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Block 2 Gross > Lecture 19: Middle Mediastinum > Flashcards

Lecture 19: Middle Mediastinum Flashcards

1
Q

Contents of the middle mediastinum

A

pericardium (the envelops phrenic nerves, heart, root of aorta, distal segment of the superior vena cava, pulmonary veins, inferior vena cava, pulmonary trunk, right pulmonary arteries, and right and left main stem bronchi)

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2
Q

What are the components of pericardium

A

Visceral and partietal pericardium create the pericardial cavity contains serous fluid- derived from intraembryonic coelomic space

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3
Q

Pericarditis

A

inflammation of the pericardial sac- can result in fluid accumulation in pericardial cavity which impedes the motion of the heart. Procedure to remove fluid is pericardiocentesis

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4
Q

Cardiac tamponade

A

The accumulation of fluid in the pericardial cavity that impedes the motion of the heart caused by inflammation of the pericardial sac

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5
Q

What are the two pericardial sinuses

A

oblique and tranverse

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6
Q

Transverse sinus

A

connects the right and left sides of the cavity, and separates the outflow tracts (aorta and pulmonary trunk) from the inflow tract (superior vena cava)

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7
Q

Oblique sinus

A

Inverted U-shaped on the dorsal to the left atrium between the pulmonary veins and superior vena cava

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8
Q

Clinical significance of these sinuses?

A

??

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9
Q

Are the right and left sides of the heart on the left and right sides of the thorax

A

no

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10
Q

What is the orientation of the heart after rotation during development

A

right ventricle is anterior and positioned to the left along with the left ventricle

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11
Q

What region of the heart comprises the base?

A

the posterior aspect

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12
Q

What region comprises the apex of the heart

A

left ventricle (the inferiolateral tip)

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13
Q

Where is the apex of the heart normally positioned?

A

5th intercostal space

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14
Q

Coronary sulcus

A

encircles the heart and discerns between the atrium and ventricles

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15
Q

Interventricular sulci

A

separates the two ventricles (one on the anterior and posterior)

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16
Q

Anterior surface of the heart

A

mainly right ventricle with a little right atrium

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17
Q

Posterior surface of heart

A

Left atrium with smaller portions of the left ventrical and right atrium

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18
Q

Diaphragmatic surface of hear

A

mostly right ventricle with a little contribution by the left ventricle

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19
Q

Superior boarder of heart

A

roots of aorta, pulmonary a., and superior vena cava

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20
Q

Where are the strongest heart sounds and why

A

left to the sternum because the heart is usually slightly left of the midline

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21
Q

Dextrocardia

A

when the heart is slightly right to the midline instead of left and results in the strongest heart sounds being to the right of the sternum

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22
Q

How does some endocardial tissues receive nourishment

A

via direct diffusion of oxygen and nutrients from blood within the cardiac chambers

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23
Q

Where do the coronary arteries and veins travel

A

beneath the epicardium (visceral peritoneum embedded in fat

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24
Q

What aortic sinus is the right coronary artery originated in?

A

right aortic sinus (of Valsalva)

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25
Q

What does the right coronary a. supply

A

Right atrium, right ventricle, and SA node

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26
Q

What are two important branches given off by the right coronary a.

A

nodal a. (posterior to right auricle) and right marginal a. (descending right cardiac border)

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27
Q

What does the left coronary a. supply

A

much of the left ventricle, small part of right ventricle, ventricular septum, and part of the left atrium

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28
Q

Where does the left coronary a course

A

arises from aorta and passes posterior to pulmonary trunk

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29
Q

Where does the left coronary a. branch

A

coronary sinus

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30
Q

What are the two branches of the left coronary a.

A

left anterioventricular branch and circumflex blanch

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31
Q

What gives rise to the left marginal a.

A

the circumflex artery

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32
Q

Where does the circumflex a. travel

A

in the coronary sulcus

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33
Q

What is the inter ventricular septum primarily supplied by?

A

branches of the left coronary a.

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34
Q

What does the nodal branch supply

A

right atrium and SA node (sin-atrial node)

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35
Q

What does the right marginal a. supply?

A

Anterior wall of the right ventricle

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36
Q

What does the posterior inter ventricular a. supply?

A

Posterior wall of the right ventricle and the posterior part of the inter ventricular septum

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37
Q

What does the anterior inter ventricular a supply?

A

anterior left ventricle, most of the anterior inter ventricular septum, apex

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38
Q

What does the left marginal a. supply?

A

Lateral wall of the left ventricle

39
Q

What does the circumflex branch supply?

A

Posterior wall of the left atrium and left ventricle

40
Q

Describe how we know if a heart is right dominant

A

The posterior inter ventricular a is derived from the right coronary a. and the right coronary crosses to the left side to supply the left ventricularwal and posterior inter ventricular septum.

41
Q

Left commence?

A

Posterior interventricular a. derived from the left coronary a.

42
Q

Codominence? ***

A

coronary arteries are balance?

