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Structures (ASV) > Lecture 22: Heart Gross Anatomy > Flashcards

Lecture 22: Heart Gross Anatomy Flashcards

1
Q

Mediastinum

A

Space between the pleural cavities

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2
Q

Phrenic nerve: Fiber type, roots, trajectory

A

GSE; C3, 4, 5; Through middle mediastinum, to the diaphragm

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3
Q

What vessels supply the diaphragm and pericardium?

A

Pericardiacophrenic arteries and veins

Artery is a branch of the internal thoracic artery

Vein drains into internal thoracic vein

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4
Q

What are the sacs of the pericardium?

A

There are 2:

  1. Outer fibrous sac (composed of fibrous pericaridum)
  2. Inner serous sac (composed of serous pericardium, with parietal and visceral layers, with a pericardial cavity in between)
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5
Q

components of inner serous sac

A

Serous pericardium of the 2 pericardium sacs; composed of an outer parietal layer, middle pericardial cavity, and inner visceral layer, which is aka epicaridum

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6
Q

What’s another name for the visceral layer of the pericardium’s inner serous sac?

A

Epicardium

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7
Q

3 layers of the wall of the heart

A

epicardium, myocardium (cardiac muscle), endocardium

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8
Q

What are sulci, where do you see them, what are they composed of?

A

A component of the epicardium that are grooves of adipose tissue on the surface of the heart (aka FAT!)

Demarcate the chambers of the heart on the heart’s surface

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9
Q

What do the (anterior/posterior) coronary sulci (sing: sulcus) demarcate?

A

2 atria from 2 ventricles

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10
Q

What do the anterior/posterior interventricular sulci (sing: sulcus) demarcate?

A

Right ventricle from Left ventricle

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11
Q

What are the coronary arteries/veins embedded?

A

In the adipose tissue of the sulci

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12
Q

What do coronary arteries do?

A

Supply myocardium with oxygen; their occlusion results in a heart attack

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13
Q

Major branches of the Right Coronary Artery

A
  1. Sinuatrial nodal branch (supplies the SA node)
  2. Marginal branch
  3. Atrioventricular nodal artery (supplies the AV node)
  4. Posterior interventricular branch
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14
Q

Major branches of the Left Coronary Artery

A
  1. Anterior interventricular branch (aka LAD, Left anterior descending artery)
  2. Circumflex branch
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15
Q

What is the first branch of the aorta?

A

Coronary arteries

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16
Q

What does left anterior descending artery (LAD) run along?

A

Anterior interventricular sulcus

It is known as the Interventricular branch, the Widow Maker because where heart attacks occur most often

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17
Q

Location/path of the Right coronary artery

A

Originates from right aortic sinus of the ascending aorta; descends in the coronary sulcus between RA and RV

Travels in the coronary sulcus to reach posterior surface of the heart; there it anastomoses with circumflex branch of left coronary artery

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18
Q

What runs within the coronary sulcus?

A

Right coronary artery, small cardiac vein, coronary sinus, circumflex branch of the left coronary artery

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19
Q

What is the right atrial branch?

A

Branch of the RCA

Supplies the SA node

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20
Q

Where does sinuatrial nodal branch supply come from?

A

60% from Right coronary artery; 40% from Left coronary artery

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21
Q

Atrioventricular nodal artery supply?

A

Branch of the posterior interventricular branch of the RCA; 80% supply to AV nodal artery from the RCA, 20% from the LCA

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22
Q

Wheres does the LAD run?

A

Anterior interoventricular sulcus

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23
Q

What does the Right coronary artery supply?

A

Right atrium
Right ventricle
Posterior part of the Left ventricle
Posterior part of the interventricular sulcus

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24
Q

What does the Left coronary artery supply?

A

Left atrium
Left ventricle
Variable amount of Right ventricle
Most of the interventricular sulcus

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25
Q

Right coronary artery dominance

A

Normal distribution pattern of the coronary arteries means a right dominant coronary artery (supplies to 70% of heart) because the posterior interventricular branch arises from the RCA, and it supplies much of the posterior wall of the LV

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26
Q

Left coronary artery dominance

A

Normally, LCA supplies only 15% of the heart

In hearts with left dominant coronary artery, posterior interventricular branch arises from enlarged circumflex branch –> supplies most of posterior wall of LV

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27
Q

What do coronary arteries do?

