Heart coverings and coronary circulation Oct31 M2 COPY Flashcards
heart apex location
far to the left. 5th rib and midclavicular line itnersection
where to put stethoscope to listen to heart and how to get there
2nd intercostal space (rib 2 to rib 3). Angle of Louis, go to the left
last space where can put stethoscope and listen to the heart and why
fifth intercostal space. is where apex located
4 portions of mediastinum
superior, anterior, middle, posterior
superior mediast location and contents
above sternal angle. Big vessels that lead to neck and upper limbs
middle medastinum synonym and content
(pericardial cavity) where heart sits
ant mediastinum charact
very narrow
post mediastinum location
from rib 2 to far back inferiorly (touches first lumbar vertebra)
post mediastinum contents
aorta, IVC, nerves, lymphatics, etc.
ant mediastinum content
thymus in childhood (becomes fat tissue in adulthood)
3 branchings on arch of aorta from right to left
- right brachiocephalic trunk
- left common carotid artery (to left side of head and neck)
- left subclavian artery (to left arm)
right brachiocephalic trunk further branching
- right subclavian artery (to left arm)
- right common carotid artery (to right side of head and neck)
main veins going to the SVC
right subclavian vein, right internal + external jugular vein to right brachiocephalic vein
left subclavian vein, left internal + external jugular vein to left brachiocephalic vein
where subclavian veins travel
below subclavian arteries
where jugular veins travel
near carotid arteries
something to note about parietal and visceral serous pericardium
is a continuous tissue
oblique sinus def
dead end where parietal serous pericardium becomes visceral (epicardium)
how to reach oblique sinus
go posteriorly behind the heart until blockage
transverse sinus def
space created by dead end of serous pericardium and located below pulm trunk and aorta
transverse sinus separates what
arteries (above it, aorta, pulm artery) and veins (below it): pulm veins, SVC, IVC
is the transverse sinus a dead end
no, can pass through it. is an open space
sulci of the heart and where they run
coronary sulci (between atria and ventricles, run posteriorly) interventricular sulci (between ventricles, run anteriorly and posteriorly)
2 branchings of aorta that go to supply heart and where they travel
right and left coronary arteries (travel in right and left coronary sulci)
branchings of the right coronary artery
- marginal branch goes to supply right ventricle (RV) posteriorly
- posterior interventricular branch
branchings of left coronary artery
- circumflex branch supplies LV posteriorly
- Anterior interventricular branch (Left anterior descending = LAD)
name of vessel supplying the SA node
sino-atrial nodal branch
trajectory of SA nodal branch if comes from right coronary artery
starts anteriorly, goes back behind SVC and comes back anteriorly to supply AV node
trajectory of SA nodal branch if comes from left coronary artery
starts posteriorly, goes back behind arch of aorta, pulm arteries and SVC and coms back anteriorly to supply the AV node
right dominant heart def
is right coronary artery dominant. posterior intervent branch comes from right coronary artery
left dominant heart def
is left coronary artery dominant. posterior intervent branch comes from left coronary artery
right vs left dominant heart prevalence and danger
85% right 15% left: more dangerous
2 rare configurations of coronary arteries
- circumflex branch comes from right coronary artery
2. all branches (even circumflex and posterior interventricular) come from left coronary artery
why variations in heart dominance (left coronary or right coronary or 2 rare variants) is important
important clinically if obstruction. have to know how many vessels downstream blocked
coronary artery bypass graft goal and how
if a heart vessel is blocked, bypass with extra tube (graft) from aorta to downstream of the occlusion
3 cardiac veins to know and location
- small cardiac vein near marginal branch
- middle cardiac vein near posterior interventricular artery
- great cardiac vein along left anterior descending
where small, middle and great cardiac vein join
posteriorly at the coronary sinus
coronary sinus precise location and characteristic
posteriorly in the coronary sulcus. contains hole to drain in the right atrium directly
pericardiocentesis def
draining of pericardial effusion (in pericardial sac)
pericardiocentesis best way to do it (where to go through)
go between xiphoid process and left costal margin