Pericardium and heart Flashcards
1
Q
The middle mediastinum includes the:
A
pericardium, heart, and the roots of its great vessels
2
Q
___ is a fibroserous membrane that covers the heart and the beginning of the great
vessels
A
Pericardium
3
Q
The pericardium is a closed sac composed of two layers:
A
Fibrous Pericardium & Serous Pericardium
4
Q
Serous Pericardium consists of two layers:
A
Parietal Layer, Visceral Layer (epicardium)
5
Q
a glistening serous membrane that lines the internal surface of the fibrous pericardium
A
Parietal Layer of serous pericardium
6
Q
this layer is reflected onto the heart of the great vessels
A
Visceral Layer of serous pericardium
7
Q
____ is the home of the heart
A
Pericardium
8
Q
____ pericardium is external side, ____ layer of serous pericardium is on internal side
A
Fibrous; parietal
9
Q
The multiple attachment points of the fibrous pericardium _____ inside the fibrous pericardium
A
keep the heart well tethered in place
10
Q
The ______ is influenced by movements of the heart and great vessels, the sternum, and the diaphragm
A
pericardium
11
Q
Inelastic quality protects the heart against sudden overfilling by ____
A
limiting its distension
12
Q
Fibrous Pericardium: Protects the heart from ____ by serving as physical barrier between the muscular body of the heart and adjacent organs prone to injury, such as the lungs
A
infection
13
Q
The pericardial cavity is the _____ between opposing layers of the parietal and visceral layers of serous pericardium
A
potential space
14
Q
(The pericardial cavity) Normally contains a thin film of fluid that enables the heart to _____ (lubrication)
A
move and beat in a frictionless environment
15
Q
Arterial supply of pericardium is mainly from the _______, a slender branch of the internal thoracic artery that accompanies the phrenic nerve to the diaphragm
A
pericardiacophrenic artery
16
Q
Arterial supply of pericardium is mainly from the pericardiacophrenic artery, a slender branch of the _____ that accompanies the phrenic nerve to the diaphragm
A
internal thoracic artery
17
Q
A
18
Q
Arterial supply of pericardium is mainly from the pericardiacophrenic artery, a slender branch of the internal thoracic artery that accompanies the _____ to the diaphragm
A
phrenic nerve
19
Q
Venous drainage of the pericardium is by the ______, tributaries of the brachiocephalic (or internal thoracic) veins
A
pericardiacophrenic veins
20
Q
Venous drainage of the pericardium is by the pericardiacophrenic veins, tributaries of the _____ (or internal thoracic) veins
A
brachiocephalic
21
Q
Somatic sensation to the fibrous and parietal layer of pericardium is from the ___
A
phrenic nerves
22
Q
(Phrenic Nerves) Pain sensations conveyed by these nerves are commonly referred to the _____ of the ipsilateral supraclavicular region (or top of shoulder of the same side)
A
skin (C3-C5 dermatomes)
23
Q
Visceral sensory to the ____ is via the cardiac plexuses
A
epicardium
24
Q
T/F: epicardium is sensitive to pain
A
False; epicardium is insensitive to pain
25
Visceral sensory to the epicardium is via the _______
cardiac plexuses
26
Medical emergency that occurs when fluid or air builds up in the pericardial sac, compressing the heart and making it difficult to pump blood
Cardiac Tamponade
27
-- fluid in pericardial sac
Pericardial effusion
28
Used to treat cardiac tamponade by inserting a needle and catheter into the pericardial cavity using ultrasound as a guide
Pericardiocentesis
29
Pericardiocentesis: Used to treat cardiac tamponade by inserting a needle and catheter into the ______ using ultrasound as a guide
pericardial cavity
30
Ideal puncture site is close to the maximum fluid accumulation and has no intervening organs (name this site)
substernal
31
3 possible sites for pericardiocentesis
Parasternal, Substernal, Apical
32
= inferolateral part of left ventricle. Posterior to left 5th intercostal space
Apex
33
= heart’s posterior aspect (opposite the apex), mainly formed by left atrium and where great vessels enter heart
Base
34
Where do the great vessels enter the heart?
the base (mainly formed by left atrium)
35
Components of heart:
4 chambers (2 atria, 2 ventricles), 4 valves, great vessels, coronary v e s s e l s
36
___ and ___ border the heart on the right
SVC and Right atrium
37
Border left side of the heart
aortic arch, pulmonary artery, left auricle and left ventricle
Inferior – right ventricle and small portion of left ventric
38
right ventricle and small portion of left ventricle--which border of the heart?
