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Middle mediastina Flashcards

1
Q

The mediastinum is a

A

central compartment located in the the thoracic cavity

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2
Q

How many divisions does the mediastinum have?

A
  • 2 divisions but 4 parts
  • superior and inferior divisions
  • anterior, middle, posterior and superior
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3
Q

Boundary between the superior and inferior mediastinum

A

T4-T5 transthoracic plane

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4
Q

Lateral boundary of the mediastinum

A

pulmonary cavities

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5
Q

Middle mediastinum diagram

A

insert

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6
Q

Boundaries of the middle mediastinum (5):

  • between
  • superiorly
  • inferiorly
  • laterally
  • surface landmarks
A
  • between anterior and posterior
    mediastinum
  • superiorly: superior mediastinum
  • inferiorly: diaphragm, T8-T9 supine, T9-T10
    standing
  • laterally: pulmonary cavities
  • surface landmarks: left costal cartilage and
    anterior rib end III-V
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7
Q

Middle mediastinum Content (5):

A
  • pericardium
  • heart
  • origin/root of great vessels: ascending
    aorta, pulmonary trunk divides into PA, PV,
    superior and inferior vena cava
  • right and left phrenic nerve
  • right and left periocardiophrenic vessels
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8
Q

middle mediastinum content diagram

A

insert

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9
Q

What is the pericardium?

A

fibroserous membrane surrounding heat and root of great vessels

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10
Q

Fibrous pericardium

A
  • tough, external layer
  • dense, irregular CT
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11
Q

Serous pericardium

A
  • serous membrane, internal layer
  • mesothelium (lateral plate mesoderm)
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12
Q

Fibrous Pericardium: tough, external layer:

  • function
  • superiorly
  • inferiorly
  • anteriorly
  • posteriorly
A
  • prevent overfilling of heart
  • superiorly: continuous with adventitia of
    great vessels
  • inferiorly: adhered to the central tendon of
    the diaphragm
    “pericardiophrenic ligament”
  • anteriorly: attached to the sternum
    “sternopericardial ligaments”
  • posteriorly: loosely adhered to the
    posterior mediastinum content by loose
    connective tissue
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13
Q

Serous Pericardium: serous membrane, internal layer: three parts:

A
  • parietal layer
  • pericardial cavity: potential space
    containing fluid
  • viscera layer (epicardium)
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14
Q

Serous membrane of pericardium: site of reflection of parietal layer onto the visceral layer:

A
  • aorta and pulmonary trunk (arterial)
  • superior vena cava, inferior vena cava, and
    pulmonary veins (venous)
  • reflections from pericardial sinuses
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15
Q

Cardiac Tamponade:

A
  • excess fluid within the pericardial cavity
    prevents filling of the heart
  • restricts contraction of the heart
  • if there was no fibrous layer that would not
    matter as the serous membrane would
    expand along with systole
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16
Q

Pericardial Sinuses: State:

A
  • reflection of parietal layer onto the visceral
    layer of the serous pericardium
  • impressions found in the pericardial sac
    found where the great vessels enter it
  • transverse pericardial sinus
  • oblique pericardial sinus
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17
Q

Pericardium diagram

A

insert

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18
Q

Fibrous pericardium diagram

A

insert

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19
Q

Serous pericardium diagram

A

insert

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20
Q

Pericardial sinsuses diagram

A

insert

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21
Q

Transverse pericardial sinus:

A
  • reflection between arterial and venous
    group of great vessels
  • relevance: cross-clamp arterial group for
    coronary bypass
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22
Q

Oblique Pericardial Sinus:

A
  • reflection around venous group of great vessels
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23
Q

Pericardium blood supply diagram

A

insert

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24
Q

Blood supply to the pericardium and pericardial sinuses:

