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CardioPulm > Karen Tong Lecture > Flashcards

Karen Tong Lecture Flashcards

1
Q

Inferior Mediastinum

A

Anterior:

middle: heart
posterior: descending aorta, esophagus, vagus nerve

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2
Q

What envelops the heart

A

Fibrous pericardium: continuous with central tendon of diaphragm, prevent heart from overfilling

Parietal pericardium: inside fibrous

Visceral serous pericardium: inside parietal

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3
Q

pericardial cavity

A

filled with fluid that allows heart to pump without friction

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4
Q

what supplies blood to pericardium

A

pericardiacophrenic artery

pericardiacophrenic vein

phrenic nerve: only does sensory

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5
Q

Too much fluid in heart

A

causes: hemopericardium
pneumopericardium

treatments:
pericardiocentesis
emergency thoracotomy

“cardiac tamponade”

cute compression of the heart caused by a rapid accumulation of fluid or blood in the pericardial cavity from wounds to the heart or pericardial effusion

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6
Q

Start of diastole

A

aortic and pulmonic valves close

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7
Q

Oval Fossa

A

Septum between two atria

Sinus venarum: smooth wall

Pectinate muscle: rough wall

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8
Q

Crista Terminalis

A

separates smooth wall and rough wall

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9
Q

papillary muscles correspond to cusps

A

anterior papillary muscle: anterior cusp

posterior papillary muscle: posterior cusp

septal papillary muscle: septal cusp

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10
Q

pulmonary trunk

A

spaces behind cusps are trunks

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11
Q

Right Coronary A

A

supplies RA, most of RV, part of LV and IV septum, SA node and AV node

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12
Q

branches of right coronary A

A

sinuatrial nodal a

conus branch of right coronary A

atrial branch of right coronary A

Right marginal A

Atrioventricular Nodal A

Posterior Interventicular A

Right Posterolateral A

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13
Q

left coronary artery

A

Supplies LA, most of LV, part of RV, most of IVS, SA node

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14
Q

branches of left coronary artery

A

Anterior interventricular A

  • Lateral A
  • conus branch of left coronary Artery

Circumflex A

  • left marginal A
  • posterior left ventricular A
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15
Q

Small cardiac vein

A

runs with right marginal artery, dumps into coronary sinus

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16
Q

Great cardiac vein

A

runs with anterior inerventricular artery, before dumping into coronary sinus

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17
Q

Heart dominance

A

if it comes off RCA, right dominant

if it comes off LCA, left dominant

Codominance is possible

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18
Q

MI

A

Sudden occlusion of major artery by embolus

myocardium becomes infarcted, necrosis

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19
Q

Most common sites of MI:

A

Anterior IV, RCA, circumflex branch of LCA

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20
Q

Treatment of MI

A

coronary bypass graft, coronary angioplasty

pain is not relieved by rest

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21
Q

Coronary atherosclerosis

A

most common cause of ischemic heart disease

lipid deposits in coronary arteries

insufficient blood supply can lead to MI

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22
Q

Angina Pectoris

A

Pain that originates in the heart and produces a strangling pain of the
chest.

Angina Pectoris literally means strangling pain of the chest. The main is usually the
result of narrow or obstructed coronary arteries that produces ischemia of the myocardium

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23
Q

SA Node

A

“Pacemaker”, control heartrate

in junction of SVC and RA near sulcus terminalis
“in right atrium”

initiates and regulates impulses

supplied by SA nodal Artery

Stimulated by sympathetics and inhibited by parasympathetics

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24
Q

AV node, the gatekeeper

A

in interatrial septum near opening of coronary sinus

-lies in septal wall of right atrium, receives stimulus from SA node, sends it to AV bundle

supplied by AV nodal a, mostly comes from right coronary artery

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25
Q

right AV bundle

A

stimulates muscles of IVS, anterior papillary muscle through moderator band and RV wall

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26
Q

Fibrillation

A

rapid irregular uncoordinated contractions of cardiac muscle

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27
Q

Cardiac Plexus

A

Anterior to trachea, contributions from sympathetic and parasympathetic nerves

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28
Q

Sympathetic

A

T1-T4

Increased heart rate, impulse conduction, force of contraction

increased blood flow through CA

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29
Q

Parasympathetic

A

Vagus nerve

slows HR, reduces force of contraction
constricts CA

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30
Q

chordae tendinae

A

attach cusps to valves

31
Q

Sternal angle separates which two parts of the mediastinum?