Inferior
39
right and left atria and auricles; ascending aorta, pulmonary trunk, and SVC all emerge or enter heart here--which border of the heart?
Superior
40
– enlarged heart
Cardiomegaly
41
– deviation of heart to one side
Mediastinal shift
42
– inversion of heart position
Dextrocardia
43
Heart is positioned obliquely in the chest with the ____ most posterior and superior and the ____ anterior and inferior
left atrium; right ventricle
44
Structures that open into RA (carrying oxygen poor blood):
SVC, IVC, coronary sinus
45
Smooth thin-walled posterior part that receives SVC, IVC, and coronary sinus
right ventricle
46
(RV): Anterior area with _____ muscle (including the auricle) is divided from smooth section by crista terminalis
pectinate
47
(RV) Anterior area with pectinate muscle (including the auricle) is divided from smooth section by _____
crista terminalis
48
The ____ divides the right atrium from the left atrium
interatrial septum
49
_____ is a remnant of the fetal foramen ovale and valve
Fossa ovalis
50
______ is specific to the right atrium
Crista Terminalis (and fossa ovalis? i dont think so bc on interatrial septum so technically both?)
51
T/F: As many as 25% of individuals have an atrial septal defect
True
52
If ______ is too large, it allows oxygenated blood to be shunted to the right atrium and results in an overloading of the pulmonary system.
Patent Foramen Ovale
53
(Patent Foramen Ovale) If this is too large, it allows _____ blood to be shunted to the ____ and results in an overloading of the pulmonary system.
oxygenated; right atrium
54
RV receives blood from the right atrium through the _____, which is guarded by the tricuspid valve
right atrioventricular orifice
55
What is the consequence of the patent foramen ovale being too large?
overloading of the pulmonary system; Subsequently, the right ventricle and pulmonary trunk will become enlarged
56
RV receives blood from the right atrium through the right atrioventricular orifice, which is guarded by the ____
tricuspid valve
57
= irregular muscular elevations on internal surface of right ventricle
Trabeculae carnae
58
_____ has two parts:
* Muscularpartinferior
*Membranous part that is superior and posterior
Interventricular septum
59
Ascending Aorta, pulmonary trunk, and SVC all emerge of enter the heart here (name the border)
Superior Border of the heart
60
Pulmonary valve is a semilunar valve guarding the ____
--Which side of the heart?
pulmonary trunk; right side
61
_____ is a semilunar valve guarding the pulmonary trunk
Pulmonary valve
62
pulmonary valve separates
right ventricle from pulmonary trunk/artery
63
RV: Blood flow follows ___ path, changing direction about 140o
a U-shaped
64
25% of all congenital heart defects are
Ventricular Septum Defects (VSDs)
65
Ventricular Septum Defects (VSDs): occur in ____
muscular portion (these can spontaneously close)
--more inferior and anterior
66
Opening between R and L
ventricles causing shunting of blood
Ventricular Septum Defects (VSDs)
67
Which VSDs more commonly corrected surgically
Membranous defects (more superior and posterior)
68
LA: Receives oxygenated blood from the lungs via ______
four pulmonary veins
69
Left Atrium: Smooth interior except for pectinate muscles in the ________
left auricle
70
Receives blood from the left atrium through the left atrioventricular orifice and guarded by the bicuspid or mitral valve
Left Ventricle
71
LV: Receives blood from the left atrium through the ____ and guarded by the bicuspid or mitral valve
left atrioventricular orifice
72
LV: Receives blood from the left atrium through the left atrioventricular orifice and guarded by the ____
bicuspid or mitral valve
73
valve associate with right ventricle
tricuspid valve (guarding the right atrioventricular orifice) + pulmonary valve
74
Valve associated with the left ventricle
bicuspid or mitral valve + aortic valv
75
Specific to the ventricles
trabeculae carnae
76
LV: Receives blood from the left atrium through the left atrioventricular orifice and guarded by the _____
bicuspid or mitral valve
77
Internal surface of LV is also characterized by presence of ____
trabeculae carnae
78
T/F: wall of RV is 2-3x thicker than LV
False; LV is thicker
79
LV: The aortic valve is a semilunar valve guarding the _______
ascending aorta
80
Blood flow takes two right turns resulting in a 180 degree change in direction (where?)