43
Q

ischemia (minor)

A

insufficicent coronary blood flow, leads to angina pectoris (chest pain)

44
Q

ischemia (major)

A

dysrhythmias or cardiac arrest

45
Q

cause of ischemia

A

arteriosclerosis

46
Q

What are the two systems used for venous drainage of the heart

A

cardiac veins and thebesians veins

47
Q

Great cardiac v. location

A

begins at the cardiac apex, follows the anterior inter ventricular sulcus to the base of the ventricles then passes to the left in the coronary sinus

48
Q

What does the great cardiac v. drain

A

Left artrium and both ventricles

49
Q

Middle cardiac v. location

A

starts at the cardiac apex rises in the posterior inter ventricular sulcus and ends in the coronary sinus

50
Q

What does the middle cardiac v. drain

A

posterior ventricular surface

51
Q

Anterior cardiac v. locations

A

span the anterioventricular groove and drain directly into the right atrium

52
Q

What does the Anterior cardiac v. drain

A

from the upper surface of the right ventricle

53
Q

thebesian veins location

A

begin in the myocardium and empty into the cardia atria or ventricles.

54
Q

What empties into the right atrium

A

superior and inferior vena cava

55
Q

crista terminalis

A

raised ridge on the inner arterial wall that demarcates its anterior and posterior segments

56
Q

Where is the SA node found?

A

where the crust terminals meets the perimeter of the superior vena cava oriface

57
Q

Inforeior vena cava valve

A

semi-lumar shaped tissue

58
Q

Fossa ovalis location- embryonic remenent

A

septal wall of right atrium- site of fetal foramen ovale

59
Q

Valve of coronary sinus is what shape?

A

crescent shaped

60
Q

What are the 3 leaflets of the tricuspid valves

A

Anterior, Posterior, and Septal

61
Q

Position of the anterior and posterior leaflets

A

Anterior-Superior

Posterior- Inferior

62
Q

Purpose of chord tendinae

A

the tether the leaflets to the ventricular wall and help keep the valve leaflets closely approximated during systole(when pressures within the ventricular chambers are highest) this prevents blood from leaking from the ventricle back into the arterial chamber

63
Q

What two papillary muscles does the posterior ventricle have

A

anterior and posterior

64
Q

Where does the moderator band pass?

A

Passes from the inferior portion of the septal wall to the base of the anterior papillary muscles.

65
Q

What are the 3 cusps of the pulmonary valve

A

anterior left and right

66
Q

What does the pulmonary trunk branch into

A

right and left pulmonary arteries

67
Q

Ligamentum arteriosum

A

connects the pulmonary trunk to the ascending aorta. Remnant of ductus arteriosus

68
Q

What lung will the right pulmonary artery go to

A

right

69
Q

Are the pulmonary arteries posterior or anterior to the mainstream bronchi?

A

Anterior

70
Q

What are the branches of the right/left pulmonary a

A

Upper and lower (to supply their respective lobes)

71
Q

Position of the anterior and posterior leaflets of the mitral valve

A

Superior and inferior respectively

72
Q

Mitral vale

A

Connects the left atrium to left ventricle and is a bicuspid valve

73
Q

How many cusps does the aortic valve have and what are they called?

A

3- called right and left coronary cusp and non-coronary cusp

74
Q

What are aortic sinuses of Valsalva

A

3 small dialations called the right and left coronary and non-coronary

75
Q

Where are the chemoreceptors located in the heart and what do they do?

A

Located in the wall of the ascending aorta they monitor pH and CO2 in the blood.

76
Q

Why are the sounds of valves hear at a site distant from their location

A

because anatomically they lie close to one another and and posterior to the sternum

77
Q

Where is the aortic valve heard?

A

right 2nd intercostal space

78
Q

Where is the pulmonic valve heard?

A

Left second intercostal space

79
Q

Where is the mitral valve heard?

A

left 5th intercostal space at midclavicular line

80
Q

Where is the tricuspid valve heard?

A

to the left of the xiphosternal junction

81
Q

What does the cardiac cycle consist of

A

diastole and systole

82
Q

diastole

A

ventricular filling

83
Q

systole

A

ventricular emptying

84
Q

Diastole begins with…

A

the closure of the aortic and pulmonic valves. Blood now flows from the right atrium across the tricuspid valve to the right ventricle and from the left atrium across the mitral valve into the left ventricle

85
Q

Systole begins when…

A

When the ventricles are full. The ventricular muscles begin to contract which forces the tricuspid valves of the aorta and pulmonary trunk to open

86
Q

Lub sound of hear

A

caused by the vibration of blood in the ventricular chambers as systole begins and the atrioventricular (A-V) valves shut

87
Q

dub sound of heart

A

caused by vibration of blood from the closure of the aortic and pulmonary valves at the end of systole

88
Q

What is the pacemaker of the heart

A

SA node (At the junction of crust terminalis and superior vena cava in right atrium)

89
Q

Where is the atrioventricular node (AV) located?

A

near the base of the intertribal septum along opening of coronary sinus

90
Q

Where does the atrioventricular bundle of his run and divide into?

A

The atrioventricular bundle of his exits the AV node and travels in the inter ventricular septum where it divides into right and left bundle branches

91
Q

Right bundle branch (traveling distance)

A

travels inferiorly in the septum to enter the moderator band and terminate in the base of the anterior papillary muscle of the left ventricle

92
Q

Left bundle branch

A

Also courses in the inter ventricular septum which terminates in the base of each papillary muscle of the left ventricle

93
Q

Both the heath receive sympathetic or parasympathetic innervation

A

both- also receives visceral sensory nerves

94
Q

Where are the sympathetic ganglion that innervate the heart located

A

Spinal cord segments T1-T6

Block 2 Gross (11 decks)

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