Powerpoint 1 - Intro Flashcards by Daniel R.

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

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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

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These 2 interfere with sound wave transmission

Air and bone

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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

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What ribs during inspiration?

4th and 5th

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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

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Easier to take pictures on inspiration or expiration?

Depends on the axis in which you’re imaging

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Inspiration involves expansion in what 2 ways

Anteroposterior expansion AND lateral expansion

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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

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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

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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

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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

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Know how to label this photo

Review “TEST PICS” on ipad Notes

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What’s responsible for perfusing heart muscle and its inner structures?

The coronary arteries

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Why are the coronary arteries named such?

Because the network of arteries form a crown around the heart

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Origin of the Left Coronary Artery

Originates above the valve at the left sinus of Valsalva as the left main coronary

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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

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The Left Coronary Artery (LCA) supplies blood to where exactly?

It supplies the LEFT atrium, LEFT ventricle, and segments of the interventricular septum

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The Right Coronary Artery originates where?

Originates above the valve at the right sinus of Valsalva

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Anatomy of the Right Coronary Artery

Courses in the atrioventricular groove

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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

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What DRAINS the heart muscle?

Cardiac veins

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The cardiac veins, their anatomy…

Usually course with the arteries

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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?

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