Heart Flashcards
the roof of the right diaphragm and the right lobe of the liver are ______ to both the lower and part of the middle lobe of the right lung.
posterior
Congestion in the right side (right side CHF) leads to:
systemic venous hypertension and systemic edema.
Congestion in the left side (Left side CHF) leads to:
Pulmonary venous hypertension and pulmonary edema
The mediastinum is divided into the superior mediastinum and inferior mediastinum by a horizontal plane through the ______ on the anterior surface and intersecting through the vertebral column at the ______ intervertebral disc.
sternal angle of Louis, T4-T5 intervertebral disc.
The superior mediastinum contains:
The superior mediastinum contains portions of the great vessels, trachea and esophagus as well as major nerves that enter or exit the mediastinum from the neck and upper extremity.
The inferior mediastinum is further subdivided into:
The inferior mediastinum is further subdivided into anterior, middle and posterior regions.
The anterior mediastinum lies between the:
The anterior mediastinum lies between the sternum and pericardial sac
The anterior mediastinum contains:
The anterior mediastinum contains blood vessels, lymphatic structures, and the thymus gland.
the _____ regresses after the juvenile period.
the thymus gland
The middle mediastinum contains the:
The middle mediastinum contains the heart as well as phrenic nerves and pericardiophrenic vessels.
The posterior mediastinum contains
the thoracic portion of the esophagus, descending aorta, and thoracic duct as well as the thoracic sympathetic chain and segmental vessels and nerves.
Note the border between the superior and inferior mediastinum through the:
sternal angle of Louis
The vertebral level is at the T4/5 intervertebral disc
bifurcation of the trachea (and therefore the carina) is approximately in this plane:
sternal angle of Louis
The vertebral level is at the T4/5 intervertebral disc
the left ________ (behind the manubrium) merges with the right _______ vein at the right margin of the _______ in the first intercostal space to form the ________ .
the left brachiocephalic vein (behind the manubrium) merges with the right brachiocephalic vein at the right margin of the manubrium in the first intercostal space to form the SVC.
the arch of the aorta is found at the:
the sternal angle (intervertebral level T4/5)
the branches off the arch of the aorta:
innominate (brachiocephalic trunk) to the right and the left common carotid and left subclavian arteries to the left
the nipple ____ intercostal space in the midclavicular line – dermatome of the ____ thoracic spinal nerve
the nipple (4th intercostal space) in the midclavicular line – dermatome of the 4th thoracic spinal nerve
the right hemidiaphragm can arise as high as:
the nipple (4th intercostal space) in the midclavicular line – therefore a penetrating trauma as high as the nipple or below on the right side can result in abdominal injuries due to the dome shape of the diaphragm
the apex of the _____ of each lung arises in the ___ and is surrounded by the ______ of the pleura
the apex of the superior lobe of each lung arises in the neck and is surrounded by the cupula of the pleura
the border between the _____and ______mediastinum is through the articulation between the manubrium of the sternum and the body of the sternum at the:
the border between the superior and inferior mediastinum is through the articulation between the manubrium of the sternum a nd the body of the sternum at the sternal angle of Louis
On radiographic examination the sternal angle of Louis is found at the vertebral level of the ________
On radiographic examination this landmark is found at the vertebral level of the intervertebral disc between T4 and T5
the left ______ or _______ vein crosses directly behind the ________. It is so superficial that it is runs against the inner surface of the bone.
the left brachiocephalic or innominate vein crosses directly behind the manubrium. It is so superficial that it is runs against the inner surface of the bone.
The _________ merges with the________ at the right margin of the manubrium to form the________ in the _____ intercostal space.
The left brachiocephalic merges with the right brachiocephalic vein at the right margin of the manubrium to form the superior vena cava in the first intercostal space.
the arch of the aorta arises from the ascending aorta at:
the arch of the aorta arises from the ascending aorta at the sternal angle
The 3 great vessels that branch off the arch of the aorta arise posterior to the _________ and posterior to the manubrium.
