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
2
Q
what chamber of the heart is most anterior
A
right ventricle
3
Q
what chamber is most posterior
A
left atrium
4
Q
where is the apex of the heart on the chest surface
A
ICS 5, medial to midclavicular line
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
6
Q
what is in the mediastinum?
A
heart esophagus trachea great vessels thoracic duct
7
Q
what are the divisions of the mediastinum
A
superior
anterior
posterior
middle
8
Q
where is the superior mediastinum?
A
superior to the sternal angle line up to thoracic aperture
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
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
11
Q
where is the anterior region of mediastinum?
A
anterior to pericardium
12
Q
what is in the anterior region of mediastinum?
A
lower thymus
fat
lymph nodes
connective tissue
13
Q
where is the posterior region of mediastinum?
A
posterior to pericardial sac
14
Q
what is in the posterior region of mediastinum
A
esophagus thoracic aorta azygous hemiazygous thoracic duct vagus nerve sympathetic nerves
15
Q
where is the middle region of mediastinum?
A
pericardial sac
16
Q
what is in the pericardial sac?
A
pericardium heart roots of great vessels arch of azygous vein main bronchi phrenic nerves
17
Q
what is the pericardium?
A
double walled sac containing the heart and great vessels
located around the middle region of the mediastinum
18
Q
what are the two layers of pericardium
A
fibrous pericardium- outer tough layer
serous pericardium- inner smooth lining
19
Q
what are the layers of the serous pericardium?
A
parietal serous- lines fibrous pericardium
visceral serous- covers the heart
20
Q
visceral serous layer is the equivalent of the
A
epicardium
21
Q
where is the pericardial cavity and what is in it
A
between the parietal and visceral serous layers
contains serous fluid
22
Q
where are the parietal and visceral pericardium continuous
A
roots of great vessels
23
Q
what are sternopericardial ligaments
A
connect the fibrous pericardium to the posterior sternum
24
Q
what are the pericardiophrenic ligaments
A
connects fibrous pericardium to central tendon of diaphragm
25
what is the role of the fibrous pericardium
prevents heart from over filling
26
describe each layer of the heart wall
epicardium- visceral pericardium
myocardium- cardiac muscle
endocardium- endothelium and sub endothelium CT that covers valves
27
what is the blood supply of the parietal layer?
pericardiacophrenic artery
28
where does the pericardiacophrenic artery come from and go to?
branch of internal thoracic artery and runs with the phrenic nerve
29
what is the venous drainage of the parietal layer of pericardium?
pericardiaphrenic vein
30
what does the pericardiacophrenic vein drain into?
brachiocephalic or internal thoracic veins
31
what is the fibrous pericardium fused to and what effect does it have
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
32
what supplies the visceral layer of pericardium?
coronary artery and branches from descending aorta
33
what drains the visceral layer of pericardium
coronary vein and coronary sinus tributaries
34
what forms pericardial sinuses
intersection of visceral and parietal layers at the roots of great vessels
35
what are the two pericardial sinuses
transverse and oblique
36
where is the transverse pericardial sinus and how is it formed
anterior to SVC, posterior to aorta and pulmonary trunk
| formed by the arterial and venous ends of the heart tube coming together
37
what is good about the transverse pericardial sinus?
place to tie ligatures and insert tubes during surgery
38
where is the oblique pericardial sinus and how is it formed?
between the pulmonary veins
| formed by vein expansion, pushing a pericardial reflection out around them
39
do the pericardial sinuses touch
no
40
what is pericarditis
inflammation of pericardium due to infection or a systemic illness
41
what causes pericardial rub
friction between the layers of the pericardium due to inflammation
42
what is a pericardial effusion and what does it cause
fluid from pericardial capillaries getting into the pericardial cavity
causes cardiac tampanade- heart can't fill because the fibrous pericardium doesn't stretch
43
what is a pericardiocentesis
removing fluid from the pericardial space by inserting a needing into the bare area at ICS5
44
what is hemopericardium?
blood in the pericardial cavity
45
what causes hemopericardium?
stab wound
weak area of heart muscle
bleeding from cardiac operations
46
what are the components of the fibrous skeleton of the heart
4 fibrous rings (annuli fibrosa) around each valve
2 fibrous trigone- ring connections
3 membranous septums- interarterial, interventricular, atrioventricular
47
what is the function of the fibrous skeleton of the heart?
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
48
what structures form the right boarder of the heart?
superior vena cava
right atrium
inferior vena cava
49
what structures form the left boarder of the heart
aortic arch
pulmonary trunk
left ventricle
50
what is the superior boarder of the heart
atria and auricles
51
what is the inferior boarder of the heart
IVC
RV
LV
52
what is the width of a normal heart
less than the width from the midsternal line to the lateral rib line
53
where does the heart sit relative to the midsternal line?
