Mediastinum: Heart & Lungs Flashcards
Identify the external features of the lungs.
Apex
Lobes (L2, R3)
Superior, middle (only in R lung), inferior lobes
Fissures (between lobes: oblique and horizontal)
Lingula (L lung only)
Explain the pattern of branching and the structural anatomy of the bronchial tree
Trachea > R & L Primary Bronchii > Secondary (lobar) > Tertiary (segmental)
R primary bronchus is more vertical
Identify the left lung using only the related structures of their medial surfaces
Aortic arch Thoracic aorta Esophagus Heart Lingula
Identify the right lung using only the related structures of their medial surfaces
SVC
Esophagus
Azygos vein
Heart
Describe the pleural coverings of the lungs including the regions and recesses
Parietal pleura (wall=outer layer adjacent to the thoracic wall, mediastinum, and diaphragm) Regions: -cervical part -costal part -diaphragmatic part -mediastinal part
Recesses: (filled with serus fluid to provide low friction environment for cavity expansion)
- costalmediastinal recess
- costodiaphragmatic recess
Visceral pleura (organ=surrounds the lungs)
List the layers of the pericardium from superficial to deep
External layers:
Fibrous pericardium, parietal pericardium, pericardial cavity (space b/t layers of parietal and visceral layers-frictionless layer for heart movement), visceral pericardium (aka epicardium), myocardium (cardiac muscle), and endocardium (endothelial cells)
Identify the surface features of the heart
visceral pericardium
Ligamentum arteriosum (pulmonary trunk, arch of aorta)
left atrium, left auricle
left ventricle
cardiac apex
anterior interventricular sulcus
right ventricle
coronary sulcus
right atrium, right auricle
coronary sinus in posterior corony sulcus
SVC, IVC, aortic arch, pulmonary trunk (br to R, L arteries), pulmonary veins
Identify cardiac auscultation sites
Aortic & Pulmonary sites are in the 2nd intercostal space
(semilunar valves)
R AV Tricuspid & L AV Mitral sites are found in the 5th intercostal space
(AV valves)
sites are located superficial to the vector blood follows as it passes thru each chamber
[blood carries sounds in the direction it flows]
Explain the arrangement between chordae tendineae and the valves of the heart
The chordae tendineae is found ONLY in L&R atrioventricular valves (bicuspid/mitral and tricuspid) in the L&R atria
The tendinous cords arise from papillary muscles. During contraction, the cords tighten and draw/maintain cusps together to prevent reflux (i.e. from RV back to RA reflux)
The left phrenic nerve passes ________ to the root of the left lung.
anterior
The left phrenic nerve is positioned ________ to the pericardial sac.
lateral
The left phrenic nerve passes _________ to the ascending aorta.
lateral
The right phrenic nerve is positioned _________ to the superior vena cava.
lateral
The right phrenic nerve is positioned __________ to the pericardial sac.
lateral
The right phrenic nerve passes ________ to the root of the right lung.
anterior
The azygos vein (arch) passes _______ to the right main bronchus.
superior
Name the structures that comprise the root of the lung and how they vary between right and left lung.
Structures: pulmonary artery br, pulmonary veins br, primary bronchus (L and R), hilum, visceral pleura > pulmonary ligament
Key difference: branches of pulmonary artery differ from R to L roots
RA-LS:
R Lung: Anterior pulmonary artery to primary bronchus
L Lung: Superiors pulmonary artery to primary bronchus
Name the internal features of the RA.
interatrial septum (smoth wall)
fossa ovalis (remnant, R to L atria)
valved surface of IFV
valved surface of coronary sinus (drains blood from surfacee of the heart)
R atrioventricular orifice with AV valve
pectinate muscles (rough)
crista terminals (ridge where pectinated meets interatrial septum)
Name the internal features of the RV.
conus arteriosus
supraventricular crest
R atrioventricular valve, anterior cusp (tricuspid valve)
chordae tendinae (tendinous cords of papillary muscle)
anterior papillary muscle
posterior papillary muscle
septal papillary muscle
septomarginal trabecula (moderator band, adapted in conducting system to assist c proper timing of activation of papillary muscles)
trabecular carnae (rough muscular lining)
interventricular septum (wall b/t ventricles)
valve of pulmonary trunk (semilunar valve)
Name the internal features of the LA.
anterior papillary muscle
posterior papillary muscle
trabeculae carneae ofinterventricular septum
chordae tendineae
L atrioventricular valve (bicuspid or mitral valve)
Name the internal features of the LV.
pectinate muscles left auricle left superior pulmonary vein valve of foramen ovale (don't need to know) left atrium interatrial septum
___________ ___________ is to ventricles as pectinate muscles is to atria.
Trabecula carneae
Papillary muscle and cordae tendinae is found in ___________.
atrioventricular valves
What are the two semilunar valves and how do they function?
