L2 - Heart & Mediastinum Flashcards
Where is the Sternal Angle located?
Attaches at the 2nd rib and in between T4 and T5
The pericardial sac is located where in reference to the lungs and diaphragm?
The pericardial sac is between the lungs and superior to the diaphragm
Where is the phrenic nerve located?
Anterior to the Lung Hillium and in between the pericardium and lungs
The mediastinum has four divisions, what are they?
Superior, Anterior, Middle, and Posterior.
What are the contents of the Superior Mediastinum? Whats the Mnemonic?
Mnemonic: LETS TAT
Thymus
Arch of Aorta
SVC
Trachea
Esophagus
Thoracic Duct
Left Recurrent Laryngeal Nerve
What are the contents of the anterior Mediastinum
Thymus (before we become adults its thymus then as we grow it becomes fat)
Fat and connective tissue
Lymph nodes
What are the contents of the middle mediastinum?
Pericardium
Phrenic Nerve
Heart
Roots of the Great Vessels
Arch of the Azygous Vein
Main Bronchi
What is the middle mediastinum bound by?
The middle mediastinum is bound
Superiorly by the
Transverse thoracic plane (sternal angle to T 4,5)
What are the contents of the Posterior Mediastinum? Mnemonic?
Mnemonic: DATE
Descending Aorta
Azygous and Hemiazygous Vein
Thoracic Duct
Esophagus
The veins on the body of the wall are?
what do they do and where do they drain into?
Hemiazygos and Accessory Hemiazygos Vein → Azygos Vein → SVC
They drain on the body wall
External Chest Wall has locations such as the APEX, BASE, and Valve sounds
Where are they?
Aortic Valve, Pulmonary Valve are at the top
Aortic Valve → Medial side (right) of the sternum
Pulmonary Valve → Left side of the sternum
Apex → Within the Fifth intercostal space
Mitral Valve → Lower left lateral side
What does the Pericardium attach to?
Pericardium attaches to the Diaphragm
Which of these are NOT located in the middle mediastinum (inferior)?
A. Phrenic Nerves
B. Pericardium
C. Azygos Veins
D. Arch of Azygos
E. Roots of Great Vessels
F. Main Bronchi
C. Azygos Veins
The development of the Pericardium of the heart : Outside to inside
Outside to Inside:
Fibrous Pericardium
Serous Pericardium
Parietal Pericardium
(Pleural Cavity b/n)
Visceral Pericardium
If you remove the parietal pericardium: You see ?
If you remove the parietal pericardium:
You see the main coronary vessels
Right ventricle makes up the majority of the anterior portion of the heart
SVC and IVC drain into what atrium?
Right Atrium
Pulmonary Veins drain into what atrium?
Left Atrium
Transverse Sinus
Transverse Sinus:
Stick finger over the SVC and behind pulmonary trunk
Your finger is running what used to be was the venous end and arterial end of the heart tube
You do that surgically sometimes if someone is bleeding too much and squeeze your thumb there to pinch off the bleeding
Transverse Sinus is Posterior to?
Transverse Sinus is Anterior to?
Posterior: Aorta and Pulmonary Trunk
Anterior: SVC
What are the borders of the Oblique Sinus ?
Borders:
Pulmonary Veins
IVC
All the major veins of the heart drains into the ?
Coronoary Sinus
When all the major veins drain into the Coronary Sinus, what does the coronary sinus drain into?
The Right Atrium
Which view of the heart can you see the Coronary Sinus on?
Posterior
Base of the heart has how many pulmonary arteries and pulmonary veins?
2 Pulmonary Arteries
4 Pulmonary Veins
Circulation of the Heart to the Lungs. What kind of blood goes to the lungs?
Deoxygenated → SVC, IVC & CS → RA →Tricuspid Valve → RV → Pulmonary Trunk → Pulmonary Arteries (2) → Lungs
Circulation of the Heart from the lungs. What kind of blood comes from the lungs?
oxygenated → Lungs → Pulmonary Veins (4)→ LA→ Bicuspid Valve → LV → Aorta
The pulmonary arteries and veins carry deoxygenated and oxygenated blood, respectively.
