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cardio > Heather's Anatomy Notes > Flashcards

Heather's Anatomy Notes Flashcards

1
Q

The embryonic heart begins as a straight tube with one-way blood flow. What are the input and output ends of this tube?

A

Sinus venosus is the input end of the heart tube

Truncus arteriosus is the output end of the heart tube The heart initially develops outside the body, and folds in order to fit into the thoracic cavity

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2
Q

Subdivision of the embryonic heart tube produces chambers. Which septa create the chambers?

A

Septum primum subdivides the atria, leaving an open portion (osmium premium)

Septum secundum then covers the foramen primum, leaving an opposing open portion (foramen ovale)

Septum primum becomes a flap covering foramen ovale, with a second opening in it (foramen secundum), which fuses shut after birth

The interventricular septum grows outward to divide the ventricles and has both muscular and membranous components

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3
Q

How does ventricular septal defect occur?

A

Ventricular septal defect: the membranous portion of the ventricular septum is often incomplete; these are the most common type of congenital anomalies of the heart. Causes pulmonary hypertension, because SV decreases, causing imbalance

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4
Q

How does atrial septal defect occur?

A

Incomplete closure of the foramen ovale after birth is the most common problem leading to an atrial septal defect; can cause enlargement of the right atrium, because blood from the LA flows back into the RA

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5
Q

Where do the great vessels of the heart (and most circulation of the head) arise from?

A

Great vessels of the heart arise from the embryonic pharyngeal arches

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6
Q

What is the ductus arteriosus, and what embryonic structure does it arise from?

A

The ductus arteriosus is one of the left-right shunts in the heart during fetal circulation; it arises from the sixth pharyngeal arch artery

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7
Q

Where do the large veins around the heart come from?

A

The large veins around the heart develop through remodeling of the cardinal veins

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8
Q

Clinical Correlation: Variants in the Great Vessels

A

Most variation in the pattern of the great vessels is asymptomatic

Some variants, such as double aortic arches, have serious clinical consequences including compression of the esophagus and trachea

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9
Q

List the 5 shunts and additional circulatory structures that exist in fetal circulation, and what they become in adult circulation

A
  1. Foramen ovale –> fossa ovalis
  2. Umbilical vein (intra-abdominal part) –> ligamentum teres
  3. Ductus venosus –> ligamentum venosum
  4. Umbilical arteries and abdominal ligaments –> medial umbilical ligaments, superior vesical artery (supplies bladder)
  5. Ductus arteriosus –> ligamentum arteriosum

Failure of the fetal circulation to remodel results in adult presence of some fetal elements, which may or may not have clinical consequences

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10
Q

What are the functional compartments of the thorax?

And the subdivisions of the mediastinum?

A

Mediastinum:

  • Heart
  • Trachea
  • Great vessels
  • Esophagus

Pulmonary cavities:

  • Lungs

The mediastinum can be further divided into superior, inferior, anterior, middle, and posterior compartments.

The heart and great vessels lie in the middle mediastinum

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11
Q

The heart and pericardial cavity are lined by a membrane called the pericardium. What are the layers of this membrane?

A
  • Fibrous pericardium; continuous with the central tendon of the diaphragm and forming the external inelastic layer
  • Parietal serous pericardium; lines the fibrous pericardium
  • Visceral serous pericardium; continuous with the parietal pericardium, but lying directly on the heart
  • Pericardial cavity is the space between the two layers of the serous pericardium
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12
Q

Clinical Correlation: Cardiac Tamponade

A

Heart compression occurs when the pericardial cavity fills with fluid, because the fluid is not compressible.

Perforating wounds, as well as blood leakage following an MI, result in hemopericardium - blood in the pericardial cavity

The sudden increase in fluid results in increased pressure in teh pericardial cavity, and reduction of heart volume. Decreases SV and cardiac output.

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13
Q

Three layers of the walls of the heart

A

Endocardium: innermost endothelial layer

Myocardium: middle layer consisting of helical cardiac smooth muscle

Epicardium: outermost layer, equivalent to the visceral serous pericardium

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14
Q

What are the different thicknesses of the atria and ventricles of the heart?