A
  • pericardiophrenic artery
  • musculophrenic artery
  • coronary artery
  • bronchial artery/ oesophageal artery/
    superior phrenic artery directly from the
    thoracic aorta
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25
Venous drainage of the pericardium and pericardial sinuses:
- pericardiophrenic vein - azygous venous system tributaries
26
Three layers of the hear:
- endocardium: inner layer of endothelium and CT - myocardium: middle layer of myocytes (cardiac muscle cells) - epicardium (visceral serous pericardium): outer layer
27
layers of heart diagram
insert
28
Structure of the heart:
- 2 sides: right and left - 4 chambers: right atrium, left atrium, right ventricle, left ventricle - 4 valves: bicuspid = mitral, tricuspid = right, pulmonary semilunar valve and aortic semilunar valve - right side: receives venous blood, circulates de-oxygenated blood to the lungs - left side: receives arterial blood, circulates oxygenated blood to the body
29
Heart structure diagram
insert
30
heart structure (lines) diagram
insert
31
Cardiac cycle: (graph)
- insert a level
32
cardiac cycle diagram
insert
33
Orientation of the heart:
- trapezoid from anterior and posterior views - apex: 5th intercostal space mid-clavicular line, formed by inferolateral part of the left ventricle - base: T6-T9, formed by left atrium (minor contribution from right atrium) - 4 surfaces - 4 borders
34
Orientation of the heart: 4 surfaces: - anterior surface: - inferior surface: - right pulmonary surface: - left pulmonary surface:
- anterior surface: (sternocostal) right ventricle - inferior surface: (diaphragmatic) left ventricle, part of right ventricle - right pulmonary surface: right atrium - left pulmonary surface: left ventricle
35
Orientation of the heart: 4 surfaces: diagram
insert
36
Orientation of the heart: 4 borders:
- right border: RA, between superior and inferior vena cava - inferior border: RV, part LV - left border: LV and left auricle - superior border: RA, LA, right auricle, left auricle, ascending aorta, pulmonary trunk, superior vena cava
37
Orientation of the heart: 4 borders: diagram:
insert
38
Right atrium anatomy:
- right auricle - sinus venarum = smooth walled - pectinate muscle - crista terminalis (internal) - sulcus terminalis (external) - vessel opening: superior vena cava, inferior vena cava, coronary sinus - fossa ovalis (foramen ovale)
39
Right atrium internal structure diagram
insert
40
Right ventricle Anatomy:
- conus arteriosus (infundibulum) - trabeculae carneae - supraventricular ridge - tricupsid valve, cusps and orifice - chordae tendineae - 3 papillary muscles: anterior, septal, posterior - pulmonary semilunar valve - pulmonary sinus
41
What carries theright branch of the atrioventricular bundle?
- moderator band from the base of interventricular septum to the anterior papillary muscle - RV
42
Diagram of right ventricle of heart
insert
43
Left atrium anatomy:
- left auricle - pectinate muscle - fossa ovalis (foramen ovale)
44
Left atrium diagram:
insert
45
Left ventricle anatomy:
- trabecular carneae - 2 papillary muscles: anterior and posterior - mitral valve: cusps and orifice - chordae tendineae - aortic vestibule - aortic valve: semilunar cusps and sinuses - coronary artery orifices: right and left
46
left ventricle diagram
insert
47
break diagram 1
insert
48
break diagram 2
insert
49
The right and left coronary arteries arise from
aortic sinuses, coronary orifices
50
Pathway of the right coronary artery:
in coronary/sulcus/ atrioventricular sulcus/ groove
51
Pathway of the left coronary artery:
between the pulmonary trunk and left auricle in the coronary sulcus
52
Right and left coronary artery diagram
insert
53
Right coronary arteries: - location - branches - supplies
- arise from right aortic sinus, coronary orifice Branches: - sinoatrial node br. (60%) - right marginal br. - atrioventricular node br. (80%) - posterior interventricular br. CARDIAC DOMINANCE (67%) - supplies the right atrium, right ventricle, left ventricle (diaphragmatic surface)
