Lecture 3-4 CV Anatomy

Question 1

Sternal angle

Answer 1

Sternal angle is the line junction between manubrium and sternal body. 2nd rib articulates there.

Question 2

Which vein is over the 1st rib?

Answer 2

The subclavian v.

Question 3

Why is it problematic to kick someone in the back?

Answer 3

Kidney anterior to the floating ribs 11&12!

Question 4

what is the landmark used for Aspiration/Needle in the Sac around the Heart ?

Answer 4

Do so by using the xiphoid process as a landmark
Palpate xiphoid process by feeling the medial process of the rib cage and going superior
Needle between costal margin of rib cage and xiphoid process and go obliquely and superior laterally

** long story short: put needle lateral to typhoid process *

Question 5

What is above the first rib?

Answer 5

Lung apex is above the first rib.

Question 6

How do we put in a central line?

Answer 6

Feel jugular notch with one finger and palpate collarbone until feel the concavity of the bone going posteriorly. Insert there to reach the subclavian vein.

Question 7

True or False. 1st rib articulates with the manubrium and is under the clavicle.

Answer 7

True

Question 8

True or False. VPR from spinal column is coming around and using ________ travel where it needs to get to from posterior spine to anterior body way. The intercostal space is between the ribs to get where they need to go.

Answer 8

intercostal space

Question 9

Which artery can be harvested?

Answer 9

Internal thoracic a. = posterior intercostal anastomosis with the anterior via this artery. Can be removed as you would still have blood flow from the posterior to anterior to serve the body wall, and can also harvest this artery (aka cabbage surgery)

Question 10

Where is neurovasculature bundle? Where should a tap be done?

Answer 10

The VAN is below the rib. The tap should be done above the rib to avoid nerves (nerves are only inferior the rib)!

Question 11

How does the rib move during respiration?

Answer 11

Inspire = diaphragm descends, pulling inferiorly and raises the ribs to pull up and forward and that will increase the thoracic volume
Expire – let diaphragm relax, ascend, and elastic recoil pushes out and rib cage falls anterior posterior and inferiorly
** easy way to know this demonstrate it during the exam, know that what I feel moving is my ribcage and that the opposite direction is the way the diaphragm moves.

Question 12

What do external and internal intercostals do?

Answer 12

External intercostal muscles of forced inhalation.
Internal intercostals are the primary muscles of forced exhalation.
** EI, IE pneumonic **

Question 13

Which arteries serve the thoracic organs

Answer 13

Thoracic aorta a. and intercostal branches.

Question 14

What artery is taken for coronary artery bypass?

Answer 14

Internal Thoracic Arteries

Question 15

Mediastinum

Answer 15

collection of spaces between the lungs bounded by anterior chest wall sternum, posterior spinal column, lateral lungs.

Question 16

What is in the anterior mediastinum?

Answer 16

Pericardial sac is the anterior mediastinum, the thymus gland lives there.

Question 17

True or False. Superior mediastinum has major blood vessels like aortic arch. The root of those structures here in mediastinal space.
Middle: heart located.
Anterior: thymus gland
Posterior: major blood vessels descend to get to throax, abdomen, etc i.e. descending thoracic aorta

Answer 17

True

Question 18

What are the major veins of the posterior body wall and anterior body wall?

Answer 18

Azygos v.: MAJOR vein of POSTERIOR body wall

Internal thoracic v.: serves ANTERIOR body wall

Question 19

True or False. Vagus PS serves the heart and lungs! It serves everything PS in thorax and abdomen.

Answer 19

True

Question 20

What serves the heart?

Answer 20

Thoracic aorta

Question 21

What CN serves the carotid sinus?

Answer 21

CN 9 and 10

Question 22

How many layers in heart vs. lung

Answer 22

Lung (2): visceral, parietal

Heart (3): visceral, parietal, fibrous

Question 23

Where do lymph nodes end?

Answer 23

Region around pectorals major

Question 24

True or False.
Left heart back. Bulk in posterior.
Right heart comes to front. Bulk in anterior.

Answer 24

True.

• • she got Left Back (posterior) because she was bulky or LB**
• • step Right to the Front (anterior) **
• *LB, RF**

Question 25

Path of blood through the heart

Answer 25

Subclavian + IJV –> Brachiocephalic left and right –>  superior vena cava–>  right atrium –> right ventricle –> pulmonary artery –>  lungs  —> pulmonary v. –> left atrium –> left ventricle –> aorta –> systemic circulation

Question 26

True or False. We never hear valves. We can hear changes in flow though.

Answer 26

True

Question 27

Where does the right heart provide blood?

Answer 27

To the lungs.

Question 28

What does chorda tendinae attach to?

Answer 28

On ventricle walls papillary muscle bands attach to chordae tendinae which are attached to the leaflet of the valves.

Question 29

Pulmonary and aortic valves

Answer 29

Pulmonary: left, right, anterior cusp
Aortic: left, right, posterior cusp

Question 30

HEART STUFFF.

Answer 30

Blood moves through the aortic valve to serve the body…

Systolic = contracts 
Diastolic = at rest

Chamber contraction
Ventricle = right pushes into lungs and left pushes into body.
Atria = right pushes blood into right ventricle and left atrium into left ventricle

Aortic Valve
Cardiac output = into aortic arch (left in particular). When heart is at rest, the column of blood slams down onto the aortic valve cusps
3 cusps:
1. Right = superior to this is the opening to the right coronary a.
2. Left = superior to this is the opening to the left coronary a.
3. Posterior = no opening near this

Question 31

Systolic vs. Dystolic

Answer 31

The whole body eats food, gets blood etc. when the heart contracts
Heat beats and blood moves through pipes but the heart itself is not served at the same time
Systolic = when the heart is in systolic and contracts itself it does not serve itself, it just squeezes out blood
Diastolic = heart is served only when at rest, blood slams down and forces blood inferiorly
Heart pain = due to the heart only feeding itself at rest, heart pain and chest pain from coronary a. blockage is during eating, working out, sex etc. When the heart needs the most food it gets the least amount because it is contracting and so the heart beat increases to serve the rest of the body instead of serving itself

Question 32

Coronary sinus

Answer 32

biggest vein posterior, mostly everything drains here, and it drains directly into the right atrium

Question 33

Which artery is most commonly blocked?

Answer 33

Left anterior descending (LAD)/ ’widowmaker’: left heart, anterior heart, and bulk of interventricular septum.

LAD + LCA

Question 34

Circumflex branch:

Answer 34

serves space between atria and ventricle= superolateral aspect of left heart

Question 35

Right coronary artery

Answer 35

Right coronary artery (RCA) travels between right atrium and right ventricle and first sends marginal branch on inferolateral aspect of the right heart, right ventricle, and atrium.

Question 36

Right marginal Posterior descending artery (PDA):

Answer 36

posterior right heart, and posterior aspect of interventricular septum.