Powerpoint 1 - Intro Flashcards
Superior mediastinum contains:
Aortic arch, SVC
Brachiocephalic arteries and veins Proximal segments of the lt CCA and lt subclavian artery
Parts of thymus gland, lymph nodes, & nerves Trachea, esophagus
Inferior mediastinum is divided into 3 parts:
Anterior mediastinum – lies anterior to heart and contains lymph nodes, muscles, and small blood vessels
Middle mediastinum –contains the heart, pericardium, ascending ao, terminal end of SVC, PA and branches, terminal parts of rt and lt pulmonary veins, & phrenic nerves
Posterior mediastinum – contains the descending thoracic ao, bifurcation of the trachea, rt and lt main bronchi, the esophagus, the azygous and hemiazygous veins, the splenic nerves, and thoracic lymphatic duct
These 2 interfere with sound wave transmission
Air and bone
During inspiration:
The diaphragm contracts and moves down Intrathoracic pressure decreases allowing air into the lungs
Deep inspiration and holding it may enhance the ability to image the heart by increasing the size of the intercostal space
On test: what happens? VENOUS RETURN DECREASES… harder for blood to travel upward due to the increased pressure from the diaphragm on the abdominal cavity
What ribs during inspiration?
4th and 5th
During expiration:
The diaphragm moves upward
Intrathoracic pressure increases and forces air out
Holding the breath out m ay enhance the US image by preventing expansion of the lungs within the thoracic cavity
On test: venous return INCREASES to heart… less pressure from the diaphragm on abdominal cavity
Easier to take pictures on inspiration or expiration?
Depends on the axis in which you’re imaging
Inspiration involves expansion in what 2 ways
Anteroposterior expansion AND lateral expansion
Pericardium made of two components
Fibrous pericardium
Tough outer sac made of connective tissue which completely surrounds heart but doesn’t adhere to or touch it
It is continuous with the adventia of the great vessels superiorly
AND
Serosal (inner) pericardium WHICH HAS 2 layers
Visceral or epicardial layer adheres to the surface of the heart and makes up the epicardium
At the base of the heart, at the origin of the great vessels, the serosal pericardium folds back on itself to form the outer or parietal layer
2/3 of what and 1/2 of what lie within the pericardium?
2/3 of the proximal ascending aorta and main pulmonary artery and
1⁄2 of the of the SVC
This is why type A (ascending) aortic dissections will result in rapid fluid accumulation around the heart and tamponade
Fluid accumulates in the pericardial space between the serosal layers of pericardium
Function of the pericardium
Reduce friction with cardiac movement
Allow the heart to move freely with each beat, facilitating ejection and volume changes
Contain the heart within the mediastinum, esp. during trauma
Serve as a barrier to infection
Know how to label this photo
Review “TEST PICS” on ipad Notes
What’s responsible for perfusing heart muscle and its inner structures?
The coronary arteries
Why are the coronary arteries named such?
Because the network of arteries form a crown around the heart
Origin of the Left Coronary Artery
Originates above the valve at the left sinus of Valsalva as the left main coronary
Talk more about the Left Coronary Artery and its anatomy
The left main coronary bifurcates almost immediately into the left anterior descending (LAD) and left circumflex arteries
The Left Coronary Artery (LCA) supplies blood to where exactly?
It supplies the LEFT atrium, LEFT ventricle, and segments of the interventricular septum
The Right Coronary Artery originates where?
Originates above the valve at the right sinus of Valsalva
Anatomy of the Right Coronary Artery
Courses in the atrioventricular groove
The Right Coronary Artery supplies what part of the heart with blood?
It supplies the right atrium, right ventricle, and segments of the interventricular septum
What DRAINS the heart muscle?
Cardiac veins
The cardiac veins, their anatomy…
Usually course with the arteries
The thebesian valve is where…
The cardiac veins converge at the coronary sinus and empty into the right atrium (RA) through the THEBESIAN VALVE
What drains in the Right Atrium?
