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ACE Unit 2 > TBL 11 - Middle mediastinum > Flashcards

TBL 11 - Middle mediastinum Flashcards

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1
Q

Common causes of mediastinal widening discovered in chest radiographs

A

Any structure in the mediastinum.
Trauma from head on collision resulting in hemorrhage into mediastinum from lacerated great vessels
Malignant lymphoma enlarging the lymph nodes
Hypertrophy of the heart due to congestive heart failure

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2
Q

What embryonic tissue forms the fibrous pericardium?

A

The pleuropericardial membranes

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3
Q

Describe the pericardial sac and what it is associated with?

A

The fibrous and serous pericardium. The serous pericardium is continuous at the roots of the great vessels but is made of parietal and visceral layers. The sac fuses with the central tendon of the diaphragm

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4
Q

What is the transverse pericardial sinus?

A

Pathway posterior to intrapericardial parts of the aorta and pulmonary trunk and anterior to the SVC and pulmonary veins

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5
Q

Why can cardiac tamponade be fatal?

A

Heart compression from fluid outside the heart but in the pericardial cavity that compromises heart volume.

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6
Q

How is pericardiocentesis normally performed?

A

A wide-bore needle through the 5th or 6th ICS near sternum where the pericardial sac is exposed by the left pleural sac.

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7
Q

How do cardiac surgeons use the sinus?

A

Used to clamp the large vessels to divert circulation blood while performing cardiac surgery

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8
Q

What closes during diastole? What opens? What happens?

A

Aortic and pulmonary valves close and mitral and tricuspid valves open. SVC, IVC, and pulmonary veins refill the atria and ventricles. At the end of diastole, atrial compression completes refilling

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9
Q

What closes during systole? What opens? What happens?

A

Mitral and tricuspid valves close. Ventricular contraction thrusts the aortic and pulmonary valves open pushing blood into the aorta and pulmonary arteries. Vascular pressure returns venous blood into the atria

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10
Q

Which valve consists of two cusps?

A

Mitral

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11
Q

What causes heart sound S1?

A

Closure of mitral and tricuspid valves during systole

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12
Q

What causes heart sound S2

A

Closure of aortic and pulmonary valves during diastole

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13
Q

Most common valvular abnormalities

A

Aortic valve stenosis and mitral valve prolapse (insufficiency)

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14
Q

Why are auscultation sites situated superficial to the chamber or vessel into which blood has passed rather than directly above the valves?

A

Blood carries sound in the direction of flow so you want to listen to where the blood should move

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15
Q

How is a murmur from a prolapsed mitral valve classified? Which heart chamber is affected and why can pulmonary edema result?

A

Systolic murmur. Left atrium. Pulmonary edema from the backup of blood in the pulmonary circuit

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16
Q

Why does left ventricular hypertrophy with associated dyspnea result from aortic valve stenosis? How is the resulting murmur classified?

A

Blood has difficulty flowing through the aortic valve so the left ventricle has to work harder and the body has difficulty getting O2 to all the tissues. The murmur is systolic because that is where the blood is flowing through this valve

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17
Q

Which cardiac chamber is affected by pulmonary valve stenosis and pulmonary valve insufficiency? How are the respective murmurs classified and where could edema occur?

A

Right ventricle. Systolic for stenosis. Diastolic for insufficiency. Edema can occur systemically

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18
Q

How is the murmur from aortic valve insufficiency classified and what is the resulting collapsing pulse?

A

Diastolic. Collapsing pulse

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19
Q

How are isolated dextrocardia and dextrocardia associated with situs inversus distinguished?

A

Apex is on the right instead of left (heart is reversed in dextrocardia). Situs inversus is where all the thoracic and abdominal viscera are reversed. Isolated is just the heart reversed

20
Q

What are the auricles and what do they cover?

A

Right overlaps ascending aorta

Left overlaps the pulmonary trunk. The auricles are pouch like projections that increase atrial capacity

21
Q

Left border of heart of silhouette in radiographs?

A

Arch of the aorta, pulmonary trunk, left auricle, left ventricle

22
Q

Right border of heart of silhouette in radiographs?

A

Right brachiocephalic vein, SVC, Right atrium, IVC

23
Q

What causes the aortic knobs?

A

Decreased blood flow into aorta = small knobs

Increased flow = large knobs

24
Q

Describe right atrium

A

Posterior = smooth
Anterior = ridged cardiac muscle
Interatrial septum has oval fossa

25
Q

Describe right ventricle

A

Smooth outflow tract.
Ridged cardiac muscle on inflow portion.
Fibrous cordae tendieae connect ends of the three cusps of the tricuspid valve to papillary muscles that project into the lumen. the moderator band helps conduct the signal through the ventricular lumen to the other side to result in a synchronous ventricular contraction

26
Q

Purpose of the papillary muscles in the right ventricle

A

Tense the chord tendineae during systole to prevent retrograde flow in the right atrium

27
Q

Cor pulmonale

A

Progressive strain on right ventricle that can lead to failure. Occurs due to pulmonary hypertension

28
Q

Why are shortness of breath and cyanosis during physical activity often the first symptoms of cor pulmonale?

