CV1 Flashcards
true ribs
false ribs
floating ribs
1-7
8-10
11 and 12
flail chest
multiple broken ribs in 2 or more places
thoracic wall moves in during inspiration and out during expiration
xiphoid process level of rib and dermatome
7th rib but T6 dermatome
transverse thoracic plane
sternal angle-disc bw TV4-5
seperation bw sup and inf mediastinum
sternocostal joint
1st one is synchondrosis-impt for respiation
2-7 are plane
dislocations
costochondral
synchondrosis
seperation
rib dislocation
rib seperation
rib fracture
sternocostal
costochondral
usually angle (and usually middle ribs)
external intercostal
*only one that elevates ribs (inspiration)
A:maintain intercostal space during respiration by elevating ribs during inspiration
N: intercostal nn
internal intercostals
A:maintain intercostal space during respiration by depressing ribs during expiration
N: intercostal nn
innermost intercostals
*lat
A:maintain intercostal space during respiration by depressing ribs during expiration
N: intercostal nn
subcostal
*post and spans more than one rib level
A: depress ribs during expiration
N: intercostal nn
transversus thoracis
*ant
A: depress ribs during expiration
N: intercostal nn 2-6
endothoracic fascia
deep thoracic fascia
top part is sibsons
adheres parietal pleura to thoracic wall
pump handle
increase A-P
why the first rib is a synchodrosis
bucket handle
increase transverse
musculophrenic and superior epigastric
musculophrenic is lateral
superior epigastric is medial
intercostal nn
ventral rami of spinal nn
superior mediastinum Ant to post
thymus,
brachicephalic vv-formed by int. jugular and subclavian
Aortic arch and branches-starts and ends at TTP
brachiocephalic trunk, L common coratid, L subclav a
SVC-formed by 2 brachiocephalic vv
trachea
esophagus
phrenic n course into thorax
passes ant to subclavian a
vagus n course and branches
larygeal, cardiac, pulmonary, and esophageal branches
lat border of common carotid and passes post to root of lung and in the post mediastinum on esophagus
left becomes the anterior vagal trunk
right becomes post vagal trunk
recurrent larageal nn
branches of vagus n
left-under arch or aorta, lat to lig arteriosum and then goes up
right-around r. subclavian a
post mediastinum
portion of inf medistinum
esophagus and decending aorta azygous vv, splancnic nn, thoracic duct
esophagus
starts at C6
in sup media its post and left of trachea and then in midline in post media
esophageal constriction
C6-pharyngoesophageal
TTP-aortabronchial
T10-diaphragmatic
esophagus innervation
symp-travel with CP splancnic and pain can feel like an MI
PS-vagus
azygous v
formed by right ascending lumbar and right subcostal vv.
at T4 goes ant over root of right lung to enter SVC
hemiazygous
formed by left ascending lumbar and left subcostal vv
gets 9-11 intercostal vv then cross at T9 to go to azygous
accessory hemiazygous
drains 5-8 and crosses at T8 into azygous
left 1-4 intercostal vv aka left superior intercostal v
drain directly into left brachicephalic v
right superior intercostal v (2-4 intercostal v)
drain into azygous
thoracic duct
starts at L2 at the cisterna chyli and travels post to esophagus. At T5 crosses to the left of esophagus and enters the venous angle
thoracic splancnic nn
preganglionic sympathetic axons to preaortic (paravertebral ganglia)
greatest T5-T9
Lesser T10 and 11
Least T12
hiatal hernia
abdominal viscera through esophageal hiatus
UR tract
LR tract
Upper- nose, pharynx, larynx
Lower- trachea, bronchi, lungs
trachea
starts at C6 and divides into primary bronchi which the right one is wider shorter and vertical so things get stuck
lung pleura
serosal membrane (only thing in pleural space) viceral and parital
lung parital pleura
costal, diaphragmatic, mediastinal, and cervical surfaces
mediastinal surface of lung parital pleura
continuous with the visceral, together with visceral pleura forms pulmonary ligamnet
pulmonary lig
point of fixation for the lung
cervical extension of the lung parital pleura
reinforced by sibsons (suprapleral) of endothoracic fascia
pneumothorax
collapsed lung DT puncture of pleura (either one)
pluritis of the lung
inflammaed pleura and don’t slide over one another
pain from
parietal pleura which has sensory fibers from phrenic and intercostal nn so refered pain is C345
visceral pleura has sensory that travel with autonomic fibers
bare area of heart
rib space 5/6
Tension pneumothorax
*parietal
DT trauma, emhysema, lung cancer, COPD
signs are distended neck veins and hypoTN from low CO
caused by loss of integrity of pleura (either one) resulting in air getting in but unable to leave so there is an increase in intrathoracic pressure and you have mediastinal shift to contralateral side and comprimises venous return
spontaneous pneumo
*viceral
in tall lanky males
right lung
oblique and horizontal fissure=3 lobes sup, middle (4-6 ribs), inf
art is ant to bronchus
left lung
oblique fissure=2 lobes sup and inf
cardiac notch and lingula
art is sup to bronchus
pulm veins location
usually ant and inf
bronchi location
usually post
viceral pleura and lung paranchema lymph
bronchopulmonary node -> sup and inf tracheaobronchiol nodes-> bronchomediastinal trunk
bronchomediastinal trunk left and right drainage
left into the toracic duct
right into the right lymphatic duct
bronchi and bronchioles lymph drainage
pulmonary nodes-> bronchopulmonary nodes-> tracheobronchiole nodes-> bronchomediastinal trunk
lung paritel pleura lymph drainage
to thoracic wall aka intercostal nodes
which recesses are only occupied during deep inspiration?
costomediastinal and costodiaphragmatic
which recess would you find a pleural effusion in xray?