A

RA: 1-2 mm thick, low pressure

LA: 1-2 mm thick, low pressure

RV: 5-10 mm thick, low pressure

LV: 15-30 mm thick, high pressure

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15
Q

Clinical Correlation: Ventricular hypertrophy

What conditions lead to hypertrophy of the LV?

A

Conditions in which the heart has to work harder to overcome resistance in the circulation lead to hypertrophy of the ventricles:

  • Aortic stenosis
  • Systemic HTN
  • Pulmonary valve stenosis
  • Pulmonary arterial hypertension (COPD, altitude, etc)
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16
Q

What are the 3 functions of the fibrous skeleton of the heart?

A
  • Supports the valves of the heart
  • Insulates the atria from the ventricles
  • Provides an anchor point for the muscle fibers
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17
Q

What are the auricles of the heart?

A

The auricles are muscular sacs that increase the capacity of the atria

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18
Q

What are the great vessels of the heart?

A

The aortic arch, pulmonary trunk, and pulmonary arteries and veins

The superior and inferios vena cava

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19
Q

How does blood get into and out of the right atrium?

A

Blood enters the RA through the superior/inferior vena cava, and the coronary sinus.

Blood exits the RA through the right AV valve (tricuspid valve)

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20
Q

How does blood leave the right ventricle?

And where does that blood go?

A

Blood leaves the RV through the pulmonary semi-lunar valve, and the pulmonary trunk.

This blood goes to the lungs via pulmonary circulation.

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21
Q

How does blood get into and out of the left atrium?

A

Blood enters the LA through the 4 pulmonary veins

Blood leaves the LA through the left AV valve (mitral valve, bicuspid valve)

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22
Q

How does blood leave the left ventricle?

And where does that blood go?

A

Blood leaves the LV throught the aortic semi-lunar valve, and the aortic arch

This blood leaves through the aorta, and goes out into systemic circulation to supply blood to the entire body

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23
Q

Clinical Correlation: Heart murmur

What is a heart murmur?

What can cause a murmur?

A

A heart murmur is the sound caused by rapid or turbulent blood flow across the valves in the heart. It may be heard on systole or diastole, and in different positions on the thorax.

Types of murmurs:

Stenosis: narrowing of valves or vessels

Atrial or ventricular septal defects

May be benign, especially if found in a younger person.

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24
Q

What two arteries are the first branches off the ascending aorta?

And which one is the dominant one?

A

The RCA and LCA are the first branches off the aorta, and whichever one gives rise to the posterior interventricular (descending) branch is the dominant branch

RCA dominance is more common, occuring in 67% of people

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25
Q

What are the branches that come off of the right coronary artery?

And what areas does the RCA supply?

A

The RCA gives off, in order:

  • Sinoatrial nodal branch
  • Atrioventricular nodal branch
  • Posterior interventricular branch
  • Interventricular septal branch

The RCA typically supplies the RA, most of the RV, diaphragmatic surface of the LV, posterior third of the interventricular septum, the SA node, and the AV node.

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26
Q

What are the branches that come off of the left coronary artery?

And what areas does the LCA supply?

A

The LCA gives off, in order:

  • Sinoatrial nodal branch (in 40%)
  • Left anterior interventricular branch (LAD)
  • Circumflex branch
  • Left marginal branch

The LCA thus typically supplies the LA, most of the LV, part of the RV, most of the interventricular septum including the AV bundle, and the SA node in 40% of people.

27
Q

How does de-oxygenated venous blood drain from the heart?

A

Most veins draining the heart empty into the coronary sinus

  • The anterior interventricular vein drains into the great cardiac vein, and drains the areas supplied by the LCA
  • The middle cardiac vein accompanies the posterior interventricular branch of the RCA
  • The small cardiac vein accompanies the right marginal branch of the RCA
  • Small anterior cardiac veins drain the RV and drain directly into the right atrium
28
Q

Clinical Correlation: Myocardial Infarction

What are the different causes of an MI?

