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SMP - Cardiopulmonary Lab Practical > Dissection of Coronary Arteries and Heart Chambers > Flashcards

Dissection of Coronary Arteries and Heart Chambers Flashcards

1
Q

What is the pericardium?

A

Fibroserous sac surrounding the heart and roots of great vessels

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2
Q

2 components of pericardium? Describe each.

A
  1. Serous pericardium: thin with 2 parts

2. Fibrous pericardium: tough connective tissue defining the borders of the middle mediastinum

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3
Q

2 portions of serous pericardium? Describe each.

A
  1. Parietal layer lining the inner surface of the fibrous pericardium
  2. Visceral layer adhering to the heart
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4
Q

Other name for visceral pericardium?

A

Epicardium

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5
Q

Where are the visceral and parietal pericardial layers continuous?

A

At the roots of the great vessels

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6
Q

Describe the borders/attachments of the fibrous pericardium.

A
  1. Inferiorly: base attached to the central tendon of the diaphragm and to a small muscular area on the left side
  2. Superiorly: apex continuous with tunica adventitia of great vessels
  3. Anteriorly: attached to posterior surface of sternum by sternopericardial ligaments
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7
Q

Purpose of fibrous pericardium?

A
  1. Retains heart in its position

2. Limits cardiac distention

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8
Q

Innervation of fibrous pericardium? Location of these nerves related to what?

A

Phrenic nerves

Related to embryological origin of the diaphragm and changes that occur during the formation of the pericardial cavity

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9
Q

Blood supply of fibrous pericardium? Location?

A

Pericardiacophrenic arteries located within the fibrous pericardium

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10
Q

What are the 2 pericardial sinuses?

A

Reflections of serous pericardium:

  1. Oblique pericardial sinus
  2. Transverse pericardial sinus
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11
Q

Describe the oblique pericardial sinus.

A

Cul-de-sac posterior to the left atrium formed by the posterior reflection surrounding the pulmonary veins, SVC, and IVC that is J shaped

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12
Q

Describe the transverse pericardial sinus.

A

Passage posterior to the ascending aorta and pulmonary trunk anterior to SVC and superior to LA, between the reflection surrounding the pulmonary veins and a superior reflection surrounding the arteries, the aorta, and the pulmonary trunk

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13
Q

During surgery, how to separate the veins from the arteries in the great vessels?

A

Open pericardium anteriorly and place a finger in the transverse sinus

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14
Q

During surgery, how to place hand in the oblique pericardial sinus?

A

Place hand under apex of the heart and move it superiorly and posteriorly to slip into it

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15
Q

5 arteries supplying the pericardium?

A

Branches from:

  1. Pericardiacophrenic arteries
  2. Internal thoracic arteries
  3. Musculophrenic arteries
  4. Inferior phrenic arteries
  5. Thoracic aorta
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16
Q

Where do veins from the pericardium drain?

A
  1. Azygos system of veins
  2. Internal thoracic veins
  3. Superior phrenic veins
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17
Q

3 nerves innervating the pericardium?

A

Arise from:

  1. Vagus nerves
  2. Phrenic nerves
  3. Sympathetic trunks
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18
Q

Where is pain from parietal and fibrous pericardia felt?

A

Pain in C3-C5 dermatomes = lateral neck and supraclavicular region of shoulder

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19
Q

What is pericarditis? Common causes?

A

Inflammatory condition of the pericardium

Common causes: viral, bacterial infections, systemic illnesses (chronic renal failure), and after myocardial infarction

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20
Q

What is a common cause of bacterial pericarditis? How can this be avoided?

A

Oral surgery

Prophylactic antibiotics

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21
Q

How to distinguish pericarditis from myocardial infarction in a patient?

A

Pain in both in central chest that radiates to one or both arms

Pain of pericarditis may be relieved by sitting forward and a EKG is used to distinguish them for sure

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22
Q

What is pericardial effusion? Treatment?

