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Foundations 3 > CVS anatomy > Flashcards

CVS anatomy Flashcards

1
Q

Mediastinum borders:

A

Superior: Superior thoracic aperture
Inferior: Diaphragm
Anterior: Sternum and costal cartilages
Posterior: Thoracic vertebral bodies

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2
Q

What are the divisions of the mediastinum?

A

Superior, inferior (Sternal angle), Anterior, middle (heart) and posterior

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3
Q

What is present in the superior mediastinum?

A

Trachea, oesophagus, vagus nerve, phrenic nerve, arch of the aorta (great vessels), superior vena cava, thymus, thoracic duct

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4
Q

What is present in the anterior mediastinum?

A

Sternopericardial ligament (attach pericardium to posterior surface of sternum), internal thoracic vessels, thymus: atrophies by adults

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5
Q

What is present in the middle mediastinum?

A

Heart, pericardium, tracheal bifurcation into bronchi, ascending aorta, pulmonary trunk, superior vena cava, phrenic nerve, T1-T4 sympathetic trunk and vagus nerve, tracheobronchial lymph nodes (bronchial nodes within the hilum of the lungs)

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6
Q

What is present in the posterior mediastinum?

A

Oesophagus, thoracic aorta, azygous, thoracic duct, sympathetic trunks,

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7
Q

What is the function of azygous vein system?

A

Drainage of posterior thoracic wall into superior vena cava

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8
Q

What is the pathway of azygous vein system?

A

Azygous vein originates at the confluence of right subcostal and right ascending lumbar between L1-3 which forms hemiazygous and accessory hemiazygous on the left side arches over the right lung to enter the SVC around T4.

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9
Q

What does the pericardial sac contain?

A

Fibrous external layer and serous internal layer (consists of parietal and visceral serous layer with a pericardial cavity which is a potential space that has a thin fluid to reduce friction)

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10
Q

What pathology could occur with the pericardial sac?

A

Cardiac tamponade where there is a fluid built up in the pericardial cavity which then puts pressure on the heart and this can cause cardiogenic shock.

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11
Q

What is the function of the sternopericardial ligament?

A

Attaches the pericardium to the posterior surface of the sternum

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12
Q

What is the fibrous pericardium continuous with?

A
  • Central tendon of the diaphragm (pericardiophrenic ligament)
  • Tunica adventitia of the great vessels
  • Deep cervical fascia
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13
Q

What supplies the pericardium?

A
  • Phrenic nerve, vagus and sympathetic
  • Pericardiophrenic artery branch of internal thoracic artery
  • Pericardiophrenic nerve drains into brachiocephalic vein
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14
Q

What is the percentage ratio of heart:thorax should be?

A

<50%

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15
Q

Why do we use a posterior-anterior film for the thorax?

A

Reduce cardiac shadowing as with anterior-posterior; cardiomegaly is a common finding but not accurate

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16
Q

When do we use anterior-posterior film for the thorax?

A

Patient very unwell or unable to stand

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17
Q

What is the function of the fibrous skeleton?

A
  • Acts as an electrical insulator that separates atrium and ventricle
  • Keep the orifices of atrioventricular and semilunar valves patent and prevent them from being overly distended when there is an increased blood volume
  • Provides attachment for leaflets and cusps of valves
  • Provides attachment for myocardium
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18
Q

What is the function of an auricle?

A

Muscular pouch to increase capacity of atrium

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19
Q

Where is the coronary sinus drainage located at?

A

Between the inferior vena cava valve and right atrioventricular valve

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20
Q

What is the oval fossa? What is its clinical significance in a foetus?

A

Oval fossa is a remnant of foramen ovale that is needed because pressure is higher in right. Closure after birth

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21
Q

What is the problem with an atrial septal defect?

A

Left to right shunting and this can result in right heart failure due to increase in right ventricular pressure.

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22
Q

What occurs to the right ventricle superiorly?

A

It tapers into a conus arteriosus to enter pulmonary trunk

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23
Q

What attaches to the chorda tendinae?

A

Papillary muscles which attach to the ventricular wall

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24
Q

What is the function of the chorda tendinae?

A

Hold the 3 tricuspid and 2 bicuspid cusps in place.

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25
Q

How does the papillary muscle control chorda tendinae?

A

Papillary muscles contract to pull the chorda tendinae so that the valves do not bulge when the pressure is higher in the ventricle thus preventing prolapse of the valves just before systole

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26
Q

What are the 3 tricuspid cusps?

