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MS 1 SF3 Cardiothoracic > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is Sternal angle of Louis?

The sternal angle of Louis is an important landmark for what anatomic structures?

A

Symphysis joint between the body and manubrium of sternum

  • Importance:
    1. Costal cartilage of Rib 2 articulates with sternum
    2. Level of intervertebral disc between thoracic vertebrae 4 and 5
    3. Arzygos vein dumps into superior vena cava
    4. Separates superior and inferior mediastinum
    5. The Aortic arch begins as ascending aorta and ends as descending aorta at level of sternal angle
    6. Trachea divides into main bronchi at level of sternal angle
    7. Superior extent of fibrous pericardium at sternal angle
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2
Q

What are the 7 structures palpable on a patient

Explain component(s) of each structure

A
  1. Jugular (suprasternal) notch
  2. Sternum (has manubrium, body - obtain bone marrow samples and xyphoid process - cartilage in young, ossifies in adults)
  3. Clavicle (not part of thoracic joint but joined by synovial joint - allow some mobility)
  4. Ribs 2-10 (ribs 1,11,12 are not palpable)
  5. Intercostal Space - btw ribs
  6. Costal margin - costal cartilages of 8,9,10 join costal cartilage of rib above i.e 7,8,9
  7. Nipple and surrounding Areola of mammary gland - 4th intercostal space at midclavicular line
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3
Q

Identify

True ribs
False ribs
Floating ribs
Atypical shape rib

A
  1. True ribs - Ribs 1-7. They ARTICULATE with the sternum
  2. False ribs - Ribs 8-12: DO NOT ARTICULATE with the sternum
  3. Floating ribs - Rib 11 and 12 : Do not articulate with sternum or any other ribs (8,9,10 form costal margins with the costal cartilage of the ribs above them 7,8,9)
  4. Atypical shape rib - Rib 1: has a flat shape and lies inferior to clavicle. NOT PALPABLE
  • *Ribs 2-10 are palpable ribs
  • *Ribs 1,11,12 are not palpable. 1 is inferior to clavicle and 11 and 12 are floating ribs so not attached to anything.
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4
Q

What are the 2 main contents of the Intercostal spaces?

A
  1. 3 layers of intercostal muscles (extend from rib above to rib below, support thoracic and elevate or depress ribs during breathing)
    **Innervated by intercostal nerves (VENTRAL RAMI of thoracic spinal nerves T1-T11)
    A. External intercostal muscle - anteroinferior fibers
    *extends from rib tubercle to costochondral junction (where bony rib and cartilage joins)
    * External/anterior intercostal membrane - (adjacent to sternum) is a thin connective tissue aponeurosis of EIM in the anterior part of each intercostal space

B. Internal intercostal muscle - posteroinferior

  • Fibers in 90 degree angle to EIM to strengthen thoracic wall
  • Internal/posterior intercostal membrane - (adjacent to vertebral column) thin connective tissue aponeurosis that replace IIM in the posterior part of intercostal space

C. Innermost intercostal muscles - poseroinferior
*lateral half of intercostal space
ONLY ONE INTERCOSTAL SPACE

*some extra muscles are
D. Transversus - superolateral
*SPAN 1-2 INTERCOSTAL SPACES
*course obliquely deep to. The internal thoracic vessels
*insert into lower border of costal cartilage 3-6

E. Subcostalis - posteroinferior

  • SPAN 1-2 INTERCOSTAL SPACES
  • Numerous in lower regions of the posterior thoracic wall
  • extend from angle of ribs to more medial part on ribs below
  1. Neurovascular bundle
    - composed of intercostal VAN (Vein, artery and nerve)
    - located btw internal and innermost muscle layers
    - Nerve is the weakest and can be easily damaged due to it not being a part of the costal groove
    - All cross along costal groove at inferior border of the rib
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5
Q

Identify the procedure and how it is done?

