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HS Exam 2 > Heart and Mediastinum > Flashcards

Heart and Mediastinum Flashcards

1
Q

what forms the right and left boarders of the cardiac shadow

A

right boarder- SVC, RA, IVC

left boarder- AA, LV, pulmonary trunk

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2
Q

what chamber of the heart is most anterior

A

right ventricle

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3
Q

what chamber is most posterior

A

left atrium

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4
Q

where is the apex of the heart on the chest surface

A

ICS 5, medial to midclavicular line

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5
Q

if a clot blocks the circumflex branch of the left coronary artery, what area of heart musculature will be ischemic

A

part of the left ventricle

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6
Q

what is in the mediastinum?

A 
heart
esophagus
trachea
great vessels
thoracic duct
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7
Q

what are the divisions of the mediastinum

A

superior
anterior
posterior
middle

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8
Q

where is the superior mediastinum?

A

superior to the sternal angle line up to thoracic aperture

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9
Q

what is in the superior region of the mediastinum

A 
brachioecphalic veins
upper SVC
aortic arch and branches
thoracic duct
esophagus
trachea
upper thymus
vagus nerve
recurrent laryngeal nerves
phrenic nerve
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10
Q

where is the inferior region of mediastinum? what regions are in it?

A

inferior to the sternal angle

divided by the pericardium into anterior, posterior and middle regions

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11
Q

where is the anterior region of mediastinum?

A

anterior to pericardium

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12
Q

what is in the anterior region of mediastinum?

A

lower thymus
fat
lymph nodes
connective tissue

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13
Q

where is the posterior region of mediastinum?

A

posterior to pericardial sac

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14
Q

what is in the posterior region of mediastinum

A 
esophagus
thoracic aorta
azygous
hemiazygous
thoracic duct
vagus nerve
sympathetic nerves
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15
Q

where is the middle region of mediastinum?

A

pericardial sac

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16
Q

what is in the pericardial sac?

A 
pericardium
heart
roots of great vessels
arch of azygous vein
main bronchi
phrenic nerves
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17
Q

what is the pericardium?

A

double walled sac containing the heart and great vessels

located around the middle region of the mediastinum

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18
Q

what are the two layers of pericardium

A

fibrous pericardium- outer tough layer

serous pericardium- inner smooth lining

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19
Q

what are the layers of the serous pericardium?

A

parietal serous- lines fibrous pericardium

visceral serous- covers the heart

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20
Q

visceral serous layer is the equivalent of the

A

epicardium

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21
Q

where is the pericardial cavity and what is in it

A

between the parietal and visceral serous layers

contains serous fluid

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22
Q

where are the parietal and visceral pericardium continuous

A

roots of great vessels

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23
Q

what are sternopericardial ligaments

A

connect the fibrous pericardium to the posterior sternum

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24
Q

what are the pericardiophrenic ligaments

A

connects fibrous pericardium to central tendon of diaphragm

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25
Q

what is the role of the fibrous pericardium

A

prevents heart from over filling

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26
Q

describe each layer of the heart wall

A

epicardium- visceral pericardium
myocardium- cardiac muscle
endocardium- endothelium and sub endothelium CT that covers valves

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27
Q

what is the blood supply of the parietal layer?

A

pericardiacophrenic artery

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28
Q

where does the pericardiacophrenic artery come from and go to?

A

branch of internal thoracic artery and runs with the phrenic nerve

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29
Q

what is the venous drainage of the parietal layer of pericardium?

A

pericardiaphrenic vein

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30
Q

what does the pericardiacophrenic vein drain into?

A

brachiocephalic or internal thoracic veins

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31
Q

what is the fibrous pericardium fused to and what effect does it have

A

fused to outer layer of great vessels, posterior surface of sternum, central tendon of diaphragm
influenced by the movements of the heart, great vessels, sternum, and diaphragm

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32
Q

what supplies the visceral layer of pericardium?

A

coronary artery and branches from descending aorta

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33
Q

what drains the visceral layer of pericardium

A

coronary vein and coronary sinus tributaries

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34
Q

what forms pericardial sinuses

A

intersection of visceral and parietal layers at the roots of great vessels

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35
Q

what are the two pericardial sinuses

A

transverse and oblique

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36
Q

where is the transverse pericardial sinus and how is it formed

A

anterior to SVC, posterior to aorta and pulmonary trunk

formed by the arterial and venous ends of the heart tube coming together

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37
Q

what is good about the transverse pericardial sinus?

A

place to tie ligatures and insert tubes during surgery

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38
Q

where is the oblique pericardial sinus and how is it formed?