Left ventricle
81
Explain the difference in direction of blood flow in each ventricle
Right ventricle is a U-shape (RA--> RV--> Pulmonary Trunk; Left ventricle is 180 degrees, takes to right turns (LA-->LV--> Aorta)
82
Right atrioventricular valve has three cups (tricuspid valve) –
anterior, posterior, septal
83
Left atrioventricular valve has two cusps (bicuspid valve, also mitral valve) –
anterior and posterior
84
_____ connect the chordae tendineae to the trabeculae carnae
Papillary muscles (ventricles?)
85
The anterior papillary muscle is connected to the interventricular septum in the right ventricle by the ____. This will carry part of the right branch of the AV bundle, a part of the conducting system of the heart to the anterior papillary muscle
septomarginal trabeculae (moderator band)
86
The anterior papillary muscle is connected to the _____ in the right ventricle by the septomarginal trabeculae (moderator band). This will carry part of the right branch of the AV bundle, a part of the conducting system of the heart to the anterior papillary muscle
interventricular septum
87
The anterior papillary muscle is connected to the interventricular septum in the _____ by the septomarginal trabeculae (moderator band).
right ventricle
88
The anterior papillary muscle is connected to the interventricular septum in the right ventricle by the septomarginal trabeculae (moderator band). This will carry part of the right branch of the ____, a part of the conducting system of the heart to the anterior papillary muscle
AV bundle
89
are literally “heartstrings” bridging the valve leaflets to the papillary muscle
Chordae tendineae
90
Chordae tendineae are literally “heartstrings” bridging the valve leaflets to the ____
papillary muscle
91
Left atrioventricular valve has two cusps (bicuspid valve, also mitral valve) –
anterior and posterior
92
is the most commonly diseased of the valves in the heart
The mitral valve
93
Mitral Valve: Leaflets can prolapse into the:
left atrium
94
Period of Ventricular elongation and filling
disatole
95
During diastole which valves are open/closed
--av open
--Semilunar valves closed
96
Two heart sounds are heard with a stethoscope: a lub (1st) sound as the blood is transferred from the atria into the ventricles (Name this valve) and a dub (2nd) sound as the ventricles expel blood from the heart (name this valve)
AV open, SL open
97
function to prevent backflow into the atria during ventricular contraction (systole)
Atrioventricular valves
98
(AV valves) ____ and ____ prevent the cusps from prolapsing into the atria
Papillary muscles and chordae tendineae
99
malfuncting ____ valve allows backflow into left Atrium causing englargement
Mitral valve
100
Name the 2 semilunar valves
Pulmonary and aortic
101
Pulmonary valve separates
right ventricle and pulmonary trunk
102
aortic valve separates
left ventricle and ascending aorta
103
have three cup-like cusps that
prevent backflow into the ventricles
during ventricular relaxation (diastole)
Semilunar valves
104
T/F: semilunar valves associated with chordinae tendinae and papillary muscle
false; not associated
105
Describe the cusps of semilunar valves
(3 cusps) Right, left, Posterior
--each cusp has fibrous nodule
--each has thin CT lunule
106
When semilunar valves close, the nodules and lunules ___
meet in the center
107
The coronary arteries arise from the
left and right
aortic sinuses.
108
The sinus without a coronary artery is nor called the
posterior (noncoronary) aortic sinus.
109
The coronary arteries fill as the aortic sinuses fill following
ventricular contraction.
