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ANAT-316 > Lecture 3: Pericardium and Coronary Circulation > Flashcards

Lecture 3: Pericardium and Coronary Circulation Flashcards

1
Q

What are the vertical boundaries of the mediastinum?

A

the parasternal lines and the left midclavicular line

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2
Q

What are the horizontal boundaries of the mediastinum?

A

the sternal angle (manubriosternal joint) and the xiphisternal joint

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3
Q

What is the superior limit of the mediastinum?

A

the sternal angle at the level of T4/T5

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4
Q

What is the inferior limit of the mediastinum?

A

the xiphisternal joint at the level of T9

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5
Q

What is the mediastinum?

A

the compartment in the thoracic cavity that holds the heart

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6
Q

What are the boundaries of the mediastinum?

A

1st rib, diaphragm, rib cage, & thoracic vertebrae

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7
Q

What does the mediastinum contain?

A

the extrapulmonary organs

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8
Q

What are the 5 contents of the middle mediastinum?

A
  1. heart
  2. great vessels (roots)
  3. neurovasculature inside pericardium
  4. neurovasculature outside pericardium
  5. respiratory system
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9
Q

What are the contents of the great vessels found in the middle mediastinum?

A

the aorta, pulmonary trunk and arteries (R/L), pulmonary veins, superior and inferior vena cavae

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10
Q

What are the contents of the neurovasculature inside the pericardium?

A

coronary circulation and cardiac plexus

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11
Q

What are the contents of the neurovasculature outside the pericardium?

A

phrenic nerves and pericardiacophrenic arteries and veins

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12
Q

What is the content of the respiratory system found in the middle mediastinum?

A

the primary bronchi (L/R)

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13
Q

What is the heart enveloped by?

A

the serous pericardium and pericardial cavity

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14
Q

What is the heart’s additional membrane called?

A

the fibrous pericardium (FC)

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15
Q

What is the fibrous pericardium made of?

A

dense connective tissue

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16
Q

What is the fibrous pericardium anchored to?

A

the roots of great vessels, diaphragm and thoracic wall

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17
Q

What can the fibrous pericardium be covered in?

A

pericardial fat

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18
Q

What are the two layers of serous pericardium called?

A

parietal and visceral layers

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19
Q

What is the parietal layer of the serous pericardium adhered to?

A

deep surface of fibrous pericardium

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20
Q

Which layer of the pericardium is hard to separate?

A

the parietal layer of the serous pericardium

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21
Q

What is the pericardial cavity?

A

potential space between layers of serous pericardium

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22
Q

What does the visceral layer of the serous pericardium do?

A

it ‘shrink-wraps’ the heart

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23
Q

What are there variable amounts of in the visceral layer of the serous pericardium?

A

epicardial fat

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24
Q

What is the order of the pericardium?

A
  1. fibrous pericardium
  2. serous pericardium (parietal layer)
  3. pericardial cavity
  4. serous pericardium (visceral layer)
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25
Q

What creates pericardial sinuses?

A

when the visceral serous pericardium transitions to parietal serous pericardium where the fibrous pericardium is anchored to the great vessels

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26
Q

What are pericardial sinuses?

A

cul-de-sacs within the pericardial cavity

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27
Q

What are the 2 pericardial sinuses called?

A

oblique and transverse sinus

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28
Q

Where is the oblique sinus found?

A

posterior to the heart (left ventricle/atrium)

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29
Q

Where is the transverse sinus found?

A

posterior to the aorta and pulmonary trunk

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30
Q

Why does the pericardial cavity only contain a few mL of serous fluid?

A

to ease gliding of the beating heart against surrounding tissues

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31
Q

Which layer of the pericardium restricts the expansion of the heart to help direct blood out the ventricles?

A

the tough fibrous pericardium

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32
Q

What is pericardial effusion?

A

buildup of excess fluid in the pericardial cavity that may be slow

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33
Q

What happens to the fibrous pericardium when there is pericardial effusion?

A

it stretches in response

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34
Q

What is cardiac tamponade?

A

large or rapid pericardial effusion that causes the heart to accelerate to maintain volume of blood

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35
Q

What can the heart do if there is a cardiac tamponade?

A

stop beating

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36
Q

What is the intervention for a cardiac tamponade?

A

pericardiocentesis

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37
Q

What are the two pumps in the heart?

A

the right and left pump

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38
Q

What are the two pumps in the heart divided into?

A

2 chambers

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39
Q

What are the 2 chambers of the heart called?

A

the atrium and ventricle

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40
Q

Where is the heart rotated around in anatomical position?

A

the longitudinal axis towards the left

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41
Q

Where is the heart’s inferior end (apex) tilted towards in anatomical position?

A

the left and anterior

42
Q

What do the muscular walls of the four chambers of the heart create?

A

sulci

43
Q

What are sulci?

A

shallow grooves on the external surface

44
Q

What do sulci contain?

A

coronary circulation and variable fat

45
Q

What is the atrioventricular sulcus?

A

ring around the heart between atria and ventricles

46
Q

Where is the inter ventricular sulcus found?

A

between left and right ventricles, anterior to posterior

47
Q

What provides blood supply to the heart?

A

the right and left coronary arteries

48
Q

Where do the right and left coronary arteries come from?

A

the first two branches of the aorta

49
Q

Where are the right and left coronary arteries located?

