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Med 2: Cardio > Goal 2: Pericardium > Flashcards

Goal 2: Pericardium Flashcards

1
Q

Describe the location of the pericardium. What is behind it? What’s in front of it?

A
  • front: sternum body, 2-6th coastal cartilages

- behind: T5-T8

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2
Q

What are the two types of pericardium?

A
  • outer- fibrous

- inner- serous— parietal layer and visceral layer

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3
Q

What is the transverse sinus? What is the surgical significance of the transverse sinus?

A
  • transverse passage between tubular reflections of serous pericardium, lined by visceral layer ONLY
  • CABG- clamp arterial and venous ends during surgery
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4
Q

What sinus is found between parietal and visceral layers of pericardium? This sinus is closed at all sides except?

A
  • oblique sinus

- except below

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5
Q

From what artery does the internal thoracic artery arise from?

A

Subclavian artery

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6
Q

List artery path starting from the subclavian artery. (Pericardium)

A
  • subclavian
  • internal thoracic
  • pericardiocophrenic
  • musculophrenic and internal thoracic arteries
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7
Q

What arteries are located in the visceral layer of pericardium?

A

Coronary arteries

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8
Q

If the brachiocephalic vein is ligated, what vein is at risk?

A

Pericardiacophrenic

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9
Q

From center of heart to the outside, what nerves are there?

A

-in to out: recurrent laryngeal, vagus, phrenic

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10
Q

Pain is felt at dermatones C3-C5 in relation to the heart. What nerve is possibly the cause? Where is dermatone C3-C5?

A
  • phrenic nerve

- top of shoulder, ipsilateral supraclavicular region

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11
Q

Where do you hear pericardial friction rubs? What do you hear? What causes this?

A
  • with stethoscope, over the left sternal border and upper ribs
  • rustle of silk
  • inflamed pericardium, causes chest pains
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12
Q

Patient has fluid in their pericardium. What is this called? Why is this bad?

A
  • pericardial effusion

- can’t fully expand heart when it pumps

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13
Q

What is cardiac tamponade? Why is it life threatening? How is it treated?

A
  • excess fluid in pericardial cavity
  • compresses heart and doesn’t allow it to pump properly. Decreases heart’s CO and increase venous pressure
  • pericardiocentesis
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14
Q

Where is the needle inserted to perform a pericardiacentesis?

A

-left subcostal angle, through the left 5th or 6th intercostal space by sternum

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15
Q

What part of the mediastinum is the pericardium located?

A

Middle mediastinum

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16
Q

The cardiac cycle starts with what and end with what?

A
  • starts with diastole- filling

- ends with systole- emptying or contracting

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17
Q

What are the 3 layers of the heart CHAMBERS?

A
  • endocardium: thin internal, connective tissue
  • myocardium: thick, middle- cardiac muscle
  • epicardium: thin external, visceral layer
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18
Q

What chamber of the heart does the apex mostly comprise of? Base?

A
  • apex: left ventricle

- base: partly right and left ventricle

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19
Q

If a bullet went through the right parasternal border ABOVE the 3rd rib, what structure will get hit?

A

SVC

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20
Q

If a bullet went between the 3rd and 6th right ribs, what structure will get hit?

A

right atrium

21
Q

If a bullet went through the left parasternal border between the 3rd and 5th ribs, what structure will get hit?

A

Right ventricle

22
Q

If a bullet went through the left para stern Al border at the 2nd intercostal space, what structure will get hit?

A

Left atrium

23
Q

What structure increases the right atrium’s capacity to hold more blood?

A

Right auricle

24
Q

Where would you find the foramen ovale in a fetus?

A

At the interstitial septum

25
Q

What structures comprise the right ventricle?

A

Traveculae carneae: irregular muscular elevations

26
Q

What is the purpose of papillary muscles? What connects these muscles to the valves?

A
  • prevent valve prolapse

- chordae tendinae

27
Q

The superior part of this marks the SA node and it runs from IVC to SVC.

A

Crista terminalis

28
Q

What is S1 and S2? Which comes first?

A
  • S1: mitral and tricuspid closing
  • S2: semilumar valves
  • S1 first and then S2
29
Q

Which heart valves have 3 cusps? Which have 2?