A

superior and inferior mediastinum

32
Q

Divisions of inferior mediastinum

A

anterior, middle and posterior mediastinum

33
Q

location of anterior mediastinum

A

anterior to heart

34
Q

middle mediastinum

A

is the heart

35
Q

posterior mediastinum

A

posterior to the heart

36
Q

which part of the heart receives blood from the body?

A

right side of the heart receives blood from superior and inferior vena cava, to be sent to lungs for oxygenation

37
Q

which part of heart pumps oxygenated blood to body?

A

left side of heart receives oxygen rich blood from lungs, pumps it to rest of body

38
Q

Systemic Circulation

A

Left Atrium past the Bicuspid Valve into the Left Ventricle out
of the Heart past the Aortic Valve into the Aorta, through the arterial system, through the
capillaries, though the venous system and back into the Heart through the Inferior and Superior
Vena Cavae

39
Q

Pulmonary Circulation

A

from the Superior and Inferior Vena Cavae into the Right Atrium past
the Tricuspid Valve into the Right Ventricle out of the Heart past the Pulmonary Valve into the
Pulmonary Trunk, through the Right and Left Lungs Back into the Heart through the Pulmonary
Veins

40
Q

Epicardium of heart

A

outermost layer; made up of Visceral Serous

Pericardium

41
Q

Myocardium of heart

A

thick muscular layer made up of spiraling,

overlapping layers of Cardiac muscle

42
Q

Myocardial Infarction

A

lack of blood flow to a specific area of the myocardium, usually the
result of a blockage in a Coronary A.

Coronary Atherosclerosis, or buildup of lipids on the
internal walls of the Coronary arteries decreases the size of lumen of that vessel, increasing the
likelihood of an embolus, or plug blocking a vessel off entirely

43
Q

Endocardium

A

thin internal endothelial and subendothelial layer

lining the inside of the chambers of the Heart and valves

44
Q

Fibrous Skeleton of the Heart

A

1.Produces attachment points for the Myocardium
2. Produces attachment points for the vales of the cuspid
valves
3. Supports and strengthens Atrioventricular and
Semilunar orifices
4. Provides an electrically insulated barrier between the
Atria and the Ventricles

45
Q

Apex

A

inferolateral part of the Left Ventricle,

formed by left ventricle, in left fifth intercostal space, used to auscultate mitral valve

46
Q

Base

A

posterior portion, formed primarily by left atrium

47
Q

Surfaces

A
  1. Sternocostal (Right Ventricle)
  2. Diaphragmatic (Right and Left Ventricles)
  3. Pulmonary (Paired; Right Atrium and Left Ventricle,
    occupying the Cardiac Impression on both Lungs)
48
Q

Borders

A
  1. Right (Right Atrium)
  2. Inferior (Right Ventricle)
  3. Left (Left Ventricle)
  4. Superior (Right and Left Atria and the exit point for the
    Aorta and Pulmonary Trunk)
49
Q

Right Atrioventricular Groove

A

between the Right Atrium and

Right Ventricle, transmits the Right Coronary A

50
Q

Left Atrioventricular Groove

A

between the Left Atrium and

Left Ventricle, houses the Coronary Sinus

51
Q

Anterior Interventricular Groove

A

between Right and Left
Ventricles on the anterior aspect of the Heart, transmits the
Anterior Interventricular A. and Great Cardiac V

52
Q

Posterior Interventricular Groove

A

between Right and Left
Ventricles on the posterior aspect of the Heart, transmits the
Posterior Interventricular A. and the Middle Cardiac V

53
Q

Sulcus Terminalis

A

external vertical groove corresponding to

the internal Crista Terminalis

54
Q

Ligamentum Arteriosum, what is it?

A

Travels from the superior aspect of the Pulmonary Trunk to
the inferior concave border of the Aortic Arch. The Ligamentum Arteriosum is the adult remnant
of the embryological Ductus Arteriosus which shunted blood from the Pulmonary Trunk to the
Aorta to bypass the nonfunctional lungs.

55
Q

What loops around the aortic arch and ligamentum arteriosum?