-Insertion of a chest tube through the thoracic wall and into the pleural cavity that surrounds the lungs

A

THORACOSTOMY

  • Indicated to drain abnormal fluid or air in the pleural cavity surrounding lungs
  • Chest tube is placed at the bottom of the intercostal space, immediately above the rib, to avoid damage to the neurovascular bundle
  • The position should be between the mid AXILLARY and the anterior AXILLARY lines at the 4th or 5th intercostal space on the superior border of the rib
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6
Q

Intercostal arteries supply muscles, fascia and overlying skin .

What are 2 intercostal arteries that supply each intercostal space

A
  1. Posterior intercostal artery
    - branch of aorta except 1st and 2nd posterior artery which is a branch of supreme/superior intercostal artery which is a branch of costocervical trunk of subclavian a. (Supply 1st and 2nd intercostal spaces)
    - LARGER than anterior intercostal a.
  2. Anterior intercostal artery
    - Upper 6 intercostal spaces; INTERNAL THORACIC/MAMMARY a.
    - 7-8th intercostal spaces ; MUSCULOPHRENIC a.
    - There are no anterior intercostal artery for 10th and 11th intercostal space (mainly supplied by posterior)
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7
Q

Tell me more about the Internal thoracic (mammary) artery

A
  • located adjacent to sternum btw the internal intercostal and transversus thoracic muscles
  • branch of SUBCLAVIAN a.
  • divides into 2 terminal branches :
  1. Musculophrenic artery
    - supply anterior intercostal arteries of 7-7 intercostal space ad adjacent diaphragm
  2. Superior (epigastric) artery
    - continuation of internal thoracic artery inferiorly through sternocostal hiatus and into abdominal wall structure
    - supply anterior abdominal wall
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8
Q

2 branches of venous drainage of intercostal spaces

A
  1. Posterior intercostal veins
    - drain POSTERIORLY into azygos vein on the right and hemiazygos/accessory hemiazygos vein on the left
  2. Anterior intercostal veins
    - drain anteriorly into internal thoracic and musculophrenic veins
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9
Q

What do intercostal nerves carry

A
  • Ventral/anterior rami of thoracic spinal nerves carry ;
  1. Somatic motor innervation to muscles of thoracic wall (intercostal, subcostal and transversus muscle)
  2. Somatic sensory innervation from skin and parietal pleura
  3. Postganglionic sympathetic fibers to the periphery
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10
Q

A pleural recess is a narrow region of the pleural cavity formed in areas where parietal pleura reflects from one region to adjacent region.

  • What are the 2 types of recess and which is clinical important as it can accumulate fluids
  • Which can lung pass into during inspiration
A
  1. COSTODIAPHRAGMATIC (Costophrenic) RECESS
    - found on right and left sides
    - slitlike spaces of reflection of costal pleural to diaphragmatic pleurae (btw base of lung to diaphragmatic pleurae)
    - lungs don’t enter this space upon inspiration
    - ABNORMAL FLUIDS CAN ACCUMULATE (blood, lymph) in disease states (pleural effusion) and can be visible on X-ray
  2. Costomediastinal recess
    - space formed by reflection of costal pleura to mediastinal pleura
    - anterior margins of LUNG PASS INTO SPACE during inspiration
    - LARGEST ON LEFT underlying the heart
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11
Q

What levels are the base of lung and base of pleural cavity at the 3 planes

A
  1. Midclavicular plane
    A. Lung at rib 6
    B. Pleural cavity at rib 8
  2. Mid AXILLARY plane
    A. Lung at rib 8
    B. Pleural cavity at rib 10
  3. Posterior-inferior border
    A. Lung at Spine of vertebra T10
    B. Pleural cavity at Spine of vertebra T12
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12
Q

Identify abnormal condition of pleural

  • results in fibrous connective tissue adhesions between visceral and parietal pleurae which would result in an audible sound during breathing called FRICTION RUB
A

PLEURISY - inflammation of pleura

**patient can also have referred pain due to innervation of pleura and other body region by the same spinal nerves

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13
Q

Sensory innervation of parietal pleura? (2)

A
  1. Intercostal nerves
    - costal pleura
    - peripheral part of diaphragmatic pleura
  2. Phrenic nerve
    - formed by anterior rami of spinal nerves C3-5
    - medial to mediastinal pleura
    - innervates mediastinal pleura and central part of diaphragmatic pleura
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14
Q

