Heart ( Handout ) Flashcards by J Santisteban

The pericardium extends just superior to the ___________ to the ____________

Sternal angle

Xiphisternal joint

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Fibroserous membrane that covers the heart and beginning of great essels

Pericardium

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2 layers of pericardium

Fibrous and serous

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What are the layers of the serous pericardium

Visceral and Parietal

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Tough external layer that stabilizes the heart and prevents the heart from overdilating

A. Fibrous pericardium
B. Serous pericardium

A. Fibrous

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The fibrous pericardium fuses SUPERIORLY with _________ of the great vessels

Tunica adventitia

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Attaches the pericardium to the posterior part of the sternum

Sternopericardial ligament

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The fibrous pericardium blends with the central tendon of the diaphragm to form what ligament?

Pericardiacophrenic ligament

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Composed mainly of mesothelium that lines the internal surface of the fibrous pericardium and external surface of the heart

Serous pericardium

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Serous layer that lines the internal surface of the fibrous pericardium
A. Parietal
B. Visceral

A. Parietal

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Closely applied to the heart and makes up the epicardium
A. Parietal
B. Visceral

B. Visceral

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Where is the visceral continuous with the parietal layer?

Where aorta and pulmonary trunk leave the heart

2. Where SVC, IVC, and pulmonary veins enter the heart

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Potential space between the parietal and visceral layer

Pericardial cavity

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How much fluid is contained in the pericardial sac?

30-50ml

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A space that lies posterior to the aorta and pulmonary trunk and anterior to the SVC
A. Transversus sinus
B. Oblique sinus

A. Transverse Sinus

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Boundary of the Transversus Sinus: 
Serous pericardium covering the posterior aspect of the pulmonary trunk and ascending aorta
A. Anterior
B. Posterior
C. Inferior
D. Lateral

A. Anterior

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Boundary of the Transversus Sinus: 
Pericardium covering the SVC
A. Anterior
B. Posterior
C. Inferior
D. Lateral

B. Posterior

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Boundary of the Transversus Sinus: 
Visceral pericardium covering the atria of the heart
A. Anterior
B. Posterior
C. Inferior
D. Lateral

C. Inferior

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Pocket-like recess in the pericardial cavity posterior to the base of the heart
A. Transversus sinus
B. Oblique sinus

B. Oblique sinus

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Boundary of the Oblique Sinus:
Pericardial reflections surrounding the pulmonary veins and IVC
A. Anterior
B. Posterior
C. Inferior
D. Lateral

D. Lateral

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MAIN blood supply of the pericardium

Pericardiacophrenic a

Internal thoracic a

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Small contributions of arterial blood to the pericardium comes from?

CBEMS
Coronary (visceral only)
Bronchial
Esophageal
Musculophrenic
Superior phrenic

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Venous drainage of the pericardium

Pericardiacophrenic v to brachiocephalic v

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The phrenic nerve supplies what part of the pericardium?

Fibrous pericardium

PARIETAL layer of the serous pericardium

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The sympathetic trunks and vagus nerve supplies what part of the pericardium?

VISCERAL layer of the serous pericardium

Condition: compromises expansion of the heart that limits the amount of blood the heart can receiving thereby decreasing the cardiac output

Cardiac tamponade

Drainage of fluid from pericardial cavity that is done for cardiac tamponade relief

Pericardiocentesis

In performing pericardiocentesis, a wide bore is inserted where?

5th-6th ICS near sternum

What is the normal weight of the heart?

250-300g in female | 300-350g in males

A complex of dense collagen that provides attachment for the leaflets, cusps, and myocardium

Fibrous skeleton

What are the structures formed by the fibrous skeleton?

4 fibrous rings R & L fibrous trigone Membranous parts of the interatrial and interventricular septum

Keeps the orifices of the AV and semilunar valves patent and forms an electric insulator

Fibrous skeleton

Formed by the inferolateral part of the left ventricle

Apex of the heart

The apex of the heart lies where?

Posterior to the L 5th ICS, 9cm from the median plane

Where the sounds of mitral valve closure are maximal

Apex | - apex beat

Opposite the apex and forma the posterior aspect of the heart

Base

Formed mainly by the L atrium and partially by the R atrium

Base

Extends superiorly to the bifurcation of pulmonary trunk and inferiorly to the coronary groove

Base

The base of the heart receives what vessels?