A

Anterior, septal and posterior cusp

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27
Q

What are the 3 papillary muscles in the right ventricle?

A

Anterior papillary- attach to the anterior/posterior cusp
Posterior papillary- attach to the posterior/septal cusp
Septal papillary- attach to the septal and anterior cusp

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28
Q

What makes the auricle?

A

Small rough pectinate muscles

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29
Q

How many tributaries of pulmonary veins are there?

A

4- 2 superior and 2 inferior

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30
Q

Is the wall of right atrium thicker than the left?

A

No, left atrium thicker than the right

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31
Q

What does the inferior border of left ventricle consists of?

A

2-3x thicker than right ventricle, more covered with trabeculae cornea, 2 papillary muscles (anterior/posterior) and 2 cusps,

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32
Q

How many cusps do pulmonary and aortic valves have?

A

3- anterior, right and left for pulmonary and posterior,right,left for aortic.

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33
Q

Where is the anatomical location of the aortic sinus and its function?

A

Superior to the aortic valve- dilation in the aortic arch which is the origin of coronary arteries which supply the myocardium

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34
Q

What is the effect of aortic stenosis?

A

Narrowing of the valve can cause turbulent blood flow which can be heard as a murmur.

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35
Q

What is the treatment for aortic stenosis?

A

Valve replacement or balloon valvuloplasty

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36
Q

What is the function of the right and left fibrous trigones?

A

Attach the AV valve to the aortic valce

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37
Q

Pathway of the right coronary artery?

A

Right coronary –> along coronary sulcus –> Right marginal artery–> Posterior interventricular artery
Also branch to SA and AV node

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38
Q

Pathway of the left coronary artery?

A

Left coronary–> Left anterior descending down the interventricular groove –> Left marginal –> Circumflex artery

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39
Q

There are 2 anatomical variations called right dominant and left dominant?

A

Right dominant: Posterior interventricular artery branch of right coronary artery: Supplies large portion of posterior left ventricle
Left dominant: Posterior interventricular branch of circumflex artery so enlarged

40
Q

What aspect of the heart does the right coronary artery supply?

A

Right atrium/ventricle, SA/AV node, some left atrium and ventricle

41
Q

What aspect of the heart does the left coronary artery supply?

A

Left atrium and ventricle, interventricular septum which includes the Bundle of His

42
Q

What is a coronary angioplasty?

A

Catheter entered from femoral artery until it reaches coronary artery, wire passes through the stenosis and the balloon the deflated to widen the obstruction

43
Q

What is a coronary artery bypass grafting?

A

If the coronary angioplasty cannot be done then the great saphenous vein is cut into segments and each piece is used to bypass the blocked sections of the coronary artery

44
Q

What are the 4 main tributaries that coronary sinus receives from?

A

great, posterior, middle and small cardiac vein

45
Q

What is the pathway of the great cardiac vein?

A

Starts at the apex, follows the anterior interventricular groove, reaches coronary sulcus, turns left continuing posteriorly, forms an enlargement of coronary sinus

46
Q

Pathway of the middle cardiac vein?

A

Also called the posterior interventricular vein, follows the posterior interventricular groove from the apex to reach the coronary sulcus

47
Q

Pathway of the small cardiac vein?

A

Right border of the heart continues in the coronary sulcus to drain into coronary sinus

48
Q

Pathway of the posterior cardiac vein

A

Posterior surface of the left ventricle just left to middle cardiac vein enters either directly/via great cardiac vein into coronary sinus

49
Q

What are the lymphatic vessels that follow the coronary arteries?

A

Tracheobronchial and brachicephalic

50
Q

What is the anatomical location of the cardiac plexus?

A

anterior to the tracheal bifurcation and posterior to the aortic arch and pulmonary trunk

51
Q

What sympathetic supply does the heart receive?

A

Pre-synaptic fibres: Superior 5/6 thoracic segments
Post-synaptic: Cervical and superior thoracic paravertebral ganglia of the sympathetic trunk.
Post-synaptic fibres transverse cardiopulmonary splanchnic nerves to SA/AV node and the ventricles, arterioles/venules.

52
Q

What parasympathetic supply does the heart receive?3

A

Pre-synaptic fibres of the vagus nerve

Post-synaptic cell bodies located in the atrial wall and interatrial septum near SA/AV nodes along coronary arteries

53
Q

What is the cardiac plexus divided into?

A

Superficial between pulmonary trunk and aortic arch and deep between aortic arch and trache

54
Q

What supplies the thymus?

