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ANAT 214 > Heart and Pericardium > Flashcards

Heart and Pericardium Flashcards

1
Q

Describe general position of heart

A

In thoracic cavity
Deviated towards left side
In middle mediastinum - heart occupies most of this space

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2
Q

Describe boundaries of heart - all = 4

A

Sup = sternal angle, manubriosternal joint - t4/5, rib 2
Inferior = xiphisternal joint - level of t9
Left = left midclavicular line - lines up with apex of heart, at level of t9 (apex)
Parasternal lines = parallel, lateral borders of sternum

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3
Q

What is mediastinum

A

Compartment in thoracic cavity

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4
Q

What is mediastinum bounded by

A

1st rib
Diaphragm
Rib cage
Thoracic vertebrae

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5
Q

Name and explain regions of mediastinum - gen

A

Extrapulmonary = non lung organs, divided into 4 regions = sup and inf (ant, mid, post)

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6
Q

Describe superior mediastinum

A

Sup = Rib 1 - thoracic inlet
Inf = sternal angle, rib 2, t4/5

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7
Q

Describe inferior mediastinum

A

Sup = sternal angle, rib 2, t4/5
Inf = diaphragm
ANTERIOR, MIDDLE AND POSTERIOR MEDIASTINUM

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8
Q

Describe what is in middle mediastinum

A

Heart
Roots of great vessels
Nv
Respiratory system

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9
Q

Describe heart in middle mediastinum

A

2 serous and 1 fibrous pericardial coverings

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10
Q

Describe roots of great vessels in middle mediastinum

A

Aorta and pulmonary trunk (t junction)= away and towards heart
Arteries= right and left pulmonary arteries, biggest in body, 4 pulmonary veins
Svc = head, neck and upper limbs
Ivc = abdomen and below and lower ribs

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11
Q

Describe neurovasculature in middle mediastinum

A

INSIDE pericardium = for heart, coronary circulation and cardiac plexus
OUTSIDE pericardium =phrenic nerves and pericardiophrenic arteries and veins

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12
Q

Describe respiratory system in middle mediastinum

A

Left and right primary bronchi

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13
Q

What is heart enveloped by

A

Continuous double layer of serous membrane= pericardium

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14
Q

Describe pericardiums - gen

A

serous pericardium, encloses potential space = pericardial cavity
Has additional outer membrane = fibrous pericardium (tough ct layer, outside pericardial membrane)

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15
Q

Name all the layers of pericardium from superficial to deep

A

Fibrous pericaridum
Serous parietal pericardium
Serous visceral pericardium

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16
Q

Describe fibrous pericardium

A

Outermost
Dense ct
Anchored to roots of great vessels (pulm trunk), diaphragm and thoracic wall (sternum)
Covered in pericardial fat (above diaphragm=bottom of pericardium)

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17
Q

Describe serous pericardium - parietal layer

A

Adhered to fibrous pericardium
Deep surface- if flip = inner surface of fibrous
Hard to separate

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18
Q

Describe serous pericardium - visceral layer

A

Innermost
Shrink wraps heart
Nv visible within
Variable amounts epicardial fat - deep to serous pericardium, upon heart

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19
Q

What is pericardial cavity

A

Potential space between layers of serous pericardium

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20
Q

Are the visceral and parietal pericardium’s continuous

A

Visceral reflects and becomes continuous with parietal at where pulmonary trunk meets heart wall

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21
Q

Describe function of pericardial cavity and fibrous pericardium

A

Pericardial cavity normally contains few ml serous fluid = ease gliding of beating heart against surrounding tissues
Tough fibrous pericardium = restricts expansion of heart to help direct blood out vessels, rigid wall so when expands = helps direct blood away from heart

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22
Q

What is pericardial effusion

A

Build up of excess fluid in pericardial cavity between serous layers
May be slow = allows fibrous pericardium to stretch in response

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23
Q

What is cardiac tamponade

A

Large or rapid pericardial effusion = causes heart to accelerate to maintain volume of blood pumped despise diminishing pericardial space
Heart may stop beating - since less blood pumping = hr increase so much that heart will stop beating (decreasing space, so less blood pumped)

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24
Q

What is intervention to treat cardiac tamponade

A

Pericardiocentesis = syringe and drain space

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25
Q

Describe external presentation of heart

A

2 pumps = right and left
Each divided into 2 chambers = atrium and ventricle

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26
Q

Describe heart in ANATomical position

A

Heart rotated around longitudinal axis towards left and its inferior end (apex) tilted towards left and anterior

