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Y1 - Anatomy of the Thorax > Lecture 5 - Anatomy of the heart and nerves of thorax > Flashcards

Lecture 5 - Anatomy of the heart and nerves of thorax Flashcards

1
Q

What is the pericardium?

A

A fibroserous sac that surrounds the heart and its great vessels, consisting of a fibrous and a serous layer.

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2
Q

What does the fibrous pericardium do?

A

A tough connective tissue that defines the boundaries of the middle mediastinum.

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3
Q

What innervates the fibrous pericardium?

A

Phrenic nerves as they pass through it on their route to the diaphragm.

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4
Q

What does the serous pericardium do?

A

Much thinner than fibrous pericardium and divided into visceral and parietal pericardium.
Visceral - adheres to the heart and forms its outer covering
Parietal - lines the inner surface of the fibrous pericardium

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5
Q

What is another name for the parietal pericardium?

A

Epicardium

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6
Q

What is the pericardial cavity/space?

A

Small gap between the visceral and parietal pericardium where a small amount of fluid resides.

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7
Q

How are sinus’ formed?

A

By reflections of the two continuous layers of serous pericardium around the roots of the great vessels.

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8
Q

What are the two pericardial sinuses and where are they found?

A
  • Transverse pericardial sinus (aorta and pulmonary trunk)

- Oblique pericardial sinus (superior and inferior vena cava and pulmonary veins - more posterior)

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9
Q

What is pericarditis?

A

Inflammation of the serous pericardium of the heart, resulting in the accumulation of fluid in the pericardial cavity which can affect the beating pattern of the heart.

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10
Q

What is cardiac tamponade?

A

Severe form of pericarditis resulting in the heart not being able to fill properly, meaning it is unable to propel blood around the body normally. Often requires fibrous pericardium to be surgically opened (pericardiocentesis)

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11
Q

Do the atria or the ventricles have thinner walls?

A

Atria

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12
Q

Which blood vessels empty into the right atrium?

A
  • Superior vena cava (superior and posteriorly)
  • Inferior vena cava (inferior and posteriorly)
  • Coronary sinus (medially to IVC)
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13
Q

What does the coronary sinus do?

A

Carry the deoxygenated blood from the myocardium back to the right atrium to be oxygenated.

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14
Q

What are the small folds of tissue in the right atrium associated with?

A

Embryonic sinus venous (valve of the coronary sinus and IVC). IVC valve was thought to direct blood to foramen ovale to the left atrium in foetal development.

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15
Q

What is the other method of draining deoxygenated blood from the myocardium into the RA?

A

Very small blood vessels along the walls of the RA called foramina of the vena cordis minimae, draining blood from myocardium directly into RA.

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16
Q

What structures are found in the right ventricle?

A
  • Trabeculae carnae on inflow portion of RV walls
  • Some trabeculae carnae known as papillary muscles, attaching to ventricular surface and cordae tendineae
  • Cordae tendineae connect papillary muscles to the free edges of the tricuspid valves
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17
Q

What is the function of the cordae tendineae and papillary muscles?

A

Prevent eversion of the valves as well as ensuring the cusps do not separate during ventricular contraction (prevent back flow into atria)

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18
Q

How many papillary muscles are present in the right ventricle and what are they called?

A

3

  • Anterior (largest)
  • Posterior
  • Septal (small or absent)
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19
Q

What is the left atrium derived from (embryologically)?

A

Pulmonary vein

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20
Q

Which chamber makes up the majority of the posterior surface of the heart?

A

Left atrium

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21
Q

What are the differences in shape between the two ventricles?

A
  • Left is more conical and longer than the right ventricle.
  • Trabeclae carnae are more delicate/finer in the left ventricle
  • Only two papillary muscles found here
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22
Q

How many papillary muscles are found in the left ventricle?

A

2
- Posterior
- Anterior
Both are larger in size than the 3 found in the right ventricle

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23
Q

What are the four valves found in the heart?

A
  • Tricuspid (R AV valve)
  • Pulmonary valve
  • Mitral (L AV valve)
  • Aortic
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24
Q

Describe the structure of the tricuspid valve.

A
  • 3 cusps (anterior, posterior and septal)

- Cusps attached to fibrous ring that surround atrioventricular orifice that maintains shape of valve

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25
Q

Describe the structure of the pulmonary valve.

A
  • Three semilunar cusps (left, right and anterior)
  • Each cusp forms a pocket-like sinus that fills following ventricular contraction from the blood recoil, forcing the cusps closed
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26
Q

Describe the structure of the mitral valve.

A
  • Two cusps (anterior and posterior)

- Similar fibrous ring to tricuspid valve

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27
Q

Describe the structure of the aortic valve.

A
  • Three semilunar cusps (right, left and posterior) that form pocket-like sinuses
  • As blood recoils from aorta, the pocket-like sinuses are filled and blood is forced into left and right coronary arteries
28
Q

What is the difference between the right and left sinuses and the posterior sinus?

A

Right and left sinuses arise from the right and left coronary arteries so posterior sinus is sometimes referred to as non-coronary.

29
Q

What is the path of the right coronary artery?

A

Right coronary artery originates from right coronary sinus and passes anteriorly and descends vertically in the coronary sulcus. It later branches into separate arteries.

