Pericardium and Heart (Part 3) Flashcards
A fibroserous sac that encloses the heart and the roots of the great vessels and occupies the middle mediastinum
Pericardium
What composed Pericardium?
fibrous pericardium and serous pericardium
Where does pericardium receive blood?
from the pericardiophrenic, bronchial, and esophageal arteries
What innervates pericardium?
vasomotor and sensory fibers from the phrenic and vagus nerves and the sympathetic trunks
A strong, dense, fibrous layer that blends with the adventitia of the roots of the great vessels and central tendon of the diaphragm
Fibrous Pericardium
Consists of the parietal layer, which lines the inner surface of the fibrous pericardium, and the visceral layer, which forms the outer layer (epicardium) of the heart wall and the roots of the great vessels
Serous Pericardium
lines the inner surface of the fibrous pericardium
parietal layer
forms the outer layer (epicardium) of the heart wall and the roots of the great vessels
visceral layer,
Potential space between the visceral layer of the serous pericardium (epicardium) and the parietal layer of the serous pericardium lining the inner surfaces of the fibrous pericardium
Pericardial Cavity
A subdivision of the pericardial sac, lying posterior to the ascending aorta and pulmonary trunk, anterior to the SVC, and superior to the left atrium and the pulmonary veins
Transverse Sinus
Great importance to the cardiac surgeon because while performing surgery on the aorta or pulmonary artery, a surgeon can pass a finger and make a ligature through the sinus between the arteries and veins, thus stopping the blood circulation with the ligature
Transverse Sinus
A subdivision of the pericardial sac behind the heart, surrounded by the reflection of the serous pericardium around the right and left pulmonary veins and the inferior vena cava
Oblique Sinus
inflammation of the pericardium
Pericarditis
inflammation of the myocardium
Myocarditis
acute compression of the heart cause of a rapid accumulation of fluid or blood
Cardiac tamponade
accumulation of fluid in the pericardial space
Pericardial effusion
a surgical puncture of the pericardial cavity
Pericardiocentesis
Where is the landmark of Pericardiocentesis?
fifth intercostal space left to the sternum
Other term for pericardial effusion
“water-bottle” appearance
Normal cardiothoracic ratio
0.5
Systematic circulation (Heart Circulation)
SVC/IVC - RA - TV - RV - PV - PT/PA - PV - LA - MV - LV - AV - AA - body
What are the branches of arteries of the aortic arch?
left subclavian artery
left common carotid artery
brachiocephalic trunk
Where is brachiocephalic trunk located and what are its branches?
Only in the right
right subclavian artery
right common carotid artery
blunt rounded extremity of the heart
apex
What forms the apex?
left ventricle
Where is the apex?
fifth intercostal space slightly medial to the midclavicular (or nipple) line
What is the location of apex useful clinically for?
left border of the heart
auscultating the mitral valve
What is the posterior aspect of the heart?
Base
What forms the base?
left atrium
What forms the right (acute) border of the heart?
SVC,
right atrium, and
IVC
What forms the left (obtuse) border of the heart?
left ventricle
What forms the left border of heart in chest x-ray?
aortic arch,
pulmonary trunk,
left auricle, and
left ventricle
What are the layers of the heart wall?
endocardium,
myocardium, and
epicardium
a groove on the external surface of the right atrium, marks the junction of the primitive sinus venosus with the atrium in the embryo and corresponds to a ridge on the internal heart surface, the crista terminalis
Sulcus terminalis
a groove on the external surface of the heart, marks the division between the atria and the ventricles.
Coronary sulcus
the point at which the interventricular and interatrial sulci cross the coronary sulcus
crux
What are the inferior borders of the heart?
Left and right ventricle
What are the superior borders of the heart?
Right and left atrium and the great vessels
What is the anterior (sternocostal) surface of the heart?
Right ventricle
What is the inferior (diaphragmatic) surface of the heart?
Left and right ventricle
Serves to differentiate the smooth area of right atrium to the pectinate area (rough area)
Crista terminales
What separates the atria and ventricles?
Coronary sulcus
What contains the coronary sulcus?
right coronary artery
small cardiac vein
coronary sinus
circumflex artery
What is atrioventricular groove?
groove between the atria and ventricles
What is the interventricular groove?
groove between the ventricles
Meeting point of IA groove, post AV groove, and post IV groove?
Crux
What is the artery in the right atrioventricular groove?