A

Pericardial cavity becomes a real space with fluid build-up causing compression of the heart = cardiac tamponade and biventricular failure

Treatment = pericardiocentesis (draining)

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23
Q

Where exactly is pericardiocentesis performed? Why? Other name for this area?

A

Bare area of the pericardium = Larrey’s area => just inferior to the 5th rib (5th intercostal space) about 1 inch to the left of the sternum

No lung overlying this area

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24
Q

What is constrictive pericarditis? Diagnosis? Treatment?

A

Abnormal thickening of the pericardial sac that can compress the heart and result in heart failure

Diagnosis: inspect jugular venous pulse for Kussmaul’s sign

Treatment: surgical opening of pericardium

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25
Q

What is jugular venous distention called? When is this observed?

A

Kussmaul’s sign

During inspiration, when the venous pressure in the jugulars is supposed to decline

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26
Q

Borders of mediastinum?

A
  1. Laterally: pleural cavities
  2. Anteriorly: sternum
  3. Posteriorly: thoracic vertebrae
  4. Superiorly: thoracic aperture
  5. Inferiorly: diaphragm
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27
Q

Parts of mediastinum?

A
  1. Superior

2. Inferior: anterior, middle, and posterior

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28
Q

Describe the pericardium in cadavers.

A

Fibrous and parietal pericardia are adhered together and cannot be separated

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29
Q

How is one of the cardiac sinuses exploited during bypass surgery?

A

The location of the transverse one is exploited as a surgical clamp is introduced into the space to separate the aorta from the pulmonary trunk and then blood flow of the aorta/pulmonary trunk is stopped momentarily before great vessels are connected to the bypass machine

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30
Q

Describe the orientation of the heart.

A

Pyramid resting on its side with apex pointing forward, downward, and to the left and base facing posteriorly

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31
Q

Components of the base of the heart?

A
  1. LA
  2. Small portion of RA
  3. Proximal parts of great veins: pulmonary veins and venae cavae
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32
Q

What is unique about the LA compared to the other heart chambers?

A
  1. It does not sit on the diaphragm (large gap between the 2)
  2. It rests directly on the esophagus posteriorly (soft vertical bump on LA if you remove the heart) - both are perpendicular to each other
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33
Q

Vertebral borders of base of the heart?

A

Sitting: T5 to T8
Standing: T6 to T9

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34
Q

What is the apex of the heart formed by? Surface projection?

A

Formed by inferolateral part of the LV

Surface projection: left 5th intercostal space, 8-9 (3.3 inches) cm from the midsternal line

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35
Q

How many surfaces does the heart have? Describe them.

A
  1. Anterior surface: mostly RV with a little RA and LV
  2. Diaphragmatic surface: LV and small portion of RV
  3. Left pulmonary surface: faces the left lung, is broad and convex and is mostly LV and portion of LA
  4. Right pulmonary surface: faces the right lung is broad and convex and is the RA
  5. Base surface: mostly LA
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36
Q

What separates the diaphragmatic surface of the heart and the base of the heart?

A

Coronary sinus

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37
Q

How many margins does the heart have? Describe them.

A

4 total:

  1. Inferior margin: sharp edge between diaphragmatic and anterior surfaces (mostly RV + LV near apex)
  2. Right and left margins = right and left pulmonary surfaces
  3. Obtuse margin: round edge between left pulmonary surface and diaphragmatic surface extending from left auricle to cardiac apex (mostly LV + left auricle superiorly)
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38
Q

Other name for inferior margin of the heart?

A

Acute margin of the heart

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39
Q

Other name for anterior surface of the heart?

A

Sternocostal

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40
Q

What forms the external coronary sulci?

A

Internal partitions dividing the heart into 4 chambers

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41
Q

What are the 2 sulci of the surface of the heart? Describe the position of each.

