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Heart, Lung, Kidney > Dissection - Heart > Flashcards

Dissection - Heart Flashcards

1
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A
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2
Q

The RCA runs between what 2 structures?

A

Right atrium and right ventricle

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3
Q

What is most commonly the first branch off the RCA?

A

Sinoatrial nodal branch

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4
Q
  • What is the posterior interventricular artery also commonly known as?
  • Where does it travel on the heart?
  • Does it branch off the right or left RCA?
A
  • Posterior descending artery
  • In the interventricular groove
  • Branches off right in our slides but can also branch off left depending on person
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5
Q

Where does the left coronary artery travel on the heart?

A

Between the left and right atria, direct branch off the aorta

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6
Q

What are the 3 possible branches of the LCA?

A

Circumflex

Left marginal

Left anterior descending (LAD) aka anterior interventricular

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7
Q

What are the 2 possible branches of the circumflex artery that we need to know?

A

Left marginal

Posterior descending artery aka posterior interventricular

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8
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9
Q

The small, middle, and great cardiac venins drain into the […] which empties into the […]

A

Coronary sinus

Right atrium

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13
Q

The greater cardiac vein travels along the […] on the […] surface of the heart while the middle cardiac vein travels along the […] on the […] surface of the heart.

A

interventricular septum

anterior

interventricular septum

posterior

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14
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15
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16
Q

The […] vein is more predominant on the left side of the heart and gives rise to the […] vein while the […] vein is more predominant on the right side of the heart and gives rise to the […] vein.

A

Greater cardiac

Left marginal

Small cardiac

Right marginal

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17
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18
Q
  • In 80 - 85 % of people, the posterior descending artery is a branch of the […] artery.
  • In the remaining 15 - 20% of people, it is a branch of which artery?
A
  • RCA (right dominant)
  • Either circumflex (left dominant) or it can be co-dominant (contributions from both circumflex and RCA)
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25
Q

What landmark divides the inferior and superior mediastinum?

A

Sternal angle

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26
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31
Q

The most inferior aspect of the heart sits on the most […] aspect of the diaphragm at the level of the nipple. The heart is shifted to the […] side of the body. The […], […] and […] are deep to the manubrium and sternal body, at approximately the level of the sternal angle.

A

Superior

Left

Aortic arch, superior vena cava, and great vessels

32
Q

Where is the thymus? What does it look like in an adult?

A

Sits on top of the heart. In adult, is mostly fat, not distinguishable as an organ.

33
Q

What are the layers of the pericardium? (3)

A
34
Q

What is the pericardial cavity?

A

The parietal and visceral pericardium are continuous at the roots of the great vessels where they form a potential space called the pericardial cavity. This is filled with fluid that lubricates the layers of pericardium allowing for the heart muscle to move against the layers without friction.

35
Q

What angle is this viewed from?

Label all structures.

A
36
Q

Briefly describe the course of travel of blood in the body starting from the periphery to the heart.

A

Blood in tissues –> superior (head, neck, and UE) and inferior (rest of body) vena cava –> right atrium –> right ventricle –> pulmonary artery –> lungs –> pulmonary vein –> left atrium –> left ventricle –> aorta –> tissues

37
Q

What view of the heart is shown?

Label all structures.

A
38
Q

What view of the heart is shown?

Label all structures.

A
39
Q

Blood that enters the right atria can come from the […], […], or […]

A

SVC

IVC

Coronary sinus (blood that was pumped to heart tissue itself, needs to go back to lungs)

40
Q

The floor of the atria are […] while the walls are made of […] muscle. The transition between these 2 muscular types is seen at the […]

A

Smooth

Pectinate

Crista terminalis

41
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A
42
Q

What is the fossa ovale?

A

An embryological remnant of the hole between the L & R atria that was present during development

43
Q

The papillary muscles are projetions of the […] on the walls of the ventricles.

A

Trabeculae carnae

44
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A
45
Q

What is the function of the papillary muscles?

A

They contract during ventricular contraction and provide tension on the mitral and tricuspid valves so that the force of contraction does not cause them to open into the atria and cause backflow of blood.

46
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A
47
Q

How can you remember what side of the heart the tricuspid and bicuspid valves are on?

A

Tri before you Bi

Blood goes through right side of heart (Tri) before it goes to the left side of the heart (Bi)

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50
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52
Q

Describe the general series of events in embryological development of the heart.