The 3 great vessels that branch off the arch of the aorta arise posterior to the left brachiocephalic vein posterior to the manubrium.
the innominate artery branching above the right sternoclavicular joint to form the _______ and the _______
the innominate artery branching above the right sternoclavicular joint to form the right common carotid and the right subclavian artery,
The trachea will lie between the two common carotid arteries at the _________
The trachea will lie between the two common carotid arteries at the suprasternal or jugular notch.
The base of the heart is composed largely of the_____
The base of the heart is composed largely of the left atrium
the apex of the heart is where the _______ reaches its termination in the _____ intercostal space near the _______ line.
the apex of the heart is where the interventricular sulcus reaches its termination in the fifth intercostal space near the midclavicular line
The _______ or ______ margin of the heart is formed by the right atrium and right ventricle along the
The right or acute margin of the heart is formed by the right atrium and right ventricle along the
as the heart grows into the mediastinum it invaginates into a ______ sac as seen for the lungs.
serous sac as seen for the lungs.
That portion of the serous membrane intimate with the surface of the heart and a portion of the great vessels is the _________
That portion of the serous membrane intimate with the surface of the heart and a portion of the great vessels is the serous pericardium.
Together with fatty tissue this visceral pericardium constitutes the ______
Together with fatty tissue this visceral pericardium constitutes the epicardium of the heart.
The muscular walls of the chambers are the _______
The muscular walls of the chambers are the myocardium
The remainder of the serous sac is part of the_______ and a thin layer of ______ between the visceral and parietal layer permit movement during beating of the heart
The remainder of the serous sac is part of the parietal pericardium and a thin layer of serous fluid between the visceral and parietal layer permit movement during beating of the heart
The ________ includes an outer, dense fibrous layer as well as the thin serous membrane.
The parietal pericardium includes an outer, dense fibrous layer as well as the thin serous membrane.
Note how the parietal pericardium reflects over_____
Note how the parietal pericardium reflects over the great vessels.
There are spaces in the pericardium where serous fluid can accumulate during _________
There are spaces in the pericardium where serous fluid can accumulate during a pericardial effusion.
_______ is deep to the aorta and pulmonary trunks
Transverse sinus is deep to the aorta and pulmonary trunks
______ is under the apex of the heart and extends to the junction of the parietal and visceral pericardium formed around the pulmonary veins
Oblique sinus is under the apex of the heart and extends to the junction of the parietal and visceral pericardium formed around the pulmonary veins
Manubrium covers the confluence of the ______ to form the _______, the Arch of the Aorta / 3 branches
Manubrium covers the confluence of the Brachiocephalic veins to form the SVC, the Arch of the Aorta / 3 branches
Heart ______side is ______ beneath the sternum
Heart right side is anterior beneath the sternum
Heart ____ side is posterior, left atrium is base - esophagus
Heart left side is posterior, left atrium is base - esophagus
______ divides atria from ventricles
Coronary sulcus divides atria from ventricles
_______ or ______ margin of heart - right sternum
Right or Acute margin of heart - right sternum
______ margin - left side of the heart
Oblique margin - left side of the heart
Valve Auscultation (S2) 2nd intercostal space – \_\_\_\_– \_\_\_\_\_right – \_\_\_\_\_\_\_left
Semilunar – Aorta right – Pulmonary left
Valve Auscultation (S1) 5th intercostal space Atrioventricular – \_\_\_\_\_\_\_\_ midclavicular (Apex) – \_\_\_\_\_\_\_left of Xiphoid
Valve Auscultation (S1) 5th intercostal space Atrioventricular – Mitral midclavicular (Apex) – Tricuspid left of Xiphoid
Pericardial Effusion can produce _______
Pericardial Effusion can produce Cardiac Tamponade
Manubrium covers the confluence of the _______ to form the _____ , the Arch of the Aorta / 3 branches
Manubrium covers the confluence of the Brachiocephalic veins to form the SVC, the Arch of the Aorta / 3 branches