A

between the pulmonary veins

formed by vein expansion, pushing a pericardial reflection out around them

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39
Q

do the pericardial sinuses touch

A

no

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40
Q

what is pericarditis

A

inflammation of pericardium due to infection or a systemic illness

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41
Q

what causes pericardial rub

A

friction between the layers of the pericardium due to inflammation

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42
Q

what is a pericardial effusion and what does it cause

A

fluid from pericardial capillaries getting into the pericardial cavity
causes cardiac tampanade- heart can’t fill because the fibrous pericardium doesn’t stretch

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43
Q

what is a pericardiocentesis

A

removing fluid from the pericardial space by inserting a needing into the bare area at ICS5

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44
Q

what is hemopericardium?

A

blood in the pericardial cavity

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45
Q

what causes hemopericardium?

A

stab wound
weak area of heart muscle
bleeding from cardiac operations

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46
Q

what are the components of the fibrous skeleton of the heart

A

4 fibrous rings (annuli fibrosa) around each valve
2 fibrous trigone- ring connections
3 membranous septums- interarterial, interventricular, atrioventricular

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47
Q

what is the function of the fibrous skeleton of the heart?

A

myocardium attachment
keeps valves open and prevents overextension
attachment for leaflets and valve cusps
electrical insulation
AV bundle goes through to get signal to the ventricles

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48
Q

what structures form the right boarder of the heart?

A

superior vena cava
right atrium
inferior vena cava

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49
Q

what structures form the left boarder of the heart

A

aortic arch
pulmonary trunk
left ventricle

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50
Q

what is the superior boarder of the heart

A

atria and auricles

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51
Q

what is the inferior boarder of the heart

A

IVC
RV
LV

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52
Q

what is the width of a normal heart

A

less than the width from the midsternal line to the lateral rib line

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53
Q

where does the heart sit relative to the midsternal line?

A

1/3 on right

2/3 on left

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54
Q

blood flow through the heart

A
  1. SVC and IVC empty into RA
  2. RA pumps through tricuspid valve to RV
  3. RV pumps through pulmonary valve to pulmonary trunk
  4. pulmonary veins return blood to LA
  5. LA pumps through mitral valve to LV
  6. LV pumps through aortic valve to aorta
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55
Q

where is the tricuspid valve and where can it be auscultated

A

posterior to sternum body at ICS 5 and 6

listen left side of sternum at ICS 4 or 5

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56
Q

what are the cusps of the tricuspid valve

A

anterior
posterior
septal

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57
Q

what is the role of the cordae tendinae and papillary muscles

A

contraction of the papillary muscles during RV contraction holds the valve closed to prevent back flow

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58
Q

where is the pulmonary valve and where can it be listened to

A

left costal cartilage 3

listen at upper left of sternum at ICS 2

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59
Q

what are the cusps of the pulmonary valve

A

semilunar valve- anteiror, left, right

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60
Q

where do the valves sit when open

A

against pulmonary artery

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61
Q

how does the pulmonary valve prevent backflow

A

when blood comes back, the valves close and form pockets preventing back flow

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62
Q

what is the pulmonary sinus

A

little pocket superior to pulmonary valve that holds blood to prevent the cusps of the pulmonary valve from sticking to the wall

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63
Q

where is the mitral valve and where is it listened to

A

posterior to sternum at ICS 3/4

listend to left of sternum at ICS 5

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64
Q

what are the cusps of the mitral valve

A

anteiror and posterior

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65
Q

where is the aortic valve and where can it be listened to

A

posterior sternum at ICS3

right of sternum at ICS2

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66
Q

what are the cusps of the aortic valve

A

semilunar valve
anterior- right and left
posterior- in the back

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67
Q

what is the lunule

A

midpoint of the cusps of the aortic valve that come together in the center when the valve is closed

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68
Q

what is the aortic sinus

A

dilation in the aorta superior to the valve

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69
Q

what comes immediately off of of the aorta

A

coronary arteries

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70
Q

what is apex beat

A

max point of pulsation against the anterior thoracic wall

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71
Q

where are the auscultation locations relative to the heart valves?

A

downstream of the valve location

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72
Q

valve stenosis

A

stiff valve doesn’t open all the way resulting in hypertrophy of the chamber before it

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73
Q

valve incompetence (regurgitation)

A

incomplete valve closure resulting in blood moving backward into the previous chamber during contraction

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74
Q

what is the most commonly diseased valve?

A

mitral

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75
Q

what are auricles for?

A

located on the superior portion of atria, used to increase capacity if ncessary

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76
Q

what is the sinus venarum?

A

smooth posterior right atria chamber wall

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77
Q

what is the pectinate muscle?