Explain development of lungs from:

-what week it begins

A
  1. IN WEEKS 4: lanryngotracheal groove appears in the floor of the foregut/pharynx
  2. Transesophageal folds (margins of the groove) fuse together to form the laryngotracheal tube which bifurcates into right and left lung buds
  3. These lung buds grow in the pleura sacs and form;
    * Main/primary bronchus
    * Lobar/Secondary bronchus
    * Segmental/tertiary bronchus
  4. The linings of the airways are formed from endoderm
  5. SPLANCHNIC MESODERM (surround the tube) forms connective tissue, cartilage and muscle of airways
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15
Q

Identify the condition

  • due to improper fusion of tracheosophageal folds (to form laryngotracheal tube - bronchus, esophagus)
  • Occurence 1:2500 births and requires surgical intervention
  • result in POLYHYDRAMNIOS ; since amniotic fluid drank by fetus cant enter stomach or intestine which is state of fetal absorption
A

TEF

-Transesophageal fistula (abnormal channel btw 2 structures)
WITH
-Esophageal Atresia (absence of normal lumen)

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16
Q

What is Endothoracic fascia and it’s function

A
  • Separates parietal pleura from ribs and intercostal muscles from thoracic wall (separate pleura from thoracic wall)
  • Allow surgeons to easily separate pleura from thoracic wall and avoid entering the pleural cavity.
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17
Q

Open vs closed pneumothorax

A
  • In Open pneumothorax; air enters into pleural cavity from channel through thoracic wall made by KNIFE WOUND
  • In Closed pneumothorax; air enters into pleural cavity from RUPTURE OF AIR TUBES at surface of lungs
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18
Q

Oblique vs Horizontal fissure

A
  1. OBLIQUE FISSURE
    - located on both sides of lungs
    - separated superior and inferior lobes
    - extends anteriorly from rib 6 at costochondal junction to spine of vertebra T4 POSTERIORLY
  2. HORIZONTAL FISSURE
    - located only in right lung
    - between superior and middle right lobes
    - follows the 4th costal cartilage to oblique fissure at mid AXILLARY line
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19
Q

Identify procedure

  • done to remove fluid of gas
  • Needle is inserted in mid AXILLARY line at intercostal space T4 to lessen damage/contact with diaphragm

Why?

A

PARACENTESIS

Because under diaphragm you can damage

  • Liver on the right
  • Spleen on the left
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20
Q

What part of the lung is the doorway where nerves and vessels enter and leave?

-what are the contents of this doorway?

A

HILUM OF LUNG

Contents (5)

  1. Bronchi
  2. Pulmonary artery (deoxygenated blood)
  3. Pulmonary vein (oxygenated blood)
  4. Bronchial arteries and veins (to and from stroma of lungs)
  5. Lymph vessels (bronchopulmonary/hilar nodes)
  6. Autonomic nerves

RALS

  • On right lung, eparterial bronchus is superior to pulmonary artery
  • On left lung, pulmonary artery is most superior (no eparterial bronchus)
  • other bronchus posterior
  • pulmonary veins anterior and inferior
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21
Q

Identify respiration types

    • scalene muscles contract to draw ribs 1 and 2 superiorly
    • intercostal contract and draw lower ribs superiorly
    • volume of thoracic cavity INCREASED (intrathoracic pressure decreased)
  2. RECTUS abd and oblique muscles of abd contract to draw lower ribs inferiorly
    - Intercostals contract and draw upper ribs inferiorly
    - volume of thoracic cavity is DECREASED (intrathoracic pressure increased)
A
  1. INSPIRATION

2. EXPIRATION

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22
Q

What four structures fuse to form diaphragm?

