Thoracic Cardiology Flashcards
1
Q
What separates the superior and inferior mediastinum?
A
Sternal angle
2
Q
What are the subdivisions of the inferior mediastinum?
A
Anterior - ant. To heart
Middle - heart
Posterior - posterior to heart
3
Q
What are the basic characterizations of the heart?
A
2 sided, 4 chambered
Self-initializations
Self adjusting pump
Propels blood to to all parts of body
4
Q
What does the R side of the heart receive blood from?
Where does it send blood to?
A
Receives blood from superior and inferior vena cava
Pumps blood out to lungs for oxygenation
5
Q
What does the left side receive blood from?
Where does it pump it out to?
A
Receives Oxygen rich blood from lungs
Pumps it out to entire body via aorta
6
Q
What is the flow of systemic circulation?
A
From LA —bicuspid valve—> LV
—aortic valve—> aorta —> arterial system
—> capillaries —> venous system —>
superior/inferior vena cava —> heart
7
Q
What is the flow of pulmonary circulation?
A
Superior/inferior Vena Cava —> RA
RA—tricuspid valve—> RV
RV—pulmonary valve—> pulmonary trunk
Trunk—>R/L lungs —> pulmonary Vs.
—> heart
8
Q
What are the layers of the Pericardium? (4)
A
Epicardium
Myocardium
Endocardium
Fibrous skeleton of heart
9
Q
What is the epicardiuM?
What makes it up?
A
Outermost layer of the pericardium
Made up of visceral serous pericardium
10
Q
What is the myocardium?
A
Thick muscular layer made up of spiraling overlapping layers of cardiac M.
11
Q
What is the endocardium?
A
Thin internal endothelial and subendothelial layer lining the inside of the chambers of the heart and valves
12
Q
What makes up the fibrous skeleton of the heart?
A
Dense collagenous fibers
13
Q
Where is the apex of the heart?
A
Inferolaterally part of the LV and projects predominantly to the left
14
Q
Where is the base of heart?
A
Posterior portion near the LA
15
Q
What are the surfaces of the heart? (3)
A
Sternocostal
Diaphragmatic
Pulmonary
16
Q
Where is the sternocostal surface?
A
Right ventricle
17
Q
Where is the diaphragmatic surface?
A
R and L ventricles
18
Q
What are the pulmonary surfaces?
What space does this surface occupy?
A
Paired surfaces of RA and LV
Occupies cardiac impression on BOTH lungs
19
Q
What are the borders of the heart?
A
Right
Inferior
Left
Superior
20
Q
Where is the right border of the heart?
A
Along the right atrium
21
Q
Where is the inferior border of the heart?
A
Right ventricle
22
Q
Where is the left border of the heart?
A
Along the left ventricle
23
Q
Where is the superior border of the heart?
A
Along the right and left stria
24
Q
What does the superior border of the allow for?
A
For an exit point for the aorta and pulmonary trunk
25
Where is the right atrioventricular groove?
What runs in it?
B/w RA and RV
Transmits the Right Coronary A.
26
Where is the left atrioventricular groove?
What is here?
B/w LA and LV
Houses coronary sinus
27
Where is the Anterior interventricular groove?
What does it transmit?
B/w RV and LV on ANTERIOR aspect of the heart
Transmits Anterior interventricular A. And Great Cardiac V.
28
Where is the Posterior Interventricular groove?
What does it transmit?
B/w RV and LV on POSTERIOR aspect of the heart
Transmits Posterior Interventricular a. And the Middle Cardiac V.
29
What is the sulcus terminalis?
External vertical groove corresponding to the internal crista terminalis
30
What is the ligamentous arteriosus?
Embryological remnant of the ductus arteriosus
31
What is the Ductus Arteriosus?
Embryological communication b/w pulmonary trunk and arch of aorta
32
What are the Internal features of the Right Atrium?
Sinus vernarum
Pectinate m.
Crista terminalis
Interatrial septum
Opening for coronary sinus
33
Where and what is the
Sinus Vernarum?
Posterior RA
SMOOTH, thin walled region where vena cava and coronary sinus empty
34
Where and what is the pectinate msucle?
Anterior RA
ROUGH muscular wall
Right auricle
35
What and where in the crista terminalis?
Internal ridge separating smooth and rough regions in the RA
36
Where and what is the interatrial septum?
Wall b/w the 2 atria
37
What is found within the interatrial septum?
Fossa ovalis
38
What is the fossa ovalis ?
Embryonic remnant of the foramen ovalis
39
What is the
RIGHT atrioventricular orifice?
What can occlude it?
Passage from RA to RV
Could be occluded by Tricuspid valve
40
Where and what is the tricuspid valve?
In RV
Separates RA and RV
41
What are the features found in the tricuspid valve?
```
Anterior cusp
Posterior cusp
Septal cusp
Chorda tendineae
Anterior papillary m.