A

rough musculature anterior right atria wall

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78
Q

what is the sulcus terminals?

A

external groove separating separating anterior and posterior atria wall

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79
Q

what is the crista terminales

A

internal vertical ridge separating smooth and rough atrial wall

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80
Q

what vessels empty into the RA?

A

IVC
SVC
coronary sinus

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81
Q

what separates the right and left atrium?

A

internal septum

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82
Q

what and where is the fossa ovalis

A

depression left from the closure of the foramen oval during development (hole between the atria)
located in the internal septum

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83
Q

what are the 5 differences between the left and right atria?

A 
smaller
thicker walls
4 pulmonary veins empty into it
mostly smooth walls
valve is bicuspid
84
Q

what is the cornosus arteriosus?

A

superior, leads to pulmonary trunk in the right ventricle

85
Q

what is the trabecular carneae?

A

irregular muscular ridges in the right ventricle

86
Q

what chambers are papillary muscles and chord tendinae in?

A

ventricles

87
Q

what separates the ventricles

A

interventricular septum

88
Q

what is the septomarginal trabeculae

A

muscular bundle stretching from the inter ventricular septum to the anterior papillary muscle and carries the righ bundle branch of the av bundle

89
Q

moderator band

A

septomarginal trabeculae

90
Q

cornosus arteriosus

A

infundibulum

91
Q

how is the left ventricular different from the right ventricle?

A

thicker walls
bicuspid valve- 2 papillary muscles
aortic valve

92
Q

what are the muscular ridges called in the right atria vs ventricles

A

atria- pectinate muscle

ventricle- trabeculae carneae

93
Q

what is the aortic vestibule

A

superoanterior area of LV leading to aortic surface

94
Q

which ventricle has more trabecular carneae?

A

left

95
Q

what supplies blood to the myocardium and epicardium?

A

coronary arteries

96
Q

where do the left and right coronary arteries come from?

A

aorta- first branches off from aortic sinus

97
Q

where does the right coronary artery run

A

in the coronary sulcus (atrioventricular groove)

98
Q

what are the branches of the right coronary artery and where do they go

A

sianonodal branch- SA node
right marginal branch- right heart boarder, runs toward apex
posterior inter ventricular branch- runs in posterior inter ventricular groove toward apex, supplies ventricles

99
Q

what forms the anastamosis of the heart and where

A

RCA with the circumflex and inter ventricular branches of the LCA

100
Q

where does the left coronary artery run

A

off of left aortic sinus

goes between the left auricle and pulmonary trunk to run in coronary groove

101
Q

what are the branches of the LCA and where do they go

A

left circumflex branch- around left boarder to posterior side gives off left marginal branch that supplies LV
anterior inter ventricular branch- goes along inter ventricular septum and supplies both ventricles and the septum

102
Q

what do the cardiac veins drain into?

A

coronary sinus or directly into right atrium

103
Q

where is the coronary sinus?

A

runs left to right in the posterior coronary groove

receives blood from great, middle, and small cardiac veins

104
Q

where is the great cardiac vein

A

from apex and comes up with the anterior inter ventricular artery from the LCA
wraps around the left heart

105
Q

where is the middle cardiac vein

A

travels with posterior inter ventricular artery o f the RCA

106
Q

where is the small cardiac vein

A

runs with right marginal artery of the RCA

107
Q

where are the anterior cardiac veins and what do they drain into

A

begin at anterior right ventricle and empty into the right atrium directly

108
Q

what is coronary artery disease

A

occlusion of coronary artery caused by atherosclerosis leading to inadequate oxygen to myocardium

109
Q

myocardial infarction

A

myocardial necrosis and severe chest pain that does not go away

110
Q

angina pectoralis

A

arterial constriction leading to oxygen deficiency and pain that is alleviated with rest (pain only during activity)

111
Q

what vein is used for a coronary artery bypass graft?

A

great saphenous vein

112
Q

what is coronary angioplasty

A

balloon catheter inserted and inflated to stretch open an occluded artery

113
Q

path of cardiac conducting system

A

SA node-> AV node-> bundle of his->right bundle branch-> left bundle branch -> purkinje fibers

114
Q

what is the SA node

A

pacemaker located under the epicardium between the SVC and RA that generates impulses

115
Q

what is the AV node

A

interventricular septum near the coronary sinus that gets a signal from the SA node after a delay and sends the signal to the ventricles via the bundle of His

116
Q

what is the bundle of His

A

bridge between atrial and ventricular myocardium that passes through the fibrous skeleton along the inter ventricular septum