Heart right side is _____ beneath the sternum
Heart right side is anterior beneath the sternum
Heart left side is ______, left atrium is base - esophagus
Heart left side is posterior, left atrium is base - esophagus
________ terminates at the Apex in the _____ intercostal space -midclavicular line
Interventricular sulcus terminates at the Apex in the fifth intercostal space -midclavicular line
_______ sulcus divides atrium from ventricles
Coronary sulcus divides atria from ventricles
Right or Acute margin of heart:
Right or Acute margin of heart - right sternum
Oblique margin:
Oblique margin - left side of the heart
Valve Auscultation: (S2) _______
– Semilunar – ____right – ______ left
Valve Auscultation (S2) 2nd intercostal space – Semilunar – Aorta right – Pulmonary left
Valve Auscultation (S1) \_\_\_\_\_ intercostal space Atrioventricular – \_\_\_\_\_\_\_ midclavicular (Apex) – \_\_\_\_\_\_ left of Xiphoid
Valve Auscultation (S1) 5th intercostal space Atrioventricular – Mitral midclavicular (Apex) – Tricuspid left of Xiphoid
Pericardial Effusion can produce ________
Pericardial Effusion can produce Cardiac Tamponade
key structures in the Right Atrium:
Sinus Venarum, coronary sinus, fossa ovale
Pectinate Muscle, crista terminale
key structures in the Right Ventricle
Trabeculae carnae, papillary muscle, chordae tendinea, tricuspid valve cusps, moderator band
Conus Arteriosus (Infundibulum)
Tricuspid Valve cusps, Pulmonic valve components
Identify key structures in the Left Atrium
Ostia of pulmonary veins, Left auricle
Identify key structures in the Left Ventricle
Trabeculae carnae, myocardium
Mitral valve cusps, Aortic valve components
key structures in the Interventricular Septum
intermuscular septum
inter membraneous septum
correlate coronary arteries with the blood supply of myocardium in each chamber
Capillary blood flow enters venules that join together to form cardiac veins that drain into the coronary sinus located on the posterior side of the heart, which drains into the right atrium. There are also anterior cardiac veins and thesbesian veins drain directly into the cardiac chambers.
Epicardium (including the surface visceral pericardium)
The epicardium is a thin layer of connective tissue and fat, and serves as an additional layer of protection for the heart, and is also considered to be a continuation of the serous pericardium.
Myocardium (the cardiac muscle)
The myocardium is the muscular wall of the heart, or the heart muscle. It contracts to pump blood out of the heart and then relaxes as the heart refills with returning blood. The myocardium’s smooth outer membrane is called the epicardium. Its inner lining is called the endocardium.
Endocardium (continuous with the endothelium of vessels)
The endocardium is the innermost layer of tissue that lines the chambers of the heart. Its cells are embryologically and biologically similar to the endothelial cells that line blood vessels. The endocardium also provides protection to the valves and heart chambers.
Endocardium (inner surface continuous with _______ of veins supplying the heart and arteries exiting the heart)
Endocardium (inner surface continuous with endothelium of veins supplying the heart and arteries exiting the heart)
Myocardium – cardiac muscle required for _____– the intrinsic electrical conducting system coordinates the contraction of this layer
Myocardium – cardiac muscle required for contraction – the intrinsic electrical conducting system coordinates the contraction of this layer
Epicardium – the visceral layer of pericardium filled with _______, the epicardium contains ______ and ________ valleys (sulci) that contain blood vessels of the heart
Epicardium – the visceral layer of pericardium filled with fat, the epicardium contains deep fat covered and fat filled valleys (sulci) that contain blood vessels of the heart
the epicardial fat pad surrounds _________
the epicardial fat pad surrounds coronary vessels in the epicardium
the coronary arteries have _______ that branch into and supply the capillary beds of the _______
the coronary arteries have perforating vessels that branch into and supply the capillary beds of the myocardium
the inner surface of the heart is the ______
the inner surface of the heart is the endocardium
the twisting action of ______ during systole
the twisting action of ventricular contraction during systole. Note also the intercalated discs unique to cardiac muscles.
