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Anatomy MD3001 > Heart- internal structure and surface anatomy > Flashcards

Heart- internal structure and surface anatomy Flashcards

1
Q

What are the surfaces of the heart and what makes up each of them?

A

• Sternocostal (anterior)

  • right ventricle
  • right atrium
  • some of left ventricle

• Diaphragmatic (inferior)

  • Sits on the central tendon
  • Left ventricle
  • Some right ventricle
  • separated from the base by the coronary sinus

• Right pulmonary
- right atrium

• Left pulmonary
- left ventricle

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2
Q

What makes up the base of the heart?

A
  • mainly the left atrium and pulmonary veins

* Small portion of the right atrium

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3
Q

Describe the position of the base of the heart

A

• Fixed posteriorly to the pericardium at the level of T6- T9 (when standing, T5-T8 when supine)

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4
Q

Where is the apex of the heart?

A
  • Left side of the 5th intercostal space
  • 8-10cm away from the midline
  • More superior and lateral in children
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5
Q

What are the heart margins?

A

• Right margin
- right atrium

• Left margin

  • Left ventricle
  • Left auricle

• Inferior margin

  • Right ventricle
  • Left ventricle (apex)
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6
Q

External sulci

A
  • Anterior intercostal sulcus
  • Anterior inter ventricular artery
  • Great cardiac vein
  • Right of the apex
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7
Q

Coronary sulcus

A
  • Separates the atria from the ventricles
  • Right coronary sinus
  • Left circumflex artery
  • Cornoary sinus
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8
Q

What percentage of venous blood of the heart is drained by the coronary sinus?

A

• 60%

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9
Q

Posterior interventricular sulcus

A
  • Posterior interventricualr artery

* Middle cardiac vein (posterior interventriuclar vein)

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10
Q

What is the function of the right atrium?

A
  • Temporary reservoir for deoxygenated blood

* Receives blood from the superior vena cava , inferior vena cava, coronary sinus and smallest cardiac veins

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11
Q

What separates the right atrium from the right auricle?

A
  • Crista terminals internally (muscular ridge)

* Sulcus terminals externally

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12
Q

Fossa ovalis

A
  • On the right side of the IA septum

* Site of foramen vale in the foetus

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13
Q

What is the margin of fossa ovale?

A

Limbus fossa ovalis

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14
Q

At what level does the SVC open in to the atrium?

A

Behind the 3rd right costal cartilage

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15
Q

Which vessels opening into the right atrium have valves and which don’t?

A

Valves:
• Inferior vena cava
• Coronary sinus

No Valves:
• Superior vena cava
• Openings of the smallest cardiac veins

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16
Q

What is the right auricle?

A
  • Rough surface formed by the pectinate muscles

* Provides some power of contraction without significantly thickening the cardiac wall

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17
Q

Where is the right ventricle

A

It sits on the central tendon of the diaphragm

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18
Q

What is the thickness of the right ventricle?

A

• 3-4mm

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19
Q

What is the outflow tract of the right ventricle?

A
  • Infundibulum [conus arteriosus]
  • Pulmonary trunk arises here
  • Surface of the infundibulum is smooth
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20
Q

What are the muscular ridges in the wall of the right ventricle called?

A

Trabecular carnea

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21
Q

What are the 3 types of muscle on the right ventricular wall?

A
  • Trabecular carnea
  • Septomarginal trabecular (moderator band)
  • Papillary muscles
22
Q

Describe the septomarginal trabecular muscle

A
  • Act as a bridge between the septum and the anterior papillary muscles
  • Carries the right bundle branch of the AV bundle of the cardiac conduction system
23
Q

Describe the papillary muscles

A
  • Fibrous chords called chorda tendinae run between their apex and free edges of tricuspid valve cusps
  • Contract before ventricular contraction
  • Chorda tendinae prevent the exertion of cusps
  • chorda tendinae from one papillary muscle attach to more than one cusp
24
Q

Describe the tricuspid valve

A
  • Closes the AV orifice
  • Consists of 3 cusps (anterior, posterior and septal)
  • Base of each cusp attached to right fibrous ring - anulus fibrosus
25
Q

How does blood flow through the tricuspid valve?