A
  1. Coronary sulcus: between the atria and the ventricles circumscribing the entire heart
  2. Anterior and posterior interventricular sulci: between the ventricles on both the anterior and posterior surfaces of the heart
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42
Q

3 vessels in coronary sinus?

A
  1. RCA
  2. Small cardiac vein
  3. Circumflex branch of LCA
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43
Q

Where is the coronary sinus located exteriorly?

A

Runs along the posterior coronary sulcus, medial to the IVC

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44
Q

Where do all of the cardiac veins drain?

A

All in the coronary sinus of the RA, except for the anterior cardiac veins which drain directly into the RA

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45
Q

2 vessels in anterior interventricular sulcus?

A
  1. Anterior interventricular artery

2. Great cardiac vein

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46
Q

2 vessels in postterior interventricular sulcus?

A
  1. Posterior interventricular artery

2. Middle cardiac vein

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47
Q

Position of visceral pericardium in regards to coronary sulci and vessels?

A

Superficial to

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48
Q

Where do the coronary arteries arise from?

A

From the aortic sinuses in the initial portion of the ascending aorta

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49
Q

2 coronary arteries?

A

Right and left

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50
Q

Describe the course of the RCA.

A

Right aortic sinus => passes anteriorly and then descends vertically in the coronary sulcus between RA and RV => inferior margin of heart => turns posteriorly onto diaphragmatic surface and base of heart

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51
Q

4 branches of RCA and their location?

A
  1. Atrial branch between right auricle and ascending aorta
  2. Sinu-atrial nodal branch (off of atrial branch) which passes posteriorly around SVC to supply SA node
  3. Right marginal branch off of the inferior margin of the RCA along border toward apex
  4. Posterior interventricular branch
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52
Q

Which coronary artery supplies the AV node?

A

Small branch of RCA on base/diaphragmatic surface of the heart

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53
Q

List all of the structures supplied by the RCA.

A
  1. RA
  2. RV
  3. SA node
  4. AV node
  5. Interatrial septum
  6. Portion of LA
  7. Posteroinferior third of the IV septum
  8. Portion of posterior part of LV
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54
Q

Describe the course of the LCA.

A

Left aortic sinus of ascending aorta => posterior to pulmonary trunk and anterior to left auricle => barely in coronary sulcus

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55
Q

3 branches of LCA? Include locations

A
  1. Anterior interventricular branch descends obliquely toward apex of the heart in the anterior IV sulcus (with 1-2 diagonal branches)
  2. Circumflex branch in coronary sulcus onto base/diaphragmatic surface ending before reaching the PIB
  3. Left marginal artery from the circumflex branch continues across the obtuse margin
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56
Q

Other name for anterior interventricular branch of LCA?

A

Left anterior descending artery = LAD

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57
Q

List all of the structures supplied by the LCA.

A
  1. Most of LA
  2. Most of LV
  3. Most of IV septum (including AV bundle and bundle branches)
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58
Q

What does heart dominance refer to?

A

Refers to which side of the heart is responsible for giving rise to the posterior interventricular artery

Most people (85%) are right heart dominant

For 15% of people the PIB branches off the circumflex branch of the LCA

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59
Q

What does the PIB supply?

A

Large portion of posterior wall of LV + posterior wall of RV + inferoposterior 1/3rd of IV septum

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60
Q

When not supplied by RCA, what supplies the SA and AV nodes?

A

Circumflex branch of LCA

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61
Q

Other name for PIB?

A

Posterior descending artery (PDA)

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62
Q

Other name for short LCA?

A

Left main stem vessel

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63
Q

What are the 5 major branches of the coronary veins? What about the minor 5th one? Describe their location and size.