Place your left index finger straight up as the flagpole.
Then through the _____ and out the _______.
Place your left index finger straight up as the flagpole.
Then through the IVC and out the SVC.
Find the______ to find the ant face with the right atria and ventricle.
Locate the SVC, aorta and PT
Find the______ to find the ant face with the right atria and ventricle.
Locate the SVC, aorta and PT
the differences in ventricular wall thickness – be able to relate these to chamber function
the left ventricle has thicker walls than the right because it needs to pump blood to most of the body while the right ventricle fills only the lungs.
the differences between the tricuspid valve and the aortic valve structure
THE TRICUSPID VALVE HAVE CHORDAE TENINEAE ATTACHED
the differences in the auricles and the sinus venarum for each atria
The sinus venosus is a large quadrangular cavity which precedes the atrium on the venous side of the chordate heart. In mammals, it exists distinctly only in the embryonic heart (where it is found between the two venae cavae); however, the sinus venosus persists in the adult. In the adult, it is incorporated into the wall of the right atrium to form a smooth part called the sinus venarum, also known as the venarum sinus, which is separated from the rest of the atrium by a ridge of fibres called the crista terminalis. The sinus venosus also forms the SA node and the coronary sinus.
the differences in the trabeculae carnea of the ventricles and the relatively smaller and smoother atria
are rounded or irregular muscular columns which project from the inner surface of the right and left ventricles of the heart.[1] These are different from the pectinate muscles, which are present in the right atrium and the atrial appendages of the heart.
Identify the ______(‘comb”) muscles of the right atrium (the muscles resemble the tines of a hair comb
parallel ridges in the walls of the atria of the heart. They are so-called because of their resemblance to the teeth of a comb as in pecten. Behind the crest (crista terminalis) of the right atrium the internal surface is smooth. Pectinate muscles make up the part of the wall in front of this, the right atrial appendage.
crista terminalis (terminal crest) of those muscles (that resemble the handle or back of the comb).
represents the junction between the sinus venosus and the heart in the developing embryo. In the development of the human heart, the right horn and transverse portion of the sinus venosus ultimately become incorporated with and forms a part of the adult right atrium where it is known as the sinus venarum.
The relatively smooth area on the wall of the right atrium is formed by the confluence of the ____and _____veins - it is the ________
The relatively smooth area on the wall of the right atrium is formed by the confluence of the IVC and SVC veins - it is the sinus venarum.
the ________ is in the interatrial septum.
the oval fossa (fossa ovalis) in the interatrial septum.
The _______ (also known as ________ ) is a conical pouch formed from the upper and left angle of the right ventricle in the chordate heart, from which the pulmonary trunk arises. It develops from the bulbus cordis.
The infundibulum (also known as conus arteriosus) is a conical pouch formed from the upper and left angle of the right ventricle in the chordate heart, from which the pulmonary trunk arises. It develops from the bulbus cordis.
The _______ muscles contract to restrain the prolapse of leaflets in the _______
The papillary (“nipple shaped”) muscles contract to restrain the prolapse of leaflets in the AV valves
_____ muscles are attached to the valve cusps with chordae tendineae (tendinous cords).
papillary muscles are attached to the valve cusps with chordae tendineae (tendinous cords).
In the right ventricle there are 3 cusps in the tricuspid valve: _____ , _____ or ________ cusps
In the right ventricle there are 3 cusps in the tricuspid valve: septal, anterior or posterior cusps
The _________ (“funnel”) or _________ (“arterial cone”) is the funnel shaped outlet of the right ventricle that leads through the _______ semilunar valve to the elastic pulmonary trunk that in turn branches into the pulmonary arteries.
The infundibulum (“funnel”) or conus arteriosus (“arterial cone”) is the funnel shaped outlet of the right ventricle that leads through the pulmonic semilunar valve to the elastic pulmonary trunk that in turn branches into the pulmonary arteries.