A

in sinuses created by the aortic valve cusps

50
Q

When do the aortic valve sinuses and coronary arteries fill with blood?

A

when the aortic valve shuts (during ventricular diastole)

51
Q

What happens to the coronary arteries when the aortic valve opens?

A

they become sealed by cusps

52
Q

What happens to the coronary arteries when the aortic valve closes?

A

they open and fill

53
Q

Where does the right coronary artery emerge?

A

at anterior/right base of aorta

54
Q

Where does the right coronary artery run?

A

to the right in the atrioventricular sulcus around the posterior surface

55
Q

What are the 3 main branches of the right coronary artery?

A
  1. sinoatrial nodal artery
  2. right marginal artery
  3. posterior interventricular artery
56
Q

Where does the sinoatrial nodal artery run?

A

under auricle of right atrium and loops around superior vena cava

57
Q

What does the sinoatrial nodal artery supply?

A

the sinoatrial node and right atrium

58
Q

Where does the right marginal artery run?

A

towards apex on right border of the heart

59
Q

What does the right marginal artery supply?

A

most of the right ventricle

60
Q

Where does the posterior interventricular artery run?

A

towards apex in posterior interventricular sulcus

61
Q

What does the posterior interventricular artery supply?

A

posterior ventricles and posterior 1/3 of inter ventricular septum (muscle wall)

62
Q

Where does the left coronary artery emerge from?

A

posterior/left base of aorta

63
Q

Where does the left coronary artery run?

A

to the left, posterior to pulmonary trunk

64
Q

What are the 3 divisions of the left coronary artery?

A
  1. anterior interventricular artery
  2. circumflex artery
  3. left marginal artery
65
Q

Where does the anterior interventricular artery run?

A

towards apex in anterior interventricular sulcus

66
Q

What does the anterior interventricular artery supply?

A

anterior ventricles and 2/3 of interventricular septum

67
Q

Where does the circumflex artery run?

A

under auricle of left atrium, in atrioventricular sulcus, onto posterior surface

68
Q

What does the circumflex artery supply?

A

left atrium and via #6

69
Q

Where does the left marginal artery run?

A

towards apex on the margin of the heart

70
Q

What does the left marginal artery supply?

A

most of the left ventricle

71
Q

What artery is a branch of the circumflex artery?

A

the left marginal artery

72
Q

Which two anastomoses are formed in the common coronary artery configuration?

A
  1. between end of right coronary and circumflex arteries
  2. between anterior and posterior interventricular arteries
73
Q

What is heart dominance?

A

it describes which coronary artery gives rise to the posterior interventricular artery

74
Q

Why is heart dominance important?

A

because it determines the posterior third of the interventricular septum

75
Q

What is right dominant composed of?

A

70% posterior interventricular artery from right coronary artery

76
Q

What is left dominant composed of?

A

15% posterior interventricular artery from left coronary artery and circumflex artery

77
Q

What is codominant composed of?

A

15% posterior interventricular artery from both

78
Q

What is atherosclerosis?

A

when plaque deposits build up on internal walls of coronary arteries

79
Q

What is the consequence of atherosclerosis?

A

stenosis

80
Q

What is stenosis?

A

narrowing of lumen

81
Q

What causes myocardium?

A

local ischema of heart muscle

82
Q

What is myocardial infarct?

A

tissue necrosis

83
Q

What are the stages of myocardial infarct?

A

atherosclerosis -> stenosis -> myocardium -> myocardial infarct

84
Q

What can less severe blockages be treated by?

A

angioplasty

85
Q

What is an angioplasty?

A

percutaneous coronary intervention

86
Q

What do severe blockages require?

A

coronary artery bypass graft

87
Q

What do coronary artery bypass grafts do?

A

they circumvent the blockage and restore blood flow

88
Q

Why is it important to know cardiac dominance?

A

because if blockage is in proximal LCA, then PIVA may be affected, but less so in codominant hearts

89
Q

What are the 4 cardiac veins?

A
  1. great cardiac vein
  2. middle cardiac vein
  3. small cardiac vein
  4. anterior cardiac veins
90
Q

What are the cardiac veins paired with?

A

coronary arteries

91
Q

Where are the cardiac veins paired with the arteries?

A

in the sulci

92
Q

Which artery runs with the great cardiac vein?

A

the anterior interventricular artery

93
Q

What does the great cardiac vein drain?

A

anterior ventricles and left atrium

94
Q

Which artery runs with the middle cardiac vein?

A

the posterior interventricular artery

95
Q

What does the middle cardiac vein drain?

A

posterior interventricular septum

96
Q

Which artery runs with the small cardiac vein?

A

the right marginal artery and right coronary artery

97
Q

What does the small cardiac vein drain?

A

right atrium and ventricle

98
Q

Which artery runs with the anterior cardiac veins?

A

local branches of right coronary artery

99
Q

What do the anterior cardiac veins drain?

A

the anterior right ventricle

100
Q

What is special about the anterior cardiac veins?

A

they drain directly into the right atrium

101
Q

What is the coronary sinus?

A

swelling in atrioventricular sulcus that collects venous blood form great, middle and small cardiac veins

102
Q

What does the coronary sinus open into?

A

the right atrium near the inferior vena cava

ANAT-316 (25 decks)

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