117
Q

what are the left and right bundles

A

split of the bundle of his on either side of the inter ventricular septum that lead to purkinje fibers

118
Q

what are purkinje fibers

A

take the impulse into the ventricular walls

119
Q

where are the right purkinje fibers

A

IV septum muscle
anterior papillary muscle
right ventricular wall

120
Q

where are the left purkinje fibers

A

IV septum
anterior and posterior papillary muscles
left ventricular wall

121
Q

what can compress the esophagus

A

aortic arch
left main bronchus
where the esophagus goes through the diaphragm

122
Q

where are the phrenic nerve and pericardiacophrenic vessels

A

anterior to the root of the lung between the mediastinal pleura and pericardium

123
Q

where does the pleura transition from parietal to visceral?

A

root of the lung

124
Q

what structures are on the right of the mediastinum

A 
thymus
right brachiocephalic vein
superior vena cava
trachea
right vagus and phrenic nerves
esophagus
thoracic duct
azygous
thoracic splanchnic nerves
125
Q

what structures are on the left side of mediastinum

A 
thymus
left brachocephalic
arch of aorta
left vagus and phrenic nerves
thoracic duct
esophagus
thoracic aorta
esophageal plexus
thoracic splanchnic nerves
126
Q

what are the great vessels

A

aorta
pulmonary trunk
superior/infereior vena cava
4 pulmonary veins

127
Q

what is the ligamentum arteriosum

A

connects the aortic arch to the left pulmonary artery

128
Q

where does the left vagus nerve pass over

A

crosses over the left side of the aortic arch and then passes behind the left pulmonary arter

129
Q

where is the left recurrent laryngeal nerve

A

off of the vagus nerve, inferior to the aortic arch and posterior to the ligamentum arteriosum

130
Q

which heart boarders are easily seen on a chest radiograph

A

right
inferior
left

131
Q

where is the a lex of the heart

A

left ICS 5, 9cm from midline

132
Q

what forms the base of the heart

A

left atrium and right atrium

133
Q

where does the pericardium switch from serous parietal to serous visceral

A

root of great vessels

134
Q

what is in the pericardial cavity

A

serous fluid

135
Q

where is the right atrium

A

ICS3

136
Q

where is the coronary sulcus

A

atrioventricular sulcus
separates the atria from ventricles
begins near aorta and descends on the right
vessels lie in it

137
Q

where is the inter ventricular sulcus

A

on the left between the ventricles
anterior and posterior aspects
vessels lie in them
intersects the coronary sulcus at a right angle

138
Q

what makes the sternocostal surface

A

right ventricle

139
Q

what makes the diaphragmatic surface

A

left ventricle

140
Q

what is the left pulmonary surface

A

left ventricle

where heart makes the cardiac impression on the left lung

141
Q

what is the right pulmonary surface

A

right atrium

where it makes cardiac impression on right lung

142
Q

what is the order of the great vessels right to left

A

superior vena cava
aorta
pulmonary trunk

143
Q

where is the posterior inter ventricular sulcus

A

under inferior vena cava

144
Q

where is the anterior interventricualr sulcus

A

under the left auricle

145
Q

where are the vessels of the heart located

A

between the visceral pericardium and the muscular wall

146
Q

which is more superficial cardiac veins or arteries

A

veins

147
Q

where is the coronary sinus and what does it empty into

A

diaphragmatic surface (posterior, below the pulmonary veins
in the coronary sulcus and ends before the inferior vena cava
right atria

148
Q

where is the great cardiac vein

A

superior to the coronary sinus, under the left pulmonary veins

149
Q

what sulcus does the great cardiac vein run in

A

anterior interventricular sulcus

150
Q

what sulcus does the middle cardiac vein run in

A

posterior interventricular sulcus

151
Q

where is the middle cardiac vein

A

below the inferior aorta

empties into the coronary sinus

152
Q

where is the small cardiac sinus

A

perpindicular to the middle cardiac vein, in line with the coronary sinus

153
Q

where are the anterior cardiac veins

A

cross over the atriventricular sulcus between the right atrium and right ventricle
pass superficial to right coronary artery

154
Q

what do the anterior cardiac veins drain

A

anterior wall of right ventricle and directly into right atrium

155
Q

where is the right vagus nerve

A

between the right carotid artery and the right internal jugular vein

156
Q

where is the right recurrent laryngeal nerve

A

branch of right vagus nerve

passes anteirorly to subclavian artery and then dives deep

157
Q

where are the cusps of the aortic valve

A

right and left are anterior

posterior is in the back

158
Q

where is the aortic sinus

A

behind each of the cusps of the aortic valve

159
Q

where do the coronary arteries come off

A

left- left coronary sinus right near the left cusp of the aortic valve
right- right coronary sinus next to the right cusp of the aortic valve