A
  1. Great cardiac vein: LARGE, starts at apex => anterior IV sulcus => follows circumflex branch => enlarges to form LONG LARGE coronary sinus
  2. Middle cardiac vein: MEDIUM, starts at apex => posterior IV sulcus
  3. Small cardiac vein: SMALL, starts at lower anterior portion of coronary sulcus between RA and RV => base/diaphragmatic surface
  4. Anterior cardiac veins: SMALL, on anterior border of RA and RV running along RV anterior surface and entering the anterior wall of the RA
  5. Posterior cardiac vein: SMALL, posterior surface of LV to the left of the middle cardiac vein
  6. Marginal vein: usually branches from the small cardiac vein running with the marginal artery of the RCA or just part of the anterior cardiac veins
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64
Q

Which are more superficial: coronary arteries or veins?

A

Veins

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65
Q

Where do all of the cardiac veins drain?

A

All in the coronary sinus of the RA, except for the anterior cardiac veins (and sometimes the posterior cardiac vein) which drain directly into the RA

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66
Q

Where are marginal branches of the coronary arteries located?

A

Run towards the apex of the heart

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67
Q

How are the coronary arteries accessed in an angiogram?

A

Catheter is inserted into the femoral artery and passed in a retrograde manner through the aorta into the coronary arteries (VERY invasive)

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68
Q

What area will be oxygen deprived by a blood clot or plaque that occludes a vessel?

A

The area DISTAL to the blood clot

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69
Q

What are the 6 sites of coronary occlusion in order of frequency?

A
  1. Anterior interventricular branch of the left coronary artery (or LAD) (40-50%)
  2. Right coronary artery (30-40%)
  3. Circumflex branch of the left coronary artery (15-20%)
  4. Left coronary artery
  5. Posterior interventricular branch of the right coronary artery
  6. Marginal artery branch of the right coronary artery
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70
Q

Other name for middle cardiac vein?

A

Posterior IV vein

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71
Q

What arteries is the great cardiac vein associated with?

A

LAD and circumflex

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72
Q

What arteries is the middle cardiac vein associated with?

A

PIB

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73
Q

What arteries is the small cardiac vein associated with?

A

RCA and its marginal branch

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74
Q

What arteries is the posterior cardiac vein associated with?

A

None

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75
Q

What are the venae cordis minimae? Other name?

A

Smallest cardiac veins draining directly into cardiac chambers (numerous on right and few on left, especially LV) through the foramina of the venae cordis minimae

Also called veins of Thebesius

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76
Q

Lymphatic drainage of heart?

A

Follows coronary arteries and drains into:

  1. Brachiocephalic nodes
  2. Tracheobrachial nodes
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77
Q

RA receives blood from what 4 vessels? Where does each enter?

A
  1. SVC: posterior superior surface
  2. IVC: posterior inferior surface
  3. Coronary sinus: posterior inferior surface
  4. Anterior cardiac veins: anterior surface
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78
Q

Through what does blood pass to go from RA to RV? In what direction does blood flow?

A

Right atrioventricular orifice with tricuspid valve

Direction of blood: horizontal and forward

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79
Q

What are the 6 components of the inside of the RA?

A
  1. Pectinate muscles
  2. Fossa ovalis
  3. Crista terminalis
  4. Vessels that drain into the RA
  5. SA node
  6. AV node
80
Q

What is the crista terminalis?

A

Longitudinal smooth raised ridge running from anterior opening of SVC to anterior opening of IVC on the lateral border of the RA and separates the anterior and posterior walls

81
Q

What is the sulcus terminalis cordis?

A

Shallow vertical groove on external surface of the RA from right of SVC opening to right of IVC opening

82
Q

What is the sinus of the venae cavae derived embryologically from?

A

Right horn of sinus venosus

83
Q

What is the sinus of the venae cavae?

A

Space posterior to the crista in the RA with smooth thin walls where both venae cavae empty

84
Q

What is the atrium proper?

A

Space anterior to crista including the auricle in the RA

85
Q

What is the atrium proper derived embryologically from?

A

Primitive atrium

86
Q

Where are the pectinate muscles located in the RA? Function?

A

Horizontal rough inner surface of the atrium proper

Allow for atrial contraction

87
Q

What is the right auricle?

