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CPR 1 > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

Pericardial sac

Function/parts

A

Function:
-Holds heart/roots of great vessels

Parts:

1) Fibrous Pericardium
- Defines boundaries of middle mediastinum
- Continuous w the adventitia of great vessels

2) Serous pericardium
- Has parietal layer that lines Fibrous pericardium
- Visceral layer covers the heart

(Between two layers of serous pericardium = pericardial cavity)

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2
Q

Pericardium:

Neurovasculature
Arteries, veins, nerves

A

Arteries:

1) Internal thoracic
2) Musculophrenic branches
3) Inferior phrenic
4) Thoracic aorta

Veins:

1) Azygos
2) Internal Thoracic
3) Superiorphrenic

Nerves:

1) Visceral layer of serous paricardium
- Vagus nerve/sympathetic trunk (motor innervation)
- Visceral afferents for pain (sensory)
- Fibrous pericardium (somatic sensory) by phrenic nerve

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3
Q

Pericarditis

What is it
Causes
Procedure

A

– Inflammation of pericardium

– Causes
• Infectious
• Renal failure
• Post myocardial infarction
• Post-surgical etc.

– Pericardial friction rub: Sound due to roughness of the parietal lining from inflammatory process.

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4
Q

Pericardial effusion

A

– The accumulation of excess fluid within the pericardial space may occur slowly or rapidly

– Causes:
• Pericarditis
• Connective tissue diseases
• Hypothyroidism

-Can lead to cardiac tamponade

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5
Q

Cardiac tamponade

A

-Rapid Large fluid (usually blood) accumulation
in the pericardial space leading to compression
which prevents adequate filling of the chambers

Clinical signs = *Beck’s Triad:
• Hypotension→ decreased cardiac output
• Distant heart sounds→ fluid in pericardial cavity
• Distended neck veins→ decreased diastole
filling

Treatment:
• Paraxiphoid approach – tip of the xiphoid, or
between xiphoid and left costal margin, angled
towards left shoulder.

• Apical approach - left 5th or 6th intercostal
space

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6
Q

Pericardium reflections (Foldings) Sinus’s

A

-Foldings of pericardium around vessels

1) Transverse sinus: This space would be entered to place a clamp around the proximal aorta and pulmonary trunk
(Can be clamped in surgery)

2) 2. Oblique sinus: This is a cul-de-sac formed where the serous pericardium reflects onto the pulmonary veins

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7
Q

Heart surface anatomy

Margins

A

Right pulmonary surface:
-right pulmonary surface faces the right lung and consists of the right atrium

The left pulmonary surface:
Faces the left lung and consists of the left ventricle and part of the left atrium

inferior margin (acute):
The sharp edge between the anterior and diaphragmatic surfaces of the heart

Obtuse margin:
Separates the anterior and left pulmonary surfaces it is round and extends from the left auricle to the cardiac apex

(Margins outline surfaces)

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8
Q

How are the anterior/stenocostal surface and inferior or diaphragmatic surface formed

A

The sternocostal surface:
-RIGHT ventricle

The diaphragmatic:
-left ventricle

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9
Q

Where is the Atrioventricular or Coronary sulcus (groove) and Interventricular sulcus (groove)

A

Between the atria and ventricles

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10
Q

Where does the Interventricular sulcus (groove) lie

A

Between the ventricles

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11
Q

What are Auricles and what are structure of the heart are they associated with?

A
  • Appendages of the atria

- Associated with aorta and pulmonary trunk anteriorly

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12
Q

Where are they located?

Superior and inferior vena cava

A

-located posterior to right atrium

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13
Q

Where is the apex located?

A

Left ventricle Located

at 5th intercostal space

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14
Q

What is located at the base of the heart?

A

1) Left atrium
2) Proximal parts of
pulmonary veins
3) Part of right atrium
4) proximal parts of SVC and IVC

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15
Q

What would an anterior penetrating wound most likely penetrate?

A

Right ventricle

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16
Q

If a pt swallowed an object such as a nail what structure would most likely be at risk?

A

Left artrium (most posterior structure of heart)

17
Q

What can happen if the left atrium is enlarged?

A

Dysphagia (Left atrium could compress the esophagus)

-Can do a Transesophageal ultrasound to investigate this

18
Q

What’s the normal width of the heart at inferior margin?

