Exam I - Lecture IV (🫀Anatomy, Valve Diseases) Flashcards
How many parts does the mediastinum have? Name them.
Which is where the heart is located?
4️⃣
1. Superior
2. Anterior
3. ❤️ Middle - heart located here
4. Posterior
(latter 3 considered Inferior Mediastinum)
14:15
We have ____ layers of pericardium. Includes (#) ______ layer(s) and (#) _____ layer(s).
What two nerves come off the heart and drive the diaphragm? 🫁
3; 2 parietal layers and 1 visceral layer. 15:30
Phrenic nerves. 16:30
*Schmidt said he didn’t expect us to memorize this stuff but I trust no one.
This view is showing us which view of the mediastinum?
Posterior view.
*He pointed out descending aorta and pulmonary artery and veins and some of the airway.
17:45
The vagus nerve allows for _____ input which without, our HR would be ____bpm resting.
Parasympathetic (PSNS) input, 110 bpm resting.
19:00
The right vagus nerve connects with the _____ node and the left vagus nerve connects with the _____ node.
They tell the nodes to slow down or speed up?
Right: SA node
Left: AV node
(think anatomically)
Slow down! Its the PSNS :)
18:30
What does ‘serous’ indicate?
What are the 3 pericardial layers in order from internal to external?
And what is in between the heart and the first layer?
Serous - ‘thin and slippery’, stretchy
1) Serous, visceral pericardium 2) Serous, parietal pericardium 3) Fibrous pericardium
Mucous lies between to halt friction and ease movement.
19:30
The serous, parietal pericardium is STRONGLY attached to the outer, fibrous pericardium.
T/F?
What does the toughness of the outer layer (Fibrous pericardium) prevent?
True!
Helps prevent too much filling or expansion of the ‘container’ incase of fluid buildup between layers.
*it can prevent adequate filling (cardiac tamponade)
21:10, Slide set 4
What tendon does the heart sit on?
The central tendon in the middle of the diaphragm.
*the heart moves up and down with the diaphragm bc it’s attached to it
23:00
The ______ ______ is a remnant of the ______ ______ we have in fetal life that later serves to attach the aorta and pulmonary trunk.
During fetal life, this is open to shunt blood from where to where?
ligamentum arteriosum, ductus arteriosis
Via the ductus arteriosis, blood bypasses the lungs (not needed in the womb) and shunts from the aorta to the pulmonary artery.
*if this doesnt close (normally days after birth) it is called a patent ductus arteriosis (PDA)
23:40
What does this criss-cross pattern allow the heart to do?
Basically squeeze in a twisting motion - like wringing a wet towel - to eject blood.
25:15
The AV valve on the L heart is the ______.
The cuffs of the valves are anchored to the ventricles by papillary muscles or chordae tendineae?
What do they prevent the valve from doing?
Bicuspid/Mitral valve.
Both :)
‘Bowing’ out into the atrium during systole.
26:00
Your patient has LV dilation (larger & thinner), what do you expect from the AV valve?
The anchors and valve will be stretched and not close correctly probably causing mitral regurgitation.
27:50
What % of the population has a tricuspid Aortic valve?
99%
*1-2% has a Bicuspid Aortic valve.
Goes undetected, but could cause problems in 40s-50s.
*Miller (book) says ppl will need this replaced at some point.
31:00
Where do the left and right coronary arteries receive blood flow from?
The aortic valve, one from the right aortic cusp and one from the left aortic cusp.
32:40
What is the name for the aortic cusp that has no coronary artery involvement?
The NCC or Non-Coronary Cusp on the aortic valve.
Also referred to as the posterior cusp.
34:50
Coronaries are perfused when the aortic valve is ______ and during ______.
Reduced coronary perfusion can happen if your aortic valve doesn’t do what properly?
closed, diastole
If it does not close properly. The cusps act as ‘little bowls’ and catch blood in back flow to fill the coronaries.
34:00
What is the purpose of the cartilaginous ring?
What’s its significance in heart sounds?
Who is most affected by this phenomena? and why?
Serves as an electrical insulator for the top and bottom half of the heart. ⚡️
It vibrates/rattles and creates the 3rd heart sound (end of filling) in response to lower compliance & increased blood return.
Pediatric patients bc their hearts are not as accommodating to extra volume.
BEWARE to not fluid overload them!!!
35:20
In response to compensation to increased venous return, pediatric patients will increase ____ while adults will increase ____.
Peds: increase HR (less compliant)
Adults: increase SV
37:10
The right ventricle has thinner walls.
The tricuspid valve tends to have fewer problems than the mitral why?
The mitral valve is against more pressure than the tricuspid.
38:00
The LCA splits into 2 arteries. The _____, that runs down the front of the heart and feeds the _____, and the ____ that runs around the back side of the heart and feeds the ____.
Which vessel is considered the ‘Widow Maker’? 🕷️
Left Anterior Descending artery (LAD), LV; Left Circumflex artery, LV (posterior side)
The LAD is considered the ‘Widow Maker’.
39:00
The RCA feeds the posterior descending artery (PDA) in ___% of people.
The LCA feeds the PDA in ___%. Why is this not ideal?
