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Anatomy > Middle Mediastinum > Flashcards

Middle Mediastinum Flashcards

1
Q

what is the central compartment of the thoracic cavity?

A

mediastinum

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2
Q

what structures create the boundaries of the superior mediastinum?

A

superior thoracic aperture to the level of the sternal angle

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3
Q

what are the components of the inferior mediastinum?

A

anterior, middle, and posterior mediastinum

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4
Q

what is found within the middle mediastinum?

A

heart, great vessels

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5
Q

what is the pericardium?

A

double-walled fibroserous sac that surrounds the heart

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6
Q

what are the two layers of the pericardium?

A

fibrous, serous

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7
Q

what are the two ligaments that help support the fibrous pericardium?

A

pericardiacophrenic (attaches to diaphragm), sternopericardial (attaches to thoracic cage)

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8
Q

what is the structure of the serous pericardium?

A

parietal layer, pericardial cavity, visceral layer (aka epicardium)

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9
Q

how are the sinuses of the pericardium formed?

A

reflections of the visceral layer of serous pericardium

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10
Q

part of the pericardium that extends between the SVC/IVC and between the four pulmonary veins

A

oblique pericardial sinus

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11
Q

venous drainage of the pericardium goes through which vessel?

A

pericardiacophrenic vein

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12
Q

what are the nerves that innervate the pericardium?

A

phrenic nerve (pain), vagus nerve, sympathetic trunk

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13
Q

what are the walls, from external to internal, of the heart?

A

epicardium, myocardium, endocardium

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14
Q

made up of right/left atria and right/left ventricles, the heart is a four-chambered what?

A

muscle pump

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15
Q

what is the structure called that is made up of fibrous rings of dense connective tissue that are associated with the openings between heart chambers?

A

fibrous skeleton

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16
Q

what is the posterior aspect of the of the heart called?

A

base

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17
Q

what forms the base of the heart? where does it face? what separates it from the skeleton?

A

left atrium (small contribution from right atrium)

faces T6-9 vertebral bodies

separates by aorta, esophagus, pericardial sac

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18
Q

the base of the heart receives what venous blood from which structure?

A

pulmonary veins

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19
Q

what forms the apex of the heart? where does it lie?

A

inferolateral part of left ventricle

posterior to left 5th intercostal space (adults)

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20
Q

what occurs in the apex of the heart, which is the palpable impulse of the heart?

A

apex beat

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21
Q

what chambers of the heart make up the anterior/sternocostal surface?

A

right ventricle, some left ventricle

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22
Q

what chambers of the heart make up the diaphragmatic/inferior surface?

A

left ventricle, some right ventricle

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23
Q

what chambers of the heart make up the pulmonary/left surface? what component of the heart lies within this space?

A

left ventricle

cardiac notch

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24
Q

what chambers of the heart make up the right border?

A

right atrium

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25
Q

what chambers of the heart make up the inferior border?

A

right ventricle, some left ventricle

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26
Q

what chambers of the heart make up the left border?

A

left ventricle (and left auricle)

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27
Q

what chambers of the heart make up the superior border?

A

right atrium, left atrium (right auricle, left auricle)

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28
Q

the left atrium receives what vessels from the venous system?

A

right and left pulmonary veins

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29
Q

where do you listen to heart auscultation to determine valve function?

A

downstream

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30
Q

what is the reference landmark for heart auscultation?

A

sternal angle

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31
Q

where do you listen to the aortic valuve?

A

2nd intercostal space to right of sternum

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32
Q

where do you listen to the pulmonary valve?

A

2nd intercostal space to left of sternum

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33
Q

where do you listen to the tricuspid valve?

A

5th intercostal space to left of sternum

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34
Q

where do you listen to the mitral valve?

A

apex beat

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35
Q

where is there high pressure and low pressure in the circulatory system?

A

high pressure = systemic circulation

low pressure = pulmonary circulation

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36
Q

what % of people are right coronary artery dominant? what % of people are left coronary artery dominant?

A

right - 2/3

left - 1/3

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37
Q

where does the right coronary artery arise from? where does it run through and what does it supply?

A

right aortic sinus

runs in AV sulcus to supply right atrium

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38
Q

what are the branches of the right coronary artery?

A

SA nodal branch, right marginal branch, AV nodal branch, posterior interventricular branch

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39
Q

what is supplied by the right marginal branch?