The _________ (‘wall”) is the internal wall dividing the two ventricles. It is mostly muscular but also has a small membranous component near the upper border with the atria.
The interventricular septum (‘wall”) is the internal wall dividing the two ventricles. It is mostly muscular but also has a small membranous component near the upper border with the atria.
The _________ band or moderator band is a kind of specialized band of the ________ that bridges the right ventricle from the septal wall to the marginal wall of the chamber. This band allows a pathway for the intrinsic conduction system of the heart to take a short cut to reach the marginal wall of the heart.
The septomarginal band or moderator band is a kind of specialized band of the trabeculae carneae that bridges the right ventricle from the septal wall to the marginal wall of the chamber. This band allows a pathway for the intrinsic conduction system of the heart to take a short cut to reach the marginal wall of the heart.
the consequences of Congestive Heart Failure on the Right vs. Left side of the Heart
Left-sided heart failure is the most common type of heart failure. Left-sided heart failure occurs when the left ventricle doesn’t pump efficiently. The blood backs up into your lungs instead, which causes shortness of breath and a buildup of fluid.
Right-sided heart failure usually triggered by left-sided heart failure. The accumulation of blood in the lungs caused by left-sided heart failure makes the right ventricle work harder. This can stress the right side of the heart and cause it to fail. Right-sided heart failure can also occur as a result of other conditions, such as lung disease.
Heart failure is also classified as either diastolic or systolic.
the leaflets of each AV valve are attached to a ________ that surrounds the valve
the leaflets of each AV valve are attached to a fibrous ring that surrounds the valve
The valves are anchored by a right and left _____ that forms the skeleton of the heart
The valves are anchored by a right and left fibrous trigone that forms the skeleton of the heart
The right AV or tricuspid valve forms from 3 cusps or leaflets: ____(1), ____(2) and ____(3).
The right AV or tricuspid valve is formed from 3 cusps or leaflets: anterior (1), posterior (2) and septal (3).
The left AV or bicuspid valve is formed from 2 leaflets or cusps: ____(1) and _____(2)
The left AV or bicuspid valve is formed from 2 leaflets or cusps: anterior (1) and posterior (2)
Both the aortic and pulmonary valves each have 3 semilunar cusps. The 2 valves make a figure 8.
Both the ____and ______ valves each have 3 semilunar cusps. The 2 valves make a figure 8.
The ______ valve is most anterior so it will have Anterior, left and right semilunar cusps
The pulmonary valve is most anterior so it will have Anterior, left and right semilunar cusps
The ______ valve is most posterior so it will have Posterior, left and right semilunar cusps.
The aortic valve is most posterior so it will have Posterior, left and right semilunar cusps.
Note also the ______ of the LCA behind the left aortic cusp and the _______ of the RCA behind the right aortic cusp. These are located in the aortic sinus formed by the cusp.
Note also the ostium (“mouth”) of the LCA behind the left aortic cusp and the ostium of the RCA behind the right aortic cusp. These are located in the aortic sinus formed by the cusp.
Semilunar Valves are ______ during Ventricular Filling
Semilunar Valves are Closed during Ventricular Filling
AV valves are normally passively ______ during Diastole for Ventricular Filling
AV valves are normally passively Open during Diastole for Ventricular Filling
Pulmonic valve position moves ______ and aortic valve ______,
Pulmonic valve position moves anterior and aortic valve posterior
left & right coronary a. origin at ______ behind left and right aortic valves
left & right coronary a. origin at ostia behind left and right aortic valves
AV Leaflets, passive and ______ during ventricular filling,
open
AV inflated with blood at onset of systole, held by _____muscles / ______
inflated with blood at onset of systole, held by papillary muscles / chordae tendinae
systole
Onset of contraction AV valves inflate with blood - S1 (1st heart sound), AV valves close,
______ prevent prolapse of tricuspid and mitral valve
papillary muscles prevent prolapse of tricuspid and mitral valve
________ opens semilunar valves, blood ejection into elastic arteries - pulmonary trunk and aorta
ventricular pressure opens semilunar valves, blood ejection into elastic arteries - pulmonary trunk and aorta
End of contraction, elastic artery recoil - S2 (2nd heart sound), ________
End of contraction, elastic artery recoil - S2 (2nd heart sound), Semilunar valves close
diastole: _______filling
Ventricular filling
diastole: AV valves _____ for ventricular filling, Semilunar valves _____
AV valves open for ventricular filling, Semilunar valves closed
_______ (“crown valley”) is the atrioventricular groove. It is a valley filled with fat that encircles or crowns the heart and carries the crown or coronary arteries and the reservoir that drains all 3 cardiac veins, the coronary sinus.