Pulmonary veins SVC IVC

What are the surfaces of the heart?

Sternocostal Diaphragmatic R pulmonary L pulmonary

Surface of the heart: Formed mainly by the R ventricle A. Sternocostal B. Diaphragmatic C. R pulmonary D. L pulmonary

A. Sternocostal

Surface of the heart: Forms the anterior surface of the heart A. Sternocostal B. Diaphragmatic C. R pulmonary D. L pulmonary

A. Sternocostal

Surface of the heart: Formed mainly by the L ventricle and partly by the R ventricle A. Sternocostal B. Diaphragmatic C. R pulmonary D. L pulmonary

B. Diaphragmatic

Surface of the heart: Related to the central tendon of the diaphragm A. Sternocostal B. Diaphragmatic C. R pulmonary D. L pulmonary

B. Diaphragmatic

Surface of the heart: Forms the inferior surface of the heart A. Sternocostal B. Diaphragmatic C. R pulmonary D. L pulmonary

B. Diaphragmatic

Surface of the heart: Formed mainly by the R atrium A. Sternocostal B. Diaphragmatic C. R pulmonary D. L pulmonary

C. R pulmonary

Surface of the heart: Formed mainly by the L ventricle A. Sternocostal B. Diaphragmatic C. R pulmonary D. L pulmonary

D. L pulmonary

Surface of the heart: Forms the cardiac impression of the L lung A. Sternocostal B. Diaphragmatic C. R pulmonary D. L pulmonary

D. L pulmonary

What are the four borders of the heart?

R border Inferior border L border Superior border

Border of the heart: Formed by the R atrium extending between the SVC & IVC A. R border B. Inferior border C. L border D. Superior border

A. R border

Border of the heart: Formed by the R ventricle & slightly by the L ventricle A. R border B. Inferior border C. L border D. Superior border

B. Inferior

Border of the heart: Formed by the L ventricle & slightly by the L auricle A. R border B. Inferior border C. L border D. Superior border

C. Left

Border of the heart: Formed by the R and l atria and auricles A. R border B. Inferior border C. L border D. Superior border

D. Superior

Border of the heart: Forms the inferior boundary of transverse pericardial sinus A. R border B. Inferior border C. L border D. Superior border

D. Superior

What emerges from the superior border of the heart?

Ascending aorta Pulmonary trunk SVC enters its R side

What are the three layers of the heart?

Endocardium Myocardium Epicardium

Layer of the heart: Thin internal layer A. Endocardium B. Myocardium C. Epicardium

A. Endocardium

Layer of the heart: Serves as the lining membrane of the heart and its valves A. Endocardium B. Myocardium C. Epicardium

A. Endocardium

Layer of the heart: Thick middle layer composed of cardiac muscle A. Endocardium B. Myocardium C. Epicardium

B. Myocardium

Layer of the heart: Thick external layer A. Endocardium B. Myocardium C. Epicardium

C. Epicardium

Layer of the heart: Formed by the visceral layer of the serous pericardium A. Endocardium B. Myocardium C. Epicardium

C. Epicardium

What are the four chambers of the heart?

R & L atrium | R & L ventricle

Chamber of the heart: Forms the R border of the heart A. R atrium B. L atrium C. R ventricle D. L ventricle

A. R border

The R atrium receives venous blood from what vessels?

SVC IVC Coronary sinus

The SVC opens to the superior part of the R atrium at what level?

R 3rd costal cartilage

The IVC opens to the superior part of the R atrium at what level?

5th Costal Cartilage

The R atrium has a rudimentary valve called?

Eustachian valve

Where is the opening of the coronary sinus located?

Between the atrioventricular orifice and the IVC orifice

Receives most of the cardiac veins

Opening of the coronary sinus

The coronary sinus has a valve called?

