Thoracic Cardiology Flashcards
What are the superior and inferior borders of the superior mediastinum?
superior - superior thoracic aperture
inferior - sternal angle
What are the superior and inferior borders of the inferior mediastinum?
superior - sternal angle
inferior - inferior thoracic aperture
What are the divisions of the inferior mediastinum?
anterior (in front of the heart)
middle (where the heart is)
posterior
What are the layers of the pericardium, superficial to deep?
fibrous pericardium
parietal serous pericardium
pericardial cavity
visceral serous pericardium (epicardium)
Where is the transverse pericardial sinus?
traverses between the arterial and venous vessels at the superior part of the heart
What is the surgical significance of the transverse pericardial sinus?
allows access to the area posterior to the aorta and pulmonary trunk to clamp or insert tubes of a bypass machine into these vessels
What is the oblique pericardial sinus?
wide recess posterior to the base of the heart
-not a passage … just a result of the way the veins “fan out”
Delineate the flow of blood through the heart.
superior and inferior vena cava … R atrium … tricuspid valve … R ventricle … pulmonary valve … pulmonary trunk … pulmonary A. … lungs … pulmonary V. … L atrium … bicuspid valve … L ventricle … aortic valve … ascending aorta
What are the borders of the heart?
right - R atrium
inferior - R ventricle
left - L ventricle
superior - L atrium
What are the surfaces of the heart?
pulmonary - R atrium and L ventricle
diaphragmatic - R and L ventricles
sternocostal - R ventricle
What is the groove between the R atrium and the R ventricle and what vessel(s) runs there?
right atrioventricular groove
right coronary A.
What is the groove on the anterior side of the heart between the two ventricles and what vessel(s) run there?
anterior interventricular groove
anterior interventricular A.
great cardiac V.
What is the groove on the posterior side of the heart between the left atrium and left ventricle and what vessel(s) run there?
left atrioventricular groove
coronary sinus
What is the groove on the posterior side of the heart between the two ventricles and what vessel(s) run there?
posterior interventricular groove
posterior interventricular A.
middle cardiac V.
In the right atrium, what is the structure separating the smooth wall from the rough wall?
crista terminalis
In the right atrium, what is the rough wall?
pectinate m.
What are the pocket-like embryological remnants of the splitting into a right and left atrium?
right and left auricles
What is the smooth wall of the right atrium?
sinus venarum
- posterior
- thin-walled region where the venae cavae and coronary sinus empty
Where is the fossa ovalis and what is it?
on the interatrial septum in the right atrium
-embryological remnant of the foramen ovalis
In what heart chamber is the opening for the coronary sinus?
right atrium
Where is the tricuspid valve?
separating the right atrium from the right ventricle
What are the names of the cusps of the tricuspid valve?
anterior
posterior
septal
What attaches each cusp to its corresponding papillary muscle?
chordae tendinae
What is the name of the rough wall in the right ventricle?
trabecula carnae
Where is the septomarginal trabeculum (aka moderator band)?
in the right ventricle, runs from interventricular septum to the base of the anterior papillary muscle
What is housed in the septomarginal trabeculum?
right bundle branch of the atrioventricular bundle
What is the name of the smooth wall in the right ventricle?
conus ateriorsus
The conus arteriosus is near the entrance to which great vessel?
pulmonary trunk
Where is the pulmonary valve?
separates the right ventricle from the pulmonary trunk
What are the names of the cusps of the pulmonary valve?
right
left
anterior
What is the pulmonary sinus?
space b/w the wall of the pulmonary trunk and the cusps
-“disappears” when the valve is open for blood flow
Which walls are thicker, the right atrium or the left atrium?
left
Which openings are in the left atrium?