A

right border, right ventricle

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40
Q

what is supplied by the posterior interventricular branch?

A

left ventricle, right ventricle, posterior 1/3 of IV septum

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41
Q

what, as a whole, does the right coronary artery supply?

A

right atrium, most of right ventricle, diaphragmatic surface of left ventricle, part of AV septum, SA in 60% of people, AV node in 80% of people

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42
Q

where does the left coronary artery arise from? where does it lie and what does it supply?

A

left aortic sinus

lies in coronary groove to supply left atrium

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43
Q

what are the branches of the left coronary artery?

A

SA nodal branch, anterior interventricular branch, circumflex branch

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44
Q

what is supplied by the anterior interventricular branch? what branch does it give off and what does that supply?

A

left ventricle, right ventricle, anterior 2/3 of IV septum

lateral/diagonal branch supplied left ventricle

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45
Q

what is supplied by the circumflex branch? what does it branch into and what does that supply?

A

left atrium, left ventricle

left marginal artery supplied left ventricle

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46
Q

what, as a whole, does the left coronary artery supply?

A

left atrium, most of left ventricle, part of right ventricle, most of IV septum, SA node (40% of people), AS node (20% of people)

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47
Q

where do coronary arteries lie on the heart?

A

epicardium

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48
Q

coronary arteries send what to the heart muscle?

A

intramuscular branches

49
Q

a plexus of what lines the chambers of the heart?

A

subendocardial arteries

50
Q

what are subendocardial arteries susceptible to during ventricular contraction?

A

compression

51
Q

in the heart, an anastomosis can occur between what structures?

A

intramuscular branches, subendocardial arteries

52
Q

what artery is known as the ‘widow maker’?

A

left coronary artery

53
Q

cessation of blood flow to the myocardium, known as a heart attack

A

myocardial infarction

54
Q

what are two ways to aid blood flow following a MI?

A

stent, bypass graft

55
Q

where does venous drainage empty into?

A

coronary artery or right atrium

56
Q

what are the two main veins responsible for venous drainage of the heart?

A

coronary sinus, anterior cardiac veins

57
Q

what is the path of venous drainage to the coronary sinus?

A

left marginal artery - left posterior interventricular vein - small cardiac vein - middle cardiac vein - great cardiac vein - coronary sinus

58
Q

what is the route of lymphatic drainage of the heart?

A

from subepicardial lymphatic plexus to tracheobronchial lymph nodes

59
Q

heart is a two pump system - what is the right side responsible for?

A

pulmonary circulation

60
Q

heart is a two pump system - what is the left side responsible for?

A

systemic circulation

61
Q

what occurs during diastole?

A

atrial contraction, AV valve opens, ventricular relaxation and filling

62
Q

what is the pressure like in the ventricle during diastole?

A

‘normal’ (right side is 0-1 mmHg)

63
Q

what occurs during systole?

A

AV valves close, ventricular contraction, semilunar valves open, semilunar valves close

64
Q

what is occuring during the first heart sound?

A

AV valve closure

65
Q

what is occuring during the second heart sound?

A

Semilunar valve closure

66
Q

what is the phase called when the semilunar valves open?

A

ejection phase

67
Q

during the isovolumic contraction of the ventricles, what happens to volume and pressure?

A

volume stays constant

pressure is increased (right ventricle 25 mmHg, left ventricle 120 mmHg)

68
Q

during the isovolumetric relaxation in the ventricles, what happens to volume and pressure?

A

volume increases

pressure decreases

69
Q

what is diastasis?

A

middle stage of diastole where there is atrial contraction and slow ventricular filling

70
Q

when does the refilling of the ventricles begin? what is this phase called?

A

when the atria has less blood than the ventricles

rapid filling phase

71
Q

what is the typical volume of cardiac output? maximum volume of cardiac output?

A

5-6 L blood/min

13 L blood/min

72
Q

how does cardiac output increase?

A

increased work of heart

73
Q

how do you calculate cardiac output?

A

heart rate * stroke volume

74
Q

what is a limiting factor of heart rate?

A

age

75
Q

how to calculate estimated maximum heart rate?

A

220 - age

76
Q

what is stroke volume?

A

quantity of blood expelled with each contraction

77
Q

what determines stroke volume?

A

preload, afterload, contractility

78
Q

what is preload?

A

amount of tension on ventricle before contraction

79
Q

what is afterload?

A

load against which the muscle contracts

80
Q

what is the Frank-Starling Law?