Thebesian valve

Ear-like conical muscular pouch that increases the capacity of the atrium (serves as an add-on room)

Auricle

A muscle resembling the teeth of a comb that forms the rough muscular anterior wall of the R atrium

Pectinate muscle

Smooth, thin-walled, posterior part of the R atrium where the SVC, IVC, and coronary sinus open up

Sinus venarum

A vertical ridge separating the smooth and rough parts of the atrium

Crista terminalis

Also known as the terminal groove

Sulcus terminalis

Separates the right from the left atria

Interatrial septum

Remnant of the foramen ovale

Fossa ovalis

Contains the fossa ovalis

Interatrial septum

Contains the remnant of foramen ovale

Interatrial septum

Condition: incomplete closure of the foramen ovale

Atrial septal defect

Incomplete closure of the foramen ovale will cause A. R to L shunt B. L to R shunt

B. L to R shunt

Causes enlargement of the R atrium and ventricle and dilatation of the pulmonary trunk A. R to L shunt B. L to R shunt

B. L to R shunt

Opening where poorly oxygenated blood from the R atrium is discharged into the R ventricle

R atrioventricular orifice

``` Guards the R AV orifice A. Bicuspid valve B. Tricuspid valve C. Thebesian valve D. Eustachian valve ```

B. Tricuspid valve

The tricuspid valve has three cusps. What are those?

Anterior Posterior Septal

Attached to the free edges of the cusp of the tricuspid valve

Tendinous cords

Tricuspid valve is located A. R atrium B. L atrium C. R ventricle D. L ventricle

C. R ventricle

Irregular muscular elevations that gives the ventricular wall a sponge-like appearance

Trabecular carnae

What are the three types of trabeculae carnae

Papillary muscles Moderator band Prominent ridges

Conical muscular projections attached to the ventricular wall

Papillary muscles

The papillary muscles are connected to the cusps of the tricuspid valve via?

Chordae tendinae

How many papillary muscles are present in the R ventricle?

3 - anterior - posterior - septal

Right Ventricle: Papillary muscles Arise from the anterior wall of the R ventricle A. Anterior B. Posterior C. Septal

A. Anterior

Right Ventricle: Papillary muscles Arise from the inferior wall of the R ventricle A. Anterior B. Posterior C. Septal

B. Posterior

Right Ventricle: Papillary muscles Arise from the interventricular septum A. Anterior B. Posterior C. Septal

C. Septal

Also known as septomarginal trabecula

Moderator band

Muscular bundle from the inferior part of the IVS yo the base of the anterior papillary muscle

Moderator band

Carries part of the R branch of the AV bundle to the anterior papillary muscle

Moderator band

Partition of between the R and L ventricle

Interventricular septum

The IVS has two parts. What are those?

Muscular | Membranous

Condition: incomplete closure of the ventricular septum

Ventricular septal defect

Where is the most common site of the ventricular septal defect? A. Muscular B. Membranous

B. Membranous part

Condition: incomplete closure of the ventricular septum A. R to L shunt B. L to R shunt

B. L to R shunt

Condition: incomplete closure of the ventricular septum Size of defect?

1-25mm

A shunt that may lead to pulmonary hypertension resulting to cardiac failure A. Atrial septal defect B. Ventricular septal defect

B. Ventricular septal defect

A shunt that may lead to pulmonary hypertension resulting to cardiac failure A. R to L shunt B. L to R shunt

B. L to R shunt

Arterial cone which leads into the pulmonary trunk

Conus arteriosus

Another name for conus arteriosus

Infundibulum

Separates the ridged muscular wall of the inflow part from the smooth wall of the outflow part

Supraventricular crest

Inflow A. Ridged muscular wall B. Smooth wall

A. Ridged muscular wall

Outflow A. Ridged muscular wall B. Smooth wall

B. Smooth wall

Deflects the incoming flow into the main cavity

Supraventricular crest

Deflects the outgoing flow into the conus arteriosus

Supraventricular crest

The supraventricular crest deflects the incoming flow into the ____________

Main cavity

The supraventricular crest deflects the outgoing flow into the ____________

Conus arteriosus

The supraventricular crest deflects the ________ flow into the main cavity

Incoming

The supraventricular crest deflects the ________ flow into the conus arteriosus

Outgoing

What valve guards the pulmonary orifice?

Pulmonary valve

Where is the pulmonary valve located?

Level of 3rd costal cartilage

A valve that has no tendinous cords and is located at the level of 3rd costal cartilage

Pulmonary valve

How many semilunar cusps are present in the pulmonary valve?

3 - anterior - right - left

Approx 5 cm long and 3 cm wide and conducts poorly oxygenated blood to the lungs for oxygenation

Pulmonary trunk

What are the divisions of the pulmonary trunk?

R an L pulmonary arteries

``` Forms most of the base or posterior surface of the heart A. R atrium B. L atrium C. R ventricle D. L ventricle ```

B. L atrium

Thicker wall A. R atrium B. L atrium

B. L atrium

What veins enter the L atrium?

