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ANATOMY Exam 1 > Mediastinum and Heart > Flashcards

Mediastinum and Heart Flashcards

1
Q

What is housed in the Mediastinum?

A

All the thoracic organs except the lungs

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2
Q

What are the superior and inferior borders of the mediastinum?

A

Superiorly: Superior thoracic aperture (1st ribs, manubrium, T1 vertebra)
Inferiorly: Diaphragm

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3
Q

How is the Mediastinum divided up superiorly and inferiorly?

A

Horizontal plane passing through the sternal angle and T4/T5 IV disc separates the region into the superior mediastinum and inferior mediastinum

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4
Q

Describe the Thymus.

A

It is a lymphoid organ and it undergoes gradual involution and is largely replaced by fat by adulthood, after puberty.

-Lies posterior to the manubrium and body of the sternum; its inferior aspect lies anterior to pericardium

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5
Q

What is the pericardium?

A

Fibroserous membrane that surrounds the heart & roots of the great vessels

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6
Q

Discus the location of the phrenic nerve.

A

“Ventral rami of C3, C4, C5 keep the Phrenic alive” Course on the superficial aspect of the pericardium, anterior to the root of the lungs

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7
Q

What does the phrenic nerve innervate?

A
  • Motor innervation to diaphragm
  • Sensory innervation to diaphragm, parietal pleura and pericardium (fibrous pericardium and parietal layer of serous pericardium)
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8
Q

Describe the layers of the Pericardium.

A
  • Fibrous pericardium: Tough external layer. Inelastic and so protects the heart against overfilling. Attached to the central tendon of the diaphragm
  • Parietal layer of serous pericardium: Lines inner surface of fibrous pericardium
  • Visceral layer of serous pericardium (epicardium): Continuous with parietal layer of serous pericardium at great vessels. Adhered to surface of heart
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9
Q

What is the Pericardial cavity?

A
  • Potential space between the parietal and visceral layers of the serous pericardium
  • Contains thin layer of serous fluid
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10
Q

What is pericarditis and what effect does it have?

A
  • Inflammation of the serous pericardium

- Will result in roughened surfaces that produce a pericardial friction rub during auscultation

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11
Q

What happens if fluids accumulate in the pericardial cavity?

A

Cardiac tamponade (heart compression) may result. Since the fibrous pericardium is inelastic, the fluid will eventually restrict the heart’s ability to expand and fill with blood.

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12
Q

Describe an Echo-guided pericardiocentesis.

A
  • It can be performed to drain fluids from the pericardial cavity.
  • Subxiphoid approach: A needle is inserted to the left of the xiphoid process, and directed superiorly, deep to the costal margin
  • Left parasternal approach: A needle is inserted to the left of the sternum, in the left fifth or sixth intercostal space.
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13
Q

Describe the borders of the heart.

A
  • Right border: right atrium between the superior vena cava & inferior vena cava
  • Inferior border: primarily right ventricle
  • Left border: primarily left ventricle
  • Superior border: right and left atria
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14
Q

What comprises the anterior, posterior, apex, and base of the heart?

A

Anterior position = Right ventricle
Posterior position= Left atrium
Apex = Left ventricle
Base = Left atrium

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15
Q

Discuss the brachiocephalic veins and superior vena cava (SVC).

A
  • Internal jugular + subclavian veins –> form left and right brachiocephalic veins (Left is longer)
  • Left and right brachiocephalic veins –> form the SVC

-Brachiocephalic veins lie anterior to the major arteries arising from the arch of the aorta

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16
Q

Describe the parts of the Aorta.

A

Ascending aorta: Emerges from left ventricle
Arch of the aorta: Begins at sternal angle (T4/T5), arches over the right pulmonary artery and courses posteriorly and inferiorly
Thoracic aorta: After sternal angle.

17
Q

What branches off the Aorta?

A
  • Brachiocephalic trunk: Gives rise to right subclavian and right common carotid arteries
  • Left common carotid artery
  • Left subclavian artery
18
Q

What is the location and significance of the Transverse pericardial sinus?

A
  • Located posterior to the aorta and pulmonary trunk
  • During cardiac surgery, the presence of the transverse pericardial sinus allows the surgeon to ligate or clamp the aorta and pulmonary trunk to control the arterial outflow during surgery
19
Q

What are the grooves that the coronary vessels sit in on the heart’s surface?

