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Anatomy Lab > Thorax and Heart > Flashcards

Thorax and Heart Flashcards

1
Q

Label

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3
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4
Q

What are the landmarks to outline the heart? (the lateral boarders, inferior and superior boarders)

A
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5
Q

Label and expand on the costal margin

A

The costal margin formed by the cartilages of the seventh to tenth ribs. It attaches to the body and xiphoid process of the sternum.

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6
Q
  • Where is the Jugular notch, manubrium, sternal angle at the manubriosternal joint, Xiphisternal joint?
  • What is special about some of them?
A
  • Jugular: at T3 vertebral level
  • Manubrium:at 4 level (inf. to jug notch and at the same level of superior arch of aorta)
  • Sternal angle:T4-5 (Where opening of coronary arteries live
  • Xiphisternal: T9 (Diaphragm attaches post on xiphoid process)
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7
Q

What are the surface projections of the valves and the ranges of the actual areas of auscultation?

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8
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9
Q

What is the superior thoracic aperture. Sternoclavicular joint, costochondral joint, False, true and floating ribs and the costal margins?

A

,

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10
Q

The costovertebral joints includes what?

A

include the joint of the head of the rib, in which the head articulates with two adjacent vertebral bodies and the intervertebral disc between them, and the costotransverse joint, in which the tubercle of the rib articulates with the transverse process of a vertebra.

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11
Q
  • What is the weakest park of the rib?
  • Rib fractures commonly result from what?
  • What are the most commonly fractured?
  • Direct violence may fracture a rib anywhere, and its broken ends may what?
A
  • The weakest part of a rib is just anterior to its angle.
  • Rib fractures commonly result from direct blows or indirectly from crushing injuries.
  • The middle ribs are most commonly fractured.
  • Direct violence may fracture a rib anywhere, and its broken ends may injure internal organs such as a lung or the spleen.
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12
Q

What is costochondritis?

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13
Q

What are the different areas of the sternum? Where do they level off with the vertebrae?

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14
Q

Where is the thoraic aorta, vena cava?

A
  • Thoraic aorta: posterior aspect of left side
  • Vena cava: right
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15
Q

Where are the external, internal intercostals? Posterior ramus, posterior intercostal artery, anterior intercostal artery, internal thoracic artery?

A
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16
Q

What are the two arteries that anastomoses in the anterior part of the diaphragm?

A

Interanl thoracic artery and posterior intercostal artery

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17
Q

Where and what is in the intercostal space?

A
  • Superior to inferior: Intercostal vein, artery and nerve (VAN)
  • Between innermost and internal intercostal
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18
Q

What is the intercostal nerve and sympathetic trunk connected by?

A

rami communicantes (communicating branches)

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19
Q

Intercostal nerve block:
* How does it happen?
* When is it used?
* Involves what?
* What do you need to do? What is an example?

A
  • Local anesthesia of an intercostal space is produced by injecting a local anesthetic agent around the intercostal nerves.
  • This procedure, an intercostal nerve block, is commonly used in patients with rib fractures and sometimes after thoracic surgery.
  • It involves infiltration of the anesthetic around the intercostal nerve and its collateral branches
  • Because considerable overlap in the innervation of contiguous dermatomes occurs, anesthesia of any particular area of skin usually requires injection of two adjacent nerves.
  • For example, anesthesia for a broken rib requires injection of the anesthetic agent into the region of the intercostal nerves superior and inferior to the rib, proximal to the site of fracture.
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20
Q

What is the relationship between the area of skin and skeletal muscle?

A

the relationship between the area of skin (dermatome) and skeletal muscle (myotome) innervated by a spinal nerve or segment of the spinal cord. The dermatomes of the thorax are shown on the right side of the page

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21
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22
Q

What offers alternate means of venous drainage from the thoracic, abdominal, and back regions when obstruction of the IVC occurs?

A

azygos, hemi-azygos, and accessory hemi-azygos veins

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23
Q

Cardiac-referred pain
* The heart is insensitive to what? What is it stimulated by?
* The axons of these primary sensory neurons enter where?
* What is cardiac referred pain?

