Lungs and Heart Flashcards
where are the visceral and parietal pleura continuous
At the root of the lung
What enters at the root of the lung
Bronchi, arteries, veins, lymph vessels
What are the 4 parts of the parietal pluera
Costal
Diaphragmatic
mediastinal
pleural cupula
PARTS OF THE MEDIASTINAL OFTEN FUSE WITH PERICARDIAL SAC
What is normally in the plerual cavity
lubricating pleural fluid from mesothelial lining (facilitates movement of oposing membranes)
What are pleural reflections
when parietal pleura folsds or chages directions from one wall of the cavity to another
What and where is the pulmonary ligament
aproximation of the anterior and posterior mediastinal plerua, extends inferiorly from root of each lung
What are plerual recesses
Where lungs do not mormally extend to the limits of the plerual cavity so the regions contact eachother
Lungs move in and out of these durning respiration
Where is the recess between the cotstal and diaphragmatic pleura and what is its significance
costodiaphragmatic recess
it is the infereior extreme of th pleural sac and abnormal accumulations of fluid can be found here
abtained during thoracentesis without contacting lung
What is the junction of the mediastinal and costal pleurae and what is its significance
Costomediastinal recess
Lingula of of left lung enters upon respiration, with no apparent clinical significance
What innervates the parietal plerura and is it sensitive to pain?
the phrenic nerve (diaphragmatic portion) and intercostal nerves it is sensitive to pain
Where can pain from the parietal plerua be reffered
Intercostal spaces adjcacent to pleural region
What innervates the visceral pleura and is it pain sensitive
Innervated by sympathetic and parasympathetic innervation from pulmonary plexus
pain insensitive
Do pleural sacs connect with eachother or the mediastinum
Do not connet with eachother but do connect to mediastinum at the root via the pulmonary ligament
What are the 4 parts of the lungs
apex (superior round end)
Base (concave and by diapram)
Root (passagway for structures from mediastinum
Hilum (where root attaches)
What is the size difference between the lungs and why
Right one is larger and heavier but shorter and wider (lacks cardiac notch so bigger) because the hemidiaphram is in a more superior position
What are the lobes and fissures of the right lung
Superior middle inferior lobes
Horizontal
oblique
What do the fissures of the right lung seperate
Horizontal: superior from middle
oblique: middle from inferior
What are the lobes and fissures of the left lung
Superior and inferior lobes
oblique
What lobe in the left lung deviates from the midline and what is this called
Superior lobe
Cardiac notch
What is lingula
Small projection below the cardiac notch (dips into the costomediastinal recess on inspiration)
Why mus breath sounds be listened to throuth the posterior thoracic wall
because the oblique fissure plane puts infior lobe posterior on both sides
Which section of the mediastinum is the trachea end and when does it bifurcate
In superior mediastinum, bifurcates at the sternal angle
What is the carina, why is it important
The fusion of the two medial walls of the bronchi at deviation
important radiologic landmark
What is the difference in bronchus size and why is it important
Right bronchus is wider shorter and straighter meaning foreign objects are more likely to be traped in it than the left
What is the progression of trachea branching
Trachea –> Bronchi –> Lobar (secondary) Bronchi –> Segmental (Tert) Bronchi
What is the name for the tissue supplied by a segmental bronchi
Bronchopulmonary segment
Each also has its own branch of pulmonary artery and vein
How many bronchopulmonary segments are in the right lung
10
How many bronchopulmonary segments are in the left lung
8
What lobes are drained by the left and right superior pulmonary veins
Right: superior and middle
Left: Superior
What lobes are drained by the left and right inferior pulmonary veins
Inferior lobes
WHat supplies the blood to the bronchiole connective tissue and where do they arise
Bronchial arteries
From either thoracic aorta or its intercostal branches
What arte the lymphatic plexuses serving the lungs and where are they located/ where do they drain
Superficial plexus : beneath visceral plerua drains into bronchopulmonary lymph nodes (at hillum)
Deep plexus: in submucosa of bronchi and trachea drains into pulmonary lymph nodes and THEN bronchopulmonary lymph nodes
What do bronchial veins drain and where do they drain to
drain large subdivisions of bronchial tree
right vein enters azygos
Left vein enters hemiazygous system
What are the names for the lung and heart coverings
Lung pleura
Heart serous pericardium
What does the pericardial sac enclose and where in the mediatinum is it located
Heart and roots of great vessels
Middle Mediastinum
What sits on the outside of the parietal layer of the serous pericardium
Fibrous pericardium
Where does the fibrous pericardium attach
inferiorly to central tendon of diaphram
superiorly to adventitial coverings of great vessels
What is found just deep to the visceral serous pericardium
Fat and coronary vessels
what forms pericardial sinuses and what two are there
formed by pericardial reflections in development
transverse and oblique
What gives the main arterial supply to the pericardium and where are they branched from
pericardiacophrenic and musculophrenic arteries
(and some other associated arteries)
branches of internal thoracic
Where is venous drainage of the pericarium
into triubutaries of the azygos system and the internal thoracic veins
What innervates the pericardium and which parts have pain
phrenic nerves and the cardiac plexus
parietal has pain visceral no pain
What makes up the cardiac plexus
vagal and sympathetic nerves
What are the 4 borders of the heart
right: right atrium
Left: mainly left ventricle, some left auricle
inferior: mainly right ventricle some left ventricle
Superior: enter and exit of great vessels
what is the direction of the apex of the heart
Infrolatteraly left
What indicates the divisions of the hearts chambers externally
sulci
What is contained within sulci on the heart
major vessels supplying the heart
What division does the coronary sulcus indicate
Division between atria and ventricles
What division does the intraventicular sulcus indicate
Divides ventricles
Has an anterior and posterior portion
What 4 things does the right atrium recieve blood from