The SVC, IVC, and Coronary Sinus
The external surface of the heart has grooves or sulci. Name them.
Coronary or atrioventricular groove
Interventricular groove
Anterior and Posterior Interatrial grooves
Terminal groove or sulcus terminalis
How many pulmonary veins are there?
4
Coronary groove also known as the what?
Atrioventricular groove // separates the atria from the ventricles
These 2 vessels lie within the coronary groove aka the atrioventricular groove.
The main trunk of the coronary arteries
The coronary sinus
This is formed from the separation of the right and left ventricles
Interventricular groove
The interventricular groove has two portions:
An anterior and posterior portion
The anterior interventricular groove:
Runs on the anterior surface of the heart The anterior interventricular descending branch of the lt coronary artery lies w/in
(There’s also a posterior portion of this particular groove)
Posterior interventricular groove:
Runs on the diaphragmatic surface of the heart
Contains the posterior interventricular descending coronary artery and middle cardiac vein
Echo cannot pick up
Coronary arteries! Can’t see the grooves either! So know your anatomy very well.
Interatrial grooves, talk about
They are shallow and not as pronounced as other grooves
interatrial, atrioventricular, and posterior interventricular grooves meet to form the crux of the heart
The terminal groove is also known as the
Sulcus terminalis
All of the external grooves of the heart are filled with
fatty tissue which varies with overall body fat and increases with age
4 cardiac chambers, name them.
Right atrium
Left atrium
Right ventricle
Left ventricle
RA, LA, RV, LV - practice writing them like this
How many cardiac valves?
4 cardiac valves
2 valves are are semilunar valves and 2 are atrioventricular valves
Name the two semilunar valves
The aortic valve and pulmonic valve
Name the two atrioventricular valves
The mitral (bicuspid) and tricuspid valve
APPENDAGES AKA
AURICLES
What is an appendage, or auricle as you previously learned?
Small triangular extension coming off from the superior portion of each atrium.
Within appendages there are pectinate muscles that extend into anterior surface of atria (the rest of the walls are smooth).
Anterior walls of the atria have pectinate muscles, extending from the appendages or auricles. This makes the anterior wall _______, while the rest of the walls are _________.
Bumpy, smooth.
APPENDAGES OR AURICLES ARE HARD TO SEE ON AN ECHO… TRUE OR FALSE?
TRUE
Ventricular walls or Atrial walls are thicker?
Ventricular walls due to the higher pressure… left ventricle wall is 3x thicker than the right ventricle wall
Even though the right ventricle is 3X LESS thick than the left ventricle, there is an easy way to identify the right ventricle by looking for the _________.
Moderator band ( this is seen @ the apex and is a useful landmark to differentiate RV from LV)
RV is more __________ and has 4 prominent bands
Trabeculated,
4 prominent bands are
Parietal band
Crista supraventricularis
Setal band
Moderator band ( this is seen @ the apex and is a useful landmark to differentiate RV from LV)
The left atrioventricular valve is known as the
MITRAL VALVE
The right atrioventricular valve is known as the
TRICUSPID VALVE
Atrioventricular valves
Consist of the following 4
Atrioventricular valves consist of the following four:
Fibrous annulus
Leaflets
Chordae tendinae
Papillary muscles
**Important to know because all support the structure of the valve, which is important to know when considering the pathology of a valve.
3 layers of the heart wall
Epicardium
Smooth, thin outer layer
Myocardium
Thick layer of contractile muscle
Endocardium
Thin layer of endothelial tissue lining the surface
Impt to see this layer of the heart wall on an echo
Endocardium
What is the purpose of the semilunar valves in the heart?
To prevent the backflow of blood.
Holding the breath out during expiration may enhance the ultrasound image
by preventing expansion of the lungs within the thoracic cavity
Deep inspiration and holding it may enhance
the ability to image the heart by increasing the size of the intercostal space
AHA PATIENT CARE (LIST 5)
ASDFASDF