A

The Left recurrent Laryngeal N. of the Vagus N. loops around the Aortic Arch and Ligamentum Arteriosum then ascends to the Larynx

56
Q

Pericardiocentesis

A

Drainage of blood, fluid or pus from the pericardial sac. This is
usually done to relieve cardiac tamponade

57
Q

Pericardial Effusion

A

Inflammation of the pericardium can result in the accumulation of
fluid or pus in the pericardial sac which can compress the heart. Heart compression is known as
Cardiac Tamponade.

58
Q

Pericarditis

A

Inflammation of the pericardium, which can make the pericardium rough and
produce friction. This friction called a pericardial friction rub can be observed with a
stethoscope. If left untreated the pericardium can calcify

59
Q

Surgical Significance of the Transverse Pericardial Sinus

A

this space allows cardiac
surgeons to access the area posterior to the aorta and pulmonary trunk to clamp or insert the
tubes of a bypass machine into these large vessels

60
Q

Cardiac Referred Pain

A

Ischemia stimulates visceral pain sensory fibers in the heart of the
Autonomic Nervous system. These visceral sensory fibers often share a spinal ganglion with the
somatic sensory fibers of areas such as the upper limb and superior lateral chest wall. Anginal
pain is typically referred to the area innervated by the Left Medial Brachial Cutaneous nerve,
the left substernal area, left pectoral area and medial aspect of the left upper limb are often
involved in this variety of referred pain.

61
Q

Ventricular Fibrillation

A

Rapid irregular twitching of the ventricles rendering the Heart
unable to pump blood. An electric shock administered by electrodes can cease all cardiac
movement (defibrillation), in the hopes that the Heart may begin beating regularly after a period
of time

62
Q

Atrial Fibrillation

A

Irregular twitching of the Atrial cardiac muscle fibers to which the
ventricles respond at irregular intervals. Circulation usually remains satisfactory

63
Q

Artificial Cardiac Pacemaker

A

Produces a regular electrical impulse that is carried to the
Ventricles via electrodes which are inserted through a large vein to the Superior Vena Cava, into
the Right Atrium past the Tricuspid Valve into the Endocardium of the Trabecula Carnae of the
Right Ventricle

64
Q

Ventricular Septal Defects

A

Due to the embryologically divergent tissues that make up the
Interventricular Septum that structure is particularly susceptible to defects. All defects are
clinically relevant as they allow the mixture of oxygen rich and oxygen depleted blood.

65
Q

Cardiac Catheterization

A

Insertion of a catheter into the femoral vein which is then passed
up to the Inferior Vena Cava allowing radiographic visualization of the Right Atrium, Right
Ventricle, Pulmonary Trunk and Pulmonary arteries

66
Q

Atrial Septal Defects

A

Typically involves an incomplete closure of the Foramen Ovale. It is
estimated that 15-20% of adults have a small patency of their Foramen Ovale which is
considered clinically insignificant. Larger openings in the Interatrial Septum can be clinically
significant as they allow mixture of oxygen rich and oxygen depleted blood

67
Q

Coronary Artery Bypass Graft

A

Obstruction of the coronary arteries may necessitate
replacement of a segment of the coronary artery, this process is called a coronary artery bypass
graft. The great saphenous vein is often used based on its comparable diameter to the coronary
arteries, its easy of dissection from the lower limb and the fact that it offers lengthy portions without branching or valves. The radial artery is also used

68
Q

Coronary Angioplasty

A

Insertion of a small balloon catheter into the lumen of the coronary
artery. The balloon is inflated to flatten the obstructing plaque against the wall and increase the
size of the lumen improving blood flow

69
Q

Pulmonary Embolism

A

Obstruction of a Pulmonary A. by an embolus, such as a blood clot,
fat globule or air bubble. The embolus usually passes from a vein through the right side of the
heart into the Pulmonary arteries

70
Q

middle cardiac vein

A

dump into coronary sinus, posterior interventricular artery

71
Q

Right dominant heart

A

off right coronary artery, feeds posterior

72
Q

Direction of cardiac conducting system

A

SA node to AV node to AV bundle to purkinje fibers

73
Q

-IV Septum

A

origin of septal papillary muscle

74
Q

Coronary Sulcus:

A

marks border between atria and ventricles

CardioPulm (10 decks)

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