A
  1. Septum transversum
    - incompletely separates the thoracic cavity from abdominal cavity
    - forms central tendon of diaphragm
    - RIGHT AND LEFT PERICARDIOPERITONEAL CANALS are the coelomic spaces in foregut that link the thoracic and abdominal coelomic cavities.
  2. Pleuroperitoneal membrane
    - paired layers of SOMATIC MESODERM at caudal part of pleural cavities, caudal to pleuropericardial membranes in dorsolateral part of embryo
    - fuse with 1 and 3 and CLOSE the CANALS sealing off pleural from peritoneal cavities
  3. Dorsal mesentery of esophagus - form CRURA of diaphragm
  4. Somatic mesoderm - forms skeletal MUSCLES of diaphragm
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23
Q

Positional changes and innervation of diaphragm

A
  1. Septum transversum originally at level of cervical so it’s and nerve fibers of C3, C4, C5 (PHRENIC NERVE) grow into the septum
  2. Dorsal growth of CNS MORE RAPID than ventral CNS so allow for DESCENT OF DIAPHRAGM to vertebra level L1
  3. PHRENIC NERVE dragged inferiorly with septum transversum to innervate motor diaphragm and sensory parietal pleura and peritoneum covering CENTRAL region of D
  4. Lower intercostal nerves sensory to parietal pleura and peritoneum of PERIPHERAL region of D (derived from thoracic body wall i.e pleuroperitoneal membrane)
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24
Q

Identify the 2 congenital defect of the diaphragm

    • congenital diaphragmatic defect due to absence of LEFT pleuroperitoneal membrane
    • if defect is rage will compress lungs (underdeveloped and hypoplastic) and lead to high mortality
    • herniation of STOMACH through an ENLARGED ESOPHAGEAL HIATUS of the diaphragm
    • esophageal-gastric sphincter is nonfunctional
    • infants present with VOMITING
A
  1. CONGENITAL DIAPHRAGMATIC HERNIA (Foramen of Bochdalek)

2. ESOPHAGEAL HIATAL HERNIA

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25
Q

Identify condition

  • herniation of abdominal viscera through STERNOCOSTAL HIATUS which surrounds the superior epigastric artery branch of internal thoracic
    -sternocostal hiatus abnormally enlarged due to underdeveloped of small part of muscles of diaphragm
    RARE
A

FORAMEN OF MORGAGNI or PARASTERNAL Hernia

**superior epigastric arteries go through sternocostal hiatus to supply anterior abdomen

26
Q

Fibrous pericardium is inelastic (will not expand) but fluid/blood can build up in sac due to tear in heart or coronary vessel.

  • *What condition occur from fluid mpairing expansion and contraction of heart due to external fluid pressure on heart
  • *What ways can you relieve this pressure?
A

CARDIAC TAMPONADE

  • *Use PERICARDIOCENTESIS (drain fluid from sac) to relieve pressure on heart in 2 ways:
    1. Needle PARASTENALLY into the LEFT 4th or 5th intercostal space
    2. Needle immediately to LEFT OF XIPHOID PROCESS and angled POSTERIORLY and SUPERIORLY at a 45 degree angle
27
Q

How are the borders of the fibrous pericardium different from the heart

A

All similar except at right superior border

  1. Fibrous pericardium
    - extend to level of SECOND COSTAL CARTILAGE (level of sternal angle)
  2. Heart
    - extends to level of THIRD COSTAL CARTILAGE on right side
28
Q

True concepts of fibrous pericardium (4)

A
  1. Located medial to mediastinal pleura
  2. Lined internally by the parietal pericardium
  3. It is attached to the central tendon of the diaphragm
  4. Inflammation of pericardium can result in referred pain to C3-C5
29
Q

What structures are medial and lateral to mediastinal pleura (4)

A

LATERAL
1. Mediastinal parietal pleura

MEDIAL

  1. Fibrous pericardium
  2. Superior vena cava
  3. Phrenic nerve (btw mediastinal pleura and fibrous pericardium)
  4. Pericardial sac
30
Q

List of structures in SUPERIOR mediastinum (13)

A
  1. Left and right branchiocephalic veins
  2. Aortic arch
  3. Branchiocephalic artery
  4. Left common carotid artery
  5. Left subclavian artery
  6. Trachea
  7. Left recurrent laryngeal nerve
  8. Esophagus *
  9. Thoracic duct *
  10. Phrenic nerves *
  11. Vagus nerve *
  12. Thymus *
  13. Superior vena cava *
31
Q