R and L pulmonary veins | - 2 superior and 2 inferior pulmonary veins

``` The R and L pulmonary veins enter the A. R atrium B. L atrium C. R ventricle D. L ventricle ```

B. L atrium

Forms the superior part of the L border of the heart. Also functions as an add-on room.

L auricle

True or False: | The L atrium contains pectinate muscles

True

Condition: benign neoplasm or tumor that is 90% located in the atrium and can present as a hard globular mass or may have a soft gelatinous appearance (+) fever and malaise * surgical removal is curative

Myxoma

Forms the apex of the heart, nearly all its L surface and border and most of its diaphragmatic surface A. R atrium B. L atrium C. R ventricle D. L ventricle

D. L ventricle

Walls are 2 to 3 times thick A. R ventricle B. L ventricle

B. L ventricle

Performs more work A. R ventricle B. L ventricle

B. L ventricle | - arterial pressure is higher in the systemic than in pulmonary circulation

Has a longer and narrower conical cavity A. R ventricle B. L ventricle

B. L ventricle

Opening through which the L atrium discharges oxygenated blood into the L ventricle

L atrioventricular orifice

``` The L AV orifice is surrounded by what valve? A. Bicuspid valve B. Tricuspid valve C. Mitral valve D. Thebesian valve ```

C. Mitral valve

``` Located posterior to the sternum at the level of 4th costal cartilage A. Bicuspid valve B. Tricuspid valve C. Mitral valve D. Thebesian valve ```

C. Mitral valve

``` Resembles a bishop's miter A. Bicuspid valve B. Tricuspid valve C. Mitral valve D. Thebesian valve ```

C. Mitral valve

True or False: | Tendinous cords are attached in the mitral valve

True

The mitral valve has how many cusps?

2 - anterior - posterior

Condition: ballooning of mitral valve leaflets. Leaflets are enlarged, thick, and rubbery.

Mitral valve prolapse

Trabeculae carnae is finer and more numerous A. R ventricle B. L ventricle

B. L ventricle

Anterior and posterior papillary muscles are larger A. R ventricle B. L ventricle

B. L ventricle

Presence of moderator band A. R ventricle B. L ventricle

B. R ventricle

True or False: | The L ventricle has a moderator band

False

Smooth-walled superoanterior outflow part of the L ventricle that leads to the aortic valve an aortic orifice

Aortic vestibule

Located at the upper right and posterior part in which the blood leaves the L ventricle A. Aortic valve B. Aortic vestibule C. Aortic orifice

C. Aortic orifice

``` Located posterior to the L side of the sternum at the level of the 3rd ICS A. Pulmonary valve B. Aortic valve C. Mitral valve D. Eustachian valve ```

B. Aortic valve

True or False: | The aortic valve has tendinous cords attached to it.

False

How many semilunar cusps are present in the aortic valve?

3 - right - left - posterior

``` (+) lunule and nodule and has no tendinous cords A. Pulmonary valve B. Aortic valve C. Mitral valve D. Eustachian valve ```

B. Aortic valve

The R coronary artery arises from what sinus?

R aortic sinus

The L coronary artery arises from what sinus?

L aortic sinus

Condition: Most frequent valve abnormality that results to L ventricular hypertrophy

Aortic valve stenosis

The aorta is divided into how many parts?

4 - ascending - arch - descending - abdominal

``` Arise from the base of the L ventricle A. Ascending B. Arch C. Descending A. Abdominal ```

A. Ascending

What are the branches of the ascending aorta?

R and L coronary artery

``` Continuation of the ascending aorta A. Ascending B. Arch C. Descending A. Abdominal ```

B. Arch

What are the branches of the arch of the aorta?

Brachiocephalic L common carotid L subclavian

``` Brachiocephalic A is a branch of? A. Ascending B. Arch C. Descending A. Abdominal ```

B. Arch

``` L coronary A is a branch of? A. Ascending B. Arch C. Descending A. Abdominal ```

A. Ascending

``` L common carotid A is a branch of? A. Ascending B. Arch C. Descending A. Abdominal ```

B. Arch

``` L subclavian A is a branch of? A. Ascending B. Arch C. Descending A. Abdominal ```

B. Arch

``` R coronary A is a branch of? A. Ascending B. Arch C. Descending A. Abdominal ```

A. Ascending