Right coronary artery
What is the artery
between anterior interventricular groove?
LADA or left anterior descending artery/ anterior interventricular branch
What is a common site for myocardial infraction?
LADA or left anterior descending artery/ anterior interventricular branch
It is the contour of the heart and great vessels seen on posterior-anterior (P-A) chest radiographs.
cardiovascular silhouette, or cardiac shadow
What is the right border of heart in P-A chest x-ray?
SVC,
right atrium, and
IVC
What is the left border of heart in P-A chest x-ray?
aortic arch (which produces the aortic knob),
pulmonary trunk,
left auricle,
left ventricle.
What is the inferior border of heart in P-A chest x-ray?
Right ventricle
Has an anteriorly situated rough-walled atrium proper and the auricle lined with pectinate muscles and a posteriorly situated smooth-walled sinus venarum, into which the two venae cavae open
Right atrium
What is the anterior rough wall?
atrium proper
What is the posterior smooth wall?
sinus venarum
What separates the sinus venarum and atrium proper?
Crista terminalis
Larger but thinner wall
Right atrium
How is the pressure of right atrium?
lower than left atrium
Contains the valve (Eustachian) of the IVC and the valve (Thebesian) of the coronary sinus
Right atrium
The conical muscular pouch of the upper anterior portion of the right atrium, which covers the first part of the right coronary artery
Right auricle
A posteriorly situated, smooth-walled area that is separated from the more muscular atrium proper by the crista terminalis
Sinus Venarum (Sinus Venarum Cavarum)
Where does the sinus venarum develop?
embryonic sinus venosus
What structures drain in the sinus venarum?
SVC,
IVC,
coronary sinus, and
anterior cardiac veins
Prominent ridges of atrial myocardium located in the interior of both auricles and the right atrium
Pectinate Muscles
Vertical muscular ridge running anteriorly along the right atrial wall from the opening of the SVC to the opening of the IVC, providing the origin of the pectinate muscles
Crista Terminalis
Represents the junction between the primitive sinus venarum (a smooth-walled region) and the right atrium proper and is indicated externally by the sulcus terminalis
Crista Terminalis
What is the external indication of Crista Terminalis?
sulcus terminalis
The smallest cardiac veins, which begin in the substance of the heart (endocardium and innermost layer of the myocardium) and end chiefly in the atria at the foramina venarum minimarum cordis
Venae Cordis Minimae
Where does venae cordis minimae end?
in the atria at the foramina venarum minimarum cordis
An oval-shaped depression in the interatrial septum and represents the site of the foramen ovale, through which blood runs from the right atrium to the left atrium before birth.
Fossa Ovalis
The upper rounded margin of the fossa is called?
limbus fossa ovale
Which connects the right atrium to left atrium before birth?
foramen ovale
What is the opening of the IVC?
Eustachian valve
What is the opening of the coronary sinus?
Thebesian valve
Why doesn’t the SVC have a valve and the IVC does?
IVC has valves to prevent backflow
How are the walls of left atrium?
smaller and thicker walls
What mostly makes up the walls of left atrium?
Smooth walls except for a few pectinate muscles in the auricle.
the most posterior of the four chambers
Left atrium
What is anterior to the esophagus?
Left atrium
Receives oxygenated blood through four pulmonary veins
Left atrium
Makes up the major portion of the anterior (sternocostal) surface of the heart.
Right Ventricle
Are anastomosing muscular ridges of myocardium in the ventricles
Trabeculae Carneae Cordis
right ventricle counterpart of the pectinate muscles of the right atrium
Trabeculae Carneae Cordis
Are cone-shaped muscles enveloped by endocardium.
Papillary Muscles
Extend from the anterior and posterior ventricular walls and the septum, and their apices are attached to the chordae tendineae
Papillary Muscles
Contract to tighten the chordae tendineae, preventing the cusps of the tricuspid valve from being everted into the atrium
Papillary Muscles
Extend from one papillary muscle to more than one cusp of the tricuspid valve.
Chordae Tendineae
Prevent eversion of the valve cusps into the atrium during ventricular contractions (systole)
Chordae Tendineae
Is the upper smooth-walled portion of the right ventricle, which leads to the pulmonary trunk.
Conus Arteriosus (Infundibulum)
Is an isolated band of trabeculae carneae that forms a bridge between the intraventricular (IV) septum and the base of the anterior papillary muscle of the anterior wall of the right ventricle.
