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Anatomy Pt. 2 > The Heart and Mediastinum > Flashcards

The Heart and Mediastinum Flashcards

1
Q

Describe the pericardial layers.

A

The inner (serous) pericardium is thin and double walled, and the outer (fibrous) pericardium is tough and single-layered.

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2
Q

What is cardiac tamponade? How is it treated?

A

When an effusion in the pericardium or inflammation of the pericardium restricts the heart’s ability to fill. Treated with pericardiocentesis.

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3
Q

What is the ligamentum arteriosum?

A

aka ductus arteriosus - embryonic connection between the pulmonary trunk and aortic arch to shunt blood away from the non-functioning lungs.

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4
Q

What are coronary sulci?

A

Grooves in the heart muscle that are a result of the coronary vessels. They correspond to separations between various heart chambers.

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5
Q

What are the clinical signs of a pericardial effusion?

A

Heart looks enlarged; a water-bottle appearance in the cardiac silhouette, faint heart sounds and diminished apex beat, distended jugular veins, low BP

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6
Q

How is a pericardiocentesis performed? How does it not penetrate the lungs?

A

A needle is inserted into the pericardial cavity through the fifth intercostal space to the left of the sternum, OR at the left xiphosternal angle. Because of the cardiac notch, the needle misses the pleurae and lungs but penetrates the pericardium.

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7
Q

What are the heart auricles?

A

Small, ear-shaped appendages, or out-pouchings of each atria. Function is unknown.

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8
Q

What is the fossa ovalis?

A

Where the foramen ovale was (a hole in the atrial septa during fetal development). 20-25% of the pop has probe-patent fossa ovalis, meaning that there is a small hole just big enough for a probe - asymptomatic

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9
Q

What is the coronary sinus?

A

A collection of veins joined together to form a large vessel that collects blood from arteries that supplied the heart muscle (coronary arteries) so that the blood can be dumped back into the right atrium.

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10
Q

What is the sinus venarum? What separates it from the muscular atria?

A

A large quadrangular, smooth-walled cavity which precedes the atrium on the venous side of the heart. It is separated from the atria by the crista terminalis.

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11
Q

Compare the morphology of the left atrium vs the right atrium.

A

The right is larger, thinner, and has prominent pectinate muscles, whereas the left atrium is smaller, thicker, and smoother inside.

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12
Q

Muscles inside the atria are called _______ ______, while muscles inside the ventricles are called ________ _______.

A

atrial muscles are called pectinate muscles, and ventricular muscles are called trabeculae carnae

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13
Q

The inner layer of the heart muscle is called the __________ and the outer layer is called the __________.

A

inner is the endocardium, outer is the epicardium

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14
Q

What structures are involved in preventing AV valve prolapse?

A

Chordae tendinae and papillary muscles.

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15
Q

Describe the cusps of the right AV valve.

A

Three cusps: anterior, posterior, and septal - corresponding to the three papillary muscles.

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16
Q

Describe the cusps of the left AV valve.

A

AKA mitral valve. Two cusps: posterior and anterior

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17
Q

Cardiac murmurs are caused by ________ flow in the heart.

A

turbulent

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18
Q

True or false: common pathologies of the mitral valve include prolapse and stenosis.

A

True

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19
Q

How many cusps do the semilunar valves have? Name the cusps of each semilunar valves.

A

Three. The aortic S/L valve has a right, left, and POSTERIOR cusp. The pulmonary S/L valve has a right, left, and ANTERIOR cusp.

PAPA (posterior - aortic, pulmonary - anterior)

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20
Q

How do the semilunar valves differ from the AV valves?

A

The semilunar valves are small and are not as floppy; they close simply with arterial back pressure and do not require papillary muscles.

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21
Q

What function does the heart’s CT “skeleton” serve?

A

It is a firm structure by which the valves can pull against without everything collapsing.

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22
Q

How many coronary arteries are there?

A

2 - left and right

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23
Q

How many major coronary veins are there?

A

3 - the small, middle, and great cardiac veins, which all empty into the coronary sinus - found on the posterior aspect of the heart–which then drains into the right atrium.

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24
Q

What parts of the heart are perfused by the right coronary artery?

A

Much of the right ventricular wall and posterior left ventricular wall AND the SA and AV nodes.

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25
Q

What parts of the heart are perfused by the left coronary artery?

A

Most of the left ventricle and anterior 2/3 of the ventricular septum, which includes the right and left bundle branches.

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26
Q

What are the branches of the left coronary artery and what do they supply?

A

Two branches: the interventricular branch (aka anterior descending) and the circumflex branch.

The interventricular branch supplies the anterior aspects of the right and left ventricles and the anterior 2/3 of the interventricular septum.

The circumflex branch gives off a marginal branch for the lateral margin of the left ventricle and continues onto the posterior aspect of the heart. The posterior portion forms an anastomosis with arteries from the right coronary artery and supplies the posterior portion of the LV.

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27
Q

Describe the branches of the right coronary artery and what they supply.

A

As the right coronary artery descends between the right atrium and right ventricle, it gives off a SA nodal branch and marginal branch, and it terminates as the posterior interventricular artery.

