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CPR > Thoracic Cardiology > Flashcards

Thoracic Cardiology Flashcards

1
Q

Divisions of mediastinum and relationships to heart

A

Superior and inferior mediastinum separated by sternal angle
Inferior mediastinum separated into 3 divisions:
Anterior- anterior to heart
Middle- is the heart
Posterior- posterior to heart

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2
Q

Right/left side of heart receive blood from

A

Right: superior/inferior vena cava- pumps blood to lungs for oxygenation
Left: receives from lungs and pumps to entire body

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3
Q

System circulation pathway

A

From left atrium, past bicuspid valve into left ventricle, out of heart past aortic valve into aorta, through the arterial system, through the capillaries, through the venous system and back into heart through sup/inf vena cava

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4
Q

Pulmonary circulation pathway

A

From superior/inferior vena cava, into right atrium past the tricuspid valve, into the right ventricle, out of the heart past the pulmonary valve into the pulmonary trunk, through the right/left lungs and back into the heart through the pulmonary veins

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5
Q

Cardiac layers

A

Epicardium: outermost layer made of visceral serous pericardium
Myocardium: thick muscular layer made of spiraling, overlapping layers of cardiac muscle
Endocardium: thin internal endothelial and subendothelial layer lining the inside of the chambers of the heart and valves
Fibrous skeleton of the heart: dense collagenous fibers

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6
Q

Myocardial infarction

A

Lack of blood flow to a specific area of the myocardium, usually the result of a blockage in a coronary artery
Coronary atherosclerosis, or a buildup of lipids on the internal walls of the coronary arteries decreases the size of the lumen of that vessel, increasing the likelihood of an embolus, or plug blocking off a vessel entirely

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7
Q

Angina pectoris

A

Pain that originates in the heart and produces a strangling pain of the chest
Angina pectoris literally means strangling pain of the chest
The pain is usually the result of narrow or obstructed coronary arteries that produces ischemia of the myochardium

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8
Q

Fibrous skeleton of the heart functions

A

Produces attachment points for the myocardium and valves of the cuspid valves
Supports and strengthens atrioventricular and semilunar orifices
Provides and electrically insulated barrier b/w the atria and ventricles

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9
Q

External surfaces of the heart and their relationship to heart structures

A

Sternocostal- right ventricle
Diaphragmatic- right and left ventricles
Pulmonary- paired: right atrium and left ventricle, occupying the cardiac impression on both lungs

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10
Q

Borders of heart and their relationships to structures

A

Right: right atrium
Inferior: right ventricle
Left: left ventricle
Superior: right/left atria and the exit point for the aorta and pulmonary trunk

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11
Q

Right atrioventricular groove

A

B/w right atrium and right ventricle

Transmits the right coronary artery

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12
Q

Left AV groove

A

B/w the left atrium and left ventricle

Houses the coronary sinus

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13
Q

Anterior interventricular groove

A

B/w right and left ventricles on anterior aspect of heart

Transmits the anterior interventricular artery and great cardiac vein

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14
Q

Posterior interventricular groove

A

B/w right and left ventricles on posterior surface of heart

Transmits the posterior interventricular artery and the middle cardiac vein

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15
Q

Sulcus terminalis

A

External vertical groove corresponding to the internal crista terminalis

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16
Q

Ligamentum arteriosum

A

Embryological remnant of the ductus arteriosus, which shunted blood from the pulmonary trunk to the aorta to bypass the nonfunctional lungs
Communication b/w the pulmonary trunk and the arch of the aorta

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17
Q

Ligamentum arteriosum location and relationship to nerves

A

Travels from superior pulmonary trunk to inferior border of the aortic arch
The left recurrent laryngeal nerve loops around the aortic arch and ligamentum arteriosum then ascends to the larynx

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18
Q

Right atrium structures

A

Sinus venarum - located posteriorly, where the venae cavae and coronary sinus empty
Pectinate muscle- anterior, contains right auricle
Crista terminalis- internal ridge separating smooth and rough regions
Interatrial septum- wall b/w two atria, contains fossa ovalis (remnant of the foramen ovalis)
Opening for the coronary sinus

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19
Q

Atrial septal defects

A

Typically involves an incomplete closure of the foramen ovale
It is estimated that 15-20% of adults have a small patency of their foramen ovale which is considered clinically insignificant
Larger openings in the interatrial septum can be clinically significant as they allow mixture of oxygen rich and oxygen depleted blood

20
Q

Right atrioventricular orifice

A

Passage from right atrium to right ventricle, variably occluded by the tricuspid valve

21
Q

Tricuspid valve

A

Anterior, posterior and septal cusps
Chordae tendinae- attach free edges of the three cusps to the corresponding papillary muscles
Anterior papillary muscle: joined to anterior cusp of tricuspid valve
Posterior papillary muscle: joined to posterior cusp of tricuspid valve
Septal papillary muscle: joined to septal cusp of tricuspid valve

22
Q

Trabecula carnae

A

Rough muscular region
Contains septomarginal trabeculum: moderator band, from the interventricular septum to the base of the anterior papillary muscle
-transmits the right bundle branch of the AV bundle to the anterior papillary muscle