A

Ear-like conical muscular pouch externally overlapping the ascending aorta

88
Q

Location of coronary sinus in relation to IVC?

A

Medial

89
Q

What structure helps incoming blood through foramen ovale during development?

A

Valve of IVC

90
Q

What are the small folds of tissue around the openings of the IVC and coronary sinus? Embryological derivation?

A

They are the valve of the IVC and coronary sinus from the valve of the sinus venosus

91
Q

Direction of interatrial septum?

A

Forward and to the right

92
Q

What is the thinnest portion of the interatrial septum

A

Valve of foramen ovale (opposite floor of fossa ovalis is RA)

93
Q

What is the prominent margin of the fossa ovalis called?

A

Limbus fossa ovalis

94
Q

What are the 5 components of the RV?

A
  1. Tricuspid valve
  2. 3 papillary muscles with chorda tendinae
  3. Septomarginal trabecula
  4. Trabeculae carneae
  5. Conus arteriosus
95
Q

What are the different cusps of the tricuspid valve?

A
  1. Anterior
  2. Posterior
  3. Septal
96
Q

By what are the 3 cusps of the tricuspid valve connected to the papillary muscles?

A

Via cordae tendinae

97
Q

What is another name for the septomarginal trabecula?

A

Moderator band

98
Q

Function of septomarginal trabecula?

A

Connects the inferior portion of the interventricular septum to the base of the anterior papillary muscle in the RV

99
Q

What does the septomarginal trabecula contain? Function?

A

The right bundle of the conducting system of the heart => carries signals for muscle contraction to the papillary muscles

100
Q

What are the trabeculae carneae? Function?

A

Muscular ridges roughening the inner surfaces of the RV wall forming ridges and bridges to help support the walls of the ventricles

101
Q

How do the papillary muscles work?

A

Contract to prevent cusps from prolapsing back into the RA during ventricular contraction => aka they hold the cusps shut (but do not actively close them) to prevent them from leaking when the heart contracts

102
Q

What is the conus arteriosus? What is it derived from embryologically?

A

Smooth walled outflow tract of RV leading to pulmonary trunk

Derived from bulbus cordis

103
Q

Other name for conus arteriosus?

A

Infundibulum

104
Q

Are papillary muscles trabeculae carneae?

A

YUP

105
Q

What are the 3 papillary muscles of the RV? Which is the largest? Which is most inconsistent?

A
  1. ***Anterior
  2. Posterior
  3. # Septal
106
Q

How are the chordae tendineae attached to the ventricular wall?

A

3 trabeculeae carneae

107
Q

What are the commissures of the tricuspid and bicuspid valves?

A

Sites where the bases of the cusps of the valves are continuous

108
Q

What would necrosis of a papillary muscle following a myocardial infarction lead to?

A

Valve prolapse

109
Q

Describe the cusps of the pulmonary and aortic valves.

A

3 semilunar cusps with free edges projecting into pulmonary trunk/aorta with 2 parts:

  1. Nodule: middle, thickened
  2. Lunula: lateral, thin
110
Q

What are the different cusps of the pulmonary valve?

A
  1. Left
  2. Right
  3. Anterior
111
Q

How do the pulmonary and aortic valves close?

A

Each of their cusps has a pocket like sinus (dilation in wall of proximal pulmonary trunk/aorta) that fills with blood and forces the cusps closed

AND in the aortic valve the blood recoiling also enters the coronary arteries

112
Q

What veins drain into the LA?

A

4 pulmonary veins

113
Q

Describe the 2 halves of the LA and their embryological derivation.

A
  1. Posterior half with smooth walls derived from the proximal portions of the pulmonary veins
  2. Anterior half continuous with the left auricle and containing pectinati muscles derived from primitive atrium
114
Q

Does the LA have crista terminalis?

A

NOPE

115
Q

Is the interatrial septum part of the RA or LA wall?