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27
Q

Describe chambers of heart and their visibilities from ant and post

A

Ant = see mostly right ventricle - in situ view
Post = see mainly left atrium and ventricle

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28
Q

Describe grooves - sulci

A

Muscular walls of 4 chambers of heart create sulci = shallow grooves on external surface with coronary circulation (vasculature-paired arteries and veins)
And variable fat within

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29
Q

Name the sulci of heart

A

Atrioventricular sulcus
Interventricular sulcus

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30
Q

Describe atrioventricular sulcus

A

Ring around heart between atria and ventricles = separates them
Transverse plane

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31
Q

Describe interventricular sulcus

A

Anterior = seen in anatomical position
Posterior = flips to posterior view
Between left and right ventricles, ant to post (sup to inf and back superiorly)

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32
Q

Describe heart - conceptual overview

A

Muscular organ divided into right and left pumps (Normally do not communicate in adults)
Each pump divided into 2 communicating chambers = atrium collects blood and ventricle discharges blood

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33
Q

Describe the 2 circuits of blood circulation

A

They have different roles in circulation of blood throughout body
Right pump = moves blood from heart to lungs for gas exchange = pulmonary circulation, short and nearby
Left pump = moves blood from heart to all tissues of body = systemic circulation (includes heart and bronchial circulation)

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34
Q

Describe cardiac blood flow = 1

A

Venous deoxygenated blood from systemic circulation collects into right atrium from ivc, svc, coronary sinus or directly (anterior cardiac veins) and passes into right ventricle (through valve)

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35
Q

Describe cardiac blood flow = 2

A

Deoxygenated blood then pumped from right ventricle —> pulmonary trunk/arteries and into pulmonary circulation (to lungs)= now oxygenated blood

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36
Q

Describe cardiac blood flow = 3

A

Oxygenated blood from pulmonary circulation collects in left atrium from pulmonary veins and passes into left ventricle (through valve)

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37
Q

Describe cardiac blood flow = 4

A

Oxygenated blood pumped from left ventricle —> pumped into systemic circulation through aorta and all its branches (to periphery)

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38
Q

Describe where right atrium collects blood from

A

From systemic circulation via
Svc = head, neck and upper limbs
Ivc = everything below heart
Coronary sinus = locally around heart

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39
Q

Which vessels/things that drain into right atrium have valves

A

Svc = no valve since gravity helps
Have valves to prevent back flow (passive, flaps shut in response to tendency of blood —> bc gravity to flow back)

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40
Q

Describe posterior atrial wall of right atrium

A

Where vessels enter = smooth

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41
Q

Describe anterior/lateral atrial wall of right atrium

A

Contains parallel folds of pectinate muscles, extending into right auricle
= helps expand atrial volume while minimizing atrial wall stress - to accept more of that blood coming from system

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42
Q

Describe how blood passes into right ventricle

A

Via right av valve = tricuspid

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43
Q

What are auricles

A

Left and right = blinds sacs at the end of atria = allows more blood to be collected there

44
Q

What is crista terminalis

A

Crest at transition between smooth wall and pectinate muscle

45
Q

Where is fossa ovalis

A

In smooth wall between the 2 atria =depression called fossa ovalis

46
Q

Describe in utero - fossa ovalis

A

In utero = fetal lungs and pulmonary circulation are offline, bc gas exchange occurs through placenta —> prenatal circulation includes a system of shunts that allows pulmonary circulation to be bypassed

47
Q

What is foramen ovale

A

Opening in wall between atria = allows oxygenated blood from ivc to bypass right ventricle and go into left atrium instead

48
Q

What happens to foramen ovale after birth

A

Shortly after birth = seals over and leaves impression in atrial wall = fossa ovalis (seals, heals over due to blood pressure differences)
In 25-30% of people = foramen ovale fails to close = leads to patent foramen ovale (depends on size, can lead to oxygen insufficiency so Need surgical intervention)

49
Q

Describe fetal circulation with respect to foramen ovale

A

Oxygenated blood comes back up from navel and umbilical vein —> ivc of developing embryo
Bit of oxygenated and deoxygenated mis
Then allows blood to be shunted from right to left atrium = bypass pulmonary trunk

50
Q

Describe right ventricle

A

Deoxygenated blood enters right ventricle through right av valve

51
Q

Describe right av valve

A

Has 3 cusps, linked by chordae tendinae —> 3 sets papillary muscles
3x cusps (ant, post, septal), sets of chordae, sets of papillary muscles
(Cusps —> chordae —> papillary muscles)

