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Anatomy (TOPNOTCH SUPPLEMENT) > Heart > Flashcards

Heart Flashcards

0
Q

Depends through the mediastinum lateral to fibrous pericardium

A

Phrenic nerve

Pericardiophrenic artery

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1
Q

3 layers of the Pericardium

A
  1. Visceral layer of serous pericardium
  2. Parietal layer of serous pericardium
  3. Fibrous pericardium - fuses with the ff:
    - adventitia of great vessels superiorly
    - central tendon of diaphragm inferiorly
    - sternum anteriorly
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2
Q

Recess between the great arteries & pulmonary veins

A

Transverse sinus

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3
Q

Recess of pericardial cavity

Ends in a cul-de-sac surrounded by pulmonary veins

A

Oblique sinus

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4
Q

Fluid compresses the heart because the fibrous pericardium is inelastic

Paradoxical pulse (inspiratory lowering of systolic BP by >10mmHg)

SVC compression –> facial & neck veins engorgement

A

Cardiac tamponade

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5
Q

Beck’s triad

A

Hypotension (that doesn’t respond to rehydration)

High venous pressure

Distant heart sounds

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6
Q

Pericardiocentesis

STERNAL APPROACH

A

ICS 5 or 6 left side near sternum

Penetrates the ff:

  • skin
  • superficial fascia
  • Pectoralis major
  • external intercostal muscle
  • internal intercostals muscle
  • transverse thoracic muscle
  • fibrous pericardium

Structures at risk:

  • internal thoracic artery
  • coronary arteries
  • pleura
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7
Q

Pericardiocentesis

SUBXIPHOID APPROACH

A

Left infrasternal angle, angled superiorly & posteriorly

Penetrates the ff:

  • skin
  • superficial fascia
  • anterior rectus sheath
  • rectus abdominis
  • transverse abdominis muscle
  • fibrous pericardium
  • parietal layer of serous pericardium

Structures at risk:

  • diaphragm
  • liver
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8
Q

Surfaces of the heart

A

Posterior surface (base): LA

Apex: LV at ICS5, MCL

Sterna surface: RV

Diaphragmatic surface: LV

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9
Q

Borders of the heart

A

R border: RA, SVC

L border: Aortic arch, pulmonary trunk, LA, LV

Inferior border: RV

Superior border: SVC, aorta, pulmonary trunk

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10
Q

Frequency of coronary occlusion in descending order

A

Anterior interventricular artery (L anterior descending artery)

R coronary artery

Circumflex artery

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11
Q

R coronary artery

A

Branches:

  • SA nodal artery
  • R marginal artery
  • AV nodal artery
  • Terminal branches
  • Posterior interventricular artery
  • Septal branches

Structures supplied:

  • RA
  • RV
  • SA node
  • AV node
  • Interventricular septum
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12
Q

L coronary artery

A

Circumflex artery

  • anterior marginal artery
  • obtuse marginal artery
  • arterial branches
  • post marginal artery

Anterior interventricular artery

  • anterior diagonal artery
  • septal branches

Structures supplied:

  • LA
  • LV
  • Interventricular septum
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13
Q

Venous drainage

A

GREAT CARDIA VEIN

  • follows anterior interventricular artery
  • drains into coronary sinus

MIDDLE CARDIAC VEIN

  • follows posterior interventricular artery
  • drains into coronary sinus

SMALL CARDIAC VEIN

  • follows right marginal artery
  • drains into coronary sinus

ANTERIOR CARDIAC VEIN

  • found on anterior aspect of RV
  • drains into directly to RA

SMALLEST CARDIAC VEIN

  • begin within the wall of the heart
  • directly to the nearest heart chamber
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14
Q

Heart valves & Auscultation sites

A

PULMONARY VALVE (semilunar)

  • 3 cusps (R,L, & posterior)
  • L ICS 2, parasternal

AORTIC VALVE (semilunar)

  • 3 cusps (R,L & posterior)
  • R ICS 2, parasternal

MITRAL (left AV valve)

  • 2 cusps (anterior & posterior) tethered to papillary muscle by chordate tendinae
  • cardiac apex, L ICS 5, MCL

