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Anatomy > EXAM3_G22_Middle_Mediastinum > Flashcards

EXAM3_G22_Middle_Mediastinum Flashcards

1
Q

Sternal angle creates what line? That separates the mediastinum into what regions?

A

Transverse thoracic plane

Superior and inferior regions

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2
Q

The mediastinum is divided into superior and inferior regions by the__________, the inferior region is further subdivided into what three regions?

A

Transverse thoracic plane
Anterior
Middle
Posterior

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3
Q

What are the contents of the middle mediastinum?

A

Pericardial Sac (fibrous and serous)
Heart
Roots of the great Vessels

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4
Q

The pericardial sac consists of two layers _________.

A

Fibrous- Pericardiacophrenic ligament

Serous- Parietal and Visceral pleura and pericardial cavity

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5
Q

The Fibrous pericardium makes up the ?

A

Pericardiacophrenic Ligament

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6
Q

The Serous Pericardium makes up the???

A
  1. Parietal and Visceral Pleura
  2. Pericardial Cavity :
    (Serous pericardial cavity filled with fluid cushion around entire heart)- has a parietal and visceral portion- but the cavity is the lake between the two
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7
Q

What is the Pericardial Cavity?

A

The serous filled pericardial space (lake) between the visceral pericardium and the parietal pericardium.

It’s the serous cushion of the heart

Serous pericardium is surrounded by fibrous pericardium

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8
Q

What is the ligament that attaches the pericardium to the diaphragm?

A

Pericardiacophrenic Ligament made by Fibrous pericardium

- limits filling capacity of heart and has a tough outer layer

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9
Q

What are the two pericardial sinuses?

A
  1. Transverse pericardial sinus (aorta/pulmonary trunk)

2. Oblique pericardial sinus (IVC/pulmonary veins)

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10
Q

What can surgeons use to block outflow of the great vessels?

A

Use Transverse pericardial sinus to clamp

between Aorta/Pulmonary trunk

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11
Q

The potential space closed by the serous pericardium contains _____ amount of serous fluid for ______.

A

10-50ml of serous fluid for Lubrication

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12
Q

Pericarditis is the inflammation of pericardium that results in friction between _______ and _____ that sounds like walking on snow

A

Visceral and parietal serous pericardium

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13
Q

What is it called when you have excess fluid in the pericardium (over 10-50mL of serous fluid). What is bad about it?

A

Pericardial EFFUSION

  • restricts full expansion of heart
  • reduces cardiac volume and output
  • Veins engorge and circulation fails eventually
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14
Q

What is applied pressure called?

A

Tamponade (tampon-ade) gross

  • Restricts cardiac volume and output
  • veins engorge and circulation fails eventually
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15
Q

What is the procedure to drain excess pericardial fluid?

Where is this done?

A

Pericardiocentesis

  • Left 5th or 6th intercostal space near sternum or
  • Infrasternal angle left of Xiphoid
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16
Q

Where are the two places you can perform a pericardiocentesis?

A
  1. LEFT 5th or 6th intercostal space NEAR STERNUM

2. INFRASTERNAL ANGLE (left of xiphoid)

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17
Q

What supplies blood to the pericardium?

What is innervation?

A

Bilateral:

  1. Pericardiacophrenic Artery (from Internal thoracic a.)
  2. Pericardiacophrenic Vein (drains into brachiocephalic v.)
  3. Innervated by Phrenic nerve
  4. Sensory from fibrous & parietal pericardium
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18
Q

Where does pericardiacophrenic artery come from and supply?

A

Internal thoracic artery to pericardiacophrenic a. and supplies the pericardium

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19
Q

What does the pericardiacophrenic artery drain and where does it drain into?

A

Drains blood from pericardium into the brachiocephalic v.

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20
Q

What nerve innervates the pericardium?

A

Phrenic nerve (bilaterally)

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21
Q

Where does sensory of pericardium come from?

A

Fibrous & parietal pericardium

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22
Q

Pericardial (diaphragmatic) pain is referred to the skin of what dermatomes?

A

Dermatomes 3,4,5 of ipsilateral side (RIGHT ARM PAIN)

right ear, neck, arm

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23
Q

What are the three tissues that make up the Heart Wall?

A
  1. EPICARDIUM (visceral pericardium)
  2. MYOCARDIUM (cardiac muscle)
  3. ENDOCARDIUM (endothelium + CT)
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24
Q

Where is the landmark for the apex of the heart?

A

LEFT 5th intercostal space
-handwidth from midsternal line-
this is the site to auscultate the apex beat

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25
Q

The base of the heart is formed mainly by the ______. What does it receive?

A

Left Atrium

receives blood from lungs via 4 pulmonary veins

26
Q

What is the landmark for the Base of the heart?

A

Posterior at T6-T9 vertebral Levels

- Receives 4 pulmonary veins (blood from the lungs)

27
Q

What are the four surfaces of the heart?