List of structures in the ANTERIOR mediastinum (2)

A
  1. THYMUS gland *

2. Mediastinal lymph nodes

32
Q

List of structures in MIDDLE mediastinum (9)

A
  1. Pericardium
  2. Heart
  3. Ascending aorta
  4. Pulmonary artery
  5. Pulmonary veins
  6. Inferior vena cava
  7. Arch of azygous vein
  8. Phrenic nerves *
  9. Superior vena Cava *
33
Q

List of structures in POSTERIOR mediastinum (7)

A
  1. Hemiazygos and Accessory hemiazygos veins
  2. Descending aorta
  3. Thoracic splanchnic nerves (greater, lesser, least)
  4. Vagus nerves *
  5. Thoracic duct *
  6. Esophagus *
  7. Azygos vein *
34
Q

The 2 main arteries in superior and posterior mediastinum are AORTIC ARCH and DESCENDING THORACIC AORTA

  • What are the 3 branches of the aortic arch
  • begins and ends at level of STERNAL ANGLE
  • btw ascending and descending/thoracic aorta
A

3 branches of aortic arch : 1 in right, 2 in left

RIGHT SIDE
1. Branchiocephalic artery/trunk
-MEDIAL to the VEINS
-first ANTERIOR to trachea and then at RIGHT of TRACHEA
-Has 2 further branches at level of STERNOCLAVICULAR JOINT
A. Right common carotid a. (Right side of head and neck)
B. Right subclavian a. (RUE)

LEFT SIDE

  1. Left common carotid a
    - supplied left head and neck
    - ascends At LEFT side of TRACHEA
  2. Left subclavian a.
    - supplies LUE
    - SUPERIOR and POSTERIOR to veins on right and left side.
    - POSTEROLATERAL to left cc.
35
Q

The 2 main arteries in superior and posterior mediastinum are AORTIC ARCH and DESCENDING THORACIC AORTA

*What are the 2 branches of the descending thoracic aorta (5 total)

A

Descending thoracic aorta

  • continuation of aortic arch inferior to level of sternal angle
  • descends first to the LEFT and then ANTERIOR to the THORACIC VERTEBRAE
  • passes through AORTIC HIATUS AT VERTEBRA T12 in the diaphragm

Branches
1. Paired branches
A. 9 pairs of POSTERIOR INTERCOSTAL ARTERIES to intercostal space 3-11
2. 1 pair of SUBCOSTAL below rib 12
3. 1 pair of SUPERIOR PHRENIC ARTERIES to upper side of diaphragm

  1. Unpaired branches
    A. 2 LEFT bronchial arteries
    B. 2 esophageal arteries
36
Q

What are the 5 veins in the superior and posterior mediastinum

A
  1. Right and left branchiocephalic veins
    - formed by union of INTERNAL JUGULAR AND SUBCLAVIAN VEINS
    - posterior to sternoclavicular joint
    - left brachiocephalic obliquely cross the superior mediastinum to join with the right branchiocephalic to form the SUPERIOR VENA CAVA
    - left branchio located btw thymus gland and (left cc and branchiocephalic trunk)
  2. Superior vena cava
    - extends from costal cartilages of rib 1-3
    - receives azygos vein at level of STERNAL ANGLE
    - contain DEOXYGENATED BLOOD FROM ALL STRUCTURES ABOVE DIAPHRAGM
  3. Azygos vein
    - drains blood from; posterior intercostal veins (right thoracic wall), hemiazygos and accessory hemiazygos (left thoracic wall), and esophageal veins, bronchial veins and vertebral venous plexus
    * *BRNACHOGENIC TUMORS can Mets to vertebral column and spinal cord
  4. Hemiazygos vein
    - origin from left ascending lumbar veins
    - drains the LOWER LEFT INTERCOSTAL SPACES
  5. Accessory hemiazygos vein
    - drains the MIDDLE LEFT INTERCOSTAL SPACES