These % are based on what factor?
85% (this is good)
15% (this is not so good) bc it is subjected to higher pressures.
Based on whether you are R or L coronary dominant.
40:30
The left AV valve (Mitral) is a bicuspid valve but sort of has a third cusp…
What is the name of the cusp labeled ‘1’? What is it technically a portion of?
Commissural cusp. It is a portion of the posterior cusp.
38:50
Flow is related to difference in pressures (Delta P). T/F?
True!
42:55
What 2 pressures drive coronary blood flow?
Aortic pressure and LV wall pressures.
43:00
Low wall pressure make is more difficult to perfuse the coronaries. T/F?
How are wall pressures produced? Where is the highest wall pressure found?
False!
Low wall pressures = easier to fill coronaries, High wall pressures = harder time filling.
The chamber pressure.
Highest: LV this is why you see more L heart ischemia
44:00
List the auscultation sites.
Which is easiest to hear?
How would you want to listen to achieve optimal sound?
Where is the Tricuspid auscultation site?
A, P, T, M
(🤑All Physicians Take Moneeeyyy…lolz or APe To Man 🐵)
Aortic - easiest to hear and coincidently most often where the problems are.
Listen in the direction of blood flow through the valve.
Left 5th ICS
46:00
Pitch is measured in _____.
What is the range of audibility in humans?
The 1st heart sound ‘LUB’ is ____ sec and has _____ pitch.
The 2nd ‘DUB’ is ___ secs and has ____ pitch.
Measured in Hertz.
(LOW) 20Hz - 20KHz (HIGH)
*less able to hear high pitched sounds as we age (1/2 it or more @ 80yrs)
1st: 0.14 sec, low pitch
2nd: 0.11 sec, higher in pitch
47:45
Name the systolic murmurs. (6)
Which is the loudest?
- Aortic stenosis
- pulmonic stenosis
- mitral regurgitation
- tricuspid regurgitation
- patent ductus arteriosus (both systolic and diastolic)
- VSD (from book)
Aortic stenosis is loudest.
54:00
Name the diastolic murmurs. (5)
Which is confused with an atrial kick?
- mitral stenosis
- tricuspid stenosis
- aortic regurgitation
- pulmonic regurgitation
- Patent ductus arteriosus (both systolic and diastolic)
Mitral stenosis can be confused with an atrial kick.
*Schmidt said ‘id expect to hear more noise at the start of diastole’ but the drawing doesn’t show that…
55:00
When would you expect to see a lot of coronary perfusion?
When do you see retrograde coronary flow? (sucked out of coronary artery)
Which artery is most affected?
Middle of diastole/’Diastasis’. (large delta P)
Start of systole. *notice red line (vent pressure) above dotted line (aortic pressure).
LCA is most affected.
64:00
Why is there a spike at the start of diastole for coronary bf? (2 factors)
1) Bc the vents have very low pressure d/t being almost empty = Low wall pressure
2) coronaries are wide open bc they haven’t seen perfusion for awhile
*this chart is an average of both coronaries
83:30
Why do you see a continuous flow in the RCA?
When does retrograde happen? and why in the LCA?
Bc the RV exerts way less wall pressure than the LV allowing the RCA to continuously perfuse.
It happens at beginning of ejection to the LCA. Happens bc the pressures are so high.
86:00
What shift in the PV loop would accompany mitral stenosis?
What type of axis deviation would you expect on an ECG? Why?
A left shift.
-lower volumes in LV at no added pressure
Right axis deviation.
bc R heart is hypertrophied from working so hard! 🏋🏻
89:30
Why do we have enhanced LV filling with mitral regurgitation?
With each beat, we have retrograde flow into the LA. This adds to the normal venous return thus producing a higher stroke volume.
100:15
What can you do to reduce mitral regurgitation?
What if they are in ENDSTAGE mitral regurg?
Give afterload reducers (drugs or IABP) &/or ⬆️ HR (~80-90 bpm = less time in systole)
*AVOID BRADYCARDIA = longer time in systole.
ENDSTAGE: be cautious bc you can reduce BP too much.
105:20
During aortic regurgitation, how many cc can the LV see up to?
What shift would you see on the PV loop?
~200cc
Right shift.
110:00
What is Concentric hypertrophy in the heart.
The actin and myosin increase in number which creates a thicker wall.
*this also makes the ventricle less compliant
120:00, Guyton Ch. 23
What type of hypertrophy would you expect to see with aortic regurgitation?
Eccentric LVH - dilated bc it is being filled from two places.
“Series arrangements of sarcomeres”
121:20, Guyton Ch. 23
What type of hypertrophy would you expect to see post MI (cardiac remodeling) or with congenital cardiomyopathy?
Eccentric hypertrophy.
122:00
In relation to concentric LVH, the circled region of the graph is significant why?
It shows the increased pressure/preload needed to fill the LV (during diastole) bc of the concentric (thickening) hypertrophy with aortic stenosis.
*pressure ⬆️ >4mmHg
123:45
The arrow from C –>E portrays what?
Decreased compliance - it takes more pressure to fill.
expect to see with Concentric Hypertrophy
125:00
