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MD3001 > Heart internal structure and surface anatomy > Flashcards

Heart internal structure and surface anatomy Flashcards

1
Q

What 2 types of circulation are there?
Mention their blood pressures

A
  • Systemic circuation to all the body. 70-120 mmHg
  • Pulmonary circulation to the lungs. 12-16 mmHg
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2
Q
  • What do we mean when we say arterial or venous circulation?
  • What common misconception is there with these terms?
A
  • Arterial refers to blood flowing away from the heart, venous refers to blood flowing to the heart.
  • These terms have nothing to do with the oxygen concentration of the blood in the vessels, just the direction of blood flow
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3
Q
  • Name the heart surfaces and the main structure that dominates them.
  • What separates the diaphragmatic and base surface of the heart?
A
  • Sternocostal(anterior surface): dominated by right ventricle
  • Diaphragmatic(inferior) surface: dominated by left ventricle
  • Right Pulmonary surace: dominated by right atrium
  • Left Pulmonary surface: dominated by left ventricle and cardiac impression.
  • Base(posterior) surface: dominated by the left atrium and pulmonary veins.
  • Apex
  • Coronary sinus separates inferior and posterior surfaces.
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4
Q

What is the landmark of the base, and what structures are present there?

A
  • Structures: left atrium, pulmonary veins, riht atrium
  • It is fixed to the pericardium at the level of T6-T9 vertebrae
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5
Q

Characteristics of the apex of the heart

A
  • Landmark: Left 5th intercostal, mid-clavicular line
  • Heartbeat is palpable from here
  • Useful in clinical examination to check for cardiomelagy if heartbeat is displaced lower or more laterally than the usual landmark.
  • More superior and lateral in children.
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6
Q

Name the heart margins we would see in an X Ray and the structures found in them

A
  • Right margin: R atrium
  • Left margin: L ventricle and auricle
  • Inferior margin: R ventricle and L ventricle
  • Superior margin: Auricles of atria and roots of great blood vessels
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7
Q

Name the septa and chambers in the heart

A
  • Septa:
    Interatrial
    Interventricular
    atrioventricular
  • Chambers:
    R and L atria
    R and L ventricles
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8
Q

Describe the Right atrium

Explain all the structures it contains

A

Contains the following:
* Atrium proper: smooth surface of atrium
* Auricle: it has ridges called musculi pectinati involved in contracting
* Smooth part of atrim is a modified vein formed from the IVC and SVC subsiding into the right atrium.
* SVC, IVC , coronary sinus and anterior cardiac vessels

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9
Q

Describe the Left atrium

A

Contains:
* Atrium proper with smooth surface
* Auricle with musculi pectinati that contracts
* 4 pulmonary veins: 2 from each lung

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10
Q

Mention the atrial tributaries

A

R ATRIUM
* Opening of the SVC (3rd costal cartilage). No valves
* Intervenous tubercle present: previously used to direct blood in foetal circulation, not needed in adults.
* Opening of IVC: has valve
* Opening of coronary sinus: Has valve
* Opening of anterior cardiac veins: don’t join coronary sinus

L ATRIUM
* Opening of pulmonary veins- no valves

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11
Q

Describe the R and L atrial walls

A

R ATRIUM
* Crista terminalis: separates R atrium from auricle
* Fossa ovalis: Remnant of embriological shunt or foramen ovale between atria of foetal heart which fuses up in adults

L ATRIUM
* Falx septi: Depression on the left side of interatrial septum. Caused by fusion of foramen ovale valve. NOT AT SAME LEVEL AS FO

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12
Q

What is the main function of auricles

A
  • Formed by pectinate muscles
  • Involved in atrial contraction
  • They are useful because they contract withut thickening the cardiac wall too much, making them more efficient.
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13
Q

Describe the characteristics of the R ventricle

Mention its shape, location, pressure and wall thickness

A
  • Crescented in shape(from above)
  • Behind sternum, on central tendon of diaphragm
  • Pressure at rest: 30 mmHg
  • Wall thickness: 3-4 mm
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14
Q

Describe the characteristics of the L ventricle

Mention its shape, location, pressure and wall thickness

A
  • Rpughly circuar in shape( from above)
    *Left border and apex
    *Pressure at rest: 120 mmHg
  • Wall thickness: 8-12 mm
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15
Q

Name the 4 different views of the heart we can observe from an echocardiograph

A
  • Parasternal long axis view: All of Left heart, aortic arch and valve and mitral valve
  • Parasternal short axis view : R and L ventricle and papillary muscles from LV, seen from above
  • Apical 4 chamber view: All heart chambers and their valves and septa. Image is upside down
  • Subcostal view: All heart chamber, valves, septa and the liver. Image is upside down.
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16
Q

Explain the direction of blood flow from the R and L atrioventricular valves.