4 pulmonary veins
Where is the bicuspid valve?
separating the left atrium from the left ventricle
What are the names of the cusps of the bicuspid valve?
anterior
posterior
What is the name of the rough wall in the left ventricle?
trabecula carnae
What is the aortic vestibule?
smooth wall in the left ventricle before entry into the ascending aorta
What is housed inside the interventricular septum?
atrioventricular bundle
right bundle branch
left bundle branch
What are the two parts of the interventricular septum?
fibrous part muscular part (larger)
Where is the aortic valve?
separating the left ventricle from the ascending aorta
What are the names of the cusps of the aortic valve?
left
right
posterior
What openings are in the walls of the aortic sinuses?
right - right coronary A.
left - left coronary A.
Where is the tricuspid valve in relation to other thoracic structures?
posterior to the body of the sternum and the level of the 4th and 5th intercostal spaces
Where is the pulmonary valve in relation to other thoracic structures?
at the level of the 3rd costal cartilage
Where is the bicuspid valve in relation to other thoracic structures?
posterior to the sternum, at the level of the 4th costal cartilage
Where is the aortic valve in relation to other thoracic structures?
posterior to the left side of the sternum, at the level of the 3rd intercostal space
What is the fibrous skeleton of the heart comprised of?
dense collagenous fibers
What are the functions of the fibrous skeleton?
- attachment for myocardium and valves
- supports and strengthens the atrioventricular and semilumar orifices
-electrical barrier b/w atria and ventricles
What happens at the beginning of diastole?
aortic and pulmonary valves close due to a drop in ventricular pressure
What happens in early diastole?
-heart lengthens as the ventricles relax
- atrioventricular valves open
- blood enters ventricles
What happens at the end of diastole?
atrial contraction to expel blood into the ventricles
What happens at the beginning of systole?
atrioventricular valves close due to increased ventricular pressure
What happens in early systole?
ventricles begin to contract
-increased pressure opens the pulmonary and aortic valves
What happens at the end of systole?
full ventricular contraction and expel blood into the pulmonary trunk and aorta
What is the sinuatrial node?
self-initializing collection of cardiac muscle fibers capable of creating its own action potential
What does the atrioventricular node do?
receives signals from the SA node
Which walls are thicker, atria or ventricles?
ventricles
What structures help propagate the electric signal through the ventricle walls?
atrioventricular bundle
R and L bundle branches
subendocardial branches
What is a myocardial infarction?
lack of blood flow to a specific area of myocardium
What are usual causes of a myocardial infarction?
- blockage of a coronary artery
- coronary atherosclerosis
- buildup of lipids on internal walls of coronary A.
What is angina pectoris?
pain that originates in the heart and produces a strangling pain in the chest
What is a typical cause of angina pectoris?
- narrow or obstructed coronary A. that produces ischemia of myocardium
- pain that accompanies a myocardial infarction
Pathology: Ligamentum Arteriosum
-embryological remnant of the ductus arteriosus
What is the ductus arteriosus?
-connection b/w the pulmonary trunk and the aortic arch during the fetal stage of development
What is the clinical implication of the ligamentum arteriosum?
it leaves a weak spot in the wall of the aortic arch that is susceptible to aneuryms
What nerve would be affected by an aortic aneurysm at the site of the ligamentum arteriosum?
left recurrent laryngeal A.
What parts of the heart are accessible through a cardiac catheterization and which vein is used for the access?
- right atrium, right ventricle, pulmonary trunk and pulmonary arteries
- inserted into femoral V. and passed up into the inferior vena cava
Why is the interventricular septum prone to defects?
it is comprised of two embryologically divergent tissues
What is the result of atrial septal defects and ventricular septal defects?
mixing of oxygenated and de-oxygenated blood
Where is an artificial pacemaker placed?
into the superior vena cava and down into the trabecula carnae of the right ventricle
Pathology: Pericarditis
- inflammation of the pericardium
- rough pericardium = friction
- can be observed w/ a stethoscope
- untreated = pericardium can calcify
Pathology: Pericardial Effusion
- inflammation of the pericardium can result in fluid or pus in the pericardial sac
- can compress the heart = cardiac tamponade
Pathology: Pericardiocentesis
- drainage of blood, fluid, or pus from the pericardial sac
- usually done to relieve cardiac tamponade