A

Anterior mediastinal branches of internal thoracic artery
Left brachiocephalic, internal thoracic and inferior thyroid veins
Brachiocephalic, tracheobronchial

55
Q

Which brachiocephalic vein is longer?

A

Left is longer because it needs to pass from the left to the right side

56
Q

Where do both brachiocephalic veins unite to form the SVC?

A

1st right costal cartilage

57
Q

At which level does the SVC enters the right atrium?

A

3rd right costal cartilage

58
Q

What are the branches of ascending aorta?

A

Only coronary arteries from the aortic sinuses

59
Q

What is the anatomical proximities of the aortic arch?

A

anterior to right pulmonary artery and tracheal bifurcation

60
Q

Why is the left brachiocephalic vein less protected in children?

A

Rises above the superior border of the manubrium thus it is less protected

61
Q

What are the tributaries of the right brachiocephalic vein?

A

1st posterior intercostal vein, vertebral, internal thoracic

62
Q

What are the tributaries of the left brachiocephalic vein?

A

1st posterior intercostal, left superior intercostal, internal thoracic, inferior thyroid,vertebral

63
Q

What tributary does SVC receive from before entering into right atrium?

A

Azygous vein just before entering the pericardial sac

64
Q

What crosses anteriorly to the ascending aorta, arch of the aorta and descending aorta?

A

Left brachiocephalic vein

65
Q

Where does the brachiocephalic artery divide into right common carotid and right subclavian artery?

A

Upper edge of the sternoclavicular joint

66
Q

What is coarctation of the aorta (congenital anomaly)?

A

Aortic lumen constricted distal to the left subclavian artery which can affect vascular supply to the lower limb and can result in heart failure as heart needs to work harder to pump blood at a higher pressure

67
Q

What are the 3 fixed points of attachments of the aorta? Affected during trauma

A

Aortic valve, ligamentum arteriosum and point of passing from the median arcuate ligament of the diaphragm to enter the abdomen

68
Q

Describe the positioning of the trachea.

A

Anterior to the oesophagus, enters the superior mediastinum, bifurcates at the sternal angle, crossed laterally by the azygous vein on the right and arch of the aorta of the left

69
Q

Do visceral afferents of the vagus nerve transmit information on pain to the CNS?

A

No, only on physiological processes and reflex activities

70
Q

Pathway of the right vagus nerve.

A

Enters thorax anterior to right subclavian artery where it hooks around subclavian artery and gives off right recurrent laryngeal nerve which ascends between trachea and oesophagus, RVN runs posteriorinferiorly through superior mediastinum on the right side of the trachea, posterior to right brachiocephalic vein. Divides to contribute to the right pulmonary plexus, oesophageal plexus and cardiac plexus

71
Q

Pathway of the left vagus nerve

A

Enters superior mediastinum posterior to brachiocephalic vein and between common carotid artery/subclavian artery. Reaches the arch of the aorta and branch loops around the arch, lateral to ligamentum arteriosum to form the left recurrent laryngeal nerve and ascends into trachea to innervate laryngeal muscles. Left vagus then carries on posterior to root of left lung where it branches to pulmonary plexus, joints the right vagus for oesophageal plexus

72
Q

Function of the phrenic nerve

A
  • Motor and sensory innervation to diaphragm

- Sensory innervation to pericardium and mediastinal pleura

73
Q

How do you distinguish vagus and phrenic nerve?

A

Phrenic passes anteriorly to the roots of the lung and vagus passes posteriorly

74
Q

Pathway of the right phrenic?

A

Right side of right brachiocephalic vein, lateral to vagus nerve, descends right side of the pericardium with pericardiophrenic vessels towards IVC to pierce the diaphragm near the caval opening

75
Q

Pathway of the left phrenic?

A

Slightly posterior to the brachiocephalic vein, descends lateral surface of the aortic arch lateral to left vagus, anterior to root of left lung, along fibrous pericardium, pierces diaphragm at left of the pericardium

76
Q

Why is there a hoarseness of voice when there is a mass in the aortopulmonary window and apical lung tumour (pancoast tumour)?

A

Aortopulmonary window is where left recurrent laryngeal nerve passes through between pulmonary artery and aorta and if there is a mass/lymph node enlargement compressing the nerve- left vocal cord paralysis In a pancoast tumour, the right recurrent laryngeal nerve is given off at the root of neck as it hooks over the right subclavian artery- Right vocal cord paralysis

77
Q

Give a few characteristics of pathway of the thoracic duct?