A

Supply myocardium with oxygen

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28
Q

What do cardiac veins do?

A

Remove metabolic waste products from the metabolic activity of the myocardium

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29
Q

What are the branches of the cardiac veins of the heart?

A
  1. Coronary sinus
  2. Great cardiac vein
  3. Middle cardiac vein
  4. Small cardiac vein
  5. Anterior cardiac vein
  6. Venae cordis minimae
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30
Q

What cardiac vein(s) drain into the coronary sinus / RA?

A

Great cardiac vein
Middle cardiac vein
Small cardiac vein

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31
Q

What cardiac vein(s) drain into the RA?

A

Anterior cardiac vein

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32
Q

What cardiac vein(s) drain into the RA chamber?

A

Venae cordis minimae

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33
Q

Companion vessel for LAD?

A

Great cardiac vein

34
Q

What is the pericardial cavity?

A

POTENTIAL SPACE! between the parietal seroues and visceral serous layers of the pericardium

35
Q

When do the coronary arteries fill with blood?

36
Q

Where does the coronary sinus drain to?

37
Q

Paths of cardiac veins

A

Listed from R to L/smallest to biggest:

Small cardiac vein (runs w/ R branch of RCA)
Middle cardiac vein (runs w/ posterior interventricular branch of LCA/RCA)
Great cardiac vein (runs w/ anterior interventricular a. and then circumflex branch of LCA)

38
Q

Where does great cardiac vein begin?

A

Coronary sinus (posterior side of heart)

39
Q

Where does middle cardiac vein begin?

A

Bottom of coronary sulcus

40
Q

What do arteries give off?

A

arterioles and then capillaries

41
Q

Do all arteries end in capillaries?

42
Q

Do arteries/their branches sometimes anastomose?

43
Q

What forms the basis for collateral circulation?

A

Arterial anastomoses, which allow for collateral circulation if narrowing/occlusion of artery

44
Q

Examples of arteries with anastomoses

A
  1. Posterior intercostal arteries anastomose w/ anterior intercostal arteries
  2. Superior epigastric arteries anastomose with inferior epigastric arteries
45
Q

What are end-arteries?

A

Vessels without anastomoses; their occlusion results in necrosis of the tissue supplied by the occluded vessel

46
Q

Example of end-arteries?

A

Central artery of the Retina; branches of the coronary arteries

47
Q

Do coronary arteries have anastomoses?

A

Yes, but usually insufficient to provide adequate collateral circulation.

Anastomoses occur:

  1. between interventricular branch of RCA and circumflex branch of LCA
  2. between posterior interventricular branch of RCA and LAD

See anastomoses in the interventricular sulci

48
Q

Why are coronary arteries called “functional end-arteries?

A

Because they are end-arteries ONLY in terms of physiology; NOT in terms of anatomy (since they do anastomose)

49
Q

What does coronary occlusion lead to?

A

myocardial infarction/necrosis of the myocardium, aka heart attack

50
Q

What does coronary insufficiency lead to?

A

myocardial ischemia, aka angina pectoris (cardiac pain; chest pain)

51
Q

3 most common locations of coronary occlusion

A

Proximal end of RCA
Proximal end of LAD
Proximal end of circumflex branch of RCA

52
Q

Where might cardiac pain be felt?

A

Pain arising from T1-T5 dermatomes

Typical: substernal; upper left chest; medial aspect of left upper extremity

Atypical: shoulder; neck; jaw; ear

Less common: both sides/right side of these areas

Uncommon: back between scapulae

53
Q

What does MAK call the heart?

A

A muscular pump
An electrical organ
An endocrine gland
Has its own blood supply

54
Q

Thickness of heart walls?

A

Related to workload/pressure flow of heart chambers

LV: thickest
RV: moderate
Atria: thinnest

55
Q

Myocardium made of?

A

Cardiac muscle

56
Q

Histo composition of epicardium?

A

Thickest epicardium along sulcus

Single layer of squamous cells along mesothelium; produces pericardial fluid, which invades pericardial cavity

Mostly is fat, elastic fiber

Also have lymphatic vessels, nerves

57
Q

Composition of endocardium (facing atrium)?

A

Thicker than portion on ventricle

Endo: covered by single layer of endothelium cells; beneath endo, have layer of subendothelial tissue- CT with collagen and elastic fibers, fibroblasts, and some SM cells

Also have subendocarium

58
Q

Composition of endocardium (facing ventricle)?