A
  1. Right pulmonary (mainly right atrium)
  2. Left pulmonary (mainly left ventricle)
  3. Anterior (sternocostal)- mainly right ventricle
  4. Inferior (diaphragmatic) - mainly left ventricle
28
Q

Anterior (sternocostal) surface of the heart is mostly

A

right ventricle

29
Q

Right pulmonary surface of the heart is mostly

A

Right Atrium

30
Q

Left pulmonary surface of the heart is mostly

A

left ventricle

31
Q

Inferior (diaphragmatic) surface of the heart is mostly

A

left ventricle

32
Q 
In an AP radiograph- 
Right border is mainly
Inferior border is mainly
Superior border is mainly
Left border is mainly
A

RB= Right atrium
IB- Right ventricle
SB-PERICARDIAL SINUS & left atria
LB- Left Ventricle

33
Q

In systole the ventricles squeeze/empty making a LUB sound. The Aortic semilunar valves and the Pulmonary semilunar valves ________. While the sound is being made as the ______ and _______ valves _________.

A

Aortic/Pulmonary semilunar valves open during systole

Bicuspid/Tricuspid valves CLOSE during systole which creates the LUB sound.

34
Q

At the end of Systole the ____ sound is heard, Indicating that the _________ valves have opened and the _______ valves have closed.

A

DUB sound indicates Atrial/Pulmonary SL valves CLOSED

this also means the AV valves are opened and blood is filling the ventricles

35
Q

What two valvular diseases cause pumping inefficiency?

A
  1. STENOSIS (failure of valve to open fully- slow flow)

2. INSUFFICIENCY (Prolapse)- Failure to close=backflow

36
Q

Mitral valve prolapse

A

leaflets enlarge (floppy)= edge slips into atrium during systole

Blood flows back into left atrium and causes a murmur sound which can be auscultated

37
Q

A murmur sound of the Mitral valve indicates

A

mitral valve prolapse- as blood flows back into the atrium during systole

38
Q

Where do you listen to Aortic and pulmonary valves?

A

2nd Intercostal Space

  • Aortic (right of sternum)
  • Pulmonary (Left of sternum)
39
Q

Where do you listen to Tricuspid and Bicuspid Valves?

A

5th intercostal Space

  • Tricuspid (left of sternum)
  • Bicuspid (Midclavicular line)
40
Q

Fibrous skeleton of the heart anchors _______ and _____. Four fibrous rings are made by _______ which acts like an _______ to allow atria to contract separately from ventricles.

A

anchors Myocardium and valves

4 rings of DENSE CT act like ELECTRICAL INSULATOR

41
Q

Sinu-Atrial (SA) node is located where?

A

Junction of SVC & Right Atrium

  1. initiates impulse (atrial contraction)
  2. ^ rate via sympathetics v rate via parasympathetics
  3. “Pacemaker” of heart
42
Q

Atrioventricular (AV) node function? location?

A

delays impulse

- in Right atrium (by fossa ovalis)

43
Q

AV bundle (of HIS) located?

A

located in fibrous skeleton

44
Q

Purkinje fiber location?

A

Ventricular wall and in moderator band

45
Q

Conduction system 1-6

A
  1. SA (ATRIA CONTRACT)
  2. AV
  3. AV bundle of His
  4. RL bundle branches
  5. purkinje fibers in moderator band
  6. purkinje fibers in ventricular wall
    (VENTRICLES CONTRACT @ APEX)
46
Q

What supplies the blood to epicardium and myocardium?

When do the arteries fill?

A

coronary arteries
-derived from ascending aorta
-fill during ventricular diastole
(high pressure when aortic semilunar valves close and backflow into the coronary arteries)

47
Q

what artery supplies SA node? where does it come from?

A

SA nodal artery from right coronary artery

up and over right atrium

48
Q

What artery supplies the right ventricle but doesn’t reach the apex?

A

Right marginal artery

49
Q

What warps postero-inferiorly to the diaphragmatic surface and supplies the AV node?

A

AV nodal artery from the RCA

50
Q

What supplies the diaphragmatic side of ventricles and IV septum?

A

Posterior interventricular artery from the RCA

51
Q

What can lead to disruption of the normal heart rhythm?

A

RCA Stenosis “heart block”

52
Q

What artery branches to become the Circumflex artery and left marginal artery?

A

LCA (runs posterior to pulmonary trunk; covered by left auricle)

53
Q

What are two supplies of blood for left ventricle?

A 
Circumflex artery (from LCA)
Left Marginal Artery (from LCA)
54
Q

What supplies blood to the sternocostal side of ventricles, interventricular septum, and apex of the heart?

What does it have potential to anastomose with? where?

A

Anterior Interventricular artery or LAD

  • can potentially anastomose with posterior IV artery near apex
55
Q

Right v Left Dominant heart (what more common?)

A

Right 65% - RCA >PIVa.

(left 25%)- LCA > PIVa

56
Q

Where does blood drain in the heart?

Where located?

A

Coronary Sinus that drains into right atrium
Wide venous channel on postero-inferior side of heart

  • Thick turd Underneath heart- drains next to IVC
57
Q

What parallels LAD & Circumflex artery?

A

Great cardiac vein (sternocostal surface)

58
Q

What parallels posterior interventricular artery?

A

Middle cardiac vein (diaphragmatic surface)

59
Q

What parallels right marginal artery?

A

Small cardiac vein (sternocostal surface)

60
Q

What drains into the right lymphatic duct?

A

Lymph from LEFT VENTRICLE

61
Q

What drains into thoracic duct?

A

Lymph from RIGHT VENTRICLE

Anatomy (24 decks)

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