Posterior papillary m.
Septal papillary m.
```
42
What is the Chorda tendinae?
In the RV’s Tricuspid valve
Attaches free edges of the 3 cusps to the 3 corresponding Papillary Ms.
43
How is Anterior Papillary M. Joined to the Tricuspid valve?
Chorda tendinae joins it to Anterior Cusp
44
How is the Posterior Papillary M. Jointed to the Tricsupid valve?
Chorda tendinae joins it to the posterior cusp
45
How is the Septal Papillary M. Joined to the Tricuspid valve?
Chordae tendinae joins it to the Septal Cusp
46
What and where is the Trabecula carnae?
Right Ventricle
Rough muscular region
47
What and where is the septomarginal trabeculum?
In RV’s Trabecula Carnae
Moderator band that runs from the interventricular septum to the base of the Anterior Papillary m.
48
What is the role of the septomarginal trabeculum?
Transmits the right bundle branch of Atrioventricular bundle to the Anterior papillary M.
49
What and where is the conus arteriosus?
What does it lead into?
RV’s infundibulum
SMOOTH walled
Leads into pulmonary trunk
50
What is the rough and smooth wall of the RA?
Rough: Pectinate msucle
Smooth: sinus venarum
51
What is the Rough and smooth wall of the Right Ventricle?
Rough: Trabecula carnae
Smooth: conus arteriosus
52
What and where is the pulmonary valve?
Semilunar valve in RV that separates it from the Pulmonary trunks
53
What cusps does the Pulmonary Valve have?
Has Right, Left, and Anterior Cusps
54
Where is the pulmonary sinuses?
Space b/w wall of pulmonary trunk and cusps of the pulmonary valve
55
What is the difference between the RIght and Left atrium?
left is thicker than the right
56
What and where is the left auricle?
In Left atrium and contains the pectinate m.
57
What opening is found in the Left atrium?
Opening for the 4 pulmonary veins
58
What and where is the Left Atrioventricular Orifice?
What can occlude it?
Passage from the LA and LV
Variably occluded by Bicuspid valve
59
What and where is the Bicuspid (mitral) valve?
In the LV
Separates the LA from the LV
60
What are the components of the Bicuspid valve?
```
Anterior cusp
Posterior cusp
Chordae tendinae
Anterior papillary m.
Posterior papillary m.
```
61
What does the chordae tendinae do in the left ventricle?
Attaches the free edges of the 2 cusps to ventricular surfaces
62
How is the Anterior papillary m. Joined to the Bicuspid valve?
Chordae tendinae joins it to the anterior cusp
63
How is the Posterior papillary m. Joined to the Bicuspid valve?
Chordae tendinae joins it to the posterior cusp
64
What is the Rough muscular region of the left ventricle?
Trabeculae carnae
65
What and where is the aortic vestibule?
Smooth walled Left ventricle area that leads it into the ascending aorta
66
What is the interventricular septum?
Myocardial walls that separate the 2 ventricles
67
What is housed in the interventricular septum?
Atrioventricular bundle
R and L bundle branches
Subendocardial branches
68
What are the 2 parts to the interventricular septum?
Membranous (fibrous) part -belongs to the fibrous skeleton of the heart
Muscular part - larger
69
What and where is the aortic valve?
Semilunar valve that separates LV from ascending aorta
Occupies the aortic orifice
70
What are the cusps of the Aortic valve?
Right, Let, and Posterior (non-coronary) cusps
71
What is the parts of the pericardium? (4)
Serous part
Fibrous part
Oblique pericardial sinus
Transverse pericardial sinus
72
What is the oblique pericardial sinus?
Wide recess posterior to the base of the heart
73
What is the transverse pericardial sinus?
Transverse passage transverse the origins of the great vessels
74
What is the surgical significance of the Transverse pericardial sinus?
Space allows cardiac surgeons to access area posterior to the aorta and pulmonary trunk to clamp or insert
75
What makes up the fibrous skeleton of the heart?
Made of dense collagenous fibers
76
What is the function of the fibrous skeleton of the heart?
* Produces attachment points for myocardium
* Produces attachment points for valves of cuspid valves
* Supports and strengthens atrioventiruclar and semilunar orifices
* Provides an electrically insulated barrier between the atria and the ventricles
77
What are the atrioventricular valves?
Bicuspid (LA->LV)
Tricuspid (RA->RV)
78
What does the Cardiac conducting system of the heart consists of?
Cardiac muscle cells
Specializes conducting fibers
2 bundles of nodal tissue (SA and AV)
79
What is the function of the nodal tissue bundles?
Responsible for coordinating cardiac cycle
80
Where is the Sinoatrial node?
Located in myocardium where the superior vena cava meets the right atrium
81
What is the function of the SA node?
What does it produce?