A

Lack of blood supply to the heart causes myocardial infarction, which is death of heart tissue. Things that can lead to an MI include:

  • Sudden blockage of a coronary branch by an embolism
  • Gradual occlusion (IHD) from atherosclerosis; Ischemic heart disease increases the risk of MI

Common treatments include angioplasty and coronary artery bypass grafts (often the saphenous vein).

29
Q

What structures does the right bundle branch supply?

The left bundle branch?

A

Right bundle branch: interventricular septum, anterior papillary muscle, wall of right ventricle

Left bundle branch: interventricular septum, anterior and posterior papillary muscle, wall of the left ventricle

30
Q

Clinical Correlation: Heart Block

A

Damage to the AV ndoe or bundle results in heart block. Excitation produced by the SA node does not reach the ventricles. It is often caused by IHD.

The ventricles contract at their own rate, resulting in asynchronous contraction of the ventricles. It may be corrected by implanting a pacemaker.

31
Q

How is the heart innervated?

A

The heart receives autonomic supply from the cardiac plexus

  • Sympathetic innervation derives from thoracic fibers that terminate at the SA and AV nodes, and along coronary arteries; T1-T4/5 which produce increased HR, impulse conduction, force of contraction, and coronary flow
  • Parasympathetic innervation derives from the vagus nerve (10), with cell bodies located near the SA and AV nodes and along coronary arteries; it decreases HR, force of contraction, and coronary flow
32
Q

Through what branches off the aorta does the systemic blood to the head and neck flow?

To the rest of the body?

A

Systemic blood to the head and neck is distributed via three branches off the aortic arch:

  • Brachiocephalic trunk
  • Left common carotid artery
  • Left subclavian artery

(Think ABCs –> aorta, brachiocephalic, carotid, subclavian)

Systemic blood flow to the rest of the body is distributed through the descending aorta.

33
Q

How does blood from the head, neck, and top of the thorax return to the heart?

How does the rest of the blood return to the heart?

A

Blood from the head and neck return to the RA via the SVC, whose major tributaries are the brachiocephalic veins and the azygos vein.

Systemic blood from the rest of the body is returned to the RA via the IVC.

Systemic blood from the heart is returned to the RA via the coronary sinus.

34
Q

How does blood from the heart get to the lungs, and then back from the lungs to the heart?

A

Pulmonary blood is distributed to the lungs via the pulmonary arteries (2), and is returned to the heart via the pulmonary veins (4)

35
Q

Components of the cardiac cycle, and their main outcomes

A

The two sides operate in parallel during the cardiac cycle. Systemic pressure decreases as blood moves away from the heart. The two main heart actions are:

Diastole: relaxation and filling; 2/3 of cycle; blood is transferred from the atria to the ventricles (heart sound 1: AV valves)

Systole: contraction and emptying; 1/3 of cycle; blood is transferred to circulation (heart sound 2: SL valves)

36
Q

Clinical Correlation: Tachycardia

What can cause it?

Two types?

A

The normal sinus rhythm and rate may be disrupted by intrinsic stimulation, conduction abnormalities, drugs, or other factors.

Sinus tachycardia - normal rhythm with accelerated HR; exercise

Ventricular tachycardia - dangerous condition in which the ventricles contract rapidly and irregularly; pathological

37
Q

How does the lower respiratory tract develop during fetal development?

A

The larynx, trachea, bronchi, and lungs develop as an out-pouching of the foregut, beginning during week four.

As this respiratory diverticulum elongates, a lung bud develops at it’s distal end.

Several molecules are involved in proimo-distal patterning and bud control

38
Q

Clinical Correlation: Tracheal malformations

What is a tracheoesophageal fistula?

What is a tracheal stenosis?

A

Tracheoesophageal fistula: there is an open communication between the trachea and the esophagus

Tracheal stenosis: the trachea is abnormally narrowed

39
Q

What are the 4 stages of lung maturation that lead to the production of a functional gas exchange organ?