Inferior vena cava
superior vena cava
coronary sinus
anterior cardiac veins
Where is the right atrium located relative to the intercostals
at the level of the fourth and fifth intercostal spaces
What is the smooth area of the right atrium called and what is located there
sinus venarum
contains opeinings of vena cava and coronary sinus
What is located on the anterior inner surface of the right atrium
muscular ridges called pectinate muscles
What is the crista terminalis and where does it lie
a ridge in the right atrium which seperates the rough and smooth areas (sinus venarum and pectinates) it spans the distance between the vena cava entrances
What is the sulcus termnialis
a groove on the external surface of the heart whcihc corresponds to the cristae terminalis
What is the posteromedial wall of the right atrium also, and why is it significant
the interatrial septum
the site for congenital atrial sept defects allowing passage of blood between atria
What/where s the fossa ovalis and why is is it significant
Located on the interatrial septum
previusly the site of the foramen ovale
What valve seperates the right atrium and right ventricle
Tricuspid in the atrioventricular orifice
What is the right Auricle and what does it represent
muscular pouch off right atrium projecting left
represents part of embryonic atrium
What is the conus arteriosus
cone shaped taper in superior region of the right ventricle which leads to the pulmonary trunk
What is unqiue about the conus arteriousus portion of the right ventricle
It is the only smooth portion (non trabeculae carneae)
What makes up the rough muscular area of the ventricle
Trabeculae carneae
What are the papillary muscles and how many are there
large muscleuar bundles projecteting into the ventricular cavity connect to free edge and ventricular surface of valve cusps (by cordae tendinae)
There are 2 projections (and an occasional small 3rd called septal)
What are the cords connecting papillary muscles to vlalves
Chordae tendinae
Where is the septomarginal trabecula and what is it
Moderator band
spans from interventricular septum to base of anterior papillary and carries right branch of the atrioventricular bundle from conducting system
What is the valve seperating the right ventricle and its major vessels/ what are its major vessels
Pulmonary valve or semilunar (pulmonary trunk)
How many cusps are on the pulmonary valve and when does it closed
3 (anterior, left and right)
closes when ventricle relaxes and pulmonry trunk elasticity forces blood back toward the ventircle into siuses at base of each cusp
What forms forms most of the base of the heart
left atrium
What forms superior left heart border
Left auricle
What enters the left atrium and where
four pulmonary veins (two from each lung)
on posterior wall of left atrium
What is the only non smooth inner portion of the left atrium
its left auricle
what valve seperates the left atrium from left ventrical
mitral or bicuspid valve
what forms the apex of the heart
The left ventricle
What is the smooth region of the left ventricle
Aortic vestibule
(rest is cvered with trabeculae carneae
Which ventricle is thicker
Left ventricle
What 2 parts is the interventricular sepum composed of and why is it significant emryologically
Superior membranous and inferior muscular
Site of congenital septal defects allowing passage of blood between ventricles
How many papillary muscles are in the left ventricle and what do they connect to
2 (anterior and posterior)
Mitral or bicuspid valve
What valve seperates the left atrium and ventricle
aortic vlave (three semilunar cusps left right posterior)
what are aortic sinuses
small deviations above the aortic valve
Where do the left and right coronary arteries arise from
left and right aortic sinuses
Where will you hear the tricuspid valve best
5th or 6th intercostal space near left sternal border
Where will you hear mitral valve best
Near apex of the hear in 5th intercostal space midclavicular line
Where whill you hear aortic and pulmonary valve sounds best
2nd pulmonary space on left and right borders of sternum
Why do you listen for valve sounds away from the vlave
sounds are carried with blood as it flows away
What arteries supply the heart
Left ad right coronary (travel in coronary sulcus)
What brances does the right coronary give off and what does it supply
Right atrium ventricle, interatrial septum and sa and av nodes
SA Nodal:
Marginal
AV Nodal
Terminal Posterior interventricular arteries
Which of the coronary arteries is larger
Left coronary artery
Where does the left coronary artery travel
Passes between pulmonary trunk and left auricle before braching
What are the Initial branches of the Left coronary
Branches to aiterior interventricular (left anterior descending) and circumflex artery
What is the course of the LAD
goes inferiorly in nterior interventricular groove to apex of heart to anastomais with posterior interventricualr
where does the Marginal branch of the coronary arteries arise
off of the circumflex
What is the course of the circumflex artery
Pases posteriorly in coronary sulcus to anastomose with posterior intervetnricular
what is the course of the marginal branch
follows left border of heart (left ventricle)
What is the main vein of the heart
cORONARY SINUS
What ein traels with the anterior interventricular artery
Great cardiac vein
What vein travels witht the posterior interventricular artery
Middle cardiac vein
What vein travels with the right marginal artery
small cardiac vein
What cardiac veins arise from right ventricle and emtpty directly into right atrium
anterior cardiac veins
What initiates the regular electric impulses of the heart
automatic depolarization in the SA node
What is the pass of depolarization
sa node- through atria to av node- to left and right atrioventricular bundles (bundle of his) (causes contraction of papilary muscles and then ventricles
atria contract together prior to ventricles
Why are neck injuries dangerous for lungs
project up behind strnocliedomastoid
What is a pneumothorax and why is it an issue
air into pleural cavity,
neutralizes the normally negative intrapleural pressure to atmospheric pressure
what is pericardiocentesis and where should it be done
drainage of fluid from the pericardial sac to releive pressure on heart
done in the left 5th or 6th intercostal space close to sternum
why is fluid in pericardial sac dangerous
may restrict venus return