**Right (drain to arch of azygos v.) and left (to left branchiocephalic) superior intercostal veins which drain the UPPPER INTERCOSTAL SPACES are not located in the posterior mediastinum

37
Q

Collateral pathway to right atrium if superior vena cava is blocked vs inferior vena cava blocked

A
  1. Superior vena cava syndrome
    * *unblocked superior vena cava part - azygos vein - right ascending lumbar v - lumbar veins - inferior vena cava - right atrium
  2. Tumor of liver obstruct inferior vena cava
    * * Unblocked Inferior vena cava - lumbar v - right and left ascending lumbar - hemiazygos and azygos - superior vena cava
38
Q

What is the main lymph channel of body receiving ;

  • all lymph from below the diaphragm
  • left side of thoracic cavity
  • left side of head and neck
  • left upper extremity
A

THORACIC DUCT

-drains into VENOUS system
- begins by draining the CISTERNA CHYLI (dilated lymph sac) in the abdomen
- anterior to the vertebra L1 and right of aorta
-posterior to left border of esophagus
- root of left side of neck ; drain into beginning of left branchiocephalic vein
**3 lymph trunks drain to root of neck
A. Left jugular (from head and neck)
B. Left subclavian (from upper limb)
C. Left bronchomediastinal (from left lung)

**lymphatic system is very low pressure and needs valves to move lymph which give thoracic duct a bumpy appearance

39
Q

What is not located in the mediastinum but found in right sid elf rot of neck

-short duct that drains into beginning of right brachiocephalic vein

A

RIGHT LYMPHATIC DUCT

  • drains right side of head and neck
  • right upper limb
  • right lung
  • skin of right thoracic wall

**receives 3 lymph trunks which drain independently into termination of right internal jugular or right subclavian veins
A. Right subclavian
B. Right bronchomediastinal
C. Right jugular lymph trunks

40
Q

A physician ligating a patent/open ductus arteriosus (shunt btw left pulmonary artery and arch of aorta) in an infant must NOT ligate the left recurrent laryngeal nerve why?

A

The LEFT LARYNGEAL NERVE gives motor innervation to laryngeal muscles.

**Damage to nerve will result in HOARSE VOICE (and a lawsuit).

**The LIGAMENTUM arteriosum is a former embryonic vessel of the ductus arteriosus

41
Q

Is right recurrent laryngeal nerve in superior mediastinum?

Why or why not?

A

NOT in superior mediastinum

  • *It hooks around right subclavian artery and ascends into the neck in between esophagus and trachea
  • Does not enter superior mediastinum since tight subclavian a is in the root of the neck (branch off branchiocephalic trunk which is in the superior mediastinum)
42
Q

Other branches of VAGUS NERVE

A
  1. Gives off pulmonary and cardiac branches while in superior and posterior mediastinal to form plexuses on organ
  2. Passes POSTERIOR to root of lung
  3. Forms ESOPHAGEAL PLEXUS
  4. Forms RIGHT Vagal trunk on POSTERIOR side of esophagus
  5. Form LEFT vagal trunk on ANTERIOR side of esophagus
  6. Passes with esophagus through diaphragm
43
Q

In superior mediastinum, what is the Bilobed lymphoid organ of the immune system

A

THYMUS

  • attains maximal size by puberty
  • gland regresses and becomes infiltrated with fat post puberty
  • located immediately POSTERIOR TO MANUBRIUM of sternum

**Blood supply; branches of internal thoracic artery and inferior thyroid artery

44
Q
  1. Descending thoracic aorta passes through the AORTIC HIATUS in the diaphragm at what level of vertebra?
  2. Esophagus descends from level of sternal angle to ESOPHAGEAL HIATUS at what level of vertebra?
A
  1. T12 (aortic hiatus in diaphragm)
  2. T10 (esophageal hiatus in diaphragm)
  • *esophagus lies to the RIGHT of thoracic aorta at upper thoracic levels
  • *esophagus lies ANTERIOR to thoracic aorta at esophageal hiatus of diaphragm
**PNEUMONIC 
I ate 10 eggs at 12 
Inferior vena cava - T8
esophagus - T10
Aorta - T12
45
Q