A

-Less than one hemithorax (half of the thoracic diameter)

Greater can lead to cardiomegly

19
Q

Cardiac chambers: Right Atrium

Where receives blood and structures within

A

-Receives blood from SVC, IVC & coronary sinus.

-cristaterminalis separates the smooth posterior part atrium from the area roughened by
the pectinate muscles.

-The inter-atrial septum has an oval depression (fossa ovalis)

20
Q

Cardiac chambers: Left Atrium

Where receives blood and structures within

A

Receives arterialized (oxygenated) blood from FOUR pulmonary veins; 2 left & 2 right

• Inter-atrial surface forms part of the anterior wall and has an impression of the fossa ovalis

21
Q

Where do the papillary muscles on the right ventricle attach to?

A

The tricuspid valve

(The muscles also keep the valve closed)–> Lub

22
Q

Semilunar Valves:

What are the cusps associated with the aortic and pulmonary valve?

A

Aortic:

  • right, left and posterior
  • 2 Coronary cusps
  • Right and left contain sinus’s that fill ventricular contraction closing valves and coronary arteries

Pulmonary:
-right ,left and anterior (have no associated vessels)

23
Q

Valves, Location, Auscultation

Aortic
Pulmonary
Tricuspid
Mitral

A

Aortic

  • Posterior to left side sternum at 3rd intercostal space
  • Right sternal border at 2nd intercostal space

Pulmonary

  • Left 3rd costal cartilage
  • Left costal border at 2nd intercostal space

Tricuspid
-Behind sternum at 4th& 5th intercostal space
-Left sternal border at 5
the intercostal space

Mitral

  • Behind sternum at 4th costal cartilage
  • 5th left intercostal space in midclavicular line
24
Q

Blood supply:

Right coronary artery

Branches

A

-Right coronary artery emerges from right aortic sinus –> Coronary sulcus

2) Right Marginal artery (acute marginal):
- supplies most of right ventricle

3) Posterior interventricular (posterior descending) artery:
- Supplies posterior 1/3 of IV septum

-Also supplies blood to the right atrium, SA/AV nodes/ part of left ventricle

25
Q

Blood supply

Left Coronary Artery

Branches

A

1) Anterior interventricular branch (Most frequently occluded)
- Septal branches (anterior 2/3 IV septum)

2) Circumflex artery
-Left marginal branch of
circumflex artery
-Posterior left
ventricular branch
of circumflex artery

4) Diagonal branch(es)
of LAD → anterior
wall and anterior
papillary m.)

Supplies 
Left atrium
Left ventricle
Anterior 2/3 of interventricular septum
AV bundle (of Hiss) and its branches.
Circumflex a. may also supply SA and AV nodes (rare).
26
Q

What can coronary heart disease lead to?

A

-hypoxia
-ischemia
-infarction of the myocardial tissue supplied by the
obstructed artery

27
Q

How to tell if someone is left or right dominant

A

Right dominant:
-Right coronary gives rise to PIV (most people)

Left dominant:
-Left coronary artery gives rise to PIV

28
Q

Sympathetic motor innervation of heart

  • Preganglionic
  • Synapse
  • Postganglionic
A

Preganglionic:
Lateral horn –> Cell bodies in intermediolateral cells columns from T1-T4

Synapse:
Preganglionic sibers –> T1-4 chain ganglia or ascend the chain and synapse at cervical ganglia

Postganglionic sympathetic:
Cell bodies are located in cervical and upper thoracic chain ganglia –> Carried to the cardiopulmonary nerves to the cardiac plexus –> Cardio pulmonary nerves terminate at SA and AV nodes

29
Q

Parasympathetic innervation of the heart

A

Preganglionic:

  • parasympathetic cell bodies in the vagal nuclei
  • Branch from vagus nerve –> Vagal cardiopulmonary branches

Postganglionic:
-Cell bodies: Atrial wall and interatrial septum

30
Q

How do visceral afferents for pain travel

A

w sympathetics

31
Q

How do visceral afferents for physiological reflexes travel (Ex: Stretch)

A

Follow parasympathetic fibers to the vagus nerve

CPR 1 (32 decks)

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