A
  • 3: tricuspid, aortic, pulmonic

- 2: bicuspid

30
Q

Describe the location of where to auscultate the septic valve, pulmonic, tricuspid, and bicuspid.

A
  • aortic: upper right sternum border, 2nd ICS
  • pulmonic: upper left eternal border 2nd ICS
  • tricuspid: left 5th ICS at sternal Border
  • bicuspid: left 5th ICS, near midclavicular line, at apex
31
Q

What does the RCA supply? LCA?

A
  • RCA: right atrium and ventricle, part of left ventricle and iv septum (posterior third), some SA and AV node
  • LCA: left atrium and ventricle, most of the IV septum, AV bundle, some SA node
32
Q

What are the two main branches from the LCA?

A

-LAD and circumflex arteries

33
Q

What causes angina pectoris? What symptoms do you see? Explain why the pain sensation is the way it is.

A
  • not enough blood flow to the myocardium
  • left arm shoulder or neck pain, weakness, dizziness, short of breath
  • heart pain expressed from sensory sympathetic cardiac nerve to T1-T5 but at the LEFT dorsal root ganglion, hence the left sided pain
34
Q

What causes a complete heart block? When does necrosis start to set in?

A
  • thrombus or embolus formation

- 20-30min after occlusion

35
Q

What vessel is known as the “widow maker” and why?

A
  • LAD

- supplies 2/3rds of the anterior IV septum (needed to move both ventricles)

36
Q

What are the main 2 vessels used in CABGs? Why are these vessels used?

A
  • great saphenous vein (leg)
  • internal mammary artery (chest)
  • a lot of elastic tissue and less chance of reocclusion
37
Q

What vessels all drain into the coronary sinus?

A
  • great cardiac vein
  • middle cardiac vein
  • small cardiac vein
  • left posterior ventricular vein
  • left marginal vein
  • anterior cardiac veins
  • venae cordis minimae/Thebesian veins
38
Q

What are the parasympathetic and sympathetic innervations of the conduction system of the heart?

A
  • Parasympathetic: Vagus and

- Sympathetic: T1-T5

39
Q

Where is the SA node and what vessel supplies it? What’s another name for SA node? Where is the AV node and what vessel supplies it?

A
  • SA: aka pacemaker of heart, find in upper part of crista terminalis (bottom of SVC), RCA supplies it
  • AV: find between opening of coronary sinus and septal cusp of tricuspid valve, RCA supplies it too
40
Q

What’s at the end of the Bundle of His?

A

Purkinjie fibers aka subendocardial plexus

41
Q

What forms the superficial cardiac plexus? Deep cardiac plexus? Where do you find them?

A
  • Superficial: left superior cervical sympathetic ganglion and lower cervical cardiac branch of left vagus nerve—find below arch of aorta and in front of right pulmonary artery
  • deep: branches of both left and right cervical sympathetic ganglia (EXCEPT left superior), upper 4 or 5 thoracic sympathetic ganglia, both vagus—in front of bifurcation of the trachea
42
Q

What are the sympathetic and parasympathetic of the heart?

A
  • symp: preganglionic from T1-T4/T5, postganglionic at upper cervical/thoracic ganglia
  • para: vagus
43
Q

What is the ONLY route for impulse form the atria to ventricles? If this is broken, what happens? What’s the treatment?

A
  • AV node
  • if broken, slows heart rate without impulse
  • need pacemaker to set heart rate needed to live
44
Q

What congenital defect of the heart can cause you to not auscultate the heartbeat at the left side of thorax?

A

Dextrocardia

45
Q

To start counting the ribs, where do you start from?

A
  • At the sternal angle (where sternum body and manubrium meet)
  • sternal angle= second rib
46
Q

At what vertebrae level is the arch of aorta?

A

T4

47
Q

For CABGs, what do they do to the great saphenous vein when used as a graft and why?

A

-they have to flip the vein the opposite way since it has valves!

48
Q

What vein runs with right marginal branch of the right coronary artery?

A

Small cardiac vein

49
Q

What artery runs with the great cardiac (anterior inter-ventricular) vein?

A

Anterior interventricular branch (LAD) of the left coronary artery

Med 2: Cardio (11 decks)

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