A

Starts as a tube that grows and loops around itself to form the bulboventricular loop and the auricles (atria). The auriculoventricular groove separates the atria from the ventricles. Endocardial cells from the inner surfaces of these chambers proliferate inward to form three initial septa that separate the atria, the ventricles and the atria from the ventricles. The foramen primum in the atrial septum eventually is repalced by the foramen secundum, which has a flap grow over it to become the foramen ovale that allows blood from the right atrium to enter the left atrium (but not vice versa). The truncus arteriosum ultimately gives rise to the aorta and the pulmonary trunk and is bifurcated. Cells from this bifurcation grown downward in a spiral fashion until they join up with the growth from the interventricular septa. This explains why blood from the left side of the heart has to flow to the right to reach the aorta, and vice versa. At this point, the heart is done devleoping except for the closure of the foramen ovale which happens shortly after birth.

53
Q

Describe the flow of blood in the fetal heart and how this changes shortly after birth.

A
  • SVC and IVC –> right atrium –> right ventricle –> pulmonary artery –> lungs not able to expand, so deoxy blood flows right back via pulmonary vein to left atrium –> left ventricle –> aorta–> tissues.
  • Oxygenated blood from placenta –> right atrium –> foramen ovale –> left atrium –> left ventricle –> aorta –> tissues
  • Shortly after birth, lungs inflate allowing blood from pulmonary circulation to be come oxygenated, rush of blood into left atrium pushes on the flap covering the foramen ovale from the left side –> closes shunt between left and right atria
54
Q

What gestational age is a fetus when the heart starts and ends developing?

A

Days 19 - 63 post-conception

55
Q

When does the heart begin “beating”?

A

Day 22 b/c needs to clear waste and deliver oxygen at rate that is greater than is possible via diffusion alone

56
Q

What implications does heart development timing have for abortions?

A

Heart is often fully developed before a woman may even know she’s pregnant (day 63 = 2 months ish). Many congenital heart defects cannot be detected until the fetus is 20 weeks old (5 months). Many states either already do or are moving to enact laws that ban abortion past 20 weeks. Thus, a woman may find out that her child has a defect that is not compatible with life and have no choice but to carry the child to term and deliver it only to watch it die (or be born stillborn).

57
Q

Describe the origins of the sympathetic innervation of the heart.

A
58
Q

Why does blood flow from the right atrium to the left atrium across the foramen ovale in a fetus?

A

Because pressure in the right atrium > pressure in left atrium in fetus

59
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A
60
Q

Why is the aorta to the right of the pulmonary trunk if it drains blood from the left side of the heart?

A

Spiral septum

61
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62
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63
Q
  • What is a patent foramen ovale? (PFO)
  • How common is it?
  • Does it cause symptoms?
  • If it does cause symptoms, what is the biggest concern?
A
  • When septum primum does not fully close in development
  • ~ 25% adults have PFO
  • No - foramen ovale is one way valve, blood can only flow right to left, usually not an issue as pressures are usually not great enough to cause blood flow through foramen
  • If person has small clot, can travel to right atrium and if they experience increased abdominal or interthoracic pressure while the clot is in right atrium it can pass through flutter valve to left atrium and enter circulation –> stroke risk
    *
64
Q
  • What is a patent ductus arteriosus?
  • How common is it?
  • How is it treated?
A
  • Left to right shunt that allows oxygenated blood from aorta to return back to lungs via pulmonary artery, lots of oxygenated blood to lungs can cause breathing problems and right ventricular hypertrophy
  • 75% of infants born before 28 weeks old
  • Surgically or with prostaglandin inhibitors (NSAIDS) b/c decreasing PGs triggers closing of PDA
65
Q

Atrial Septal Defect

  • What is this?
  • Is it more or less common than VSD?
  • How severe is it?
A
  • Hole in either septum primum or septum secundum that is not the foramen ovale, shuts blood between atria
  • More common
  • Depends on size, the bigger it is the more likely it is to cause pulmonary congestion, edema, right hypertrophy
66
Q

Ventricular Septal Defect

  • Caused by […]
  • More or less severe than ASD?
A
67
Q

Why does a septal defect cause right hypertrophy and why does that ultimately increase the likelihood of development of heart failure?

A

Septal defect means blood will flow from high pressure (left side) to low pressure (right side), increasing blood flow and the pressure of blood in the right side of the heart. This will lead to right hypertrophy to compensate for this new mechanical environment. Right hypertrophy increases pressure of blood in pulmonary circulation, so blood coming to left atrium and ventricle is at higher pressure, which then can cause left hypertrophy and that can lead to heart failure because the heart out pumps itself.

68
Q

What is a transposition of the great vessels?

A

If child is to survive, ductus arteriosus must remain open to allow some high pressure oxygenated blood from left ventricle to pass through it and into the descending aorta to the tissues. Must be fixed surgically, incompatible with survival.

69
Q

What is hypoplastic left heart syndrome?

A

Essentially there is no left ventricle

70
Q

What is tetralogy of fallot?

A

IHOP

Intraventricular septal defect

Hypertrophy of right ventricle

Overriding aorta

Pulmonary stenosis

Heart, Lung, Kidney (49 decks)

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