4 potential sites of constriction of esophagus

**progression of esophagus in posterior mediastinum

A
  1. Junction os PHARYNX and esophagus
  2. AORTIC ARCH (at left lateral border of esophagus)
  3. LEFT MAIN BRONCHUS (located anterior to esophagus)
  4. DIAPHRAGM at esophageal hiatus

**
Esophagus fist to the right of aorta in mid-thoracic levels, then go to the left of the aorta in lower thoracic levels and then lies anterior and left of aorta at the diaphragm

46
Q

What 4 structures pierce diaphragm and what 1 structure does not pierce but pass POSTERIORLY through diaphragm

A

PIERCE

  1. Inferior vena cava - T8 (right phrenic nerve -caval opening)
  2. Esophagus - T10 (right and left vagal nerve trunks - esophagus hiatus)
  3. Descending aorta - T12 (thoracic aorta, thoracic duct, azygos vein - aortic hiatus)
  4. Greater, lesser and least splanchnic nerves - pierce crura/legs of muscular diaphragm
  5. Sympathetic trunk does NOT pierce but it pass posterior
47
Q

Location of coronary arteries

A
  1. Right coronary artery along the coronary/atrioventricular sulcus
  2. LAD (left anterior descending) artery along the anterior interventricular sulcus
48
Q

Contents of the right atrium (8)

A
  1. Crista terminalis - morphological divides the right atrium

Anterior part -muscular walls
2. Musculi pectinate (pectinate muscles) - muscular crisscross ridges

Posterior part - smooth walls

  1. Superior vena cava
  2. Inferior vena cava
  3. Coronary sinus opening and valve
  4. Fossa ovalis - oval thin walled depression
  5. Limbus/annulus of fossa ovalis - thick upper margin of the fossa
    * *In fetus, foramen ovale bypass pulmonary circuit and allow blood flow from right to left atrium, close at birth to form fossa ovalis
    * *minor ASD called probe-patent foramen ovale
  6. Right auricle/ear - lined by pectinate muscles
49
Q

Contents of the right ventricle (6)

A
  1. Trabeculae Carneae - irregular ridges of muscle that line the ventricular lumen (fleshy beams)
  2. Infundibulum/conus arteriosus
  3. Posterior wall of right ventricle
  4. Tricuspid valve - 3 cusps ; thick at attached borders (at ventricular wall), thin at free margins in ventricular cavity
    * *ANULUS FIBROSIS is attachment site of valve cusps
    * *CHORDAE TENDINAE - attach cusp to papillary muscle
    * *PAPILLARY MUSCLE - (conical muscular projections) - anterior, posterior and septal -named same as cusps
  5. Pulmonary valve - 3 semilunar cusps
  6. Fibrous skeleton of the heart
50
Q

Identify conditions

    • Pulmonary semilunar valve do no close properly due to thick and inflexible free margins of cusps
    • Results in backflow of blood back to the right ventricle from pulmonary trunk
    • heard as HEART MURMUR
    • narrowing of pulmonary orifice due to fusion of free margins of cusps by disease
    • result in RIGHT VENTRICULAR HYPERTROPHY (right ventricle work harder to pump blood to lungs)
A
  1. Pulmonic valve incompetence

2. Pulmonary stenosis

51
Q

Name 4 functions of fibrous skeleton of heart

A
  1. Attachment site for valves (anulus fibrosis)
  2. Attachment site for cardiac fibers
  3. Separates atrial from ventricular cardiac muscles at AV orifices
  4. Gives rigidity to orifices
52
Q

Identify the chamber of the heart

  • MOSTLY SMOOTH WALLED except for lining of the left auricle (has pectinate muscles)
  • receives 4 PULMONARY VEINS
  • forms MOST OF POSTERIOR SIDE OF HEART
  • anterior wall forms part of interatrial septum and has valance for foramen ovale
A