A
  • The heart is insensitive to touch, cutting, cold, and heat; however, ischemia and the accumulation of metabolic products stimulate pain endings in the myocardium.
  • The axons of these primary sensory neurons enter spinal cord segments T1–T4 or T5, especially on the left side.
  • Cardiac-referred pain is a phenomenon whereby noxious stimuli originating in the heart are perceived by the person as pain arising from a superficial part of the body— the skin on the medial aspect of the left upper limb, for example.
24
Q

Herpes zoster infection:
* What is it?
* Where is the skin lesion?
* What does the herpes virus invade?
* What happens a few day laters?
* What confers protection?

A
  • A viral disease of spinal ganglia
  • A skin lesion with a dermatomal distribution.
  • The herpes virus invades a spinal ganglion and is transported along the axon to the skin, where it produces an infection that causes a sharp burning pain in the dermatome supplied by the involved nerve.
  • A few days later, the skin of the dermatome becomes red and vesicular eruptions appear
  • Vaccination confers protection against herpes zoster and is recommended for adults starting at age 50 years.
25
Q

What are the different areas of the mediastinum?

A
26
Q

What are the different layers of the heart?

A

Sup-deep: Fibrous pericardium, serous pericardium (parietal and visceral pericardium), Epicardium (same as visceral pericardium), myocardium and endocardium

27
Q
  • What does the pericardial sac have? Where does it run to?
  • Where is the vagus nerve?
A
  • Has phrenic n in the fiberous layer and runs down lateral
  • On the arch of aorta
28
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29
Q

Where is the base and apex of the heart?

A
  • Base: superior
  • Apex: inf and lateral
30
Q
  • What is pericardial effusion?
  • What is cardiac temponade (heart compression)?
A
  • A pericardial effusion is when excess fluid builds up in the pericardial sac around the heart.
  • Cardiac tamponade (heart compression) is a potentially lethal condition because the fibrous pericardium is tough and inelastic. Consequently, heart volume is increasingly compromised by the fluid outside the heart but inside the pericardial cavity. When there is a slow increase in the size of the heart, cardiomegaly, the pericardium gradually enlarges, allowing the enlargement of the heart to occur without compression.
31
Q

Happens when stab wounds pierce the heart?

A

Stab wounds that pierce the heart, causing blood to suddenly enter the pericardial cavity (hemopericardium), also produce cardiac tamponade. Hemopericardium may also result from perforation of a weakened area of heart muscle after a heart attack. As blood accumulates, the heart is compressed, and circulation fails.

32
Q

What is Pericardiocentesis? Where is this done?

A

(drainage of serous fluid from pericardial cavity) is usually necessary to relieve the cardiac tamponade. To remove the excess fluid, a wide-bore needle may be inserted through the left subcostal angle, or 5th or 6th intercostal space near the sternum.

33
Q
  • What is echocardiography?
  • The technique may detect what?
  • What is doppler echocardiography?
A
  • Echocardiography (ultrasonic cardiography) is a method of graphically recording the position and motion of the heart by the echo obtained from beams of ultrasonic waves directed through the thorax
  • This technique may detect as little as 20 mL of fluid in the pericardial cavity, such as that resulting from pericardial effusion.
  • Doppler echocardiography is a technique that demonstrates and records the flow of blood through the heart and great vessels by Doppler US, making it especially useful in the diagnosis and analysis of problems with blood flow through the heart, such as septal defects, and in delineating valvular stenosis and regurgitation, especially on the left side of the heart.
34
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A
35
Q

Where are the coronary artery and cardiac veins?

A

Epicardium

36
Q
  • What is the transverse pericardial sinus?
  • By passing a surgical clamp or placing a ligature around these vessels?
  • When is cardiac surgery performed?
A
  • The transverse pericardial sinus is especially important to cardiac surgeons. After the pericardial sac has been opened anteriorly, a finger can be passed through the transverse pericardial sinus posterior to the aorta and pulmonary trunk
  • By passing a surgical clamp or placing a ligature around these vessels, inserting the tubes of a bypass machine, and then tightening the ligature, surgeons can stop or divert the circulation of blood in these large arteries while performing cardiac surgery, such as coronary artery bypass grafting.
  • Cardiac surgery is performed while the patient is on a cardiopulmonary bypass machine
37
Q

Coarctation of aorta:
* What is it? What does it do?
* What is the most common site?
* What happens when the coarctation is inferior to postductal coarctation?