The SA nodal branch supplies the area of the SA node near the posterior aspect of the right atrium.

The marginal branch supplies the right ventricle.

The posterior interventricular part supplies the posterior aspect of both ventricles and the posterior 1/3 of the interventricular septum.

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28
Q

State where you would put a stethoscope to auscultate for the following structures:

  1. Pulmonic S/L valve
  2. Aortic S/L valve
  3. Mitral valve
  4. Tricuspid valve
A
  1. Pulmonic semilunar valve: put stethoscope at the 2nd intercostal space on the left side of the body.
  2. Aortic semilunar valve: put the stethoscope at the 2nd intercostal space on the right side of the body.
  3. MItral valve: put the stethoscope at the 5th intercostal space at the midclavicular line on the left side of the body.
  4. Tricuspid valve: put the stethoscope at the 5th intercostal space over the xyphoid process of the sternum.
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29
Q

From what spinal levels do sympathetic fibers that innervate the heart arise? What is the clinical significance of this?

A

T1-T4. Therefore, visceral heart pain can be referred to the T1-T4 dermatomes.

30
Q

Where does parasympathetic control of the heart come from?

A

Vagus nerve (cranial nerve CN X)

31
Q

Is heart rate and force of contraction controlled mainly through inhibition of the vagus nerves?

A

Yeah

32
Q

What is the mediastinum? What is contained within it?

A

The space between the lungs. It contains the heart and pericardium, the great vessels, and portions of the trachea and esophagus.

33
Q

How is the mediastinum further classified?

A

Into superior and inferior portions. The distinction is made by a plane that passes through the sterno-manubrial border at approximately the T4/T5 level.

34
Q

Describe how the vertebrae are numbered.

A

Seven cervical vertebrae (C1-C7), twelve thoracic vertebrae (T1-T12), and five lumbar vertebrae (L1-L5)

35
Q

What is the sternal angle aka angle of Louis?

A

The anterior angle formed by the junction of the manubrium and the body of the sternum.

36
Q

The posterior mediastinum is located behind the ______.

A

heart

37
Q

What happens to the esophageal plexus as the esophagus passes inferiorly through the diaphragm?

A

The left vagus emerges as the anterior vagal trunk and the right as the posterior vagal trunk.

LARP

38
Q

At what spinal level does the trachea split into the right and left primary bronchi?

A

At the level of the sternal angle (T4/T5 junction)

39
Q

As the thoracic aorta descends through the posterior mediastinum, it gives off the ________ _________ and __________ arteries, as well as _________ branches.

A

posterior intercostal and bronchial arteries as well as esophageal branches.

40
Q

The cisterna chyli is a _______ duct that begins in the abdomen and ascends through the posterior mediastinum in between the esophagus and thoracic aorta, changing its name into the ______ duct. It arches laterally over the apex of the left pleura and empties into the junction of the left _______ _______ and _______ veins.

A

its a lymphatic duct. Changes its name into the thoracic duct. Empties into the junction of the left internal jugular and subclavian veins.

41
Q

On which side of the body is the azygos vein located? What about the hemiazygos vein?

A

Azygos is on the right side, the hemiazygos vein is on the left.

42
Q

Is the anatomy of the hemiazygos vein highly polymorphic?

A

Yeah

43
Q

The greater splanchnic nerves are derived from the _________ chains, thoracic ganglion ____ to ____. The lesser splanchnic nerves are derived from ganglion ____ and ____. Some people have a least splanchnic that is derived from ____.

A

greater splanchnic is derived from the sympathetic chains, thoracic ganglion T5-T9.

Lesser is derived from T10 and T11.

Least splanchnic is derived from T12.

44
Q

What are the three major branches of the aortic arch? Sometimes there is a fourth. Name it.

A
  1. Right brachiocephalic artery
  2. Left common carotid artery
  3. Left subclavian artery

Sometimes the left vertebral artery arises out of the arch between the left common carotid and left subclavian arteries.

45
Q

What two arteries arise from the right brachiocephalic artery?

A
  1. Right subclavian artery

2. Right common carotid artery

46
Q

The descending aorta is in the midline of the body at which spinal level? At which spinal level does it pass through the aortic hiatus?

A

At T8 the descending aorta is in the midline.

At T11/12 it passes through the aortic hiatus.

47
Q

What are the visceral branches of the descending aorta?

A

The bronchial arteries, esophageal arteries, and arteries to the pericardium and diaphragm.

48
Q

What nerve can be compressed by an aneurysm of the aortic arch? What does this cause clinically?

A

Compresses the left recurrent laryngeal nerve. Causes coughing, hoarseness and paralysis of the ipsilateral vocal cord. It may cause dysphagia due to pressure on the esophagus and dyspnea due to pressure on the trachea, root of the lung, or phrenic nerve.

49
Q

What vessels become enlarged as a result of coarctation of the aorta? What can happen to the ribs?

A

The internal thoracic, intercostal, epigastric, and scapular arteries. As a result of increased flow through these vessels, the ribs become notched (can be called a “figure 3 sign”).

50
Q

Compare blood pressures and pulses in the radial vs. femoral arteries in the case of coarctation of the aorta.

