Heart coverings and coronary circulation Oct31 M2

Question 1

heart apex location

Answer 1

far to the left. 5th rib and midclavicular line itnersection

Question 2

where to put stethoscope to listen to heart and how to get there

Answer 2

2nd intercostal space (rib 2 to rib 3). Angle of Louis, go to the left

Question 3

last space where can put stethoscope and listen to the heart and why

Answer 3

fifth intercostal space. is where apex located

Question 4

4 portions of mediastinum

Answer 4

superior, anterior, middle, posterior

Question 5

superior mediast location and contents

Answer 5

above sternal angle. Big vessels that lead to neck and upper limbs

Question 6

middle medastinum synonym and content

Answer 6

(pericardial cavity) where heart sits

Question 7

ant mediastinum charact

Answer 7

very narrow

Question 8

post mediastinum location

Answer 8

from rib 2 to far back inferiorly (touches first lumbar vertebra)

Question 9

post mediastinum contents

Answer 9

aorta, IVC, nerves, lymphatics, etc.

Question 10

ant mediastinum content

Answer 10

thymus in childhood (becomes fat tissue in adulthood)

Question 11

3 branchings on arch of aorta from right to left

Answer 11

• right brachiocephalic trunk
• left common carotid artery (to left side of head and neck)
• left subclavian artery (to left arm)

Question 12

right brachiocephalic trunk further branching

Answer 12

• right subclavian artery (to left arm)

- right common carotid artery (to right side of head and neck)

Question 13

main veins going to the SVC

Answer 13

right subclavian vein, right internal + external jugular vein to right brachiocephalic vein
left subclavian vein, left internal + external jugular vein to left brachiocephalic vein

Question 14

where subclavian veins travel

Answer 14

below subclavian arteries

Question 15

where jugular veins travel

Answer 15

near carotid arteries

Question 16

something to note about parietal and visceral serous pericardium

Answer 16

is a continuous tissue

Question 17

oblique sinus def

Answer 17

dead end where parietal serous pericardium becomes visceral (epicardium)

Question 18

how to reach oblique sinus

Answer 18

go posteriorly behind the heart until blockage

Question 19

transverse sinus def

Answer 19

space created by dead end of serous pericardium and located below pulm trunk and aorta

Question 20

transverse sinus separates what

Answer 20

arteries (above it, aorta, pulm artery) and veins (below it): pulm veins, SVC, IVC

Question 21

is the transverse sinus a dead end

Answer 21

no, can pass through it. is an open space

Question 22

sulci of the heart and where they run

Answer 22

coronary sulci (between atria and ventricles, run posteriorly)
interventricular sulci (between ventricles, run anteriorly and posteriorly)

Question 23

2 branchings of aorta that go to supply heart and where they travel

Answer 23

right and left coronary arteries (travel in right and left coronary sulci)

Question 24

branchings of the right coronary artery

Answer 24

• marginal branch goes to supply right ventricle (RV) posteriorly
• posterior interventricular branch

Question 25

branchings of left coronary artery

Answer 25

• circumflex branch supplies LV posteriorly

- Anterior interventricular branch (Left anterior descending = LAD)

Question 26

name of vessel supplying the SA node

Answer 26

sino-atrial nodal branch

Question 27

trajectory of SA nodal branch if comes from right coronary artery

Answer 27

starts anteriorly, goes back behind SVC and comes back anteriorly to supply AV node

Question 28

trajectory of SA nodal branch if comes from left coronary artery

Answer 28

starts posteriorly, goes back behind arch of aorta, pulm arteries and SVC and coms back anteriorly to supply the AV node

Question 29

right dominant heart def

Answer 29

is right coronary artery dominant. posterior intervent branch comes from right coronary artery

Question 30

left dominant heart def

Answer 30

is left coronary artery dominant. posterior intervent branch comes from left coronary artery

Question 31

right vs left dominant heart prevalence and danger

Answer 31

85% right 15% left: more dangerous

Question 32

2 rare configurations of coronary arteries

Answer 32

1. circumflex branch comes from right coronary artery

2. all branches (even circumflex and posterior interventricular) come from left coronary artery

Question 33

why variations in heart dominance (left coronary or right coronary or 2 rare variants) is important

Answer 33

important clinically if obstruction. have to know how many vessels downstream blocked

Question 34

coronary artery bypass graft goal and how

Answer 34

if a heart vessel is blocked, bypass with extra tube (graft) from aorta to downstream of the occlusion

Question 35

3 cardiac veins to know and location

Answer 35

• small cardiac vein near marginal branch
• middle cardiac vein near posterior interventricular artery
• great cardiac vein along left anterior descending

Question 36

where small, middle and great cardiac vein join

Answer 36

posteriorly at the coronary sinus

Question 37

coronary sinus precise location and characteristic

Answer 37

posteriorly in the coronary sulcus. contains hole to drain in the right atrium directly

Question 38

pericardiocentesis def

Answer 38

draining of pericardial effusion (in pericardial sac)

Question 39

pericardiocentesis best way to do it (where to go through)

Answer 39

go between xiphoid process and left costal margin