52
Q

What is the purpose of papillary muscles and chordae tendinae

A

Hold onto cusps and prevent them from prolapsing into right atrium during ventricular contraction = systole
So blood wont flow back from ventricle to aorta
Prevent prolapse into atria during systole (ventricular systole)

53
Q

What are trabeculae carnae

A

Assists ventricualr walls
Meaty struts
Pumps deoxygenated blood out the pulmonary valve (right semilunar) into pulmonary trunk
Also helps prevent walls from sticking to each other

54
Q

Describe left atrium

A

Pulmonary veins enter here

55
Q

Describe left auricle

A

With less pectinate muscle - smaller than right

56
Q

Describe left av valve

A

Bicuspid, mitral valve
Only 2 sets of cusps/chordae/papillary muscles = anterior and posterior

57
Q

Describe left ventricular wall

A

Aortic valve, left semilunar to aorta
Wall much thicker = left needs to send blood with enough pressure to reach tips of the toes - strong pump

58
Q

Where is ligamentus arteriosum

A

At level of sternal angle

59
Q

What is ductus arteriosus

A

Second shunt to bypass pulmonary circulation = shunts blood from pulmonary trunk to aorta
All the blood hat does make it into pulmonary trunk does not go to pulmonary arteries = bypasses

60
Q

Describe what happens after birth to ductus arteriosus

A

First few months postnatal life = both shunts regress/disappear = ductus arteriosus —> ligamentum arteriosum

61
Q

Name the 2 developmental remnants we can see in adult heart

A

Fossa ovalis
Ligamentum arteriosum

62
Q

Name the 2 phases of cardiac cycle

A

Ventricular diastole
Ventricular systole

63
Q

Describe ventricular diastole - gen

A

Longer phase
Both ventricles relax and expand in volume and bring in blood from atria
Blood refills both chambers

64
Q

Describe ventricular systole - gen

A

Shorter phase
Both ventricles contract
Blood pumped out of them

65
Q

Describe valves during ventricular diastole

A

Open av = blood flows into ventricles from atria, chordae tendinae not active
Closed semilunar = no blood flows back into ventricles (since ventricles, just pumped blood out)

66
Q

Describe valves during ventricular systole

A

Open semilunar= blood flows into pulmonary trunk/aorta
Closed av = prevent back flow into atria

67
Q

Describe what heart auscultation is

A

Listening to sound of valves closing
Valves snap shut = make audible sound that can be heart by placing stethoscope in right place = auscultation

68
Q

Describe LUB sound

A

Closing of mitral and tricuspid valves
Louder sound
Snapping of av valves = shut in response to forceful contraction of ventricles (systole)- ventricular pressure spikes, short, powerful phase

69
Q

Describe DUB sound

A

Closing of aortic and pulmonary semilunar valves
Shorter

70
Q

Describe heart auscultation - parasternal lines

A

Where we can place stethoscope and heart sounds
Landmarks
Heard to hear since bone in the way so place where we can hear echo
Parasternal and midcalvicular lines

71
Q

Where to hear left semilunar - aortic valve

A

Right 2nd intercostal space at parasternal line

72
Q

Where to hear right semilunar - pulmonary valve

A

Left second intercostal space at parasternal line

73
Q

Where to heart right av valve

A

Left fifth intercostal space at parasternal line

74
Q

Where to heart left av valve

A

Left fifth intercostal space at midclavicular line

75
Q

Describe coronary arteries and openings

A

Heart needs own blood supply
Right and left coronary arteries, first 2 branches of aorta
Openings located in sinuses created by aortic valve cusps (2 openings into coronary arteries)

76
Q

When do coronary arteries fill with blood

A

Aortic valve sinuses and coronary arteries fill with blood when aortic valve shut = during ventricular diastole - semilunar must be shut for blood to get into coronary arteries
Offset compared to systemic blood (cardiac cycle)

77
Q

Describe right coronary artery

A

Emerges at anterior/right base of aorta (tip of auricle), runs to the right av sulcus, around posterior surface (loops to)

78
Q

Name branches of right coronary artery

A

Sinoatrial nodal artery
Right marginal artery
Posterior interventricular artery

79
Q

Describe sinoatrial nodal artery - branch of right coronary

A

Runs under auricle of right atrium, loops around svc, supplies sinoatrial node and right atrium
(Sinoatrial node = pacemaker of heart)

80
Q

Describe right marginal artery - branch of right coronary

A

Runs towards apex on right border (margin) of heart, supplies most of right ventricle