A

Pulses in the radial happen before the femoral (normally the other way around) and blood pressure is elevated in the radial artery (normally they are equal).

51
Q

The hemiazygos vein and accessory hemiazygos veins cross over from the _____ to _____ side of the body at the level of the 7th/8th intercostals to join the _______ vein, which ultimately drains into the _______ _______ ______.

A

they cross over from left to right to join the azygos vein, which ultimately drains into the superior vena cava

52
Q

What are the azygos and hemiazygos venous systems responsible for draining?

A

The azygos and hemiazygos venous systems drain the posterior thoracic wall from the 3rd intercostal space all the way down to the subcostal veins (veins that run along the bottom of the 12th ribs).

53
Q

Obstructions of the esophagus often occur at the four regions where it is constricted. Where are these regions?

A

C6 (upper esophageal sphincter: pharyngoesophageal)
T2/3 (crossing of the aortic arch)
T4/5 (crossing of the left primary bronchus)
–> aortobronchial
T10 (diaphragm: diaphragmatic)

54
Q

What is achalasia of the esophagus? What are the clinical manifestations?

A

Impaired esophageal contractions and failure of the inferior esophageal sphincter to relax due to degeneration of autonomic nerve plexuses. Symptoms are dysphagia, weight loss, chest pain, recurrent bronchitis or pneumonia.

55
Q

Inferior to the root of the lung, the ____ vagus lies anterior to the esophagus and the ______ vagus lies posterior to the esophagus.

A

left vagus lies anterior to the esophagus and right is posterior

56
Q

What is meany by “cardiothoracic ratio” and what is a typical/normal ratio?

A

The ratio of the width of the heart to the width of the thoracic cavity as seen on CXR. Normal is 0.5

57
Q

When someone is lying flat, at what spinal levels are the top and bottom of the heart found, respectively? What happens when people stand upright?

A

When flat, top of heart is at T4/T5 and bottom is at T8/T9. When standing, the heart drops inferiorly a little.

58
Q

What nerve supplies the mediastinal and diaphragmatic pericardium and from what spinal segments does it originate? What about the costal pericardium?

A

Mediastinal and diaphragmatic: Phrenic nerve (C3, 4, 5).

Costal: Intercostal nerves

59
Q

Where would somatic pain of the parietal pericardium be referred to?

A

The shoulder and clavicular region because the phrenic nerve (C3, 4, 5) that supplies the pericardium shares roots with the supraclavicular nerve (C3, 4) and the superior branches of the axillary nerve (C5, 6)

60
Q

What is “Beck’s triad?”

A

The three clinical symptoms of a pericardial effusion. They are pathognomonic - meaning that the symptoms are so characteristic of the disease that they are diagnostic.

Symptoms are:

  1. Muffled heart sounds, weakened beats.
  2. Jugular distension due to inability to return venous blood to the heart.
  3. Low arterial pressure.
61
Q

What function does the transverse pericardial sinus serve?

A

Permits expansion of the great vessels during systole.

62
Q

What function does the oblique pericardial sinus serve?

A

Permits expansion of the left atrium during exhalation

63
Q

Given that myocardial perfusion occurs during _________ (diastole or systole), how is it that the coronary arteries don’t get crushed against the pericardium?

A

diastole; arteries run in the sulci (grooves), which give the vessels space even when the heart is pressed against the pericardium

64
Q

What are the three physiological mechanisms that protect the heart against damage by coronary artery disease?

A
  1. Coronary artery collateralization (new capillary growth)
  2. Thebesian veins can reverse blood flow when perfusion pressure is low.
  3. “Endogenous bypass” by the vasa vasorum.
65
Q

Which three coronary arteries are most often bypassed?

A
  1. Left anterior descending (40-50%)
  2. Right coronary artery (30-40%)
  3. Circumflex branch (15-20%)
66
Q

Name three graft options for coronary bypass. Which one is preferred and why?

A
  1. Great saphenous vein
  2. Internal thoracic artery
  3. Radial artery - preferred due to greater longevity vs. vein grafts.
67
Q

The sinus venarum is built out of the same material as ______.

A

veins

68
Q

Papillary muscles contract _________ (before or after) the ventricles due to the __________ band which comes off the bundle branches that innervates the papillary muscles

A

papillary muscles contract before ventricles via the moderator band - nerve fibers that serve as a shortcut to the papillary muscles.

69
Q

What serves as the “pump” for perfusing the coronary arteries during diastole? Through which vessels does blood travel through?

A

The elastic recoil of the aorta pushes blood through the right and left aortic sinuses during diastole.

70
Q

After cardiac transplantation, is the cardiac plexus reconnected to the new heart? What is the clinical significance of this?

A

It is not reconnected. Therefore the new heart has no external nervous input. Rhythm can be increased/decreased via circulating catecholamines only.

71
Q

What is the “achilles heel” of the heart?

A

The fact that purkinje fibers are found in the endocardium - the muscle layer that will die first in the case of coronary arterial blockage. This can lead to messed up conduction/contraction of the heart.

Anatomy Pt. 2 (11 decks)

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