coronary sulcus (“crown valley”) is the atrioventricular groove. It is a valley filled with fat that encircles or crowns the heart and carries the crown or coronary arteries and the reservoir that drains all 3 cardiac veins, the coronary sinus.
The ______(valley between the ventricles) is also a fat filled valley filled with branches of the coronary arteries supplying the interventricular septum including the intrinsic conducting Purkinje fibers within the bundle of His as well as the veins draining the interventricular septum.
The interventricular sulcus (valley between the ventricles) is also a fat filled valley filled with branches of the coronary arteries supplying the interventricular septum including the intrinsic conducting Purkinje fibers within the bundle of His as well as the veins draining the interventricular septum.
________ (the “widow maker”) (left artery in the crown – it typically supplies the most ventricular territory)
Left coronary Artery (the “widow maker”) (left artery in the crown – it typically supplies the most ventricular territory)
_________ – as the name implies it encircles the heart in the coronary sulcus
circumflex arteries – as the name implies it encircles the heart in the coronary sulcus
_________ as the name implies it descends in the anterior interventricular sulcus
left anterior descending (LAD) (anterior interventricular artery) – as the name implies it descends in the anterior interventricular sulcus
_______– as the name implies it descends in the posterior interventricular sulcus. If the _____is derived from the RCA then the heart is said to be right dominant (the more common pattern) – if instead the circumflex branch supplies the _____the heart is said to be left dominant (the less common pattern).
– (posterior interventricular artery) – as the name implies it descends in the posterior interventricular sulcus. If the PDA is derived from the RCA then the heart is said to be right dominant (the more common pattern) – if instead the circumflex branch supplies the PDA the heart is said to be left dominant (the less common pattern).
the ______ often provides the blood supply to the SA node and also to the AV node via a branch of the posterior descending artery, the SA nodal artery may arise from either the LCA or the RCA but often arises from the RCA.
the RCA often provides the blood supply to the SA node and also to the AV node via a branch of the posterior descending artery, the SA nodal artery may arise from either the LCA or the RCA but often arises from the RCA.
The cardiac veins include:
the great cardiac vein, the middle cardiac vein, the small cardiac vein, anterior cardiac veins
all of the veins draining blood from the myocardium combine to form a venous reservoir – the ______
all of the veins draining blood from the myocardium combine to form a venous reservoir – the coronary sinus.
– the coronary sinus chamber of cardiac veins empties into the _____
This confluent chamber of cardiac veins empties into the right atrium.
Cardiac Veins drain Coronary Sinus
Great – with _____
Middle – with ______
Small – with _______
Cardiac Veins drain Coronary Sinus
Great – with LCA - LAD/Cx
Middle – with PDA
Small – with Right Marginal
LCA (emerges from _____ in L. Aortic Sinus) artery beneath left auricle
LCA (emerges from ostia in L. Aortic Sinus) artery beneath left auricle
RCA (emerges from _____ in R. Aortic Sinus) artery beneath right auricle
Right Marginal – most right side
PDA – Post 1/3 IV septum
RCA (emerges from ostia in R. Aortic Sinus) artery beneath right auricle
Right Marginal – most right side
PDA – Post 1/3 IV septum
Coronary Arteries encircle the heart within the ____ – between Atria & Ventricles
Coronary Arteries encircle the heart within the Coronary Sinus – between Atria & Ventricles