Aortic & Pulmonary valves
Have 3 cusps (left, posterior, right) in place that prevent backflow by allowing blood flow from high pressure to low pressure gradient (L&R coronary artery openings in the)
The coronary openings are found in the R&L cusps
The descending (thoracic) aorta passes ________ to the left main bronchus.
posterior
The descending (thoracic) aorta is positioned _______ to the lateral pericardial sac.
posterior
The descending (thoracic) aorta is positioned to the ___________ of the vertebral bodies.
left/lateral
The SVC is positioned _______ to the ascending aorta,
lateral (right)
The IVC is positioned to the ________ of the descending aorta.
right
The aortic arch passes ________ to the pulmonary trunk.
superior
The L vagus nerve passes directly _______ to the arch of the aorta.
lateral
The left recurrent laryngeal nerve passes _______ to the ligamentum arteriosum.
posterior
The left recurrent laryngeal nerve passes directly _______ to the arch of the aorta.
inferior
The SVC is positioned ___________ to the ascending aorta.
lateral (right)
The superior vena cava is positioned _________ to the ascending aorta
lateral (right)
The azygos vein (arch) passes _______ to the right main bronchus
superior
The arch of the aorta passes ________ to the pulmonary trunk.
superior
The left vagus nerve passes directly ________ to the arch of the aorta.
lateral
The left vagus nerve passes ________ to the left main bronchus
posterior
The left recurrent laryngeal nerve passes _________ to the ligamentum arteriosum.
posterior
The left recurrent laryngeal nerve passes directly ______ to the arch of the aorta.
inferior
The right vagus nerve is positioned _______ to the trachea.
lateral
The right vagus nerve passes _______ to the arch of the azygos vein and _______ to the right main bronchus.
medial; posterior
At the hilum of the left lung, the pulmonary artery is positioned ________ to the main bronchus.
superior
At the hilum of the left lung, the pulmonary veins are positioned ______ and _______ to the main bronchus.
anterior and inferior
At the hilum of the right lung, the pulmonary artery is positioned ________ to the main bronchus.
anterior
At the hilum of the right lung, the pulmonary veins are positioned _________ to the main bronchus
anterior
At the hilum of the right lung, the pulmonary veins are positioned ______ and ______ to the pulmonary arteries.
anterior and inferior
The descending (thoracic) aorta passes _______ to the left main bronchus
posterior
The descending (thoracic) aorta is positioned ________ to the pericardial sac.
posterior
The descending (thoracic) aorta is positioned to the _________ of the vertebral bodies
left (lateral)
The esophagus is positioned _______ to the trachea.
posterior
The esophagus passes _______ to the left main bronchus
posterior
The esophagus is positioned ________ to the pericardial sac
posterior
The right vagus nerve is positioned _______ to the trachea.
lateral
The right vagus nerve passes _________ to the azygos vein and _______ to the right main bronchus.
medial; posterior
The left vagus nerve passes directly _______ to the arch of the aorta.
lateral
The left vagus nerve passes _______ to the left main bronchus
posterior
The azygos vein passes ________ to the right main bronchus
superior
The thoracic duct is positioned directly _______ to the thoracic vertebral bodies.
anterior
The right posterior intercostal arteries pass _______ to the vertebral bodies.
anterior
The sympathetic chain is positioned _______ to the thoracic vertebral bodies
lateral
The greater splanchnic nerve is positioned ______-______ to the sympathetic chain.
anterior - medial
Describe the blood flow through the heart including all chambers and valves.
venous blood drains into SVC (upper body) and IVC (lower trunk, limbs) > RA > R atrioventricular (tricuspid) valve > RV > pulmonary semilunar valve > pulmonary trunk > R&L pulmonary arteries > lungs > pulmonary veins back through LA > L atrioventricular (bicuspid) valve > LV > Aortic semilunar valve > Ascending Aorta > Aortic Arch > Thoracic Aorta
Describe the location of remnants of fetal circulation, and what structures they shunted blood between.
Remnants:
LIGAMENTUM ARTERIOSUM
located between and connecting pulmonary trunk to arch of aorta
FOSSA OVALIS
located between and connecting the right and left atrium
Posterior interventricular artery anastomoses with _______________.
anterior interventricular artery
Explain the conduction system of the heart.
The components are a series of interconnected cells effective at transmitting conductive signals. They are not nerves nor axons. They are adapted cardiac myocytes that have lost contractile proteins, but can transmit signals.
Located mainly on R side of heart
Sinoatrial node (SA) > branches into Atrioventricular (AV) node and AV bundle
AV bundle > bifurcates into Left and Right bundle branches located at the AV septum and branch along walls
Includes the septomarginal trabeculae (moderator band) in the RV
Explain the anatomy underlying cardiac referred pain.
Happens as a result of a connection between the somatic and visceral n.s.
cell bodies of visceral axons & general somatic axons (skin) are shared, therefore the brain can interpret pain in areas of the skin (L pectoral, shoulder, medial UE) from pain receptors in the myocardium during a MI.