1/3 on right
| 2/3 on left
54
blood flow through the heart
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
55
where is the tricuspid valve and where can it be auscultated
posterior to sternum body at ICS 5 and 6
| listen left side of sternum at ICS 4 or 5
56
what are the cusps of the tricuspid valve
anterior
posterior
septal
57
what is the role of the cordae tendinae and papillary muscles
contraction of the papillary muscles during RV contraction holds the valve closed to prevent back flow
58
where is the pulmonary valve and where can it be listened to
left costal cartilage 3
| listen at upper left of sternum at ICS 2
59
what are the cusps of the pulmonary valve
semilunar valve- anteiror, left, right
60
where do the valves sit when open
against pulmonary artery
61
how does the pulmonary valve prevent backflow
when blood comes back, the valves close and form pockets preventing back flow
62
what is the pulmonary sinus
little pocket superior to pulmonary valve that holds blood to prevent the cusps of the pulmonary valve from sticking to the wall
63
where is the mitral valve and where is it listened to
posterior to sternum at ICS 3/4
| listend to left of sternum at ICS 5
64
what are the cusps of the mitral valve
anteiror and posterior
65
where is the aortic valve and where can it be listened to
posterior sternum at ICS3
| right of sternum at ICS2
66
what are the cusps of the aortic valve
semilunar valve
anterior- right and left
posterior- in the back
67
what is the lunule
midpoint of the cusps of the aortic valve that come together in the center when the valve is closed
68
what is the aortic sinus
dilation in the aorta superior to the valve
69
what comes immediately off of of the aorta
coronary arteries
70
what is apex beat
max point of pulsation against the anterior thoracic wall
71
where are the auscultation locations relative to the heart valves?
downstream of the valve location
72
valve stenosis
stiff valve doesn't open all the way resulting in hypertrophy of the chamber before it
73
valve incompetence (regurgitation)
incomplete valve closure resulting in blood moving backward into the previous chamber during contraction
74
what is the most commonly diseased valve?
mitral
75
what are auricles for?
located on the superior portion of atria, used to increase capacity if ncessary
76
what is the sinus venarum?
smooth posterior right atria chamber wall
77
what is the pectinate muscle?
rough musculature anterior right atria wall
78
what is the sulcus terminals?
external groove separating separating anterior and posterior atria wall
79
what is the crista terminales
internal vertical ridge separating smooth and rough atrial wall
80
what vessels empty into the RA?
IVC
SVC
coronary sinus
81
what separates the right and left atrium?
internal septum
82
what and where is the fossa ovalis
depression left from the closure of the foramen oval during development (hole between the atria)
located in the internal septum
83
what are the 5 differences between the left and right atria?
```
smaller
thicker walls
4 pulmonary veins empty into it
mostly smooth walls
valve is bicuspid
```
84
what is the cornosus arteriosus?
superior, leads to pulmonary trunk in the right ventricle
85
what is the trabecular carneae?
irregular muscular ridges in the right ventricle
86
what chambers are papillary muscles and chord tendinae in?
ventricles
87
what separates the ventricles
interventricular septum
88
what is the septomarginal trabeculae
muscular bundle stretching from the inter ventricular septum to the anterior papillary muscle and carries the righ bundle branch of the av bundle
89
moderator band
septomarginal trabeculae
90
cornosus arteriosus
infundibulum
91
how is the left ventricular different from the right ventricle?
thicker walls
bicuspid valve- 2 papillary muscles
aortic valve
92
what are the muscular ridges called in the right atria vs ventricles
atria- pectinate muscle
| ventricle- trabeculae carneae
93
what is the aortic vestibule
superoanterior area of LV leading to aortic surface
94
which ventricle has more trabecular carneae?
left
95
what supplies blood to the myocardium and epicardium?
coronary arteries
96
where do the left and right coronary arteries come from?
aorta- first branches off from aortic sinus
97
where does the right coronary artery run
in the coronary sulcus (atrioventricular groove)
98
what are the branches of the right coronary artery and where do they go
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
what forms the anastamosis of the heart and where
RCA with the circumflex and inter ventricular branches of the LCA
100
where does the left coronary artery run
off of left aortic sinus
| goes between the left auricle and pulmonary trunk to run in coronary groove
101
what are the branches of the LCA and where do they go
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
what do the cardiac veins drain into?
coronary sinus or directly into right atrium
103
where is the coronary sinus?