A

Passes in the posterior mediastinum but enters via superior mediastinum- left side of oesophagus, deep to arch of aorta.
Posterior mediastinum, it is anterior to the bodies of the inferior 7 thoracic vertebrae.
Originates from the cisterna chyli ascends through aortic caval opening of diaphragm, then posterior to left brachiocephalic vein arches over and enters into left venous angle (union of left subclavian and left internal jugular vein)

78
Q

Oesophagus pathway

A

Begins at C6 cricoid cartilage, descends midline anterior to vertebrae, crosses thoracic aorta towards midline, pierces diaphragm at T10 and ends at the cardiac opening of stomach at T11. Posterior to trachea in the superior mediastinum

79
Q

Anatomical position of oesophagus

A

Anterior to thoracic duct, thoracic aorta on its left, posterior to right pulmonary artery and left main bronchus

80
Q

Where do oesophageal arteries arise from?

A
  • Thoracic aorta
  • Inferior thyroid
  • Bronchial arteries
  • Ascending branch of left gastric
81
Q

What are the venous drainage of oesophagus?

A

Azygous, hemiazygous, oesophageal branch of the left gastric vein

82
Q

What are the lymphatic drainage for the oesophagus?

A

Posterior mediastinal and left gastric lymph nodes

83
Q

What is the innervation of the oesophagus?

A

Vagus nerve- Forms the anterior and posterior vagal trunks
Anterior vagal trunk- mostly left vagus nerve
Posterior vagal trunk- mostly right vagus nerve
Continue as it passes through the diaphragm

84
Q

What nerve provides innervation for pain sensation in the oesophagus?

A

Pain sensation transferred by the sympathetic trunks and splanchnic nerve

85
Q

Where does thoracic aorta start and end? Pathway of it

A

starts at T4 and ends at T12, passes through diaphragm caval opening at T12. Azygous vein and thoracic duct is on the right side and accompany it through the hiatus

86
Q

What are the branches of the thoracic aorta?

A
  • Unpaired visceral branches: Oesophageal arteries
  • Paired visceral branches: Bronchial arteries (commonly paired left bronchial arteries)
  • Posterolateral of paired: 9 posterior intercostal arteries that supply all but 2 upper intercostal spaces and subcostal arteries
  • Exception: superior phrenic arteries (paired, parietal branch- anastomose with musculophrenic and pericardiophrenic branches of the internal thoracic artery) and pericardial branches (unpaired branch that arise anteriorly and sends twigs to the pericardium), small mediastinal artery (supplies lymph nodes and posterior mediastinum)
87
Q

What is the anatomical position of the thoracic duct as it ascends?

A
  • Anterior to the thoracic vertebrae
  • Posterior to the oesophagus
  • Right to it is the azygous vein
  • Left to it is the thoracic aorta
  • At level T4-T6, thoracic duct ascends into the superior mediastinum and left of the midline
  • Moves to the left and arches over the internal jugular to drain into the left venous angle
88
Q

Where does the thoracic duct receives its contents from?

A
  • Upper left: Upper intercostal lymphatic trunk (upper left 6)
  • Descending thoracic lymph trunks: Lower 7 intercostal
  • Trunks from the abdomen
  • Posterior mediastinal
  • Posterior diaphragmatic
89
Q

What are the nerves that innervate the posterior mediastinum?

A

Thoracic sympathetic trunks
Pre-synaptic fibres T5-T12.
Greater, lesser and least splanchnic nerves which innervate viscera inferior to diaphragm and throughout the abdominal viscera.

90
Q

What does the greater splanchnic nerve consists of and innervate?

A

T5-T9- passes into abdomen through crus of diaphragm and ends in coeliac ganglion

91
Q

What does the lesser splanchnic nerve consists of and innervate?

A

T9-T11- passes through crus of diaphragm and ends in aorticorenal ganglion

92
Q

What does least splanchnic nerve consists of and innervate?

A

T12- End in renal plexus

93
Q

Surface anatomy of the heart: superior, right, inferior and left border

A

Superior border- Left 2nd intercostal space
Right border- Right 3rd intercostal space
Inferior- Inferior end of right border to the 5th intercostal space
Left border- Lines between superior and inferior border

94
Q

Where is the apex beat located?

A

5th intercostal space, about an inch medial to the midclavicular line

95
Q

Location of mitral, tricuspid, pulmonary and aortic valve

A

Mitral- Apex beat
Tricuspid- left of the sternum 4th intercostal space
Pulmonary- Left of the 2nd intercostal space
Aortic- Right 2nd intercostal space

Foundations 3 (8 decks)

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