A
  1. Pseudoglandular period (5-17 wks) - gas exchange not yet possible
  2. Canalicular period (16-25 wks) - primordial alveoli begin to develop
  3. Terminal sac period (24 wks - birth) - blood-air barrier is established; secretory and gas exchange alveoli develop (surfactant production!)
  4. Alveolar period (32 wks - 8 yrs) - 95% of alveoli develop after birth
40
Q

Clinical Correlation: Lung hypoplasia or Agenesis

Who does this occur in and why?

A

Underdevelopment (hypoplasia) of the lungs occurs in children with congenital diaphragmatic hernia. The presence of the abdominal viscera in the thoracic cavity impedes expansion of the developing lung.

Complete absence of one ling results from failure of the developing lung bud to bifurcate. The remaining lung is usually hyper-expanded.

41
Q

What bones make up the thoracic skeleton?

A

The thoracic skeleton includes the true ribs (1-7), false ribs (8-10), and floating ribs (11-12), along with the sternum and thoracic vertebrae

42
Q

What 8 joints are contained within the thoracic cage?

A

The thoracic cage incorporates a number of joints that permit a limited ROM, but which combine to allow the cage to expand and contract during respiration:

  • Costovertebral
  • Intervertebral (T1-T12; small rotation)
  • Costochondral (no movement)
  • Interchondral
  • Sternocostal
  • Sternoclavicular
  • Manubriosternal (fused in older individuals)
  • Xiphisternal (fused in older individuals)
43
Q

Clinical Correlation: Thoracic Skeleton Injury

A

Injury to the thoracic cage threatens the soft tissue structures beneath it. Rib injuries put the lungs at risk, and injuries to the sternum put the heart at risk.

44
Q

What are the types of intercostal muscles, and what are their functions?

A
  • External intercostals - elevate the ribs, most active during inspiration
  • Interchondral portions of internal intercostals - elevate the ribs, most active during inspiration
  • Interosseus portions of internal intercostals - depress the ribs, most active during expiration
45
Q

What role does the diaphragm play in respiration?

A

The diaphragm contracts to expand the thoracic cavity downward, by compressing the abdominal viscera. This creates a negative pressure in the lungs, and air enters the lungs passively.

46
Q

What are the accessory muscle of respiration and what do they do?

A

Scalenes - assist in expanding the thoracic cavity by fixing the first and second ribs

Pectoralis major/minor - assist in expanding the cavity

Serratus anterior - assists in expanding the cavity

47
Q

How is blood supplied to the thorax? Where does it arise from?

A

The arterial supply to the thorax is derived from:

  • The thoracic aorta, which gives rise to the posterior intercostal arteries and subcostal arteries
  • The subclavian artery, which gives rise to the internal thoracic arteries and the supreme intercostal arteries. The internal thoracic arteries give rise to the anterior intercostal arteries
  • The axillary artery, which gives rise to the superior thoracic artery and lateral thoracic artery
48
Q

In addition to the veins that follow arteries, what other veins drain the thorax?

A

Thorax is drained by three additional veins that do not have corresponding arteries:

  • Azygos vein drains the posterior walls of the thorax and abdomen, and joins the SVC before it enters the heart
  • Hemiazygos vein drains the posterior walls of the thorax and abdomen below T9, where it joins the azygos vein
  • Accessory azygos vein drains the posterior walls of the thorax between T5 and T8, where it joins the azygos vein
49
Q

Innervation of the thorax

What innervates the thorax? And the diaphragm?

A

The thorax is innervated by 12 pairs of thoracic spinal nerves:

  • The anterior rami of T1-T11 form the intercostal nerves
  • The anterior ramus of T12 forms the subcostal nerve

The diaphragm is innervated by the phrenic nerve (C3-5)

50
Q

What is the costal groove?

A

Costal groove is on the interior, inferior of each rib

There is a vein, artery, and nerve running in the costal groove on the inferior edge of each rib.

51
Q

Clinical Correlation: Tension Penumothorax

What is it, and what are teh different types?

A

Entry of air or fluid into the pleural cavity causes the surface tension between the two layers of pleurae to break. The lung no longer adheres, and collapses due to elastic recoil.