54
Heart diagram
insert
55
Left Coronary Artery: - location - branches - supplies
- arises from the left aortic sinus, coronary orifice Branches: - anterior IV br.(left anterior descending LAD) - diagonal br. (from the anterior IV br.) - circumflex br. - left marginal br. (from circumflex br.) - supplies LA,LV, part RV
56
Where does the coronary sinus?
lies in the posterior coronary sulcus
57
Cardiac veins drain into
the coronary sinus
58
Coronary veins: tributaries:
- great cardiac vein (anterior IV br.) - small cardiac vein (R marginal br.) - middle cardiac vein (posterior IV br.) - left posterior ventricular/cardiac vein
59
Coronary veins diagram
insert
60
coronary veins diagram
insert
61
Cardiac Development: what day does the paired heart tube develop? Which period of development is this in?
- Day 18 - embryonic period
62
Day 18: paired heart tube develops: - from? - why?
- from cardiac progenitor cells - to meet the nutritional needs of the embryo
63
cardiac embryology development
insert
64
What happens on day 21/22 of cardiac development?
- heart tubes fuse in midline - heart starts to beat (day 22/23) - bubus cordis and truncus arteriosus - ventricle - primordial atrium - sinus venosus
65
Day 21/22: what day of cardiac development is this?
insert diagram
66
- What happens on day 22-28 of cardiac development? - where does the atria and sinus lie in relation to this
- dextral looping (heart tube folding) "bulboventricular loop) - atria and sinus venosus lie dorsally to truncus arteriosus, bulbus cordis and ventricle
67
Day 22-28 image: what day is this?
insert diagram
68
End of week 4 of cardiac development?
- endocardial cushions form to divide the atrioventricular canal, primordial atrium and ventricle
69
insert end week 4 cardiac development
insert
70
End week 5 cardiac development?
- truncus arteriosus partitioned and 180 degree spiralling - bulbus cordis incorporated into the ventricle walls
71
End week 7 cardiac development?
IV septum closes
72
End week 5 development diagram
insert diagram
73
Pre-natal circulation diagram
insert
74
Post-natal circulation: Remnants:
- foramen ovale > fossa ovalis - ductus arteriosus > ligamentum arteriosum - ductus venosus > ligamentum venosum - left umbilical vein > ligamentum teres hepatis - umbilical arteries > median umbilical ligament
75
Conducting System of the heart:
- generates and transmits electrical impulses across cardiac myocytes (myogenic conduction) - sinoatrial node = cardiac pacemaker: - located at the superior end of the sulcus terminalis - atrioventricular node: - located near the opening of coronary sulcus - Atrioventricular bundle - bundles (left and right) - Purkinje fibers (subendocardial branches)
76
Conducting system:
insert diagram
77
conducting system
insert diagram
78
Pericardium innervation:
- sensory: phrenic nerve (C3,C4,C5) - autonomic somatic nervous system: sympathetic trunk
79
superficial cardiac plexus diagram
insert
80
Heart Innervation:
- cardiac plexus - sensory: follow SNS T1-T5/T6 - autonomic SNS: sympathetic trunk (T1- T5/T6) - autonomic peripheral nervous system: Vagus Nerve (Cranial nerve X)
81
cardiac plexus diagram
insert
82
Referred pain: from viscera to a more distant site: somatic:
- skeletal muscle, bones, connective tissues - sharp, localised pain - follow dermatome or cutaneous mapping
83
Referred pain: from viscera to a more distant site: visceral:
- viscera of body cavitities and vessels - dull, poorly localised pain - often referred to a dermatome - usually due to stretch, ischaemia, chemical irritation
84
Cardiac Referred pain to
T1-T5/T6
85
Referred pain diagram
insert
86
Which part of the trilaminar disc is the serous membrane derived from?
Lateral plate mesoderm
87
Function of the pericardial cavity:
- friction free movement of the heat when contracting
88

HLB (49 decks)

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