CVR 4 Flashcards
Right coronary artery supplies in 60% of people what?
Sinoatrial branch
What does the RCA do?
Maintain correct electrical system of the heart.
Is there sufficient anastomoses in the heart at the level of the artery?
No, they cannot compensate. However, at the capillary level over a period time you can gradually build up an anastomotic junction.
What are the 3 significant tributaries of the coronary sinus
great, middle and small cardiac vein.
What causes the valves to open and close?
The pressure is higher on one side than the other.
Capillary muscles exert a tension but they do not open or close.
Where is not capable of electrical activity
Everywhere on the heart is capable of conduction bar between the atria and ventricles there is fibrous activity which does not transmit electricity (save for one very specific pathway which is designed for it …the conducting system)
Describe the atrial muscle
part smooth, part striated due to embryology. As the heart grows the atria incorporates veins and the primitive part is smooth.
Whats teh name of the depression in the right atrium
Fossa ovalis. Developmentally significant (defect in the septum which should separate the right and left heart)
Whats the name of the depression in the right atrium
Fossa ovalis. Developmentally significant (defect in the septum which should separate the right and left heart)
What is the muscle of the ventricles
slablike, trabeculations. Heart muscle gets o2 from
What is the muscle of the ventricles
slablike, trabeculations. More and more of lost trabeculations as the heart developes.
How are the papillary muscles connected to the atrioventricular valves
chordae tendineae. Prevents valves from opening backwards under systolic pressure.
SAP and AP
SAP on the right
AP on the left
The AV valves are tri and bi
Anterior left and right posterior are assosiated with R and L coronary arteries.
Pulmonary are the opposites.
What can cause narrowing of the oesophagus
enlarged left atrium
What are the rough walled part at appendages called
Pectinate muscles of the primitive atrium.
Aortic valves
anterior
left posterior
right posterior non coronary cusp
What are you most concerned with at this level?
aortic valves and cuspid valves. Left side of the heart due to the pressures
Whats teh first thing that happens on contraction
applies pressure from underneath to the valve preventing backflow
Signal goes
SA to AV
What do swollen ankles mean generally
the heart is not pumping blood well. Also back pressure in the enck
What do swollen ankles mean generally
the heart is not pumping blood well. Also back pressure in the neck. Back pressure in the lungs can be heard and is a very bad sign.
Apex beat
lowest most lateral part of the chest where the heart can be heard. 5th intercostal space in mid clavicular line.
Heart borders?
2nd CC T4/5
Pattern of Xray reading
ABCDA Airway - black Bones - white Cardiac - less than 1.2 diameter of chest Diapragm - Air entry -
What are the aortic valve cusps?
anterior
left posterior
right posterior (non coronary cusp)
On the right coronary artery which one is behind and which one is in front of the heart?
behind = posterior interventricular artery
Anterior - marginal branch
On the left coronary artery name the branches
On top passing along the side is the Circumflex artery and anterior is the anterior interventricular branch
Name the branches of the left and right coronary artery
right = sinoatrial (60%) marginal, AV node branch, posterior IV (85%!!)
Left = Anterior IV (LAD), Circumflex is sinoatrial branch 40% and marginal
What is it called when you put a balloon into a coronary artery and place a stent in?
Percutaneous intervention
What is the venous drainage of the heart?
Anterior - great cardiac vein, small cardiac vein
Posterior - Middle cardiac vein, Coronary sinus - big one
What does the fibrous skeleton provide?
position and function
Describe the right atrium?
SVC and IVC and coronary sinus empty.
Anterior wall is rough with pectinate muscle which is part of the primitive atrium.
Posterior wall is smooth from sinus venosus.
These are seperated by crist terminalis
Sulcus terminalis
Tricuspid valve
What is the fossa ovalis
The fossa ovalis is a depression in the right atrium of the heart, at the level of the interatrial septum, the wall between right and left atrium. The fossa ovalis is the remnant of a thin fibrous sheet that covered the foramen ovale during fetal development.
What is the sulcus terminalis?
The terminal sulcus extends from the front of the superior vena cava to the front of the inferior vena cava, and represents the line of union of the sinus venosus of the embryo with the primitive atrium. On the internal aspect of the right atrium, corresponding to the terminal sulcus is the crista terminalis.