LEFT ATRIUM

53
Q

What is the site of congenital VSD (ventricular septal defect)

A

MEMBRANOUS part (thin, upper) of INTERVENTRICULAR SEPTUM

54
Q

IDENTIFY condition

  • cusps commonly affected by CALCIUM DEPOSITS in RHEUMATIC FEVER
  • cusps are stuck together and audible as HEART MURMUR
A

BICUSPID/MITRAL Valve incompetency

55
Q

What happens to the valves during diastole and systole

A

DIASTOLE

  1. Both atria contract and both ventricles relax
  2. Tricuspid and bicuspid valves are open
  3. Pulmonic and aortic valves are closed

SYSTOLE

  1. Both atria relax, both ventricles constrict
  2. Tricuspid and bicuspid valves are closed
  3. Pulmonic and aortic valves are open
56
Q

Right coronary arteries supplies (4) and has (4) branches

A

Supplies;

  1. Mostly right side of heart (right atrium and right ventricle)
  2. SA node
  3. AV node
  4. Posterior 1/3rd of interventricular septum

Branches;

  1. SA nodal branch
  2. Marginal artery
  3. AV nodal artery - supplies AV node and AV bundles
  4. Posterior interventricular branch (PDA) - supply right and left ventricle and posterior 1/3rd of interventricular septum
    - anastomose with LAD
57
Q

Left coronary artery supply (3) and (2) branches

A

Supply;

  1. Mostly left side of heart (left atrium and ventricle)
  2. Anterior 2/3rd of interventricular septum
  3. AV (atrioventricular) bundles

Branches ;

  1. LAD (left anterior descending) or anterior interventricular branch
    - supplies both ventricles and anterior 2/3rd of interventricular septum
  2. Circumflex branch
    - supplies left side of heart
58
Q

How can an occluded artery be fixed

A

CABG (coronary artery bypass syndrome)

  1. Occluded artery replaced with vein (usually form leg)
    - vein grafted to aorta at one end and to part of coronary artery not occluded
  2. Internal thoracic artery can be used to supply the heart by being stripped off the anterior thoracic wall but is still attached to the subclavian artery.
    - Artery is attached to the patent (non-occluded) part of the coronary artery
59
Q

Identify procedure

  • A balloon catheter is inserted into the ascending aorta and then into the occluded coronary artery
  • balloon is expanded using dilute contrast media (used normally in visualization of vessels)
A

ANGIOPLASTY

60
Q

Identify the innervation of heart via autonomic nervous system

    • Parasympathetic nerve
    • DECREASE heart rate and force of beat
    • CONSTRICT coronary arteries
    • INCREASE heart rate and force of the beat
    • DILATES coronary arteries
A
  1. Vagus nerve
  2. Sympathetic nerves
  • *
    3. Sensory fibers to heart
  • heart is insensitive to touch and temperature
  • pain fibers sensitive to ischemia
  • enter spinal cord at levels T1-T4 on LEFT SIDE
  • T2 is chest wall and medial aspect of upper arm
61
Q

Where do you listen for valve sounds

A
  1. Tricuspid valve - just to left of sternum near to 5th intercostal space
  2. Mitral valve - apex of heart in left 5th intercostal space (at midclavicular line)
  3. Pulmonary valve - medial end of the left 2nd intercostal space
  4. Aortic valve - medial end of right 2nd intercostal space
62
Q

What are the 5 heart dilatations of the heart and definitive structures

A
  • occurs in day 23
  1. Truncus arteriosus
    - ascending aorta
    - pulmonary trunk
  2. Bulbus cordis
    - ascending aorta
    - pulmonary trunk
    - conus arteriosus (smooth part right ventricle)
    - aortic vestibule (smooth part left ventricle)
  3. Primitive atrium
    - trabeculae part of right atrium -right auricle and anterior wall of pectinate muscles
    - left atrium (left auricle)
  4. Primitive ventricle
    - trabeculae part of right and left ventricle
  5. Sinus venosus
    - smooth part of right atrium (sinus venarum)
    - coronary sinus

MS 1 SF3 Cardiothoracic (2 decks)

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