runs left to right in the posterior coronary groove
| receives blood from great, middle, and small cardiac veins
104
where is the great cardiac vein
from apex and comes up with the anterior inter ventricular artery from the LCA
wraps around the left heart
105
where is the middle cardiac vein
travels with posterior inter ventricular artery o f the RCA
106
where is the small cardiac vein
runs with right marginal artery of the RCA
107
where are the anterior cardiac veins and what do they drain into
begin at anterior right ventricle and empty into the right atrium directly
108
what is coronary artery disease
occlusion of coronary artery caused by atherosclerosis leading to inadequate oxygen to myocardium
109
myocardial infarction
myocardial necrosis and severe chest pain that does not go away
110
angina pectoralis
arterial constriction leading to oxygen deficiency and pain that is alleviated with rest (pain only during activity)
111
what vein is used for a coronary artery bypass graft?
great saphenous vein
112
what is coronary angioplasty
balloon catheter inserted and inflated to stretch open an occluded artery
113
path of cardiac conducting system
SA node-> AV node-> bundle of his->right bundle branch-> left bundle branch -> purkinje fibers
114
what is the SA node
pacemaker located under the epicardium between the SVC and RA that generates impulses
115
what is the AV node
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
what is the bundle of His
bridge between atrial and ventricular myocardium that passes through the fibrous skeleton along the inter ventricular septum
117
what are the left and right bundles
split of the bundle of his on either side of the inter ventricular septum that lead to purkinje fibers
118
what are purkinje fibers
take the impulse into the ventricular walls
119
where are the right purkinje fibers
IV septum muscle
anterior papillary muscle
right ventricular wall
120
where are the left purkinje fibers
IV septum
anterior and posterior papillary muscles
left ventricular wall
121
what can compress the esophagus
aortic arch
left main bronchus
where the esophagus goes through the diaphragm
122
where are the phrenic nerve and pericardiacophrenic vessels
anterior to the root of the lung between the mediastinal pleura and pericardium
123
where does the pleura transition from parietal to visceral?
root of the lung
124
what structures are on the right of the mediastinum
```
thymus
right brachiocephalic vein
superior vena cava
trachea
right vagus and phrenic nerves
esophagus
thoracic duct
azygous
thoracic splanchnic nerves
```
125
what structures are on the left side of mediastinum
```
thymus
left brachocephalic
arch of aorta
left vagus and phrenic nerves
thoracic duct
esophagus
thoracic aorta
esophageal plexus
thoracic splanchnic nerves
```
126
what are the great vessels
aorta
pulmonary trunk
superior/infereior vena cava
4 pulmonary veins
127
what is the ligamentum arteriosum
connects the aortic arch to the left pulmonary artery
128
where does the left vagus nerve pass over
crosses over the left side of the aortic arch and then passes behind the left pulmonary arter
129
where is the left recurrent laryngeal nerve
off of the vagus nerve, inferior to the aortic arch and posterior to the ligamentum arteriosum
130
which heart boarders are easily seen on a chest radiograph
right
inferior
left
131
where is the a lex of the heart
left ICS 5, 9cm from midline
132
what forms the base of the heart
left atrium and right atrium
133
where does the pericardium switch from serous parietal to serous visceral
root of great vessels
134
what is in the pericardial cavity
serous fluid
135
where is the right atrium
ICS3
136
where is the coronary sulcus
atrioventricular sulcus
separates the atria from ventricles
begins near aorta and descends on the right
vessels lie in it
137
where is the inter ventricular sulcus
on the left between the ventricles
anterior and posterior aspects
vessels lie in them
intersects the coronary sulcus at a right angle
138
what makes the sternocostal surface
right ventricle
139
what makes the diaphragmatic surface
left ventricle
140
what is the left pulmonary surface
left ventricle
| where heart makes the cardiac impression on the left lung
141
what is the right pulmonary surface
right atrium
| where it makes cardiac impression on right lung
142
what is the order of the great vessels right to left
superior vena cava
aorta
pulmonary trunk
143
where is the posterior inter ventricular sulcus
under inferior vena cava
144
where is the anterior interventricualr sulcus
under the left auricle
145
where are the vessels of the heart located
between the visceral pericardium and the muscular wall
146
which is more superficial cardiac veins or arteries
veins
147
where is the coronary sinus and what does it empty into
diaphragmatic surface (posterior, below the pulmonary veins
in the coronary sulcus and ends before the inferior vena cava
right atria
148
where is the great cardiac vein
superior to the coronary sinus, under the left pulmonary veins
149
what sulcus does the great cardiac vein run in
anterior interventricular sulcus
150
what sulcus does the middle cardiac vein run in
posterior interventricular sulcus
151
where is the middle cardiac vein
