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Clinical Anatomy > Middle Mediastinum & Heart > Flashcards

Middle Mediastinum & Heart Flashcards

1
Q

Contents of the middle mediastinum

A

1) Heart
2) Pericardium
3) Great vessels
4) Phrenic nerves with vessels

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2
Q

Name the 3 layers of the pericardium

A 
Outer = fibrous
Middle = parietal serous
Inner = visceral serous
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3
Q

Name the attachments of the pericardium.

A
  • Sternal
  • Diaphragmatic
  • Adventitia of great vessels
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4
Q

Pericardial cavity

A

Potential space btwn parietal serous + visceral serous pericardium

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5
Q

Pericardial effusion

A

Excess fluid in pericardial cavity

*can occur if heart is perforated

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6
Q

Cardiac tamponade

A

Rapid accumulation of fluid in the pericardial cavity that compresses the heart

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7
Q

Pericardiocentesis

A
  • Drainage of fluid (-centesis) from the pericardial cavity

* Wide-bore needle inserted through the 5th or 6th intercostal space near the sternum or infrasternally

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8
Q

Transverse pericardial sinus

A

Recess just behind aorta + pulmonary trunk

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9
Q

Oblique pericardial sinus

A

Recess between pulmonary veins (posterior side)

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10
Q

Name the 4 borders of the heart.

A

Superior:
- Right & left atria

Right:
- Right atrium

Inferior:

  • Mostly right ventricle
  • Some left ventricle

Left:

  • Mostly left ventricle
  • Some left atrium
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11
Q

Surface anatomy of superior border of heart

A

Inferior of 2nd right rib to superior of 3rd left rib

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12
Q

Surface anatomy of right border of heart

A

3rd right costal cartilage to 6th right costal cartilage

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13
Q

Surface anatomy of inferior border of heart

A

6th right costal cartilage to 5th left intercostal space

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14
Q

Surface anatomy of left border of heart

A

Line connecting superior & inferior borders

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15
Q

Point of Maximal Impulse (PMI)

A

Apex of heart being forced against anterior thoracic wall during contraction

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16
Q

Where is the PMI located?

A

5th left intercostal space at mid-clavicular line

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17
Q

Aortic valve auscultation

A

Right upper sternal border

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18
Q

Pulmonary valve auscultation

A

Left upper sternal border

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19
Q

Tricuspid valve auscultation

A

Left sternal border (4th intercostal space)

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20
Q

Mitral valve auscultation

A

5th intercostal space around at PMI (midclavicular line)

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21
Q

Right atrium (RA)

A
  • Forms right border of heart
  • SVC + IVC + coronary veins drain into RA
  • Has smooth wall (sinus vernarum) + rough, muscular wall (pectinate muscles)
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22
Q

Crista terminalis

A

Internal separation of sinus veranrum (smooth part of RA) from right auricle

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23
Q

Coronary sinus

A
  • Where coronary veins drain into RA

- Located between IVC orifice & AV orifice

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24
Q

Pectinate muscles

A

Muscles lining RA (+ right auricle)

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25
Q

Tricuspid valve

A
  • Guards right AV orifice
  • Between RA + RV
  • 3 cusps

*Septal, anterior, posterior

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26
Q

Fossa ovalis

A
  • Remnant of foramen ovale & its valve during fetal development
  • If doesn’t close –> patent foramen ovale (PFO)
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27
Q

Chordate tendinae

A

Attach tricuspid cusps to papillary muscles

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28
Q

Papillary muscles

A
  • Contract to prevent prolapse of tricuspid valves
  • Connect to valves via chorade tendinae
  • 3 total (corresponding to tricuspid cusps)
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29
Q

Trabeculae carnae

A

Irregular muscular ridges lining RV + LV

30
Q

Conus arteriosus

A

Part of RV that tapers into arterial cone

31
Q

Supraventricular crest

A

Thick muscular ridge separating ridged muscular wall of inflow chamber from smooth wall of conus arteriosus in outflow chamber in RV

32
Q

Septomarginal trabecula (moderator band)

A
  • Curved muscular bundle running from inferior part of IV septum to base of anterior papillary muscle
  • Contains part of right bundle branches of AV bundle
  • Allows for coordinated contraction of anterior papillary muscle
33
Q

Pulmonary valve

A
  • Located at apex of conus arteriosus
  • Leads into pulmonary trunk
  • 3 cusps

*R, L, anterior –> opposite of aortic valve

34
Q

Pulmonary trunk

A
  • Carries deoxygenated blood to lungs
  • Bifurcates into R&L pulmonary arteries
  • Level of T4
35
Q

Right auricle

A
  • Small muscular pouch in RA
  • Overlaps aorta
  • Increases capacity of RA

*Look here for origin of RCA

36
Q

Left auricle

A
  • Small muscular pouch in LA
  • Overlaps pulmonary trunk
  • Has pectinate muscles in its walls

*Look here for origin of LCA

37
Q

Left atrium (LA)

A
  • Makes up most of left border of heart
  • Has large smooth wall & small muscular part (left auricle w/ pectinate muscles)
  • Pulmonary veins (4 - R&L superior, R&L inferior) drain into LA
  • Slightly thicker than RA
38
Q

Right ventricle (RV)

A
  • Forms most anterior & inferior border of heart

- Gets blood from RA through right AV orifice

39
Q

Interatrial septum

A
  • Separates atria

- Where fossa ovalis is located

40
Q

Right AV orifice

A

RA –> RV

41
Q

Left AV orifice

A

LA –> LV

42
Q

Left ventricle (LV)

A
  • Forms apex & left border of heart
  • Most of diaphragmatic surface
  • 2-3x thicker & does more work than RV due to higher BP
  • Gets blood from LA through left AV orifice
43
Q

Aortic vestibule

A

Area leading to aortic orifice

44
Q

Aortic orifice

A

LV –> aorta

45
Q

Aortic valve

A
  • Opens into aorta
  • 3 cusps

*R, L, posterior

46
Q

Mitral valve

A
  • Bicuspid valve from LA –> LV
  • Also attached to chordae tendinae & papillary muscles

*Anterior, posterior

47
Q

Aortic sinuses

A
  • Spaces between wall of aorta & each cusp of aortic valve
  • R&L contain openings into RCA & LCA

*Posterior sinus is NONCORONARY

48
Q

Name components of blood flow in relation to the heart.