A
  • In coarctation of the aorta, the arch of the aorta or descending aorta has an abnormal narrowing (stenosis) that diminishes the caliber of the aortic lumen, producing an obstruction to blood flow to the inferior part of the body
  • The most common site for a coarctation is near the ligamentum arteriosum.-> small ligament that attach aorta to pul. artery
  • When the coarctation is inferior to this site (postductal coarctation), a good collateral circulation usually develops between the proximal and distal parts of the aorta through the intercostal and internal thoracic arteries.
38
Q

What is ligamentum arteriosum?

A

Ligamentum arteriosum is a small ligament attaching the aorta to the pulmonary artery. It serves no function in adults but is the remnant of the ductus arteriosus formed within three weeks after

39
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A
40
Q
A
  • RCA to right marginal
  • LCA to circumflex (goes posterior), Anterior IV branch, left marginal, lateral branch of anterior IV branch
41
Q

What are the main supply to the left and right ventricle?

A
42
Q
A
43
Q

What happens when you have back flow of blood after systole?

A

Conorary arteries pickup

44
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A
45
Q
  • The atherosclerotic process, characterized by what? What does it result in?
  • What results in MI?
A
  • The atherosclerotic process, characterized by lipid deposits in the intima (lining layer) of the coronary arteries, begins during early adulthood and slowly results in stenosis of the lumina of the arteries
  • Insufficiency of blood supply to the heart (myocardial ischemia) may result in MI
46
Q

Cardiac catheterization:
* What do they do? Why?
* What is this process of this?
* Cath is most often performed where?

A
  • The insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes.
  • Catheterization of the coronary arteries for coronary artery disease and myocardial infarctions (“heart attacks”).
  • Catheterization is most often performed in special laboratories with fluoroscopy and highly maneuverable tables. These “cath labs” are often equipped with cabinets of catheters, stents, balloons, etc. of various sizes to increase efficiency. Monitors show the fluoroscopy imaging, electrocardiogram (ECG), pressure waves, and more.
47
Q

Coronary Angioplasty:
* What do drs. use?
* What happens when the catheter reaches the obstruction?
* After dilation of the vessel, what may be introduced?

A
  • Cardiologists or interventional radiologists use percutaneous
  • transluminal coronary angioplasty, in which they pass a catheter with a small inflatable balloon attached to its tip into the obstructed coronary artery
  • When the catheter reaches the obstruction, the balloon is inflated, flattening the atherosclerotic plaque against the vessel’s wall, and the vessel is stretched to increase the size of the lumen, thus improving blood flow. In other cases, thrombokinase is injected through the catheter; this enzyme dissolves or reduces the blood clot.
  • After dilation of the vessel, an intravascular stent may be introduced to maintain the dilation. These procedures are replacing bypass procedures requiring open surgery at markedly increasing rates
48
Q
A
49
Q

What is coronary artery disease? MI?

A

Coronary Artery Disease
* One of the leading causes of death. It has many causes, all of which result in a reduced blood supply to the vital myocardial tissue.

Myocardial Infarction
* With sudden occlusion of a major artery by an embolus (plug), the region of myocardium supplied by the occluded vessel becomes infarcted (rendered virtually bloodless) and undergoes necrosis (pathological tissue death).
* An area of myocardium that has undergone necrosis constitutes a myocardial infarction (MI). The most common cause of ischemic heart disease is coronary artery insufficiency resulting from atherosclerosis.

50
Q

What are the three most common sites of coronary artery occlusion?

A

(1) anterior IV (LAD) branch of the LCA (40–50%),
(2) RCA (30–40%),
(3) circumflex branch of the LCA (15–20%).

51
Q

Coronary Bypass Graft:
* Who may undergo this?
* What is the process?
* What vessel is used? Why?
* What does the bypass do?

A
52
Q

What do the valves have?

A
53
Q

Valvular Heart Disease:
* What is it?
* What is stenosis?
* Valvular insufficiency or regurgitation is what?
* What is the result?

A
54
Q

What are the different septal defects?

A
55
Q

Injury to Conducting System of Heart:
* Often results from what?
* Because the anterior IV branch (LAD branch) supplies the AV bundle, what is affect?
* Damage to the AV node or bundle results in what?

A
56
Q
A
57
Q

What is the lymphatic duct drainage?

A

Anatomy Lab (10 decks)

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