True
The coronary circulation. Where do the coronary arteries originate from?
Coronary Arteries originate from the Aorta
What’s another name for the Anterior Interventricular Artery?
Left Anterior Descending (LAD)
What’s another name for the Posterior Interventricular Artery?
Posterior Descending Artery (PDA)
Right Coronary Artery Branches
Right Coronary Artery
→ SA Nodal Branch
Right Marginal Artery (Not Shown)
Right Posterior Interventricular Artery
Left Coronary Artery Branches
Left Coronary Artery →
Left Anterior Interventricular Artery
Left Circumflex Artery
Left Circumflex Artery →
Left Marginal Artery (Not Shown)
The Typical Heart.
What side is dominant?
Which are of the heart receives the most circulation?
Left dominant
(Most circulation to the anterior)
On the anterior view of the heart we see the great cardiac vein.
What does it run with?
Anterior Interventricular Artery (LAD)
On the anterior view of the heart, we see the Left Marginal Vein, what does it runs with?
Left Marginal Artery
On the posterior view of the heart. we see the right small cardiac vein
what does it run with?
Right Coronary and Right Marginal Artery
On the posterior view of the heart,
We see the middle cardiac vein
what does it run with?
Posterior Interventricular Artery
On the posterior view of the heart. We see the left posterior ventricular veins
what does it run with?
by itself! ( low yield)
Which vein runs with the left anterior interventricular artery?
Great Cardiac Vein
Small Cardiac Vein
Middle Cardiac Vein
Left Marginal Vein
The right atrium is characterized by two kinds of textured areas.
What are they and what are they divided by?
The rough area of the atrium
is due to the pectinate muscles and represents the primitive atrium
Division:
Crista Terminale
The smooth area
is from absorption of part of the primitive vessels
Right Atrium is a chamber to which blood returns to the heart via and from the
The right atrium is the chamber to which deoxygenated blood returns to the heart via the superior and inferior vena cava and from the coronary system through the coronary sinus
SVC, IVC, and CS drain into?
SVC, IVC, and CS
→ RA → Tricuspid Valve → RV
The right atrium has a septal wall that contains the remnant of the foramen ovale and the indentation is termed?
Fossa Ovale
Fossa Ovale is?
Thin wall between the right and left atrium
Where blood used to be shunted from the RA to the LA embryologically
Blood leaves the right atrium through to valve to enter the right ventricle.
Tricuspid valve
How many Papillary muscles attach to the Tricuspid valve via chordae tendinae?
When thinking of Tricuspid = think 3.
Thus, three papillary muscles!
The 3 papillary muscles are important for the Right Ventricle, what are the other two main features?
Trabeculae carneae (the rough part of the wall)
Moderator band - from the septum to the ANTERIOR papillary muscle
In systole what are the ventricles doing?
Contracting
In diastole what are the ventricles doing?
Relaxing
Imfundibulum Conus ?
Its the smooth area going up toward the pulmonary trunk from the RV
What is the name of the rough area in the RA?
Pectinate Muscles
What is the name of the rough area of the right ventricle?
Trabeculae Carneae
Left Atrium has mostly smoothed or rough walled chamber?
Smooth walled chamber
What vein system brings blood into the LA?
Pulmonary veins → oxygenated
BLOOD RETURNING FROM THE LUNGS ENTERS THE ATRIUM THROUGH THE VEINS THEN THROUGH THE VALVE TO THE LEFT VENTRICLE
1) Left Atrium
2) Pulmonary Veins
3) Mitral Valve
Does the Left Atrium and ventricle have a moderator band?
NO
THE INTERIOR OF THE LEFT VENTRICLE IS CHARACTERIZED BY PAPILLARY MUSCLES.
Two papillary muscles:
Anterior and Posterior
Which statement is false?
A. The RV has 3 papillary muscles
(Anterior, Posterior, and Medial)
B. The LV has 2 papillary muscles (Anterior and Posterior)
C. The RA has Pectinate Muscles and Crista Terminale
D. The Moderator Band attaches to the Posterior Papillary Muscle of the RV
D. The Moderator Band attaches to the Posterior Papillary Muscle of the RV
Where does it really attach to?