What is the limbus?
Crest of fossa ovalis
What is the atrial septa defect?
A “hole” in the wall that separates the top two chambers of the heart. This defect allows oxygen-rich blood to leak into the oxygen-poor blood chambers in the heart. ASD is a defect in the septum between the heart’s two upper chambers (atria).
Where and what are trabeculations?
ridges in the ventricles.
What are papillary muscles?
connected to atrioventricular valves by chordae tendineae that prevent valves from opening backwards under systolic pressure
Describe the tricuspid valve
located in the right ventricle divided into anterior septal and posterior cusps attached via chordae tendinae to the papillary muscles at the septomarginal trabecula.
Describe the Pulmonary valve?
In the right ventricle comprised of anterior right and left semilunar cusps preventing backflow into the ventricle from the pulmonary trunk.
Describe the Pulmonary valve?
In the right ventricle comprised of anterior right and left semilunar cusps preventing backflow into the ventricle from the pulmonary trunk.
Describe the left atrium?
back of the heart, receives 4 pulmonary veins smooth walled due to embryonic pulmonary veins.
Rough walled part at appendage due to pectinate muscles of primitive atrium.
Left auricle, pulmonary veins, valve of foramen ovale.
What can cause narrowing of the oesophagus?
enlarged left atrium barium swallow.
What is the foramen ovale?
The foramen ovale is a normal cardiac structure found in all newborns and can be best described as a “door” between the right and left atria. The foramen ovale is essential for proper fetal circulation, directing oxygenated, nutrient-rich blood from the placenta, preferentially to the developing fetal brain.
Describe the left ventricle?
Mitral valve anterior cusp Chordae tendineae Anterior papillary muscle Trabeculae careae Posterior papillary muscle Mitral posterior cusp
Aortic valve
anterior
left posterior right posterior non coronary cusp
pulmonary valve
left anterior
right anterior
posterior
What type of tissue seperates atria from ventricles
fibrous non conductive tissue
What is the conduction system in the heart?
Specialised cardiac tissue leading from sinoatrial node to atrioventricular node
Bundle of His - right and left branches
Purkinje fibres
What are Purkinje fibres
During the ventricular contraction portion of the cardiac cycle, the Purkinje fibers carry the contraction impulse from both the left and right bundle branch to the myocardium of the ventricles
What is the bundle of His
Function. The bundle of His is an important part of the electrical conduction system of the heart, as it transmits impulses from the atrioventricular node, located at the inferior end of the interatrial septum, to the ventricles of the heart.
What is the septomarginal band
right ventricle containing part of right bundle
What is the delay of the AV node?
.12-.2 seconds therefore atria contract before ventricles
Where is the sinoatrial node?
The SA node is located in the wall (myocardium) of the right atrium, laterally to the entrance of the superior vena cava in a region called the sinus venarum (hence sino- + atrial). It is positioned roughly between a groove called the crista terminalis located on the internal surface of the heart and the corresponding sulcus terminalis, on the external surface. These grooves run between the entrance of the superior vena cava and the inferior vena cava.
Where is the AV node?
The AV node lies at the lower back section of the interatrial septum near the opening of the coronary sinus, which conducts the normal electrical impulse from the atria to the ventricles. The AV node is quite compact . It is located at the center of Koch’s triangle—a triangle enclosed by the septal leaflet of the tricuspid valve, the coronary sinus, and the membranous part of the interatrial septum.
What is the order for examining clinical cardia?
Talk to patient Look at patient Feel pulse Look at patient ankles neck Apex beat - heaves and thrills Auscultate the lungs Auscultate the heart
Where are the borders of the heart?
2nd CC right of sternum
3rd CC left of sternum
6th CC left of sternum
5th ICS right of sternum
What is the apex beat?
lowest most lateral point on the chest wall where the beat can be heard usually in the 5th intercostal space in mid clavicular
What are the points of auscultation for heart sounds?
Pulmonary - 3rd CC - 2nd ICS LEFT of sternum
Aortic - 3rd ICS - 2nd ICS RIGHT of sternum
Mitral - 4th CC - 5th left ICS MCL
Tricuspid - 4th ICS - 5th ICS left of sternum
What is stenosis?
narrowing, problem with valve opening
What is regurgitation?
problem with valve closing
