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Medicine > The heart > Flashcards

The heart Flashcards

1
Q

What is the mediastinum

A

the part of the thoracic cavity that lies between the lungs

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2
Q

What does the mediastinum contain

A

heart (pericardium), trachea, main bronchi, oesophagus, thymus gland

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3
Q

What are the divisions of the mediastinum

A

Superior
Inferior - anterior (in front of heart), middle (heart), posterior (behind heart)

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4
Q

Where is the division between superior and inferior mediastinum

A

sternal angle

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5
Q

Parts of the aorta

A

Ascending, aortic arch, descending

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6
Q

Where do the coronary arteries stem from

A

ascending aorta

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7
Q

Branches of the aortic arch (right to left)

A
  • Braciocephalic artery (right subclavian + right common carotid artery)
  • Left common carotid
  • Left subclavian
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8
Q

What does the right subclavian artery supply

A

Right upper limb

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9
Q

What does the right common carotid supply

A

Right side of head, neck, brain

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10
Q

What does the left common carotid supply

A

Left side of head, neck, brain

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11
Q

What does the left subclavian artery supply

A

left upper limb

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12
Q

Ligamentum arteriosum

A

Connection between the arch of the aorta and pulmonary trunk. Remnant of the ductus arteriosus

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13
Q

What forms the superior vena cava

A

l + r brachiocephalic vein = (l+r) internal jugular vein and subclavian vein

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14
Q

Where is the trachea palpable

A

Just above the suprasternal notch

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15
Q

What innervates the diaphragm

A

the left and right phrenic nerve (C3,C4,C5) - only motor innervation of diaphragm

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16
Q

Is the phrenic nerve somatic or autonomic

A

somatic

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17
Q

Where does the phrenic nerve move through

A

the superior thoracic aperture, then over the pericardium

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18
Q

What are the branches of the vagus nerve (CNX)

A

Pharyngeal , superior laryngeal nerve, recurrent laryngeal nerve, cardiac branches

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19
Q

What is the course of the right recurrent laryngeal nerve

A

Descends. Goes over the right subclavian artery, loops underneath it. Ascends up to the larynx

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20
Q

What is the course of the left recurrent laryngeal nerve

A

Descends. Goes over the aorta, loops underneath it. Goes back up to the larynx

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21
Q

What do the recurrent laryngeal nerves do

A

innervate the larynx. Motor to all intrinsic muscles except the cricothyroid muscle + sensory innervation below vocal cords

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22
Q

Where does the thoracic duct drain into

A

Into the venous system at the union of the left internal jugular and left subclavian veins for form left braciocephalic

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23
Q

What happens to the thymus gland with age

A

it atrophies

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24
Q

What are the layers of the pericardium

A

tough outer fibrous layer, inner serous layer (parietal + visceral)

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25
Q

What innervates the fibrous pericardium

A

the phrenic nerve

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26
Q

What are the surfaces of the heart

A

base (posterior), diaphragmatic, right pulmonary, left pulmonary, anterior surface

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27
Q

Where is the apex beat palpable

A

At the left 5th intercostal space at the midclavicular line

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28
Q

Borders of the heart (chest x ray)

A

right = right atrium
left = left ventricle
inferior = right ventricle + part of left ventricle
superior

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29
Q

What are auricles

A

outpouchings from the walls of the right and left atria

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30
Q

What are the grooves on the surface of the heart called

A

sulci

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31
Q

What is located in the sulci

A

the coronary arteries

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32
Q

What is patent ductus arteriosus

A

when the ductus arteriosus doesn’t close. Increased blood flow through pulmonary vessels can cause pulmonary hypertension

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33
Q

How can lung cancer cause hoarseness

A

Cancer at apex of lung can damage recurrent laryngeal nerve which innervates larynx

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34
Q

What is pericardial effusion

A

a build up of fluid in the pericardial cavity

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35
Q

What can pericardial effusion cause

A

cardiac tamponade. Where the fibrous pericardium can’t stretch so fluid puts pressure on heart

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36
Q

What is the importance of ductus arteriosus

A

allows blood to bypass the lungs in foetus

37
Q

What are the branches of the right coronary artery

A

1) Branches to SAN and AVN
2) Right marginal artery - majority of right ventricle
3) Posterior interventricular artery - posterior 1/3 of interventricular septum

38
Q

What are the branches of the left coronary artery

A
  • Short left main stem
    1) Left anterior descending
    2) Circumflex artery –> left marginal artery
39
Q

What does the left coronary artery supply

A

the left atrium, left ventricle, part of right ventricle, part of septum

40
Q

What does LAD supply

A

Both ventricles

41
Q

What does Cx supply

A

Left atrium and part of both ventricles

42
Q

What is left vs right dominant

A

Where the posterior interventricular artery stems from. 85% stems from RCA, 7% stems from circumflex artery

43
Q

What is the fossa ovalis

A

Remnant of the foramen ovale - hole in the interatrial septum

44
Q

What is the function of the foramen ovale

A

shunt blood from the right atrium to left atrium to bypass the lungs

45
Q

What is the crista terminalis

A

muscular ridge that separates the smooth posterior wall of the right atrium from the anterior muscular ridges