A

LA (anterior wall)

116
Q

What plane do ALL the heart valves lie on?

A

Plane of coronary sulcus

117
Q

Are the heart valves heard at the skin level where they are located?

A

NOPE, downstream from the blood flow

118
Q

Where to listen to aortic valve?

A

Right side of sternum below rib 2

119
Q

Where to listen to tricuspid valve?

A

Left side of sternum below rib 5

120
Q

Where to listen to mitral valve?

A

Apex beat of the heart: 5th intercostal space at the midclavicular line

121
Q

Where to listen to pulmonary valve?

A

Left side of sternum below rib 2

122
Q

Other name for R and L bundle branches?

A

Crura

123
Q

Which AV valve is stronger: tricuspid or mitral? Why? Implication?

A

Mitral because it only has 2 cusps and needs to withstand so much more pressure

Increase in pressure from LA to LV is 10x higher

124
Q

Difference between papillary muscles in RV and LV? Explain why.

A

Not as prominent in LV because the left ventricle wall is thicker, so the papillary muscles are located closer to the mitral valve

125
Q

What is the anterior chamber of the heart?

A

RV

126
Q

What is the posterior chamber of the heart?

A

LA

127
Q

Which heart chamber is most often contused in car accidents?

A

RV

128
Q

Through what does blood pass to go from LA to LV? In what direction does blood flow?

A

Left atrioventricular orifice with mitral valve

Direction of blood: forward to apex

129
Q

Which ventricle is longer: RV or LV?

A

LV

130
Q

What is the aortic vestibule? What is it derived from embryologically?

A

Smooth walled outflow tract of LV leading to aorta

Derived from bulbus cordis

131
Q

Position of aortic vestibule compared to infundibulum of RV?

A

Left and posterior

132
Q

What are the 4 components of the LV?

A
  1. Mitral valve
  2. 2 papillary muscles with chorda tendinae
  3. Trabeculae carneae
  4. Aortic vestibule
133
Q

Compare the right and left trabeculae carneae?

A

Left ones are more fine and delicate

134
Q

What are the 2 papillary muscles of the LV?

A
  1. Anterior

2. Posterior

135
Q

Is the IV septum part of the RV or LV wall?

A

LV

136
Q

Parts of IV septum? Describe each.

A
  1. Muscular: thick and major part of septum
  2. Membranous: thin and upper portion
    * 3. Atrioventricular portion between LV and RA
137
Q

Location of mitral valve in LV?

A

Posterior superior

138
Q

Cusps of the mitral valve?

A
  1. Anterior

2. Posterior

139
Q

What are the different cusps of the aortic valve?

A
  1. Right
  2. Left
  3. Posterior
140
Q

Other name for posterior aortic sinus?

A

Noncoronary sinus

141
Q

Heart surfaces of LA?

A

Most of the base + left pulmonary surface

142
Q

Heart surfaces of RV?

A

Most of anterior surface + diaphragmatic surface

143
Q

Heart surfaces of LV?

A

Most of left pulmonary surface + anterior surface + diaphragmatic surface

144
Q

Heart surfaces of RA?

A

Most of right pulmonary surface + anterior surface

145
Q

2 types of valve disease?

A
  1. Insufficiency

2. Stenosis

146
Q

What is mitral valve disease?

A

Mix of stenosis and insufficiency, with one of the 2 dominating

147
Q

Changes in heart anatomy caused by mitral valve disease?

A
  1. LV hypertrophy
  2. Increased pulmonary venous pressure
  3. Pulmonary edema
  4. LA enlargement and hypertrophy
148
Q

What is the cardiac skeleton?

A

Collection of dense fibrous connective tissue in the form of 4 rings (anulus fibrosus) with interconnecting areas in a plane between the atria and the ventricles surrounding:

  1. 2 atrioventricular orifices
  2. Aortic orifice
  3. Opening of pulmonary trunk
149
Q

What are the 2 interconnecting areas of the anulus fibrosus?