A
  • SVC + IVC + coronary veins drain doxy blood into RA
  • RA to RV through tricuspid valve
  • RV U-shaped turn to pulmonary trunk through pulmonary valve
  • Bring deoxy blood to lungs
  • Pulmonary veins bring oxy blood to LA
  • LA to LV through mitral valve
  • LV U-shaped turn to aorta through aortic valve
  • Oxy blood to rest of body through aorta
  • RCA & LCA at aortic sinuses bring oxy blood to heart
49
Q

Four main functions of fibrous skeleton of heart

A

1) Hold valves open
2) Site of attachment of leaflets and cusps
3) Electrical insulation
4) Site of attachment of myocardium

50
Q

Name 3 layers of the heart wall

A

1) Epicardium (thin external - formed by visceral serous pericardium)
2) Myocardium (thick middle - cardiac muscle)
3) Endocardium (thin internal - lining membrane that also covers valves)

51
Q

Review conduction pathway of heart

A

1) SA node initiates impulse + causes atria to contract
2) Impulse travels to AV node by myogenic conduction
3) Then travels down AV bundle
4) Divides into R+L bundle branches at junction of muscular + membranous parts of IV septum
5) Proceed on each side of muscular IV septum deep to endocardium
6) Ramify into subendocardial branches (Purkinje fibers)
7) Stimulate ventricle walls & papillary muscles to contract

*Own conduction system - no need to connect nerves in heart transplant

52
Q

SA node

A
  • Pacemaker of heart
  • Initiates heartbeat
  • Located heart junction of SVC + RA
53
Q

AV node

A
  • Located near opening of coronary sinus in the interatrial septum
  • Receives impulse from SA node & distributes to AV node bundle
54
Q

AV node bundle

A
  • Only bridge of conduction between atrial + ventricular myocardium
  • Through fibrous skeleton of of heart
  • Along membranous part of IV septum
55
Q

Interventricular (IV) septum

A
  • Strong separation between ventricles

- Both muscular + membranous

56
Q

Right & left bundle branches

A
  • Proceed on each side of muscular IV septum deep to endocardium
57
Q

Subendocardial branches (Purkinje fibers)

A
  • Extend into walls of ventricles

- Stimulate ventricle walls + papillary muscles to contract

58
Q

Describe the cardiac cycle

A
  • Begins w/ ventricular elongation + filling (diastole)
  • Ends w/ ventricular shortening + emptying (systole)

Lub-dub sounds

  • Lub = blood from atria to ventricles
  • Dub = ventricles expelling blood from heart
59
Q

When does blood flow into the coronary arteries?

A

Only during diastole

60
Q

Right coronary artery (RCA)

What are its 4 main branches?

What does it supply?

A
  • Arises from right aortic sinus

4 branches:

1) SA nodal branch
2) Right marginal branch
3) AV nodal branch
4) PDA

Supplies:

1) RA
2) Most RV + some LV
3) IV septum
4) SA node
5) AV node

61
Q

SA nodal branch

A
  • 1st ascending off of RCA

- Supplies SA node

62
Q

Right marginal branch

A
  • Branch off of RCA that runs along acute angle of heart
  • Does not reach apex of heart
  • Supplies right border of heart
63
Q

AV nodal branch

A
  • Branch off of RCA at crux of heart

- Supplies AV node

64
Q

Posterior descending artery (PDA)

A
  • Posterior branch off of RCA (or LCA depending on dominance)
  • Goes towards apex
  • Supplies both ventricles + IV septum
65
Q

Left coronary artery (LCA)

What are its 2 main branches?

What does it supply?

A
  • Arises from left aortic sinus

Branches:

1) Left anterior descending (LAD)
2) Left circumflex (LCX)

Supplies:

1) LA
2) Most of LV + some RV
3) Most of IV septum including AV bundle
* SA node (in 40% of people

66
Q

Left anterior descending (LAD) branch

A
  • Anterior branch of LCA
  • Passes along IV sulcus to apex
  • Supplies both ventricles + IV septum

*Sometimes branches into lateral diagonal branch

67
Q

Left circumflex (LCX) branch

A
  • Branch of LCA
  • Follows coronary sulcus around left border to posterior surface
  • Terminates before reaching crux

*Sometimes branches into left marginal branch

68
Q

How does blood drain from coronary veins into heart?

A
  • Small + middle drain into great

- Great drains into coronary sinus –> RA

69
Q

Pericardiacophrenic arteries

A
  • Supplies pericardium, diaphragm, & phrenic nerve

- Runs w/ phrenic nerve

70
Q

Total arterial revascularization (bilateral IMA + radial artery)

A
  • Use IMAs/radial artery to bypass blockage

- Right IMA usually routed behind aorta + pulmonary arteries through transverse sinus

71
Q

Arterial dominance

A
  • Origin of PDA

- Could be from RCA, LCA, or both

72
Q

Where should you insert a needle for pericardiocentesis?

A

Wide-bore needle inserted through the 5th or 6th intercostal space near the sternum or infrasternally

Clinical Anatomy (25 decks)

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