110
are the only systemic arteries to perfuse during ventricular diastole
the coronary arteries
111
The major coronary arteries are located in the ____, lying within the grooves between the chambers of the heart
epicardium
112
supply the myocardium and epicardium (visceral layer of serous pericardium)
coronary arteries
113
Tributaries of the RCA
SA Nodal branch, right marginal branch, av nodal branch, posterior intervent
114
Tributaries of the LCA
Anterior interventricular, diagonal branches, circumflex branches, left marginal branch (SA nodal, AV nodal, Post intervent--vary)
115
(RCA) Small branches to right atrium
SA Nodal Branch
116
(RCA) descends along the acute margin of heart to supply the RV
Right marginal branch
117
(RCA) descends in interventricular groove to supply posterior portions of the RV and LV and the posterior 1/3rd of the IV septum
Posterior Interventricular
118
(LCA) descends in interventricular groove to supply to anterior portions of
the RV and LV and the anterior 2/3rd of the IV septum
Anterior Interventricular
119
(LCA) to anterior portion of LV
Diagonal branch (off anterior interventricular)
120
(LCA) follows atrioventricular groove to supply the LA and superior portion of LV
Circumflex branch
121
(LCA) supply obtuse margin of heart
Left marginal Branch
122
accompanies the anterior interventricular and circumflex arteries
great cardiac vein
123
– accompanies posterior interventricular artery
Middle cardiac vein
124
– accompanies right marginal and then right coronary arteries
* Small cardiac vein
125
– descends obliquely on posterior aspect of LA to joint great cardiac vein
* Union of oblique cardiac vein and great cardiac vein marks the beginning of the coronary sinus. Coronary sinus drains into the right atrium
* Oblique cardiac vein
126
– opens directly into right atrium
* Anterior cardiac vein
127
Coronary sinus drains into the
right atrium
128
Dominance is defined by the artery that gives rise to the
posterior interventricular artery
129
Name the types of heart dominance
Right, left, co
130
The dominant artery crosses the ____, which is the junction between the IV and AV grooves) and usually gives rise to the AV nodal artery
“crux” of the heart
131
the junction between the IV and AV grooves
“crux” of the heart
132
What is the outcome of each heart dominance?
No functional differences based on dominance type, but will influence the damaged region following myocardial infarction
133
are functional end arteries
Coronary arteries
134
There is some anastomosis between anterior and posterior interventricular and circumflex with
right coronary
135
can form to bypass ischemic injury caused by coronary atherosclerosis
Collateral vessels
136
Rhythmofheartisnormallycontrolledbyagroupofautomaticallydepolarizingspecializedcardiaccells
called the
sinoatrial node (SA node)
137
SA node is located --
in the wall of the right atrium near the opening of the SVC and superior end of crista terminalis
138
initiate the wave of depolarization
SA node
139
T/F: SA node is spontaneously active
True
140
The atrioventricular node (AV node) is located :
in the interatrial septum just superior to the opening of the coronary sinus
141
Primary responsibly of AV node is to :
slow down the rate of depolarization to allow for complete ventricular filling
142
The _____ passes from the AV node in the membranous part of the IV septum and
divides into the right and left bundle branches
AV bundle (bundle of His)
143
The left and right bundle branches are insulated within the septum so that contraction of the ventricles is initiated at ___
the apex
144
____ send electrical signals to the ventricles, which then synchronously contract
Purkinje fibers
145
The heart is supplied by autonomic nerve fibers from ____
the cardiac plexus
146
Cardiac Plexus is found:
is found on anterior surface of bifurcation of trachea and on the posterior aspect of the ascending aorta and bifurcation of the pulmonary trunk
147
Cardiac plexus is formed by
_____ fibers
en route to the heart, as well as visceral
afferent fibers conveying ___ from the heart
parasympathetic and sympathetic; reflexive and
nociceptive fibers
148
Fibers extend from plexus along and to the ______ and to components of the conducting system (primarily SA node)
coronary vessels
149
Preganglionic sympathetic neuron cell bodies are in :
lateral horns of spinal cord segments T1-T5.
150
Postganglionic cells are located in the ___
cervical and paravertebral ganglia
151
Post-synaptic fibers are carried in ___,
contributing to cardiac plexus and ending in
the SA and AV nodes and along coronary arteries.
thoracic
(cardiopulmonary) splanchnic nerves
152
___ innervation increases heart rate, impulse conduction, force of heartbeat, and blood flow in coronary arteries.
Sympathetic
153
Parasympathetic innervation is via preganglionic fibers located :
in the vagus nerve.
154
____ parasympathetic fibers contribute to the cardiac plexuses.
Presynaptic
155
Parasympathetic Postganglionic cells are located in ____
the cardiac tissue (atrial wall and interatrial septum near the SA and AV nodes and along coronary arteries)
156
___ end in the SA and AV nodes and directly on the coronary arteries.
Parasympathetic Postsynaptic fibers
157
___ stimulation is responsible for decreasing heart rate, force of contraction, and constricting coronary arteries.
Parasympathetic
158
____ pathways for the heart follow the path of the sympathetics
backward
Visceral pain (nociceptive)
159
Visceral sensory pathways that participate in reflex actions that lower blood pressure and slow the heart rate are carried in :
the vagus nerve (CN X).
160
_____ does not transmit any visceral pain fibers originating in the heart, only reflexive fibers
The vagus nerve