A

Thinner than portion on atrium

Endo: covered by single layer of endothelium cells; beneath endo, have layer of subendothelial tissue- CT with collagen and elastic fibers, fibroblasts, and some SM cells

Also have subendocarium layer

59
Q

Myocardium made of

A

cardiac muscle cells, cardiac myoctyes or cardio cytes, contractile cells, myoendocrine cells (atrial myocytes), and conducting cells (nodal cells, bundle branches, purkinje fibers)

60
Q

What are cardiac myocytes?

A

Contractile cells; endocrine cells that form exclusively in the atrium- not in the ventricle!

Conduct impulses

Made up cells of SA and AV nodes, bundle branches, and purkinje fibers

61
Q

Direction of cardiac muscle fiber in myocardium

A

Spiral around ventricles and atria

62
Q

Perimysium

A

separate cardiac myocytes into bundles/fascicles

63
Q

How cardiac myocytes work?

A

Contract; leads to squeezing/twisting of ventricle to expel blood out of ventricle, wrings it out (like wet towel)

64
Q

Fibers of cardiac myocytes?

A

Actin and myosin filaments

65
Q

Intercalated disc

A

specialized intercellular junctions that draw together 2 cardiomyocytes

66
Q

How many capillaries around each cardiac myocyte cell/why?

A

5 capillaries

b/c very metabolic/active tissue, need lots of blood supply, nutrients from capillaries

67
Q

Lipofuscin pigment

A

Cardiac myocytes become yellow/brown pigment as age; are very long-lived cell

68
Q

Can cardiac myocytes regenerate?

69
Q

structure of intercalated disc

A

desmosome: 2 filaments that bind the 2 cardiac myocyte cells together

fascia adherentes: actin filaments for contractility

gap junction: lie on longitudinal portion; site of electrical and chemical transmission rapdily

70
Q

extracellular matrix of heart structure

A

made of collagen fiber bundles, extends from extracellular matrix to myocardium

basal lamina form weave surrounding cardiocytes; elastic fiber bundles wrap around them; collagen fibrils insert into basal lamina; collagen fiber bundles form collagen struts btwn neighboring cardiocytes

71
Q

atrial monocytes

A

smaller than ventricular monocytes
have granules which contain hormones
have fewer transverse-tubules than ventricular myocytes

72
Q

is the heart endocrine/exocrine organ?

A

endocrine because atrial myocytes synthesize atrial natriuretic peptide (ANP) - a peptide hormone that is stored in its granules

73
Q

What is ANP/what does it do?

A

when atrial wall stretches, it’s secreted by exocytosis into blood circulation

blocks sodium resportion in renal tubules, thereby promoting sodium excretion and urine excretion

74
Q

What conducts heart?

A

Cardiac muscle cells, NOT NERVOUS TISSUE!

75
Q

What are cardiac muscle cells specialized for?

A

Initiating normal heart beat
Conducting impulses rapidly through the heart
Coordinating contraction of the 4 heart chambers

76
Q

Components of heart’s conducting system

A

SA node
AV node
AV bundle (Bundle of His) - right and left bundle branches
Purkinje fibers (in subendocardium)

77
Q

SA node location?

A

sulcus terminales

cannot see it superficially

located at landmark btwn entrance of SVC to RA

78
Q

What does SA nodal artery supply?

A

RA and SA node

79
Q

SA node characteristics

A 
modified atrial monocytes 
small in size 
few myofibrils 
unorganized striations 
gap junctions and desmosomes 
irregular meshwork 
embedded in fibrous tissue 
autonomic nerves/blood vessels
80
Q

purkinje fiber characteristics

A 
in subendocardium
stain pale b/c of glycogen 
large in size 
have fewer myofibrils 
lack t-tubules 
no typical ICD 
have desmosomes, gap junctions
81
Q

Are there blood vessels w/in valve?

82
Q

What are heart valves made of?

A

Leaflets of fibroelastic tissue, covered by endothelium continuous with that of the lining of the heart chambers and great vessels

On ventricular side, dense plate of collagneous tissue, lamina fibrosa; toward atrial side, elastic fibers

No blood vessels are present in the valves.

Structures (ASV) (30 decks)

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