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Cardiopulmonary Renal > Gross Anatomy > Flashcards

Gross Anatomy Flashcards

1
Q

Where Is the heart located?

A

The heart is in the middle pericardium surrounded by the pericardium

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2
Q

Why does the pericardium consist of 3 layers?

A
  • limits acute cardiac dilation
  • assists atrial filling
  • mechanical and anti-friction protection
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3
Q

What is the structure-function of the outer fibrous layer of the pericardium?

A

Restrictive and attached to surrounding structures
-Superiorly to the adventitia of the great vessels

  • inferiorly to the central tendon of the diaphragm (cardiophrenic ligament)
  • Anteriorly to the sternum (sternopericardial ligaments)
  • To the bifurcation of the trachea (bronchopericardial membrane)
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4
Q

What is the structure-function of the inner serous level of the pericardium?

A
  • parietal (lines the fibrous)

- visceral (syn. Epicardium)

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5
Q

What is the structure-function of pericardial cavity of the pericardium?

A

Filled with small amount of serous fluid

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6
Q

What is the arterial supply of the pericardium?

A
  • pericardiophrenic (from internal thoracic)
  • musculophrenic (from internal thoracic)
  • inferior phrenic
  • thoracic aorta
  • coronary (visceral serous)
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7
Q

What is the veinous drainage of the pericardium?

A
  • Azygos
  • Internal thoracic
  • Superior phrenic
  • Cardiac (visceral serous)
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8
Q

What is the innervation of the pericardium?

A
  • phrenic nerve- somatic pain (fibrous only)
  • vagus- parasympathetic
  • sympathetic chain- sympathetic
  • cardiopulmonary- visceral afferents
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9
Q

How are sinuses formed?

A

At the posterior aspect of the pericardial SA the serous pericardium reflects on itself forming sinuses

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10
Q

Where is the transverse sinus located?

A

Transverse sinus: this space could be entered to place a clamp around the proximal aorta and pulmonary trunk

Anterior: Aorta and pulmonary trunk

Posterior: superior vena cava

Superior: right pulmonary artery

Inferior: atria

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11
Q

What is the oblique sinus of the heart?

A

A cul-de-sac formed where the serous pericardium reflects onto the pulmonary sinus

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12
Q

What does the heart rest on?

A

The heart rests on the diaphragm and haas the shape of an inverted cone

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13
Q

What are the borders of the heart?

A

Left and right: synchronous with pulmonary surface

Obtuse margin: between with left pulmonary and anterior surface

Inferior border: between the anterior and diaphragmatic surfaces

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14
Q

Where is the right ventricle of the heart located?

A

Right ventricle directly posterior to the sternum

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15
Q

What is the location of left atrium?

A

The left atrium lies immediately anterior to the esophagus

  • Sharp objects if swallowed can penetrate the left atrium
  • Enlargement of the left atrium can cause difficulty swallowing (dysphagia)
  • Transesophageal ultrasound
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16
Q

What is pericardial effusion?

A

Fluid accumulation in the pericardial cavity beyond the normal 30-50 ml

May be slow or rapid

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17
Q

What are the possible causes of pericardial effusion?

A
  • Systemic inflammatory conditions (connective tissue disease)
  • Metastasis
  • Hypothyroidism
  • Renal disease
  • Infection
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18
Q

What are the symptoms of pericardial effusion?

A
  • Dyspnea
  • Reduced exercise tolerance
  • Eventually progress to impaired cardiac function
  • May develop into tamponade
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19
Q

What is a cardiac tamponade?

A
  • Impaired cardiac output due to an accumulation of fluid, pus, gas, blood, or tissue in the pericardial space
  • Pulses paradoxus: exaggerated fall in systolic blood pressure (10 mmHg) during inspiration
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20
Q

What is the Beck’s triad of pericardial effusion?

A
  1. Increased pressure outside the heart decreases end-diastolic ventricular filling —> decreased stroke volume —> lower systolic blood pressure
  2. Increased pressure reduces end-systolic atrial filling capacity—> rapid increase and higher pressure in atria —> increased pressure in and distension of the jugular veins
  3. Increased fluid—> reduced heart sounds
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21
Q

How is cardiac tamponade treated?

A

Pericardiocentesis:
1. Paraxiphoid approach - tip of xiphoid, or between xiphoid and left costal margin, angled towards left shoulder

  1. Apical approach- left 5th or 6th intercostal space
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22
Q

Where does the right atrium receive blood from?

A

-SVC, IVC & coronary sinus

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23
Q

What is the function of the crista terminalis?

A

A muscular ridge (crista terminalis) separates the smooth posterior part atrium from the area roughened by the pectineus muscles

24
Q

What is the fossa ovalis?

A

The interatrial septum has an oval depression (fossa ovalis)

25
Q

What are the structures of the right atrium ?

A
  • crista terminalis
  • interatrial septum has an oval depression(fossa ovalis)
  • openings for smallest cardiac veins
26
Q

Describe the internal structure of the right ventricle

A
  • Wall is thinner than left
  • Cavity is larger than left
  • Moderator band connects the interventricular septum to the anterior papillary muscle and contains (Purkinje fibers) from right bundle branch
  • Infundibulum is smooth
27
Q

Describe the structure of atrioventricular valves

A
  • Attached to the fibrous skeleton of the heart
  • Each cusp connected to 2 papillary muscles
  • As the ventricles fill with blood (during diastole) the cusps “float” closed
  • During ventricular contraction, the papillary muscles hold the cups closed
  • During ventricular contraction, the papillary muscles hold the cups closed to avoid eversion into the atria
28
Q

What are the semilunar valves?