81
Q

Describe posterior interventricular artery - branch of right coronary

A

Piva
On posterior surface, runs towards apex in posterior av sulcus, supplies posterior ventricles, and posterior 1/3 of interventricular septum (big, muscle wall)

82
Q

Describe left coronary artery

A

Emerges at posterior/left base of aorta, runs to the left, posterior to (behind) pulmonary trunk

83
Q

Name the 2 main branches of left coronary artery

A

Anterior interventricular artery
Circumflex artery (—> left marginal artery)

84
Q

Describe anterior interventricular artery - left coronary artery

A

Aiva
Runs towards apex in anterior interventricular sulcus, supplied anterior ventricles and anterior 2/3 of interventricular septum

85
Q

Describe circumflex artery - left coronary artery

A

Runs under auricle of left atrium = runs around to posterior side in av sulcus - coronary, onto posterior surface
Supplies left atrium via left marginal artery = branch of circumflex, runs towards apex on left borders (margin or heart, supplies most of left ventricle)

86
Q

Name and describe the 2 important anastomoses of coronary arteries

A

Arterial connections, alternatives, continuous alternate connections = for blood, make sure muscle receives enough blood to function properly
Between end of right coronary and circumflex
Between piva and aiva

87
Q

Describe venous drainage of heart

A

Cardiac veins = heart drained by network cardiac veins -paired with coronary arteries and branches, usually in sulci
Most join coronary sinus before going into right atrium

88
Q

Describe coronary sinus

A

Swelling in av sulcus that collects venous blood from great, middle and small cardiac veins, opens into right atrium near ivc

89
Q

Name the 4 cardiac veins

A

Great cardiac vein
Middle cardiac vein
Small Cardiac vein
Anterior cardiac veins

90
Q

Describe great cardiac vein

A

Biggest
Runs with aiva - parallel then circumflex in left post av sulcus
Onto posterior heart —> into coronary sinus, drains anterior ventricles and left atrium

91
Q

Describe middle cardaic vein

A

Runs with piva in post interventricular sulcus
Into coronary sinus directly
Drains posterior interventricular septum

92
Q

Describe small cardiac vein

A

Runs with right marginal then right coronary
In av sulcus
Onto posterior heart
Into coronary sinus
Drains right atrium and ventricle

93
Q

Describe anterior cardiac veins

A

Runs with local branches right coronary a
Very small
Opens DIRECTLY into right atrium = not coronary sinus
Drains ant right ventricle

94
Q

Describe how the cardiac veins drain

A

Ant cardiac veins = right atrium
Great, middle and small cardiac veins = coronary sinus then right atrium

95
Q

Describe innervation of heart and pericardium = sympathetic

A

Fibers arise from spinal cord levels t1-t4 and the cervical ganglia in neck as sympathetic cardiac nerves = cause hr to increase

96
Q

Describe innervation of heart and pericardium = parasympathetic

A

Fibers come from vagus nerves as cardiac branches —>cause hr to decrease

97
Q

Describe cardiac plexus

A

Sns and pans Fibers mesh to form a cardiac plexus
Providing branches to conduction system of heart, coronary vasculature and myocardium (heart muscle wall)

98
Q

Name the 4 components of the hearts conduction system

A

Sa node
Av node
Av bundle
Purkinje Fibers

99
Q

Describe sa node - conduction

A

Group of cells near base svc
Sends signal to another node via internodal branches

100
Q

Describe av node - conduction

A

Near coronary sinus opening
Sits between atria and gives big bundle

101
Q

Describe av bundle - conduction

A

Runs down av septum = gives 2 branches = right and left bundle branch
Need both to be beating at same time so both ventricles contract at same time = systole

102
Q

Describe purkinje fibres - conduction

A

Branch to trabeculae carnae and myocardial walls

103
Q

Describe septomarginal (moderator band) - conduction

A

Bridge across inferior right ventricle for better conductance to right anterior papillary muscles (from interventricular wall to papillary)
Shortcut so signal coming from right bundle branch can jump across to synchronize action of papillary muscle on right side, so can properly function during systole and hold on to chordae to keep the av valve closed

104
Q

Describe clinical consideration - pacemaker

A

Sa node = Natural pacemaker of heart
Can have artificial pacemaker = pulls electrical current that sits where av or sa node normally is = Stabilized hr

105
Q

Can we see nodes and bundles of conduction system

A

Nodes and bundles not visible = in walls of myocardium

ANAT 214 (34 decks)

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