A
  1. Right fibrous trigone between aortic ring and right atrioventricular ring
  2. Left fibrous trigone between aortic ring and left atrioventricular ring
150
Q

What separates the atrial musculature from the ventricular musculature and isolates them electrically?

A

Cardiac skeleton

151
Q

4 basic components of cardiac conduction system?

A
  1. SA node
  2. AV node
  3. AV bundle + R/L bundle branches
  4. Subendocardial Purkinje fibers
152
Q

Describe the pathway of the heart conduction system.

A

Impulse signaling begins at SA node => impulses spread in a wave along cardiac muscle fibers of atria, signaling atria to contract => some impulses travel along the internodal pathway => AV node => impulse delay for fraction of a second => impulses pass through the AV bundle => impulses divide into R and L bundle branches => halfway through septum they become the subendocardial branches of Purjinke fibers => subendocardial branches approach heart apex and papillary muscles and arc superiorly to ventricular walls => ventricular myocardial contraction begins at apex in endocardium and then epicardium

153
Q

Where is the SA node located?

A

Superior end of crista terminalis of RA at the junction with the SVC

154
Q

Where is the AV node located?

A

Within atrioventricular septum, close to the attachment of the septal cusp of the tricuspid valve, near the opening of the coronary sinus

155
Q

Where is the AV bundle located?

A

From AV node to lower border of membranous IV septum

156
Q

Where is the right bundle branch located?

A

Right side of IV septum => septomarginal trabecula to base of anterior papillary muscle => divides and is continuous with Purkinje fibers

157
Q

Where is the left bundle branch located?

A

Left side of IV septum => divides and is continuous with Purkinje fibers

158
Q

Innervation of the heart?

A

Cardiac plexus with branches from sympa trunks and vagus nerves + visceral afferents

159
Q

2 parts of the cardiac plexus? Location for each? Innervation of each?

A
  1. Superficial: inferior to aortic arch between it and pulmonary trunk
  2. Deep: between aortic arch and tracheal bifurcation
160
Q

What does the cardiac plexus innervate?

A
  1. Conduction system
  2. Coronary blood vessels
  3. Atrial and ventricular musculatures
161
Q

Parasympathetic nerves to the cardiac plexus? Where do they synapse?

A

Preganglionic branches of the vagus nerves and recurrent laryngeal nerves synapse on postganglionic nerves in plexus or atrial walls

162
Q

Sympathetic nerves to the cardiac plexus? Where do they synapse?

A

Preganglionic fibers from T1-T4/T5 => cervical sympathetic trunks => synapse in cervical ganglia and upper thoracic ganglia => postganglionic fibers to cardiac plexus

163
Q

Pathway of visceral afferents from the heart? Which ones carry pain sensation?

A

Along both parasympathetic and sympathetic nerves from the cardiac plexus

Those associated with sympathetic system conduct pain sensation

164
Q

Do the SA and AV node appear differently in a cadaver?

A

NOPE

165
Q

What is found between the heart and the parietal pericardium?

A

FAT

166
Q

Are the 2 pericardial sinuses continuous?

A

NOPE

167
Q

What connects the aorta and pulmonary trunk?

A

Ligamentum arteriosum

168
Q

Where is the musculi pectinati mostly found in the LA?

A

Left auricle

169
Q

Surface anatomy of upper limit of heart?

A
  • 3rd costal cartilage on the right of sternum

- 2nd ICS on left of sternum

170
Q

Surface anatomy of right margin of heart?

A

Right 3rd costal cartilage to 6th costal cartilage

171
Q

Surface anatomy of left margin of heart?

A

2nd ICS to apex at midclavicular line in 5th ICS (just inferior to the nipple in men)

172
Q

Surface anatomy of lower margin of heart?

A

6th ICS to right of sternum to apex at midclavicular line in 5th ICS

173
Q

Are the pulmonary trunk and ascending aorta contained in the pericardial sac?