A
  • pulmonary

- aortic

29
Q

Describe the aortic semilunar valve

A

Right, left and posterior cups

  • two coronary cusps -associated with the Ostia of a coronary artery
  • aortic sinuses (of Valsalva) fill after ventricular contraction closing valves and simultaneously filling coronary arteries
30
Q

Describe the pulmonary semilunar valve

A

Right, left and anterior

-no associated vessels

31
Q

Where are heart valves located?

A

Heart valves are all located posterior to the sternum

32
Q

What are auscultation sites?

A

Sites of greatest sound projection

33
Q

What is the auscultation site of the aortic valve?

A

Right sternal border at 2nd intercostal space

34
Q

What is the auscultation site of the pulmonary valve?

A

Left costal border at 2nd intercostal space

35
Q

What is the auscultation site of the tricuspid valve?

A

Left sternal border at 5th intercostal space

36
Q

What is the auscultation site of the mitral valve?

A

5th left intercostal space in midclavicular line

37
Q

When does the atria contract in relation to ventricles?

A

Atria contracts 1/6th of a second before the ventricles

All parts of the ventricles contract almost simultaneously

38
Q

What is a Conduction system ?

A

Specialized cardiac muscle cells insulated from surrounding myocardium

Initiates and coordinates contraction- unidirectional

39
Q

What are the components of the conduction system?

A
  • Sinoatrial node(pacemaker)- at the junction of the SVC and right atrium
  • Atrioventricular node- in the atrioventricular septum close to the opening of the coronary sinus
  • Atrioventricular bundle- membranous part of interventricular septum
  • Left and right bundle branches (and their fascicles)- in the muscular portion of the interventricular septum and respective ventricular walls around the apex
  • Purkinje fibers- specialized cells in the ventricular walls and papillary muscles
  • Electrical activity can be detected with an ECG monitor
40
Q

What splachnic nerves are part of the visceral efferent?

A

Preganglionic sympathetic from T1-4(5) enter the sympathetic chain via grey rami communicants—> postganglionic sympathetic cervical and upper thoracic chain ganglia

These form splachnic nerves which join with cardiac branches to form cardiac plexus

41
Q

Where are cardiac branches formed by? What do they then form?

A

Preganglionic parasympathetic from vagus form cardiac branches then combines with splachnic nerves to form the cardiac plexus

Functions for visceral efferent of the heart

42
Q

What are the divisions of the cardiac plexus?

A

Two divisions:
1. Superficial part around the great vessels (Ligamentum arteriosum)

  1. Deep part, posterior to the left atrium (anterior to tracheal bifurcation)

There are small branches to the heart structures

Both of these affect heart rate, force of contraction and cardiac output. By influencing the conduction system, coronary vessels and myocardium.

43
Q

What is the role of cardiac branches in the visceral afferents?

A

Detect changes in blood pressure and body chemistry (aortic body and sinus) —> cardiac plexus—> cardiac branches to vagus —> goes to brain for regulation through the visceral efferent system

44
Q

What is the role of splachnic nerves in the visceral afferents?

A

Detect/indirect tissue damaging events- visceral pain—> cardiac plexus—> splachnic nerves via sympathetic to spinal cord —>(1 possible destination) refferred to somatic body region- refferred pain (other posssible destination)

45
Q

What is refferred pain?

A

Pain from ischemia or other noxious stimuli are transmitted via visceral afferents that pass through the cardiac plexus

Visceral afferents travel with the sympathetics to the spinal nerves soft corresponding levels

  • Enter the spinal cord between T1-4 spinal cord levels (have their cell bodies in the dorsal root ganglion)
  • Visceral pain is diffuse and refferred to the upper thoracic and medial arm
  • The intercostobrachial nerve connects the T2 spinal nerve with medial cutaneous nerve of the arm,/forearm
46
Q

What does the left coronary artery supply?

A

Supply:
-anterior 2/3 of interventricular septum

  • majority of left ventricle
  • majority of left atrium
  • AV bundle and brancges
47
Q

What does the anterior interventricular artery go and anastomoses ?

A

Anterior inter-ventricular May wrap around the apex and anastomose with the posterior interventricular

48
Q

What is dominance?

A

There is much variation in the coronary arteries and what they supply

Dominance
-determines which of the coronary arteries is responsible for the majority of supply

  • origin of the posterior interventricular artery
  • Significance for the supply of the conduction system
49
Q

What are the Branches of the right coronary artery and their accompanying vein?

A

Branch: SA node- accompanying vein: small cardiac vein

Branch: right marginal- accompanying vein: right marginal vein

Branch: posterior interventricular accompanying vein: middle cardiac vein

50
Q

What are the branches and accompanying veins of the left coronary artery?

A

Branch: anterior interventricular circumflex- accompanying vein- great cardiac vein

51
Q

What are the causes of chest pain?

A

Myocardial infarction

Pleural pain

Intercostal pain

Pericardial pain

52
Q

What are the features of the myocardial infarction?

A

Severe chest heaviness or pressure for over 20 minutes, sweating, clenched fist (Levine sign) crushing pain radiating to the arm, nausea

53
Q

What are the features of pleural pain?

A

Preceding pneumonia, pulmonary embolism, or viral respiratory infection. Acute sharp pain with breathing, coughing, or movement

54
Q

What are the features of intercostal pain?

A

Sharp pain in the thorax unilaterally worsens with chest wall movements including breathing

55
Q

What are the features of pericardial pain?

A

From pericarditis

Continuous central chest pain which can radiate to both shoulders but maybe alleviated by sitting forward

Cardiopulmonary Renal (35 decks)

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