A

Right side of heart becomes dilated because the blood cannot be pushed through the pulmonary circuit preventing the oxygenation of blood leading to shortness of breath and cyanosis

29
Q

Describe left atrium

A

Smooth with orifices for 4 pulmonary veins. Immediately posterior is the esophagus

30
Q

Describe left ventricle

A

Thick. Smooth outflow. Ridged cardiac muscle is on the inside to prevent suction during contraction. The anterior and posterior papillary muscles keep the mitral valve closed to prevent retrograde flow into the left atrium

31
Q

What type of murmur is caused by an ASD and where?

A

Systolic at the auscultation site for the pulmonary valve due to elevated forward flow through an open valve

32
Q

What type of murmur is caused by an VSD and where?

A

Systolic murmur along left parasternal line over 3th and 4th ICS

33
Q

Why does ASD induce hypertrophy of the right atrium and ventricle, and dilation of the pulmonary trunk? Which form of atrial septal defect usually lacks clinical significance?

A

There is more blood volume in the right atrium causing hypertrophy. This also overloads the pulmonary system causing hypertrophy of the right ventricle. Small atrial septal defects lack clinical significance

34
Q

How can the left-to-right shunt associated with VSD cause pulmonary hypertension and subsequent heart failure?

A

Increases pulmonary blood flow causing pulmonary hypertension eventually leading to heart failure

35
Q

Location of SA node? AV node? AV bundle? bundle branches?

A

SA - Right atrial wall adjacent to SVC orifice
AV - interatrial septum adjacent to coronary sinus orifice
AV bundle - membranous portion of inter ventricular septum
Bundle branches - endocardium of ventricles

36
Q

Which arteries supply the SA node, AV node, and AV bundle

A

Right coronary artery does 60% of SA nodes, 80% of AV nodes

Left coronary artery does rest of SA node, AV node, and AV bundle

37
Q

What nerves make up the cardiac plexus and what do they synapse with? What is their affect on heart rate and contraction and blood flow?

A

Cardiopulmonary splanchnic and vagus nerves form the plexus that synapses with the SA node muscle fibers. Sympathetic stimulation increases heart rate, impulse conduction, force of contraction, and blood flow. Parasympathetic does the opposite

38
Q

How do the consequences differ after a heart block or bundle branch block? Which block could result after surgical correction of VSD?

A

Heart block - block higher up affecting AV node and possibly SA node (if SA node spared, atria contract normal rate). Ventricles contract independently and slower.
Bundle branch block - the normal ventricle contracts fine but the other one is slow because the impulse is myogenically transmitted.
Partial heart block would result from damage to the AV bundle

39
Q

What constitutes the cardiopulmonary splanchnic nerves

A

peripheral projecting fibers from DRG at T1-T5 that go into the anterior rami, into the white communicating rami and join postsynaptic fibers in the segmental paravertebral ganglia and exit the ganglia

40
Q

How is pain felt from an MI?

A

Spinal nerve T2 causes pain to be felt as a crushing sensation beneath the sternum with pain extending onto the medial side of the left arm

41
Q

How are anginal pain and pain from myocardial infarction distinguished?

A

Angina pain is relieved by 1-2 min of rest while Mi pain is more severe and does not disappear with rest

42
Q

What does the left coronary artery generate and supply?

A

Circumflex and left anterior descending arteries. Supplies left atrium, most of left ventricle, and anterior 2/3rds of the inter ventricular septum

43
Q

What does the right coronary artery generate and supply?

A

Marginal and posterior interventricular arteries. Supplies right atrium, most of right ventricle, posterior third of the inter ventricular septum

44
Q

Which three coronary arteries account for most cases of coronary artery occlusion? What deficit?

A

LAD branch of LCA
RCA
Circumflex branch of LCA
Deficit is MI

45
Q

Describe the veins of the heart?

A

Great cardiac vein that accompanies the LAD. Coronary veins empty into coronary sinus into the right atrium

46
Q

Why are the coronary arteries perfused during diastole rather than systole?

A

Coronary arteries are filled with back flow of blood which comes from recoil of elastic aorta during diastole

47
Q

Why is coronary artery surgery in females often more difficult and less successful than in males?

A

Arteries in women have smaller diameters so it is more difficult

ACE Unit 2 (4 decks)

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