Lecture 3 Flashcards
Aspects of the thoracic skeleton (Ribs)
12 pair of ribs (c shape)
1. Ribs 1-7 -join at sternum with cartilage endpoints
2. Ribs 8-10 - Join sternum with combined cartilage at 7th rib.
3. Ribs 11-12 no anterior attachment
Other aspects of the thoracic skeleton
Sternum
1. Manubrium
a) joins to clavicle and 1st rib
b) jugular notch
- Body
Superior- angle of Louis (sternal angle)
attachment of 2nd rib. - Xiphoid process
distal portion of sternum
Aspects of the Superior Medistinum
- Trachea
- Thymus
- Brachiocephalic vein
- Aortic arch
- Esophagus thoracic duct
Aspects of Middle Mediastinum
- Heart
- Ascending Aorta
- Pulmonary Trunk and veins
- Phrenic nerves (nerves of the diaphragm
Aspects of the posterior Mediastinum
- Esophagus
- Vagus nerves
- Descending aorta
- Thoracic duct
- Sympathetic trunks
Anterior Mediastinum
- Fat
- Connective tissue
- Thymus in children
Anterior thoracic landmarks
- Suprasternal notch
- Entire three parts of sternum
Posterior Thoracic Landmarks
- Vertebra Prominens - (C7)
- Spinous processes
- Scapula
Point of maximal impulse (PMI)
Left margin of heart between r and l ventricle. (Fifth intercostal space at the midclavicular line)
Compensatory mechanisms for decrease in cardiac output
- Increased heart rate
- Stroke volume
CO=SV+HR
Cor pulmonale
Right sided heart failure unrelated to the left side.
*pulmonary hypertension could be the cause.
Some Right heart failure effects
Fluid in lungs, liver swelling, JVD
How do we increase heart contraction?
Dlgoxin
Origin of the great vessels
Bifurcation of the trachea
Red - aortic valve
Green- tricuspid valve
Purple - bicuspid valve
Blue- pulmonary valve
Dextrocardium
Rare condition where the heart is flipped positions on the right side of the chest.
Usually happens in the embryonic state where the heart doesn’t rotate.
Pericardium function
- Protects and anchors the heart
- Protects overfilling
- Minimizes most friction
Pericardial effusion
Fluid filling and buildup in the pericardial space and causes the heart not to pump properly.
Causes: difficulty breathing, can’t hear heart sounds, the heart can’t expand normally so that creates conduction issues.
** common in lupus
Cardiac Tamponade
Caused by pericarditis, which compresses the heart and inhibits usual pumping and can cause a drop in BP.
TB is often a cause.
Branches of the aorta
- Brachiocephalic
- Left common carotid
- Subclavian arteries
** branches off the aorta; an aneurysm can effect all.
Arteries of the heart muscle
Anterior view-
1. R&L Coronary (atrioventricular groove)
2. Marginal
3. Circumflex
4. Anterior interventricular arteries
Posterior view-
1. Right coronary (I’m AV groove)
2. Posterior interventricular artery
Veins of the heart muscle
Anterior view-
1. Small cardiac
2. Anterior cardiac
3. Great cardiac
Posterior view-
1. Great cardiac vein
2. Posterior vein to left ventricle
3. Coronary Sinus
4. Middle cardiac vein
AV Valve function
Prevent back flow into atria when ventricles contract.
Chordae Tendinae anchor AV valves to papillary muscles and prevent valves from being inverted.
Semilunar valve function
Prevent backflow of blood into the ventricles.
(Aortic and pulmonary)
Ventricles contract, interventricular pressure rises and blood is pushed against semi lunar valves forcing them open.
As ventricles relax, interventricular pressure drops, blood flows back from arteries filling the cusps of the semilunars forcing them closed.
How AV valves shut
Ventricle contraction increases pressure gradient which closes the AV.
Mitral valve prolapse (MVP)
Chordae Tendinae weaken, papillary muscles can also weaken.
**higher occurrence of mvp in women because of higher pressure on heart during pregnancy.
Conditions Causing Loud S1
- Mitral stenosis - ⬆️ in atrial pressure, mitral valve flaps are thicker m, more turbulent blood flow w narrower space.
- Mitral prolapse - floppy leaflet snaps into taut proplapsed position. Makes a loud “click.” ⬆️ prolapse, ⬆️ regurg
- Exercise - (right after) faster heart rate, ⬆️ventricular pressure, ⬆️ s1 sound
Conditions Causing Loud S1 cont…
- Tricuspid stenosis - thickened leaflets narrows space and have turbulent blood flow.
- Atrial septal defect-
If the foramen ovale does not close properly can lead to ⬆️ volume in RV and ⬆️ flow across pulmonary sl. - Anamalous Pulmonary Venous connection, w/ ⬆️ tricuspid flow. -
PVs drain into RA instead of LA. Increases volume and pressure on tricuspid.
Soft S1 Conditions
- Mitral Regurgitation
- Calcific Mitral Stenosis
- Immobile Mitral Valve - Severe Atrial Regurgitation
- LBBB
- Decreased LV Contractility
Synchronized S2
A2 is slightly before P2
Split S2
- Split with deep inspiration is normal- the deeper the inhale the wider the split.
- Wide Split - can be seen in RBBB (variable)
- Wide fixed S2 - usually seen in pulmonary stenosis.
- Paradoxical split - P2 closes before A2 -
- can be been in expiration and disappears in inspiration.
(Aortic stenosis, LBBB, HCM) - Fixed split with no change during inspiration
(Atrial Septal defect, RV Failure)
S3 sound location and association
occurs right after diastole; difficult to hear.
Associated with LV failure.
S4
When audible, is caused by vibration of the ventricular wall during atrial contraction.
Pts with stiffened ventricles from ventricular hypertrophy and myocardial ischemia.
Heart murmur qualities and sound + most common cause.
Turbulent blood is forced through stenotic valve, it produces an abnormal whistling sound.
When blood flows backward through incompetent valve, it produces swishing or gurgling “murmur” sound.
Common cause - Rheumatic fever.
VSD + common cause + signs
(Ventrical septal defect - hole between the ventricles)
Congenital defect. (1 in 5 children have this) The most common congenital heart defect.
**Edema is the first symptom, then cyanosis. - Causes increased right ventricle pressure and hypertrophy.
Trabeculae Carneae
Muscular ridges that crisscross and project from the inner walls of the heart ventricles. Their structure is important to their role. Had the inner surface of heart ventricles been flat, suction could occur and this would impair the heart’s ability to pump efficiently.
Tetraology of Fallot
Four heart abnormalities that bring insufficient oxygenation
- Narrowing of the pulmonary valve
- Thickening of RV wall
- Displacement of Aorta over ventricular septal defect
- Ventricular septal defect
Gall bladder referred pain location
Right upper quadrant inferior to the scapula.
Heart high frequency sounds
Closure sounds, S1, S2
Low frequency heart sounds
Early and late diastolic filling.
(Events of the ventricles)
Location of heart
Sternal angle- T4-T5- ribs 2-6
Out to in layer by layer of the heart
- Heart wall / Pericardium
- Fibrous pericardium
- Parietal serous peri
- Pericardial cavity
- Epicardium
- Myocardium
- Fibrous skeleton
- Endocardium