A

• Forwards (inferiorly) and medially

26
Q

Pulmonary valve

A
  • Consists of 3 semilunar cusps: anterior, right and left
  • on their free edge, there is a nodule of the semilunar cusp
  • Each cusp forms a pulmonary sinus which helps the closure of pulmonary valves after systole
27
Q

Describe the left atrium

A
  • makes up most of the base
  • Four pulmonary veins (no valve)
  • Consists of the left auricle and left atrium
  • Depressed area on the IA septum (falx septi) is caused by the fusion of the valve of foramen ovale (not at the same level as foramen ovale
28
Q

What is the direction of the blood flow into the left ventricle?

A

Flows anteriorly and towards the apex

29
Q

What is the thickness of the left ventricle wall?

A

8-12mm

30
Q

Papillary muscles in the left ventricle

A

Anterior and posterior (2)

31
Q

Mitral valve

A
  • 2 cusps: anterior and posterior
  • Bases of the cusps are attached to left fibrous ring (anulus fibrosus)
  • Chorda tendinae extend between their free margins and papillary muscles
32
Q

Aortic valve

A
  • Aortic vestibule is the outflow tract of the LV
  • 3 semilunar cusps: left, right and posterior
  • Between the superior surface of the cusps and aortic wall are pocket like aortic sinuses (sinus valsalvae)
33
Q

How does blood flow out of the aortic valve?

A

• Upwards, backwards and to the right

34
Q

Describe the fibrous skeleton of the heart

A
  • Structural and functional support
  • 4 fibrous rings (anulus fibrosus) around AV, aortic and pulmonary valves
  • Between the 4 rings are 2 trigones (right and left) and the membranous portions of the IA, IV and AV septa
35
Q

What is the function of the fibrous skeleton?

A

• Points of attachment for the heart cusps
• Maintains the patency and integrity of AV and semilunar orifices
• Serves as an origin/insertion for atrial and ventricular muscles
• Insulates the atria from the ventricles
- allows the independent contraction of the atria and ventricles
- Atrioventricular bundle of His should be the only conduction between them

36
Q

What are the layers of the cardiac wall and what is the make up of each of these layers?

A

• Epicardium: visceral layer of the pericardium
• Myocardium:
- atrial musculature
- ventricular musculature
- muscles arranged in spiral and circular bundles
- originate and insert on the fibrous skeleton
• Endocardium:
- Thin layer of endothelium that lines the inner surface of the walls as well as the valves

37
Q

What is the blood supply to the endocardium?

A

Receives oxygen and nutrients directly from the chambers of the heart

38
Q

Surface anatomy of each of the corners of the heart

A
  • Right 3rd costal cartilage 2cm right of midline
  • Right 6th costal cartilage 2cm right of the midline
  • Left 5th costal cartilage 8cm left of midline
  • Left 2nd costal cartilage 3cm left of midline
39
Q

What is the surface projection of the tricuspid valve?

A

Behind the right half of the sternum at the level of the 4th intercostal space

40
Q

What is the surface projection of the mitral valve?

A

Posterior to the articulation between the left 3rd costal cartilage and the sternum

41
Q

What is the surface projection of the aortic valve?

A

Posterior to the sternum, level of the 3rd intercostal space

42
Q

What is the first heart sound

A

AV valves - tricuspid and mitral

• Systole

43
Q

What is the second heart sound?

A

Semilunar valves: aortic and pulmonary

• Diastole

44
Q

Where is the tricuspid valve best heard

A

• just left of the lower part of the sternum near the 5th intercostal space

45
Q

Where is the mitral valve best heard?

A

apex of the heart, left 5th intercostal space at the mid clavicular line

46
Q

Where is the aortic valve best heard?

A

• Medial end of the right second intercostal space

47
Q

where is the pulmonary valve best heard?

A

Medial end of the left second intercostal space

48
Q

How does blood flow through the aortic valve?

A

Superiorly and to the right

49
Q

How does blood flow through the pulmonary valve?

A

Superiorly and to the left

50
Q

How does blood flow through the tricuspid valve?

A

Anteriorly and medially (towards the left)

51
Q

How does blood flow thorough the mitral valve?

A

Anteriorly and inferiorly to the apex

Anatomy MD3001 (13 decks)

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