46
Q

Is the crista terminalis in both atria

A

no, only the right

47
Q

What are the pectinate muscles

A

muscular ridges on the anterior of BOTH atria

48
Q

What are the parts of the right ventricle

A

trabeculae carnea, papillary muscles, chordae tendineae, moderator band

49
Q

What is the trabeculae carnea (TC)

A

muscular ridges on the internal ventricular wall

50
Q

What are the papillary muscles

A

modified TC which project into the lumen of the ventricle

51
Q

What are the chordae tendineae

A

fibrous chords which connect the papillary muscles to the atrioventricular valves

52
Q

What is the moderator band

A

modified TC which connects the interventricular septum to papillary muscles

53
Q

Do both ventricles have a moderator band

A

no, only the right

54
Q

What are the parts of the left ventricle

A

trabeculae carneae, papillary muscles, chordae tendineae

55
Q

How many papillary muscles are there in each ventricle

A

3 in right, 2 in left

56
Q

What keeps AV valves closed

A

Papillary muscles contracting putting pressure on the chordeae tendineae which attach to the atrioventricular valves

57
Q

What are the semilunar valves

A

The aortic and pulmonary valves

58
Q

How many cusps does each semi lunar valve have

A

3 semi circular cusps

59
Q

How many cusps do the av valves have

A

Tricuspid - 3, Mitral - 2

60
Q

Sinus + semi lunar valves

A

Sinus’ are pockets formed by the semilunar valves, they catch blood and balloon into the lumen during diastole

61
Q

Where do the coronary arteries stem from

A

From the aortic valve sinus

62
Q

Where do the coronary veins flow into

A

the coronary sinus which enters the right atrium

63
Q

When do the coronary arteries fill

A

during diastole

64
Q

What are the auscultatory area for the aortic and pulmonary valves

A

2nd intercostal space, right, left

65
Q

What are the auscultatory areas for the tricuspid and mitral valves

A

tricuspid = 5th space, just left of sternum
mitral = 5th space, midclavicular line

66
Q

What is the rate from the sino atrial node

A

70/min

67
Q

What coronary artery supplies the sino atrial node

A

RCA in 60% of people, LCA in 40%

68
Q

What supplies the atrioventricular node

A

the posterior interventricular artery

69
Q

What supplies the bundle of his

A

the left coronary artery

70
Q

What is contained in the posterior mediastinum

A

thoracic aorta, azygous vein, oesophagus, thoracic duct

71
Q

What are the branches of the aorta in p mediastinum

A

posterior intercostal, bronchial, oesophageal, pericardial, phrenic arteries

72
Q

What drains the posterior thoracic wall

A

the azygos system of veins - posterior intercostal veins, bronchial veins, oesophageal veins

73
Q

Where does the azygos vein drain into

A

the SUPERIOR vena cava

74
Q

Where does the azygous vein originate

A

lumbar azygous vein/inferior vena cava

75
Q

What are the parts of the azygous system of veins

A

azygos vein on the right side of the vertebrae
hemiazygos vein on the left side of the vertebrae (shorter)

76
Q

Where does the thoracic duct drain into

A

Into the venous system at the union of the left internal jugular and left subclavian veins

77
Q

What is the cisternae chyli

A

sac-like swelling which gives rise to thoracic duct

78
Q

What are paravertebral ganglia

A

Ganglia (collection of cell bodies outside CNS) in the sympathetic trunk

79
Q

Where do sympathetic neurones originate

A

T1 - L2/3. Leave the spinal chord in spinal nerve, then immediately enter sympathetic trunk

80
Q

What do preganglionic axons do once they enter the sympathetic trunk

A

1) synapses in ganglion at level of entry
2) ascends/descends trunk before synapsing at ganglion
3) travels through trunk + ganglion without synapsing

81
Q

What is the sympathetic innervation of the thoracic viscera

A

the cardiopulmonary splanchnic nerves

82
Q

What is the sympathetic innervation of the abdomen

A

the abdominopelvic splanchnic nerves

83
Q

What is the parasympathetic innervation of the thoracic viscera

A

vagus nerve

84
Q

What are autonomic plexuses

A

a mesh of sympathetic and parasympathetic fibres

85
Q

What are the autonomic plexuses in the thorax

A

the cardiac plexus, pulmonary plexus, oesophageal plexus

86
Q

Where do the cardiopulmonary splanchnic nerves originate/go back to

A

T1-T5

87
Q

What is cardiac referred pain

A

When cardiac problems are felt as pain in the central chest, left side of neck and left arm

88
Q

Why does cardiac referred pain occur

A

Somatic sensory information from skin of chest wall, neck, arm also enters spinal chord at T1-T5, as well as cardiopulmonary splanchnic nerves. Hence, the brain interprets cardiac pain as pain in those areas

89
Q

Where is pain from diaphragm felt

A

shoulder

Medicine (15 decks)

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