costodiaphragmatic
fibrous pericardium where and innervation
anchors heart and prevents overfilling
phrenic
serous pericardium where
visceral and parietal layers
parietal pericardium where and innervation
underside of fibrous pericardium
phrenic
visceral pericardium where and innervation
on the heart itself also called epicardium
cardiac plexus but no pain fibers here
pericardial sac
potential space
cardiac temponade
when the pericardial sac is filled with fluid and the heart cant fill to capacity
transverse pericardial sinus
*where you clamp during bypass and cardiac surgery
behind aorta and pulm trunk but in front of SVC and pulm veins
oblique pericardial sinus
blind caul de sac bw pulm veins and IVC
pericardial refered pain (pericardidtis)
C345
fibrous skeleton of heart
structural support for valves
insulates against impulse propagation from A to V
RA structures (6)
sinus venarum, auricle, crista terminalis, fossa ovalus, SA and AV nodes
sinus venarum
smooth part of RA where IVC SVC and coronary veins enter
auricle
in atria has pectinate muscles
crista terminalis
divides sinus venarum and auricle in RA
SA and AV locations
SA-subepicardium near SVC
AV-subendocardium near coronary sinus opening
RV structures (5 main 10 total)
trabelcula carnae (moderator band), conus arteriousus, tricuspid (chordae tendinae and papilary mm) interventricular septum (membranous and muscular) pulmonary semilunar valve
trabeculae carnae
vent mm finer but more in left
moderator band (septomarginal)
specialized trabecular carnae in RV m from intervent spetum to ant pap m
conus arteriosus
smooth part of RV where the pulm a starts
mitral and tricuspid valve and structures
chordae tendinae connect valve to pap mm
interventricular septum parts
membranus-short and sup
muscular-long and thick
LA structures (3)
gets 4 pulmonary vv, auricle, mitral
LV structures (4 main 6 total)
trabecular carnae, aortic vestibule, mitral (CT and pap mm), aortic semilunar valve
aortic vestibule
smooth part of LV leading to aorta
regurg
valve insufficiency can cause a murmur along with stenosis
sites for auscultation
A-2nd ICS on right
P-2nd ICS on left
T-4th ICS on left
M-4th or 5th ICS left MCL
CAD
atherosclerosis leads to less blood in heart
Ischemia
below MI threshold leads to angina
what travels with what
Great CV with LAD
Middle CV with PDA
Small CV with right marginal a
heart lymph drainage
RCA->ant. mediatinal LN->left bronchomediastinal trunk
LCA->inf. tracheobronchiole N->R. bronchomediastinal trunk
cardiac plexus
postgang symp (T1-T4) (lung is T2-T6) and pregang PS
superficial-under AA
deep-on trachea
cardiopulmonic splancnic nn
postganglionic sympathetic nerve processes
refered pain of MI
pain fibers (GVA) follow sympathetic (GVE) to T1-4
plexus has what fibers in it?
symp, PS, and GVA
4 parts of the fetal heart from cranial to caudal
bulbis cordis, ventricle, atrium, sinus venosus
what comes from the bulbus cordis
truncus arteriosus=pulmonary trunk and aorta
conus cordis=RV-conus arteriosus LV=aortic vestibule
caudal portion=trabecula carnae of RV
what comes from the ventricle
trabecula carnae of LV
what comes from the atrium
left and right auricles
what comes from the sinus venosus
right horn=sinus venarum of RA
left horn=coronary sinus
what makes the interatrial septum
septum secundum
what makes the valve of FO
septum primium
what makes the AV seperation
endocardial cushions (NC cells)
ASD
Can cause a stroke
hole in atrial septum DT ostium secundum defect either bc septum primeum regresses too much or septum secundum doesnt form
VSD
hole in V septum and L-R shunt
what causes L to R shunt (late cyanosis)
VSD, ASD, PDA
endocardial cushion defect
ASD
pulmonary or aortic stenosis
semilunar valve malformation results in Patent FO and PDA
tetralogy of Fallot
unequal division of TA by conotruncal ridges PROVE Pulmonary stenosis RVH-(boot shaped heart on CX) Overiding aorta VSD
Transposition of GV
Very bad! conotruncal ridges fail to spiral aorta from RV and pulmonary from LV have to have patent FO and PDA to be compatible with life newborn cyanosis
persistent TA
conotruncal ridges dont form
undivided TA gets blood from both Vs
cyanosis of newborn
DiGeorge
CATCH 22 Cleft palate Abnormal facies Thymic aplasia Cardiac defects HypoCa
Retroesophageal R subclavian a
right 4th regresses and so forms on the left of Left subclavian and has to bend back to the right behind esophagus and can cause dysphagia
PDA
L to R shunt results in increase pulmonary flow and decreased systemic flow
Coarctication of aorta
aortic constriction
preductal-at birth id collateral circulation didnt happen
postductal-early adolescence and huge intercostal aa
double aortic arch
right dorsal aorta persists and fuses with left and forms ring around trachea and esophagus and causes dysphagia
course of vagus
right-behing ascending aorta
left-in front of arch
course of recurrent larengeal nn
right-loops under subclavian
left-under AA and Lig Art
umbilical vein
ligamentum teres hepatis
ductus venosus
bypass liver to IVC
becomes ligamentum venosum
umbilical aa
medial umbilical ligs
absent IVC
to azygous
Left SVC
r common cardinal degenerates but left persists
blood goes to coronary sinus to RA
double SVC
both persists and drain as said before
R- L shunt (cyanosis of the newborn)
transposition, TOF, PTA
conotruncal ridges
unequal division-
fail to spiral
fail to form
unequal division-TOF
fail to spiral-TGV
fail to form-PTA
pleural effusion
Becks triad DDD Distended ext jugular Distant heart sounds Decreased blood pressure