160
Q

where is the left coronary artery

A

between the left auricle and the pulmonary trunk in the coronary sulcus

161
Q

what sulcus is the anterior inter ventricular branch in

A

anterior ventricular sulcus

162
Q

what is the LAD artery

A

left anterior descending artery

anterior inter ventricular branch of the left coronary artery

163
Q

what vein runs with the LAD

A

great cardiac vein

164
Q

what does the circumflex branch of the left coronary run with

A

coronary sinus

165
Q

what sulcus is the circumflex branch in

A

coronary sulcus on the left

166
Q

where does the RCA originate

A

coronary sulcus between the right auricle and the ascending aorta

167
Q

where does the anterior right atrial branch come from

A

near the beginning of the RCA

168
Q

what does the anterior right atrial branch of the RCA give off

A

sinu-atrical nodal branch which goes to the SA node

169
Q

what does the RCA run in

A

coronary sulcus on the right

170
Q

where does the right marginal branch of the RCA come from

A

near the inferior boarder of the heart

171
Q

what vein does the right marginal branch run with

A

small cardiac vein

172
Q

when does the posterior inter ventricular branch start

A

when the RCA gets to the posterior inter ventricular sulcus

173
Q

where and what forms the anastamosis of the heart

A

posterior inter ventricular and anterior inter ventricular arteries
in the inter ventricular sulcus

174
Q

what vein runs with the posterior inter ventricular branch

A

middle cardiac vein

175
Q

where are the pectinate muscles

A

anterior wall of the right atrium

176
Q

where is the crista terminalis

A

vertical ridge of muscle connecting the pectinate muscles

177
Q

where is the ostium of the coronary sinus

A

in the posterior right atria between the inferior vena cava and the AV valve opening

178
Q

where is the interatrial septum

A

between the atria, where the fossa ovalis is

179
Q

where is the sinus venarum

A

area of the right atrial wall between the openings of the vena cavae

180
Q

where is the brachiocephalic trunk

A

right side, gives off subclavian and right carotid arteries

181
Q

where is the brachiocephalic artery

A

none, only veins

the artery is the brachiocephalic trunk which is only on the right side

182
Q

where are the brachiocephalic veins

A

lead into superior vena cava

183
Q

where are the left common carotid and left subclavian arteries

A

come off of the aortic arch

184
Q

where are the brachiocephalic veins

A

left and right sides, lead into the superior vena cava

185
Q

where are the cusps of the tricuspid valve

A

anterior- in front
posterior- in back
septal- on left side

186
Q

which papillary muscle in the right ventricle is the largest

A

anterior

187
Q

where do the cordae tendinae attach in the right ventricle

A

adjacent sides of 2 cusps

188
Q

where are trabecular carneae

A

right ventricle

189
Q

where is the septomarginal trabecula

A

from the inter ventricular septum to base of anterior papillary muscle

190
Q

moderator band

A

septomarginal trabecula

191
Q

where are the cusps of the pulmonary valve

A

anterior- front

right and left- back

192
Q

where are the pectinate muscles in the right atrium

A

auricle

193
Q

where are the cusps of the mitral valve

A

anterior

posterior

194
Q

where is the thymus

A

anterior in superior mediastinum

195
Q

what is the relationship between the superior vena cava and the right lung root

A

superior vena cava passes anterior to the root of the right lung

196
Q

where does the arch of the zaygos vein pass

A

superior to the root of the right lung

197
Q

relationship between the phrenic nerves and brachiocephalic veins and the lung roots

A

phrenic nerves passes posteriorly to brachiocephalic veins and anterior to lung roots

198
Q

what do the laryngeal nerves do

A

vocal cord innervation

199
Q

relationship between trachea and esophagus

A

trachea is anterior

esophagus is posterior

200
Q

what side of midline is esophagus

A

right

201
Q

what side is the thoracic aorta to the midline

A

left

202
Q

where is the thoracic duct

A

between the azygos vein and the thoracic aorta

posteiror to the esophagus

203
Q

where is the sympathetic trunk

A

ribs 2-9

204
Q

where are sympathetic ganglion

A

one for each thoracic vertebra level

205
Q

where is the greater splanchnic nerve

A

gets fibers from 5-9 sympathetic ganglia

located on T5-9 between the sympathetic trunk and the esophagus

206
Q

where is the lesser splanchnic nerve

A

between the sympathetic trunk and the greater splanchnic nerve starting at T10

HS Exam 2 (24 decks)

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