A

TRICUSPID VALVE( right)
* Cusps are attached to the anulus fibrosus
* Blood flows anteriorly and medially
* Landmark: inferior right sternum

BICUSPID/MITRAL VALVE( left)
* Cusps attached to anulus fibrosis
* Blood flows towards apex
* Landmark: inferior left sternum

17
Q

Describe the characteristics and function of the chordae tendinae

A
  • Fibrous chords between papillary muscles and AV valves cusps.
  • Prevent valve prolapse, therefore helping in preventing backflow of blood during ventricular contraction.
  • Chordae T. from one P. muscle attaches to more than 1 cusp.
18
Q

Describe the outflow pathways of blood from ventricles

A

R VENTRICLE
* Infundibulum (meaning funnel): Smooth superior area that leads to pulmonary trunk
* Blood flows up,back then to the left.
L VENTRICLE
* Has aortic vestibule
* Infundibulum
* Blood flows up, back and takes a sharp-U turn to the right.

19
Q

Name the cusps of the pulmonary and aortic semilunar valves.

A
  • Pulmonary valve(Right) has 3 cusps: anterior, left and right
  • Aortic valve(left) has 3 cusps: posterior, left and right.

Both semilunar valves have a nodule at each apex of valve which help SL cusps lock together.

20
Q

Describe the Pulmonary and Aortic sinuses

A

Pulmonary(R)
* There are 3. There are behid the cusps
* They fill during diastole, closing the valve

Aortic(L)
* Also called sinuses of Vasalva
* There are 3: Left. right and non-coronary sinus.
* Openings of left and right coronary arteries behind left and right cusps of atrial cusps
* Fill during diastole

21
Q

Describe the fibrous skeleton of the heart

A
  • Complex set of fibrous rings with connecting areas.
  • Structural and functional support of heart
  • Made up of 4 fibrous rings called anulus fibrosus which surround AV and SL valves and 2 trigones(R and L), along with the membranes of all the heart septa.
    FUNCTIONS
  • Origin/insertion for papilllary muscles
  • Attachment for valves
  • Trigones electrically insulates atria and ventricles to allow independent contraction. Bundle of His passes through here
22
Q

Describe the structure of the cardiac wall

A
  • Endocardium-inner-Continous with endothelium of blood v., lines inner walls nd valves. Receives nutrients by diffusion from blood in chambers.
  • Myocardium-middle layer. Contractile
  • Epicardium-outer-Continous with the visceral layer of the serous pericardium
23
Q
  • Describe the myocardium in more detail
  • Embriology of myocardium

Mention arrangement of muscles, and names of muscles that makes it up

A
  • Muscles are arranged in spiral and ciruclar bundles
  • Origin and insertion in fibrous skeleton
  • Atrial musculature made up of pectinate muscles
  • Ventricular musculature made up of trabercula carnea(meaty bridge), papillary muscles and septomarginal band
24
Q

Name and describe the 3 muscles of the ventricles

A
  1. Trabecula carnea: irregular muscular ridges. Equivalent of pectinate muscles in Vent.
  2. Papillary muscles: Can be anterior, posterior, left or right. They contract before ventricles do.
  3. Septomarginal trabecula: Only in R ventricle. Bridge between Iv septum and anterior papillary muscle, to ensure coordinated contraction of Ant. PM. Carries right branch of Av bundle in cardiac conduction.

Without S. trabecula, anterior pm would contract at a different time than the rest pm.

25
Q

What causes each heart sound

A

S1 ( lub): closing of AV valves for ventricular systole
S2(dub): closing of SL valves for diastole

26
Q

What actions can change the heart sounds?

A
  • Sitting
  • Recumbent position
  • Breathing
  • Deep breaths
  • Vasalva manoeuvre: expiration while closing mouth and nose.
  • Exercise
27
Q

Surface anatomy and landmarks of heart from which we can hear heart sound

A
  1. R 3rd costal cartilage, 2cm from midline
  2. R 6th costal cartilage, 2 cm from midline
  3. L 5th intercostal space, 7-9 cm from midline(apex of heart)
  4. L 2nd costal cartilage, 3 cm from midline
28
Q

Surface anatomy for valves

A
  • Tricuspid valve: Behind R sternum, 4th intercostal
  • Mitral valve: Behind articulation between L 4th costal c. and sternum
  • Pulmonary valve: Poserior to articulation between L 3rd costal c. and sternum
  • Aortic valve:Posternium to sternum, 3rd intercostal

All valves lie behind sternum between 3rd & 4th c.cartilage/intercostal

29
Q

Where is the best location to hear the 2 heart sounds?

A

S1-LUB
* Tricuspid valve: best at lower sternum, ner 4th intercostal
* Mitral valve: best at left 5th intercostal, midclavicular line
S2- DUB
* Aortic valve: best at right 2nd intercostal
* Pulmonary valve: best at left 2nd intercostal

30
Q
  • Define murmur
  • Where are they best heard at
A
  • Disturbance in the laminar blood flow through a valve or backflow of blood through a valve.
  • Best heard in the right heart
31
Q

What structures of the heart/margins can be seen in a Chest X ray

A
  • SVC and IVC
  • Right atrium
  • Aortic arch: forming an aortic knuckle which impresses as a bulge in superior mediastinum.
  • Pulmonary trunk
  • Left auricle tip
  • Left ventricle
32
Q

When doing a Chest X Ray of a patient to see their lungs, what action would you indicate they do and why?

A
  • I would indicate they take a deep breathe in.
  • Because as we inspire strongly, the hear goes down and becomes more narrow as it is attached to the diaphragm, the clavicle goes up, allowing us to see the lungs much better

MD3001 (5 decks)

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