A

if venous return increases, the stroke volume will increase by the same amount (CO = venous return)

81
Q

what determines preload?

A

distensibility (dilation) of cardiac muscle, venous return

82
Q

what effects venous return?

A

sympathetic stimulation of heart, sympathetic stimulation of large central veins, sympathetic stimulation of arterioles

83
Q

what effect does sympathetic stimulation of heart cause?

A

increases contractility of myocardium

84
Q

what effect does sympathetic stimulation of large central veins cause?

A

constriction of veins to maintain central venous pressure

85
Q

what effect does sympathetic stimulation of arterioles cause?

A

diversion of blood from inactive tissues

86
Q

how to calculate contractility?

A

force * velocity of contraction

87
Q

what is beneficial about increased contractility?

A

offset problems with handling venous return or raised systemic arterial pressure

88
Q

what determines afterload?

A

compliance/elasticity of vessels, systemic/mean arterial pressure

89
Q

are large vessels more or less compliant than small vessels?

A

more

90
Q

compliance can be affected by smooth muscle tone in what vessels?

A

arterioles

91
Q

how do you calculate systemic/mean arterial pressure?

A

cardiac output * total peripheral resistance

92
Q

how to estimate MAP?

A

(diastolic pressure + pulse pressure) / 3

93
Q

what is pulse pressure?

A

systolic pressure - diastolic pressure

94
Q

what blood pressure-related condition decreases stroke volume?

A

hypertension (HBP)

95
Q

what is the minimum MAP needed for adequate tissue perfusion?

A

60 mmHG

96
Q

what effects MAP?

A

local metabolic needs, vasoactive substances, central nervous system

97
Q

what happens to arterioles when more energy is needed? what happens to arterioles when less energy is needed?

A

arteriole dilation

arteriole constriction

98
Q

what vasoactive substances affect MAP?

A

epinephrine, angiotensin, ADH

99
Q

what role does the central nervous system play in affecting MAP?

A

SNS stimulations arteriole contraction

100
Q

what is the conducting system of the heart?

A

SA node (pacemaker) - AV node - AV bundle (right and left branches) - subendocardial branches (aka purkinje fibers)

101
Q

what is the innervation of the heart?

A

cardiac plexuses

102
Q

what does the sympathetic nervous system do to the heart?

A

increase heart rate, increase force, dilate coronary arteries

103
Q

what does the parasympathetic nervous system do to the heart?

A

decrease heart rate, decrease force, constrict coronary arteries

104
Q

how do the cardiac muscle depolarize?

A

in sequence (rhymically)

105
Q

what is the rhythmicity and conduction rate of SA nodal cells?

A

highest rhythmicity

slowest conduction rate

106
Q

where are transitional cells located? what is their rhythmicity and conduction rate?

A

in nodes and conducting system

slow rhythmicity, fast conduction rate

107
Q

what is the rhythmicity and conduction rate of Purkinje cells?

A

slow rhythmicity

fast conduction rate

108
Q

typical cardiac muscle cells can conduct an impulse - however, they do not do what unless a pathologic situation occurs?

A

independent rhythms

109
Q

what are the effects of the sympathetic nervous system on the cardiac plexus?

A

increase heart rate, impulse conduction, contraction force

110
Q

what are the effects of the parasympathetic nervous system on the cardiac plexus?

A

decrease heart rate, reduce force of contraction, constrict coronary arteries

111
Q

where are parasympathetic presynaptic fibers from in the cardiac plexus?

A

vagus nerve

112
Q

where are parasympathetic postsynaptic neurons from in the cardiac plexus?

A

atrial wall

113
Q

where are sympathetic presynaptic fibers from in the cardiac plexus?

A

upper 5 or 6 thoracic spinal cord segments

114
Q

where are sympathetic postsynaptic fibers from in the cardiac plexus?

A

cervical and superior thoracic sympathetic chain to SA and AV nodes

115
Q

where is referred cardiac pain? what is another name for this condition?

A

substernal and left pectoral region into left medial upper limb

angina

116
Q

what is referred cardiac pain (angina) caused by?

A

visceral afferent fibers in sympathetic nerves

117
Q

angina is pain as being perceived to be where?

A

in the superficial part of the body

118
Q

visceral afferent fibers in sympathetic nerves interact with somatic afferent neurons where?

A

same lower cervical segments of the spinal cord

Anatomy (8 decks)

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