below the inferior aorta
| empties into the coronary sinus
152
where is the small cardiac sinus
perpindicular to the middle cardiac vein, in line with the coronary sinus
153
where are the anterior cardiac veins
cross over the atriventricular sulcus between the right atrium and right ventricle
pass superficial to right coronary artery
154
what do the anterior cardiac veins drain
anterior wall of right ventricle and directly into right atrium
155
where is the right vagus nerve
between the right carotid artery and the right internal jugular vein
156
where is the right recurrent laryngeal nerve
branch of right vagus nerve
| passes anteirorly to subclavian artery and then dives deep
157
where are the cusps of the aortic valve
right and left are anterior
| posterior is in the back
158
where is the aortic sinus
behind each of the cusps of the aortic valve
159
where do the coronary arteries come off
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
where is the left coronary artery
between the left auricle and the pulmonary trunk in the coronary sulcus
161
what sulcus is the anterior inter ventricular branch in
anterior ventricular sulcus
162
what is the LAD artery
left anterior descending artery
| anterior inter ventricular branch of the left coronary artery
163
what vein runs with the LAD
great cardiac vein
164
what does the circumflex branch of the left coronary run with
coronary sinus
165
what sulcus is the circumflex branch in
coronary sulcus on the left
166
where does the RCA originate
coronary sulcus between the right auricle and the ascending aorta
167
where does the anterior right atrial branch come from
near the beginning of the RCA
168
what does the anterior right atrial branch of the RCA give off
sinu-atrical nodal branch which goes to the SA node
169
what does the RCA run in
coronary sulcus on the right
170
where does the right marginal branch of the RCA come from
near the inferior boarder of the heart
171
what vein does the right marginal branch run with
small cardiac vein
172
when does the posterior inter ventricular branch start
when the RCA gets to the posterior inter ventricular sulcus
173
where and what forms the anastamosis of the heart
posterior inter ventricular and anterior inter ventricular arteries
in the inter ventricular sulcus
174
what vein runs with the posterior inter ventricular branch
middle cardiac vein
175
where are the pectinate muscles
anterior wall of the right atrium
176
where is the crista terminalis
vertical ridge of muscle connecting the pectinate muscles
177
where is the ostium of the coronary sinus
in the posterior right atria between the inferior vena cava and the AV valve opening
178
where is the interatrial septum
between the atria, where the fossa ovalis is
179
where is the sinus venarum
area of the right atrial wall between the openings of the vena cavae
180
where is the brachiocephalic trunk
right side, gives off subclavian and right carotid arteries
181
where is the brachiocephalic artery
none, only veins
| the artery is the brachiocephalic trunk which is only on the right side
182
where are the brachiocephalic veins
lead into superior vena cava
183
where are the left common carotid and left subclavian arteries
come off of the aortic arch
184
where are the brachiocephalic veins
left and right sides, lead into the superior vena cava
185
where are the cusps of the tricuspid valve
anterior- in front
posterior- in back
septal- on left side
186
which papillary muscle in the right ventricle is the largest
anterior
187
where do the cordae tendinae attach in the right ventricle
adjacent sides of 2 cusps
188
where are trabecular carneae
right ventricle
189
where is the septomarginal trabecula
from the inter ventricular septum to base of anterior papillary muscle
190
moderator band
septomarginal trabecula
191
where are the cusps of the pulmonary valve
anterior- front
| right and left- back
192
where are the pectinate muscles in the right atrium
auricle
193
where are the cusps of the mitral valve
anterior
| posterior
194
where is the thymus
anterior in superior mediastinum
195
what is the relationship between the superior vena cava and the right lung root
superior vena cava passes anterior to the root of the right lung
196
where does the arch of the zaygos vein pass
superior to the root of the right lung
197
relationship between the phrenic nerves and brachiocephalic veins and the lung roots
phrenic nerves passes posteriorly to brachiocephalic veins and anterior to lung roots
198
what do the laryngeal nerves do
vocal cord innervation
199
relationship between trachea and esophagus
trachea is anterior
| esophagus is posterior
200
what side of midline is esophagus
right
201
what side is the thoracic aorta to the midline
left
202
where is the thoracic duct
between the azygos vein and the thoracic aorta
| posteiror to the esophagus
203
where is the sympathetic trunk
ribs 2-9
204
where are sympathetic ganglion
one for each thoracic vertebra level
205
where is the greater splanchnic nerve
gets fibers from 5-9 sympathetic ganglia
| located on T5-9 between the sympathetic trunk and the esophagus
206
where is the lesser splanchnic nerve
between the sympathetic trunk and the greater splanchnic nerve starting at T10