Septomarginal Trabecula (Moderator Band)
prevent overdistention of the ventricle and carries the right limb (Purkinje fibers) of the atrioventricular (AV) bundle from the septum to the sternocostal wall of the ventricle.
Septomarginal Trabecula (Moderator Band)
Unique to right ventricle
Septomarginal Trabecula (Moderator Band)
the place of origin of the septal papillary muscle
IV Septum
a common site of ventricular septal defects (VSDs)
small membranous upper part of IV Septum
Lies at the back of the heart, and its apex is directed downward, forward, and toward the left.
Left Ventricle
Left ventricle contains two papillary muscles (anterior and posterior) with their chordae tendineae and a meshwork of muscular ridges, the?
trabeculae carneae cordis
Performs harder work, has a thicker (two to three times as thick) wall, and is longer, narrower, and more conical-shaped
Left Ventricle
How is the Left Ventricle divided?
ventricle proper
aortic vestibule
a necrosis of the myocardium because the oxygen supply to heart is not enough
Myocardial infarction
attacks of chest pain originating in the heart (general term) and felt beneath sternum due to insufficient supply of oxygen to the heart muscle
Angina pectoris
Lies behind the medial end of the left third costal cartilage and adjoining part of the sternum.
Pulmonary Valve (semilunar valve)
Where is pulmonary valve most audible?
left second intercostal space
opened by ventricular systole and shut slightly after closure of the aortic valve
Pulmonary Valve (semilunar valve)
Lies behind the left half of the sternum opposite the third intercostal space.
Aortic Valve (semilunar valve)
Where is aortic valve most audible?
right second intercostal space
its closure at the beginning of ventricular diastole causes the second (“dub”) heart sound.
Aortic Valve (semilunar valve)
Lies between the right atrium and ventricle, behind the
Tricuspid (Right AV) Valve
Where is tricuspid valve most audible?
left lower part of the body of the sternum
its closure contributes to the first (“lub”) heart sound.
Tricuspid (Right AV) Valve
called the mitral valve because it is shaped like a bishop’s miter
Bicuspid (Left AV) Valve
Lies between the left atrium and ventricle, behind the left half of the sternum at the fourth costal cartilage, and has two cusps: a larger anterior and a smaller posterior.
Bicuspid (Left AV) Valve
its closure at the onset of ventricular systole causes the first (“lub”) heart sound.
Bicuspid (Left AV) Valve
Where is bicuspid valve most audible?
apical region of the heart in the left fifth intercostal space at the midclavicular line.
closed slightly before the tricuspid valve by the ventricular contraction (systole)
Bicuspid (Left AV) Valve
closed during the ventricular systole (contraction)
Tricuspid (Right AV) Valve
closed during ventricular diastole
Aortic Valve (semilunar valve)
inflammation of endocardium
Endocarditis
Sound generated by turbulence of blood flow through an orifice of the heart
Cardiac murmur
Caused by the closure of the tricuspid and mitral valves at the onset of ventricular systole
First (“Lub”) Sound
Caused by the closure of the aortic and pulmonary valves (and vibration of walls of the heart and major vessels) at the onset of ventricular diastole
Second (“Dub”) Sound
composed of modified, specialized cardiac muscle cells that lie immediately beneath the endocardium and carry impulses throughout the cardiac muscle
Conducting System of the Heart
Is a small mass of specialized cardiac muscle fibers that lies in the myocardium at the upper end of the crista terminalis near the opening of the SVC in the right atrium
Sinoatrial Node
known as the pacemaker of the heart and initiates the heartbeat
Sinoatrial Node
What supplies Sinoatrial Node?
sinus node artery
What branch is sinus node artery in?
right coronary artery
Lies in the septal wall of the right atrium, superior and medial to the opening of the coronary sinus in the right atrium, receives the impulse from the sinoatrial (SA) node and passes it to the AV bundle.
AV Node
What supplies AV Node and where does it arise?
AV nodal artery
arises from the right coronary artery
innervated by autonomic nerve fibers, although the cardiac muscle fibers lack motor endings
AV Node
Begins at the AV node and runs along the membranous part of the interventricular septum.
AV Bundle (Bundle of His)
Splits into right and left branches, which descend into the muscular part of the interventricular septum, and breaks up into terminal conducting fibers (Purkinje fibers) to spread out into the ventricular walls
AV Bundle (Bundle of His)
asynchronous contraction of heart
arrhythmia
heart block
Damage to the conducting system
