium
Visceral serous pericardium
What is pericardiocentesis?
Draining fluid from the pericardial cavity
How is the needle inserted in pericardiocentesis?
Via infrasternal angle
Directed superoposteriorly
Aspirating continuously
What is the transverse pericardial sinus?
Space within the pericardial cavity, posterosuperiorly
Lies posterior to the pulmonary trunk and ascending aorta
What is the transverse pericardial sinus used for?
Cardiac surgeons use it to identify and isolate the great vessels in order to commence cardiopulmonary bypass
What does pericardium look like in diagrams?
Grey sack surrounding heart
What does pulmonary trunk divide into?
Right and left pulmonary arteries
Biggest looking vessel? and ones either side of it
Aorta then pulmonary trunk then superior vena cava
What lies inferior to the aorta etc?
Pulmonary veins (4) and then inferior vena cava is a bit more inferior
Clinically important surfaces of the heart?
Anterior (sternocostal)
Diaphragmatic (inferior)
Base (posterior)
Clinically important borders of the heart?
Right (lateral) border
Left (lateral) border
Inferior border (normally on right ventricle)
Superior border
Clinically important point on heart?
Apex
Where do you palpate the apex beat?
5th left intercostal space in the mid-clavicular line
What are pulmonary trunk and pulmonary arteries carrying?
Deoxygenated blood to lungs
What does the brachiocephalic trunk divide into?
Right and left subclavian vein
What is an auricle?
Extension of right atrium (it’s like an overfill area)
What does the coronary groove show?
Where right atrium becomes ventricle
What is on either side of the trachea?
Right and left carotid artery
Anterior inter-ventricular groove?
Separates ventricles and a branch of the left coronary artery is in it
What is in the coronary groove?
Right coronary artery
What does the coronary groove indicate?
Surface marking for the tricuspid valve
Base surface?
All of the posterior left atrium
What separates base and diaphragmatic surface?
Coronary sinus vein
Diaphragmatic surface?
The posterior ventricles
Where do the coronary arteries arise from?
Ascending aorta
Where is the right coronary artery?
In coronary (right atrioventricular) groove
Where is the left (main stem) coronary artery?
In left atrioventricular groove between pulmonary trunk and left auricle
After the first branch of the aorta?
Coronary arteries NOT brachiocephalic trunk
What does the left coronary artery give way to?
Left anterior descending (LAD)(anterior interventricular artery) and this then branches into the lateral/diagonal branch
Where does venous blood ultimately drain back to?
Coronary sinus
What is the coronary sinus?
The coronary sinus is a short venous conduit (in the atrioventricular groove posteriorly) which receives deoxygenated blood from most of the cardiac veins and drains into the right atrium
What does a septum do?
Divides the heart into right and left side
Septum between the 2 atria is called?
Interatrial septum - position indicated by interatrial groove
Septum between ventricles is called?
Interventricular septum - indicated by anterior inter-ventricular groove
Why a septal defect is bad?
- can allow mixing of arterial and venous blood in the heart
- mixed arterial and venous blood reduced oxygen content of systemic arterial blood in the aorta
- This is called hypoxaemia
How many cardiac valves are there?
4
Where generally are the cardiac valves?
One valve at the exit of each cardiac chamber
Where is the pulmonary valve?
Between pulmonary trunk and and right ventricle
Where is the mitral (bicuspid) valve?
Between left atrium and left ventricle
Where is the aortic valve?
Between the left ventricle and the aorta
Where is the tricuspid valve?
Between right atrium and right ventricle
What valves cause the lub sound?
The tricuspid and mitral
What valves cause the dub sound?
Pulmonary and aortic valve
Tricuspid cusps?
Anterior, posterior and septal
Pulmonary valve cusps?
anterior right and left cusps
Aortic valve cusps?
Right, left and posterior cusps and sinuses (spaces within cusps)
What arises from the left and right aortic sinuses?
Coronary arteries
What side is tricuspid valve on?
Mitral?
Right
Left
What is moderator band?
Carries fibres of right bundle branch to the papillary muscle of the anterior cusp.
Where would you auscultate the aortic valve?
2nd right intercostal space at sternal edge
Where would you auscultate the pulmonary valve?
2nd left ICS sternal edge
Where would you auscultate the tricuspid valve?
4th left ICS sternal edge (lower left sternal edge)
Where would you auscultate the mitral valve?
5th left ICS midclavicular line