23
Q

Conus arteriosus

A

Leads into the pulmonary trunk

24
Q

Pulmonary valve

A

Semilunar valve possessing right, left and anterior cusps, separates right ventricle from pulmonary trunk
Pulmonary sinuses- space b/w the wall of the pulmonary trunk and the cusps of the pulmonary valve

25
Q

Cardiac catheterization

A

Insertion of a catheter into the femoral vein which is then passed up to the inferior vena cava allowing radiographic visualization of the right atrium, right ventricle, pulmonary trunk and pulmonary arteries

26
Q

Left atrium

A

Contains:
Left auricle (contains pectinate muscle)
Openings for the 4 pulmonary veins
Interatrial septum

27
Q

Left AV orifice

A

Passage from left atrium to left ventricle, variably occluded by the bicuspid valve

28
Q

Bicuspid valve

A

AKA mitral valve, separates left atrium from left ventricle
Anterior, posterior cusps
Separates left ventricle from left atrium
Chordae tendinae- attaches cusps to ventricular surfaces
Anterior papillary muscle: joined to anterior cusp of bicuspid valve
Posterior papillary muscle: joined to posterior cusp of bicuspid valve

29
Q

Left ventricle contains:

A

Bicuspid valve
Trabecula carnae- rough muscular region
Aortic vestibule- leads into ascending aorta
Interventricular septum: myocardial wall separating the two ventricles, houses the AV bundle, right and left bundle branches and subendocardial branches
- described as having a fibrous part that belongs to the fibrous skeleton of the heart and much larger muscular part
Aortic valve

30
Q

Ventricular septal defects

A

Due to the embryologically divergent tissues that make up the interventricular septum that structure is particularly susceptible to defects. All defects are clinically relevant as they allow the mixture of oxygen rich and oxygen depleted blood

31
Q

Aortic valve

A

Semilunar valve possessing right, left and posterior (non coronary) cusps
Separates L ventricle from the ascending aorta, occupies the aortic orifice
Aortic sinuses- space b/w the wall of the ascending aorta and cusps of the aortic valve, the right and left aortic sinuses house the openings for the right and left coronary arteries

32
Q

Conducting system of the heart

A

Consists of cardiac muscle cells, specialized conducting fibers and two bundles of nodal tissue responsible for coordinating the cardiac cycle
-SA/AV nodes and bundles

33
Q

SA node

A

Located in myocardium, where the superior vena cava meets the right atrium
Small bundle of specialized cardiac muscle fibers that initiate and regulate impulses that propagates through the atrial walls, producing diastole
“pacemaker” of the heart

34
Q

AV node

A

Small bundle of specialized cardiac muscle fibers located in the interatrial septum near the opening for the coronary sinus, responds to the impulse from the SA node that distributed through the wall of the atrium and distributes that signal through the ventricles

35
Q

AV bundle

A

Crosses the electrically insulated barrier provided by the fibrous skeleton of the heart and distributes the impulse from the AV node into a right/left AV bundle which then distributes as subendocardial branches

36
Q

Subendocardial branches

A

Distribute the AV nodal impulse from the R/L AV bundle branches first to the interventricular septum, then to the papillary muscles, and finally to the rest of the ventricular wall; also called purkinje fibers

37
Q

Artificial cardiac pacemaker

A

Produces a regular electrical impulse that is carried to the ventricles via electrodes which are inserted through a large vein to the superior vena cava, into the right atrium past the tricuspid valve into the endocardium of the trabecula carnae of the right ventricle

38
Q

Atrial fibrillation

A

Irregular twitching of the atrial cardiac muscle fibers to which the ventricles respond at irregular intervals
Circulation usually remains satisfactory

39
Q

Ventricular fibrillation

A

Rapid irregular twitching of the ventricles rendering the heart unable to pump blood.
An electric shock administered by electrodes can cease all cardiac movement (defibrillation), in the hopes that the heart may begin beating regularly after a period of time

40
Q

Cardiac referred pain

A

Ischemia stimulates visceral pain sensory fibers in the heart of the autonomic nervous system
These visceral sensory fibers often share a spinal ganglion with the somatic sensory fibers of areas such as the upper limb and superior lateral chest wall
Anginal pain is typically referred to the area innervated by the left medial brachial cutaneous nerve, the left substernal area, left pectoral area and medial aspect of the left upper limb are often involved in this variety of referred pain

41
Q

Pericardium

A

Serous
-parietal: adhered to the fibrous pericardium
-visceral: adhered to the heart, makes up epicardium
Fibrous
Oblique pericardial sinus- wide recess posterior to base of heart
Transverse pericardial sinus- transverse passage traversing the origins of the great vessels

42
Q

Surgical significance of the transverse pericardial sinus

A

This space allows cardiac surgeons to access the area posterior to the aorta and pulmonary trunk to clamp or insert the tubes of a bypass machine into these large vessels

43
Q

Pericarditis

A

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

44
Q

Pericardial effusion

A

Inflammation of the pericardium can result in the accumulation of fluid or pus in the pericardial sac which can compress the heart
Heart compression is known as cardiac tamponade

45
Q

Pericadiocentesis

A

Drainage of blood, fluid or pus from the pericardial sac

This is usually done to relieve cardiac tamponade

CPR (24 decks)

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