Pneumothorax: air enters the pleural cavity, either throught the parietal or visceral pleura

Haemothorax: blood enters the pleural cavity, usually from an injury to the thoracic cage

52
Q

Clinical Correlation: Foreign Bodies in the Lungs

Where do foreign bodies usually end up in the lungs and why?

A

The orientation of the primary bronchi affects the likelihood an aspirated object will enter the left or right lung.

The right primary bronchus is normally more vertically oriented and slightly wider than the left, so most aspirated objects end up in the right lung.

53
Q

Clinical Correlation: COPD

A

COPD describes several conditions in which air flow in the lungs is obstructed.

Emphysema: common COPD, usually caused by chronic exposure to toxic chemical including those found in tobacco smoke

Chronic inflammation of the alveoli eventually leads to their destruction, reducing the ability of the lungs to exchange gases.

54
Q

Pulmonary circulation

How do the lungs receive their blood, and how is the blood drained back to the heart?

A
  • The pulmonary arteries arise from the pulmonary trunk at the sternal angle
  • Pulmonary arteries give rise to lobar arteries which in turn give rise to segmental arteries, which run parallel to bronchi
  • Each alveolus is surrounded by a capillary trunk
  • The roots of the lungs are supplied by the two left and one right bronchial arteries
  • The superior and inferior pulmonary veins drain the lobar and segmental veins, and return oxygenated blood to the heart
  • The bronchial veins drain part of the roots of the lungs into the azygos/hemiazygos system, while the pulmonary veins drain the rest
55
Q

How are the lungs innervated?

A

Lung innervation is by the anterior and posterior pulmonary plexi

Parasympathetic innervation is derived from the vagus nerve; bronchoconstriction, vasodilation, secretomotor

Sympathetic innervation is derived from postsynaptic fibers of the sympathetic chain (T1-T4); bronchodilation, vasoconstriction, secretory inhibition

Visceral afferent innervation is also supplied by the vagus nerve

56
Q

What types of pain and referred pain can be felt by the lungs?

A

The visceral pleura has no sensory capacity. The parietal pleura, however, is sensitive to pain and is innervated by the intercostal and phrenic nerves.

Referred pain from intercostal stimulation will occur in the dermatomes of the thoracic wall.

Referred pain from phrenic nerve stimulation will occur in the dermatomes of C3-C5, on the shoulder and at the base of the neck

57
Q

What sinuses make up the nasal cavity? What is the structure of the nasal cavity?

A

The frontal, ethmoid, sphenoid, and maxillary paranasal sinuses are air-filled extensions of the respiratory portion of the nasal cavity. The sinuses increase surface area for exchange of heat and moisture.

The nasal cavities are supported by nasal conchae, which are formed by the turbinate bones. Nasal conchae are covered by mucosa.

58
Q

What are the roles of the larynx?

A

The roles of the larynx:

Protect and maintain the airway

Responsible for vocalization

59
Q
A
60
Q

Nine cartilages of the laryngeal skeleton

A
  • Paired arytenoids, corniculates, and cuneiforms
  • Single thyroid, cricoid, and epiglottic

The cartilaginous elements are held together by a series of ligaments and membranes.

The epiglottis acts as a valve, closing the superior aperture of the larynx during swallowing.

61
Q

What structures make up the voice box?

A

The vocal folds of the larynx control sound production. They each contain a vocal ligament and a vocalis muscle.

The aperture between the vocal folds is called the rima glottidis.

Variation in the tension and length of the vocal folds, and shape of the rima glottidis, produces changes in vocal pitch.

62
Q

What are the intrinsic and extrinsic musculatures of the larynx, and what do they each do?

A

The extrinsic musculature moves the larynx as a unit. The suprahyoid muscles elevate the larynx and hyoid. The infrahyoid muscles depress the larynx and hyoid.

The intrinsic musculature of the larynx alters the length and tension of the vocal folds and the shape of the rima glottidis.

63
Q

Clinical Correlation: Cricothyrotomy

A

The thyroid cartilage and cricothyroid cartilage can be used to locate the cricothyroid ligament. In an emergency, the cricothyroid ligament can be pierced to establish a patent airway without causing damage to other key organs in the region.

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