TRICUSPID (right AV valve)

  • 3 cusps (anterior, posterior & septal) tethered to papillary muscle by chorda tendinae
  • ICS 5, over the sternum
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15
Q

Conduction system

A

SA node

AV node

Bundle of His

Left & right bundle

Purkinje fibers

16
Q

Pacemaker, just beneath the pericardium, at the junction of SVC & RA

A

SA node

17
Q

Just beneath the endocardium

On the R side of interarterial septum

Near the ostium of coronary sinus

A

AV node

18
Q

Travels in subendocardial layer

On the R side of Interventricular septum

A

Bundle of His

19
Q

Left bundle further divides into thin anterior & thick posterior division

A

Left & right bundle

20
Q

As terminal branches

A

Purkinje fibers

21
Q

Abnormal migration of neural crest cells –> skewed aorticopulmosegment –> R to L shunt –> cyanosis

4 components:

  • pulmonary stenosis
  • RVH
  • overriding aorta
  • VSD
A

Tetralogy of Fallot (TOF)

22
Q

Incomplete fusion of R and L bulbar ridge and AV cushions –> L to R shunt initially –> if uncorrected, ⬆️ pulmonary blood flow –> pulmonary hypertension –> R to L shunt (Eisenmenger complex)

A

Membranous VSD

23
Q

Ductus arteriosus (DA)

Fails to close (connection between L pulmonary artery & aortic arch) –> L to R shunt

DA normally closes within few hours after birth to form the Ligamentum arteriosum

Premature infants
Maternal rubella during pregnancy

Maintains patency: PG E1, asphyxia

Promotes closure:

  • PG inhibitors (indomethacin)
  • ACH
  • histamine
  • catecholamines
A

Patent ductus arteriosus (PDA)

24
Q

MC cause: atherosclerosis

Precipitated by exertion, relieved by rest, <30mins

A

Ischemic heart disease

Angina pectoris

25
Q

Mac cause: atherosclerosis

Complications: CHF, arrhythmia (1st 24 hours)

ECG: ST elevation –> Q waves, inverted T waves

Cardiac enzymes: CK (6-12 hours), Troponin (12 hours), LDH (reversed LDH1:LDH2 ratio 24 horus after)

Treatment & rationale:

  • sublingual nitroglycerin (vasodilator)
  • b-blocker (relieve tachycardia, hypertension)
  • tPA/streptokinase (reduce infrared tissue)
  • atropine (relieve bradycardia)
  • warfarin/heparin (prevent ventricular aneurysm, embolism, DVT)
A

Acute myocardial infarction

26
Q

RV dilatation caused by pulmonary hypertension

Acute - following a large thrombopulmonary embolism

Chronic - due to prolonged obstruction of pulmonary vasculature (e.g. Emphysema)

A

Cor pulmonale

27
Q

Fibrous scarring & calcium nodules

MC affects aortic valve

A

Calcific valve disease

28
Q

Anti-streptococcal antibodies cross-react with heart valves

MC affects mitral valve –> smart, wart-like vegetations (verrucae), “ fish mouth or button hole”, stenosis

Pathognomonic lesion: Aschoff bodies (perivascular, fibrinoid, necrosis-surrounded inflammatory Aschoff cells)

A

Rheumatic heart disease

29
Q

ACUTE

  • S. Aureus (50%), Strep 35%)
  • previously normal valves
  • Large friable vegetations –> septic emboli

SSX:

  • splinter hemorrhages in nail beds
  • Janeway lesions (nontender, palms & soles)
A

Acute infective endocarditis

30
Q

S. Epidermis, S. Viridans, Enterococcus sp.

Gram negative bacilli

Previously abnormal valves

SSX:

  • Rott spots (retinal hemorrhages)
  • Osler nodes (tender, fingers & toes)
  • anemia, hematuria, splenomegaly
A

Infective endocarditis (SUBACUTE)

31
Q

Congenital, accessory conduction pathway

Re-entry loop may develop –> supraventricular tachycardia

A

Wolff-Parkinson-White syndrome

Anatomy (TOPNOTCH SUPPLEMENT) (71 decks)

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