Initiated and regulates impulses that propagates thru atrial walls via myogenic conduction
Produces diastole
82
What is the pacemaker of the heart?
SA node
83
Where is the Atrioventricular node?
Located in the interatrial septum near the opening for the coronary sinus
84
What does the AV node respond to?
Responds to the impulse from the sinuatrial node that is distributed thru the wall of the atrium and distributes that signal thru the ventricles
85
What does the AV bundle do?
Crosses the electrically insulated barrier provided by the fibrous skeleton of heart
Distributes impulse from AV node to the R and L AV bundles
Goes on furhter as the subendocardial branches
86
What do the subendocardial branches do?
Distribute the AV nodal impulse form the R. And L. Atrioventricular bundle branches
to...
Interventricular septum
Then to..
Papillary Ms. (anterior first)
And then to rest of ventricular wall
87
What are subendocardial branches also known as?
Purkinje fibers
88
What is a myocardial infarction?
| What is it usually a result of?
Lack of blood flow t a specific area of the myocardium
Usually a result of Blockage in a Coronary A.
89
What is coronary atherosclerosis?
What is it assoc. w/?
◦ Buildup of lipids on internal walls of the coronary artery decreases size of lumen of that vessel
◦ Increases likelihood of an embolus, or plug, blocking a vessel off entirely.
Myocardial infarction
90
What is angina pectoris?
What causes it?
Pain that originates in heart and produces a strangling pain of chase
Result of narrow or obstructed coronary arteries that produces ischemia of the myocardium
91
Where does Ligamentous Arteriosus travel from and to?
What is it a remnant of?
Travels from superior aspect of the pulmonary trunk to inferior concave border of Aortic arch
Remnant of ductus arteriosus
92
What was the function of the ductus arteriosus?
Shunted blood from pulmonary trunk to the aorta to bypass the nonfunctionallungs
93
How does the Left Recurrent Laryng N. Of the Vagus N. Travel around the heart?
Loops around the aortic arch and ligamentous arteriosus then ascends to the larynx
94
What is Fossa ovalis?
Embryological remnant of the Foramen OValis
95
What do Atrial Septal defects typically involve?
How many people usually have this?
Involve incomplete closure of the Foramen Ovale
15-20% of adults
96
Why is a patent opening in the ateratrial septum clinically significant?
Allows mixture of oxygen rich and oxygen depleted blood
97
What is the cardiac catherteization process?
Insertion of a catheter into he femoral vein which is then passed up to the Inferior vena cava
98
What does a Cardiac Catherization allow for?
Allows for radiographic visualization of the RA, RV, pulmonary trunk, and pulmonary As.
99
What is the interventricular septum made from?
What does it make it susceptible to?
Made from embryologically divergent tissues
Makes it susceptible to defects
100
What is an Artificial Cardiac Pacemaker?
Produces a regular electrical impulse that is carried to ventricles via electrodes
101
How are the electrodes of an Artificial Cardiac pacemaker inserted?
Thru a large v. —> Superior Vena Cava
SVC —> RA
RA—> tricuspid valve
—> Endocardium of the Trabecular Carnae of the RV
102
What is atrial fibrillation?
How is circulation affected?
‣ Irregular twitching of th atrial cardiac muscle fibers to which the ventricles respond at irregular intervals
‣ Circulation usually remains satisfactory
103
What is ventricular fibrillation?
How is it treated??
‣ Rapid irregular twitching of the ventricles rendering the heart unable to pump blood
‣ Electric shock administered by electrodes can cease all cardiac movment (defibrillation)
• Hopefully, heart may begin beating regularly after a period of time.
104
What is cardiac referred pain?
‣ Ischemia stimulates visceral pain sensory fibers in heart of the autonomic nervous system
105
Why does cardiac referred pain happen?
• Visceral sensory fibers share spinal ganglion w/ the somatic sensory fibers of areas such as UE and Superior lateral chest wall
106
What is anginal pain referred to as?
Area innervated by the Left Medial Brachial Cutaneous Nerve, left us sternal area, left Pectoralis area and medial aspect of the left upper limb
107
What is Serous Parietal Pericardium adherent to?
Fibrous pericardium?
108
What is serous Visceral Pericardium adherent to?
What does it make up?
Adherent to the heart
Makes up the epicardium
109
What is a Pericarditis?
What happens if left untreated?
Inflammation of the pericardium, which can make the pericardium rough and produce friction.
This friction called a pericardial friction rub can be observed with a stethoscope.
If left untreated the pericardium can calcify.
110
What is pericardial effusion?
Inflammation of the pericardium resulting in accumulation of fluid or pus in the pericardial sac which can compress the heart
111
What is cardiac tamponade?
Heart compression
112
What is paricardiocentesis?
When is this procedure done?
Drainage of blood, fluid or pus from the pericardial sac
Usually done to relieve cardiac tamponade
