Heart anatomy Flashcards
What is the coronary sulcus and what does it contain?
The coronary sulcus is also known as the atrioventricular sulcus and separates the atria from the ventricles.
In this groove one can find the right coronary artery, circumflex branch of left coronary artery, coronary sinus and the great cardiac vein.
What are the anterior interventricular sulcus and posterior interventricular sulcus? What do each contain?
Anterior interventricular sulcus - divides the ventricles on the anterior side
Contains: left anterior descending artery (branch of left coronary artery), great cardiac vein
Posterior interventricular sulcus - divides the ventricles on the posterior side
Contains: right posterior descending: posterior interventricular artery - brnach of right coronary artery, middle cardiac vein.
Describe the pulmonic, aortic, mitral and tricuspid valves
Pulmonic - right
- has a left, right, and anterior flap
- most anterior
Aortic - behind and left
-has a left right and posterior flip
——both of these valves have a semilunar nodule——–, these close up the little hole that would form from three convex shapes coming together
Mitral - posterior left, and only an anterior and posterior flap
Tricuspid - posterior right, an anterior and posterior flap and also a SEPTAL VALVE.
What is the normal auscultation points for aortic valve and pulmonic valve?
(listen downstream)
Aortic valve - between left ventricle and ascending aorta
- 2nd intercostal space at the right sternal margin
- above the heart and on the right, with no bone covering
Pulmonic valve - between right ventricle and pulmonic trunk
-2nd intercostal space at the left sternal margin
What is the normal auscultation points for the tricuspid and mitral valves?
Tricuspid valve (between right atrium and right ventricle) -downstream is right ventricle which is anterior wall of heart, that is covered by sternum so you have to go just left, at the 5th intercostal space.
Mitral valve (between left atrium and left ventricle) -downstream is left ventricle which is also 5th intercostal space at the mid-clavicular line, 3&1/2 inches from sternum.
What would aortic stenosis and pulmonic stenosis sound like and where would you listen for it?
Aortic/ pulmonic stenosis - you would hear it when the outflow tracts are open which is during systolic.
AV valves would close, outflow tracts open (blood flows through - murmur) and then aortic valve closes (dub)
LUB - pshhh - DUB: systolic murmur
Aortic stenosis: Listen at where the aortic valve is which is on the right 2nd intercostal space.
Pulmonic stenosis: Listen at where the pulmonic valve is which is at the left 2nd intercostal space
What would aortic and pulmonic regurgitation sound like and where would you listen to it?
Regurgitation is heard after the valves close. They close during diastolic.
So LUB-DUB-pshhh
Aortic regurgitation: flowing from aorta to left ventricle - left ventricle is heard at left 5th subcostal space at the midclavicular line
Pulmonic regurgitation: flowing from pulmonary trunk to the right ventricle
-right ventricle is heard at the left 5th subcostal space at the sternal margin.
What would mitral and tricuspid stenosis sound like and where would you hear it?
Mitral and tricuspid stenosis murmur would be heard when the valves open.
They open during diastolic.
They open after the outflow tracts close (DUB)
LUB-DUB-pshhhh
Mitral stenosis - would be at the left ventricle so left 5th intercostal space at the midclavicular line
Tricuspid stenosis - would be at the right ventricle so left 5th intercostal space at the left sternal margin
What would mitral and tricuspid regurgitation sound like and where would you hear it?
unique postions;;;
Mitral and tricuspid regurgitation murmur would be heard when they close.
They close during systolic.
LUB -pshhh - DUB
Mitral regurgitation: blood would flow into the left atrium. Left atrium can be heard at the axilla.
Tricuspid regurgitation: blood would flow into the right atrium. Right atrium can be heard at the RIGHT 5th intercostal space at the sternal margin.
Describe the structure of the right atrium.
Three major things drain into the right atrium:
SVC, Coronary sinus, and IVC (including valves for all three)
It has a rough wall portion (pectinate muscle) and a smooth wall part. Formed by incorporation of the sinus venarum
-separation between pectinate and smooth is the crista terminalis.
The atrial septum separates right and left atrium.
The fossa ovalis (oval shaped depression with a sharp edged upper border (limbus),
Tricuspid valve leading to right ventricle.
What is the structure of the right ventricle (and describe prolapse)
The tricuspid valve is attached to papillary muscle via Chorda tendinae.
Its rough muscle portion is called the trabeculae carnae. The smooth muscle part is called the infundibulum.
There is also a septomarginal trabeculae (moderator band) which connects the right ventricle septum to the base of the papillary muscle)
Prolapse: blood forces the tricuspid valve open. If there was damaged papillary muscles that didn’t contract when the ventricle contracts or damaged chorda trabeculae, then the valve would rise, invert and open again during ventricular contraction, (leading to regurgitation)
Describe the structure of the left ventricle and left atrium.
The septum has two parts, a muscular portion and membranous portion.
The left atrium is only smooth wall and pulmonary veins drain into it.
For the mitral valve there is a posterior and anterior papillary muscles.
Each cusp is attached to more than one muscle and each papillary muscle is attached to more than one cusp.
Describe the aortic valve
Three members of the aortic valve (right, left, posterior).
There are aortic sinuses. When blood flows up the aortic sinus, it forces the valve open by pushing the cusps into the aortic sinuses.
During diastolic, the blood wants to come back but they fill the sinuses and prevents the backflow.
IN the right and left aortic sinuses are small openings, that lead to the right and left coronary arteries which supply the myocytes in the wall of heart via capillaries.
Describe the coronary arteries - including anastomoses
Lets begin with the right coronary artery as it begins its journey from the right side of the aorta.
It gives branches to the SA node and then the marginal artery which supplies only the right ventricle.
As it travels in the coronary sulcus it will wrap around behind the heart.
At the back of the heart, it will give off the posterior interventricular artery (aka posterior descending artery) ———-in right dominance——–
Form the left side of the aorta, comes off the left coronary artery which goes into the coronary sulcus and is called the circumflex artery.
The coronary artery branch descends in the anterior wall and is known as the anterior interventricular artery. (left descending artery) - most commonly occluded
LEFT AND RIGHT ANASTOMOSE at the posterior left side of the heart between the left circumflex and right coronary artery + the posterior interventricular artery and the anterior interventricular artery.
Describe the venous drainage of the heart itself.
Small middle (right) and great cardiac vein (left) all drain into the coronary sinus on the posterior wall of the heart between left atrium and left ventricle.
Anterior cardiac veins drain directly into the right atrium. (don’t use coronary sinus)
Least cardiac veins (drain directly into the chamber. (they go from the surface directly into underlying chamber)
*so some blood is going into the left chambers meaning blood is not purely oxygenated.