A

YUP both covered by serous pericardium

174
Q

Surface projection of ascending aorta?

A

Posterior to left half of body of sternum at the level of the lower edge of 3rd LEFT costal cartilage to the level of the lower edge of 2nd RIGHT costal cartilage

175
Q

Surface projections of inferior half of SVC?

A
  1. Enters fibrous pericardium at right 2nd costal cartilage

2. Enters RA at right 3rd costal cartilage

176
Q

Surface projection of superior half of IVC?

A

Enters fibrous pericardium at T8

177
Q

What kind of pericardium covers the SVC and IVC?

A

Serous

178
Q

Why does the referred pain of the heart extends to the medial arm? Describe the process during myocardial infarction.

A

Cardiac cells die => pain is transmitted through visceral sensory afferent fibers enter the spinal cord between T1 and T4 where somatic afferents from spinal nerves T1 and T4 enter as well (including the brachial nerve) => both types of afferents synapse with second neurons => interneurons synapse with second neurons => second neuron fibers pass across the cord and ascend to the somatosensory areas of the brain that represent the T1-T4 levels => brain unable to distinguish between signals => pain interpreted as arising from somatic regions

179
Q

What is referred pain? What is it due to?

A

Visceral pain perceived as originating from the skin or outer body (as somatic pain)

May be due to reflexive vasoconstriction in the vessels supplying the corresponding somatic segments

180
Q

Surface projection of mitral valve?

A

Upper border of LEFT 4th costal cartilage

181
Q

Surface projection of tricuspid valve?

A

Middle of sternal body more to the right between ribs 4 and 5

182
Q

Surface projection of aortic valve?

A

Behind left part of sternum at level of rib 4

183
Q

Surface projection of pulmonary valve?

A

LEFT 3rd costal cartilage (lower)

184
Q

Surface projection of RV?

A

Mainly posterior to the sternum

185
Q

Can you see the left coronary artery from the anterior view of the heart?

A

NOPE, need left lateral view

186
Q

Huge hole seen on posterior surface of the RA?

A

IVC

187
Q

From the superior view of the heart, are all cusps of all valves visible?

A

Yes, except for those of the tricuspid valve

188
Q

What is the longitudinal ridge lateral to the coronary sinus?

A

Valve of coronary sinus

189
Q

If you are looking at a cross-section of the heart, what would be the bloody circular structure posterior to both ventricles in between them?

A

LA

190
Q

What structure most rapidly conducts impulses to the anterior papillary muscles?

A

Moderator band

191
Q

What structure transmits pain from angina pectoris?

A

Pain from angina pectoris results from ischemia of the myocardium and is transmitted primarily via afferent nerves that travel with sympathetic fibers so the upper sympathetic trunk is likely to have these fibers

192
Q

How does pulmonary edema causes by LV failure affect gas exchange?

A

Restricts it

193
Q

How long is the LCA?

A

2 cm

194
Q

What is a common disorder caused by occlusion of the RCA? Explain.

A

Disorders of cardiac rhythm because the SA node and the AV node get their blood supply predominantly from the RCA

195
Q

In what EKG leads would an occlusion of the RCA be noticed? Why? What is this called?

A

Leads II, III, and AVF because these visualize the inferior aspect of the myocardium, which the RCA predominantly supplied = inferior or anterior myocardial infarction

196
Q

How to diagnose myocardial infarction with a blood test? Can this be done at an early stage of MI?

A

To detect enzymes released by the heart during MI = lactate dehydrogenase (LDH), creatine kinase (CK), aspartate transaminase (AST), and isozymes (creatine kinase MB) + troponin

YES, it can!

197
Q

How is nuclear medicine used to determine areas of coronary ischemia?

A

Thallium and its derivatives are potassium analogs and will be taken up by ALIVE myocardial cells only

SMP - Cardiopulmonary Lab Practical (11 decks)

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