ANTERIOR
Why are the indicated areas not directly over the valves listened to?
Because that is where the blood is going
Easier to see which valve is compromised
During diastole, the blood is moving from the to the through the (left) and (right)
During diastole, the blood is moving from the atria to the ventricles through the mitral (left) and tricuspid (right) atrioventricular
DIASTOLE THE OPENING OF THE VALVES IS DUE TO BETWEEN THE ATRIA AND VENTRICLES
THE OPENING OF THE VALVES
IS DUE TO DIFFERENTIAL PRESSURE BETWEEN THE ATRIA AND VENTRICLES
THE CONTRACTION OF THE IS RESPONSIBLE FOR PUMPING ABOUT OF THE BLOOD INTO THE VENTRICLE THE REST MOVES DOWN THE PRESSURE GRADIENT WHEN THE VALVE OPENS
THE CONTRACTION OF THE ATRIA IS RESPONSIBLE FOR PUMPING ABOUT 25% OF THE BLOOD INTO THE VENTRICLE THE REST MOVES DOWN THE PRESSURE GRADIENT WHEN THE VALVE OPENS
Blood moves from the atrium to the ventricles MOSTLY because of
pressure differential
PULMONARY AND AORTIC VALVES
The aorta has a and the pulmonary a these are called ??
The aorta has a → posterior
and the pulmonary → anterior SEMILUNAR VALVES
The mitral and tricuspid valves, also known as the
atrioventricular, or AV valves
During systole, in which the ventricles contract and force blood into the major vessels the valves are closed
and the valves are open.
Systole is the period in which the ventricles contract and force blood into the major vessels
The AV valves are closed and the SEMILUNAR valves are open
The shape of the are critical in the closing of these valves at the end of systole and the perfusion of the coronaries
semilunar valves
In diastole, the SV and AV are what?
Diastole:
SV → closed
AV → open
Tricuspid Valve → Chordae Tendineae →
Tricuspid Valve → Chordae Tendineae →
- Anterior
- Posterior
- Medial Papillary Muscles
Bicuspid Valve → Chordae Tendineae →
Bicuspid Valve → Chordae Tendineae →
Anterior and Posterior Papillary Muscles
The conduction of the depolarization of the cardiac muscle begins at the node, moves to the atrioventricular node
SA node
SA node is located near?
SVC
What is the conduction pathway?
SA →
AV →
Bundle Of His →
R & L Bundle Branches
Some Branches off Aorta:
Coronary
Bronchial
Esophageal
Posterior
What side does the dumping into the left subclavian vein occur on?
and via what duct?
Left Side:
Thoracic Duct Dumps into → Left Subclavian Vein
What does the dumping into the right subclavian occur on and from what duct?
Right Side:
Right Lymphatic Duct into → Right Subclavian Vein
Thoracic Splanchnic Nerves:
Thoracic Splanchnic Nerves:
Sympathetic
Azygous Vein drains into the
SVC
Which vein drains the body wall?
Azygous Vein (muffly lecture Qs)
What is the main drainage for the lymphatic system?
Thoracic duct
(muffly lecture Qs)
What is the sinoatrial node?
- Pacemaker of the heart
- Important to properly pace the heart and make it contract appropriately at the right time
- Contraction starts at the sinoatrial node then spread over atria
Foreman → Facet →
hole indentation
What is the purpose of the chordae tendineae and papillary muscles?
(Papillary muscles attached to the chordae tendineae)
→ They are there to keep the valves from prolapsing
→ They put tension on the chordae tendineae during systole → They put tension on it so the valves stay closed and don’t flap up
What is the structure that separates the smooth part of right atrium from the rough part of the right atrium?
crista terminalis
The heart grows
into the pericardium
Left Ventricle and Right Ventricle
Left Ventrcile, pap muscles and chrodae tendinae
Left Atrium
Leaflets
Right Atrium
Right Ventricle
Left Ventricle
Coronary Sinus
Coronary Arteries
