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HLB > Middle mediastina > Flashcards

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
Q

Venous drainage of the pericardium and pericardial sinuses:

A
  • pericardiophrenic vein
  • azygous venous system tributaries
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26
Q

Three layers of the hear:

A
  • endocardium: inner layer of endothelium
    and CT
  • myocardium: middle layer of myocytes
    (cardiac muscle cells)
  • epicardium (visceral serous pericardium):
    outer layer
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27
Q

layers of heart diagram

A

insert

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28
Q

Structure of the heart:

A
  • 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
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29
Q

Heart structure diagram

A

insert

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30
Q

heart structure (lines) diagram

A

insert

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31
Q

Cardiac cycle: (graph)

A
  • insert a level
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32
Q

cardiac cycle diagram

A

insert

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33
Q

Orientation of the heart:

A
  • 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
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34
Q

Orientation of the heart: 4 surfaces:

  • anterior surface:
  • inferior surface:
  • right pulmonary surface:
  • left pulmonary surface:
A
  • anterior surface: (sternocostal) right
    ventricle
  • inferior surface: (diaphragmatic) left
    ventricle, part of right
    ventricle
  • right pulmonary surface: right atrium
  • left pulmonary surface: left ventricle
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35
Q

Orientation of the heart: 4 surfaces: diagram

A

insert

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36
Q

Orientation of the heart: 4 borders:

A
  • 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
Q

Orientation of the heart: 4 borders: diagram:

A

insert

38
Q

Right atrium anatomy:

A
  • 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
Q

Right atrium internal structure diagram

A

insert

40
Q

Right ventricle Anatomy:

A
  • 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
Q

What carries theright branch of the atrioventricular bundle?

A
  • moderator band from the base of
    interventricular septum to the anterior
    papillary muscle
  • RV
42
Q

Diagram of right ventricle of heart

A

insert

43
Q

Left atrium anatomy:

A
  • left auricle
  • pectinate muscle
  • fossa ovalis (foramen ovale)
44
Q

Left atrium diagram:

A

insert

45
Q

Left ventricle anatomy:

A
  • 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
Q

left ventricle diagram

A

insert

47
Q

break diagram 1

A

insert

48
Q

break diagram 2

A

insert

49
Q

The right and left coronary arteries arise from

A

aortic sinuses, coronary orifices

50
Q

Pathway of the right coronary artery:

A

in coronary/sulcus/ atrioventricular sulcus/ groove

51
Q

Pathway of the left coronary artery:

A

between the pulmonary trunk and left auricle in the coronary sulcus

52
Q

Right and left coronary artery diagram

A

insert

53
Q

Right coronary arteries:

  • location
  • branches
  • supplies
A
  • 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
Q

Heart diagram

A

insert

55
Q

Left Coronary Artery:

  • location
  • branches
  • supplies
A
  • 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
Q

Where does the coronary sinus?

A

lies in the posterior coronary sulcus

57
Q

Cardiac veins drain into

A

the coronary sinus

58
Q

Coronary veins: tributaries:

A
  • great cardiac vein (anterior IV br.)
  • small cardiac vein (R marginal br.)
  • middle cardiac vein (posterior IV br.)
  • left posterior ventricular/cardiac vein
59
Q

Coronary veins diagram

A

insert

60
Q

coronary veins diagram

A

insert

61
Q

Cardiac Development: what day does the paired heart tube develop? Which period of development is this in?

A
  • Day 18
  • embryonic period
62
Q

Day 18: paired heart tube develops:

  • from?
  • why?
A
  • from cardiac progenitor cells
  • to meet the nutritional needs of the embryo
63
Q

cardiac embryology development

A

insert

64
Q

What happens on day 21/22 of cardiac development?

A
  • heart tubes fuse in midline
  • heart starts to beat (day 22/23)
  • bubus cordis and truncus arteriosus
  • ventricle
  • primordial atrium
  • sinus venosus
65
Q

Day 21/22: what day of cardiac development is this?

A

insert diagram

66
Q
  • What happens on day 22-28 of cardiac
    development?
  • where does the atria and sinus lie in
    relation to this
A
  • dextral looping (heart tube folding)
    “bulboventricular loop)
  • atria and sinus venosus lie dorsally to
    truncus arteriosus, bulbus cordis and
    ventricle
67
Q

Day 22-28 image: what day is this?

A

insert diagram

68
Q

End of week 4 of cardiac development?

A
  • endocardial cushions form to divide the
    atrioventricular canal, primordial atrium
    and ventricle
69
Q

insert end week 4 cardiac development

A

insert

70
Q

End week 5 cardiac development?

A
  • truncus arteriosus partitioned and 180
    degree spiralling
  • bulbus cordis incorporated into the
    ventricle walls
71
Q

End week 7 cardiac development?

A

IV septum closes

72
Q

End week 5 development diagram

A

insert diagram

73
Q

Pre-natal circulation diagram

A

insert

74
Q

Post-natal circulation: Remnants:

A
  • foramen ovale > fossa ovalis
  • ductus arteriosus > ligamentum arteriosum
  • ductus venosus > ligamentum venosum
  • left umbilical vein > ligamentum teres
    hepatis
  • umbilical arteries > median umbilical
    ligament
75
Q

Conducting System of the heart:

A
  • 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
Q

Conducting system:

A

insert diagram

77
Q

conducting system

A

insert diagram

78
Q

Pericardium innervation:

A
  • sensory: phrenic nerve (C3,C4,C5)
  • autonomic somatic nervous system:
    sympathetic trunk
79
Q

superficial cardiac plexus diagram

A

insert

80
Q

Heart Innervation:

A
  • 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
Q

cardiac plexus diagram

A

insert

82
Q

Referred pain: from viscera to a more distant site: somatic:

A
  • skeletal muscle, bones, connective tissues
  • sharp, localised pain
  • follow dermatome or cutaneous mapping
83
Q

Referred pain: from viscera to a more distant site: visceral:

A
  • viscera of body cavitities and vessels
  • dull, poorly localised pain
  • often referred to a dermatome
  • usually due to stretch, ischaemia, chemical
    irritation
84
Q

Cardiac Referred pain to

A

T1-T5/T6

85
Q

Referred pain diagram

A

insert

86
Q

Which part of the trilaminar disc is the serous membrane derived from?

A

Lateral plate mesoderm

87
Q

Function of the pericardial cavity:

A
  • friction free movement of the heat when contracting
88
Q
A

HLB (49 decks)

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