A
  • Coronary (atrioventricular) groove

- Anterior and posterior interventricular grooves

20
Q

What are the branches of the Right coronary artery (RCA)?

A
  • Travels in the coronary groove
  • Usually gives off sinoatrial (SA) nodal branch
  • At inferior border of the heart, gives off right marginal branch
  • Finally, gives off posterior interventricular branch which occupies the posterior interventricular groove
21
Q

What are the branches of the Left coronary artery (LCA)?

A
  • Gives off anterior interventricular branch (left anterior descending, LAD) which occupies the anterior interventricular groove and runs towards the apex of the heart
  • Gives off circumflex branch which occupies the coronary groove
  • The circumflex branch gives rise to the left marginal branch
22
Q

Describe venous draining of the heart.

A

Great, Middle, and Small cardiac vein collect into the coronary sinus (located posterior portion of the coronary groove) –> drains into right atrium

23
Q

Describe the structures in the right atrium.

A
  • Openings of the IVC, SVC, and coronary sinus
  • Right auricle is an appendage of the right atrium with pectinate muscles
  • Crista terminalis = Ridge separating auricle and smooth posterior wall
  • Fossa ovalis = oval-shaped depression in the interatrial septum that is the remnant of the embryonic foramen ovale
24
Q

Describe the structures in the right ventricle.

A
  • Trabeculae carneae muscle
  • Anterior, posterior, and septal papillary muscles
  • Chordae tendineae extend between papillary muscles and cusps of tricuspid valve
  • Septomarginal trabecula (moderator band) = Muscle bundle extending from interventricular septum to anterior papillary muscle. Carries a portion of the right bundle branch (part of the conducting system of the heart)
25
Q

Describe the structures in the left atrium.

A
  • Openings of the pulmonary veins

- Left auricle with pectinate muscles

26
Q

Describe the significance of the aortic valve.

A
  • When ventricles relax, blood fills the sinuses above the cup-like cusps; as the sinuses fill, they hold the valve closed
  • Blood in the aortic sinuses flows into coronary arteries
27
Q

What are the special bypasses in fetal circulation?

A
  • Umbilical vein –> Round ligament of the liver
  • Ductus venosus (Liver) –> Ligamentum venosum
  • Foramen ovale (Heart) –> Fossa ovalis
  • Ductus arteriosus (pulmonary trunk) –> Ligamentum arteriosum
  • Umbilical arteries –> Medial umbilical ligaments
28
Q

What are the different holes of the diaphragm and what goes through them?

A
  • Caval hiatus (T8): IVC
  • Esophageal hiatus (T10): Esophagus and Vegus nerve
  • Aortic hiatus (T12): Thoracic aorta, thoracic duct, and azygous vein
29
Q

What branch off from the thoracic aorta?

A

It lies left of the midline.

  • Bronchial arteries
  • Esophageal arteries
  • Posterior intercostal arteries course along costal grooves of ribs (part of VAN)
  • Subcostal arteries
30
Q

What makes up the Azygous system?

A
  • Azygos vein: Lies to the right of midline
  • Accessory hemiazygos vein: Lies to the left of the midline. Courses posterior to the esophagus to join the azygos vein
  • Hemiazygos vein: Lies to the left of the midline, inferior to accessory hemiazygos vein. Courses posterior to the esophagus to join the azygos vein
31
Q

What is the function of the Azygous vein?

A

-Collect blood from mediastinal structures (via bronchial, esophageal veins), thoracic wall (via posterior intercostal veins & subcostal veins),
and posterior abdominal wall (via lumbar veins)
-Drains primarily into the SVC
-To reach the SVC, it arches superior to the root of the right lung

32
Q

What does the Thoracic duct do? Where does it run?

A
  • Collects lymph from most of the body
  • Courses posterior to the esophagus on the anterior surface of the vertebral bodies, between the azygos vein and the aorta
  • Drains into left venous angle (where left subclavian and left internal jugular veins join)
33
Q

What does the right lymphatic duct do? Where does it run?

A
  • Collects lymph from the right upper quadrant (right side of head/neck/thorax, right upper extremity)
  • Drains into right venous angle (where right subclavian and right internal jugular veins join)

ANATOMY Exam 1 (6 decks)

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