30
Q

What are the main branches of the right coronary artery?

A
  • Early atrial branch (between right auricle and ascending aorta)
  • Sinu-atrial nodal branch
  • Right marginal branch
31
Q

What is the path of the left coronary artery?

A

Originates from the left coronary sinus, passing between the pulmonary trunk and left auricle before entering the coronary sulcus.

32
Q

What are the main branches of the left coronary artery?

A
  • Anterior inter ventricular artery (a.k.a. LAD - left anterior descending artery)
  • Circumflex artery
33
Q

What do the left coronary artery branches supply?

A

Most of the left atria and ventricle as well as inter ventricular septum.

34
Q

What is the coronary sulcus?

A

A groove on the outer surface of the heart that make the division between the atria and ventricles.

35
Q

Describe patterns of dominant coronary arteries.

A
  • Two thirds of the population will have a dominant right coronary artery, typically resulting in a small left circumflex
  • One third will have a dominant left coronary artery, resulting in a longer left circumflex that feeds the posterior regions as well as the medial branch coming from the left as well instead of the right
36
Q

What do they somatic spinal nerves do?

A
  • Motor to skeletal muscles
  • Sensory to body wall (NOT viscera)
  • Segmental nerves may combine to form plexi in specialised areas
37
Q

How does the vagus nerve leave the head?

A

Via the jugular foramen

38
Q

Describe the route of the vagus nerve.

A
  • Descends posteriorly and lateral to the common carotid artery
  • Plexus around oesophagus and posterior to lung root
  • Separates to form anterior and posterior oesophageal and gastric nerves
39
Q

What does the vagal oesophageal plexus do?

A

Relay pain sensations.

40
Q

Why type of innervation are the branches to the chest and abdomen?

A

Parasympathetic - control smooth and cardiac muscle as well as glands in gut and airways

41
Q

How many intercostal nerves are there?

A

11 pairs (mixed) with one subcostal nerve.

42
Q

What do the phrenic nerves supply?

A
  • Motor to diaphragm

- Sensory to central diaphragm, peritoneum, pericardium and pleura of the lungs

43
Q

Where do the phrenic nerves originate from?

A

Anterior rami of cervical plexus (C3-5)

44
Q

What vertebral levels does the cervical plexus include?

A

C3-5

45
Q

What are the surface markings for the heart?

A
  • 3rd CC 1cm from SB on R
  • 6th CC 1cm from SB on R
  • 2nd ICS/CC 2.5cm from SB on L
  • 5th ICS at MC line (9cm from SB)
46
Q

Where is the sternal border?

A

The right and left edges of the sternum.

47
Q

Where is the sternal angle?

A

At level of T4/5.

48
Q

What is meant by distal and proximal?

A

Proximal - towards the origin of the structure

Distal - away from the origin of the structure

49
Q

What is a normal amount of fluid in the pericardial cavity?

A

50ml

50
Q

What are the pericardial attachments?

A
  • Attaches to the central tendon on the diaphragm
  • Continuous with the adventitia of the great vessels
  • Anteriorly attached to the sternum by sternopericardial ligaments
51
Q

What does the pericardial sac prevent?

A

Cardiac distension - prevents the heart from overly expanding.

52
Q

What does the external common carotid supply?

A

Blood to the face, scalp and meninges via the circle fo Willis.

53
Q

Where does the aorta becoming the descending thoracic aorta?

A

At T4/5

54
Q

When does the aorta become the abdominal aorta?

A

T12 when it passes through the diaphragm.

55
Q

What is the highest point of the aortic arch?

A

Halfway between jugular notch and sternal angle.

56
Q

Where does the aortic arch begin (level) and end ?

A

2nd CC (R) and end at 2nd CC (L)

57
Q

How is blood drained from the head?

A

Via the jugular system, which passes directly downwards behind the sternocleidomastoid to join the subclavian vein to form the brachiocephalic vein.

58
Q

Where is the brachiocephalic vein formed?

A

Just superior to the 1st rib (T2)

59
Q

Where does the SVC begin and terminate?

A

From right 1st CC to the lower edge of the right 3rd CC.

60
Q

What are the surface landmarks for the R and L common carotid?

A

R - from right sternoclavicular joint to right ear lobe
L - from aortic arch to left sternoclavicular join then to left of trachea along anterior border of sternocleidomastoid muscle to the left ear lobe

61
Q

What are the surface marks for the right and left internal jugular veins?

A

Lateral to the common carotid arteries.

62
Q

What are the surface markings for the four heart valves?

A

Aortic - R sternal edge at 2nd ICS
Pulmonary - L sternal edge 2nd ICS
Tricuspid - L sterna ledge 5th ICS
Mitral - MCL 5th ICS

63
Q

What can heart murmurs be associated with?

A
  • Regurgitation - leaky, dilated valves

- Stenosis - tightened, smaller valves which struggles to open

64
Q

What is the crista terminals?

A

Smooth muscular ridge beginning at the roof other right atrium and extending down to the anterior lip of the IVC. It separates the right atrium into 2 space.

65
Q

What the difference between trabeculae carnae and the pectinate muscles?

A

Pectinate muscles are found in the atria whereas the trabeculae carnae are found in the ventricles.

Y1 - Anatomy of the Thorax (9 decks)

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