Thorax - heart and lungs Flashcards
1
Q
true ribs
A
costal cartilages of the upper 7 rib pairs articulate with the sternum
2
Q
false ribs
A
ribs 8, 9 and 10, attach to cartilage of 7th rib
3
Q
floating ribs
A
11 and 12, do not connect with anything
4
Q
flail chest
A
multiple rib fractures can create this, can impede respiration
5
Q
typical rib
A
Head, Neck, Tubercle, Body
Articulates with transverse process and vertebral body of vertebrae – costovertebral joints
6
Q
sternum
A
o Manubrium – top part of sternum, where 1st rib and clavicle articulate
Sternal angle – between manubrium and body, where 2nd rib articulates
o Body – main part
o Xiphoid process – bottom, approximately around T9
7
Q
thoracic apertures
A
o Superior thoracic aperture – 1st rib to manubrium
o Inferior thoracic aperture – costal cartilage of 7-10 ribs, diaphragm lines this
8
Q
external intercostal muscles
A
forms V shape, “hands in pockets”, superolateral to inferomedial
9
Q
internal intercostal muscles
A
forms mountain, expiration and proprioception
10
Q
innermost intercostals
A
vessels run between innermost and internal
11
Q
intercostal muscles are innervated by
A
intercostal nerves
12
Q
chest tube
A
should be inserted superior to rib because inferior to rib the intercostal bundle (n. a. v.) are inferior to the rib
13
Q
diaphragm
A
moves up and down when you breathe o Caval opening – inferior vena cava at T8 o Esophageal hiatus – esophagus at T10 o Aortic hiatus – aorta at T12 o Inspiration – contracts and flattens o Expiration – relaxes and rises
14
Q
intercostal nerves
A
(ventral rami of spinal nerves TI to T11)
o Lateral and anterior cutaneous branches
15
Q
intercostal vessels
A
branches of aorta
o Lateral cutaneous branches
16
Q
pleural cavity
A
true cavity in thorax
17
Q
visceral pleura
A
autonomic innervation sensitive to stretch
18
Q
parietal pleura
A
have somatic innervation and very sensitive to pain o Four parts Diaphragmatic – superior Mediastinal – lines lung and heart Costal – lines internal ribs Cervical (cupola)
19
Q
costodiaphragmatic recess
A
right lung, inferior
20
Q
costomediastinal recess
A
left lung, anterior near midline around where heart is
21
Q
4 lung surfaces
A
o Costal – against ribs
o Diaphragmatic – base, against diaphragm
o Mediastinal – contains hilum
o Hilar – where main bronchus, pulmonary arteries and veins are
22
Q
fissures of right lung
A
oblique and horizontal because 3 lobes
23
Q
fissures of left lung
A
only oblique
24
Q
carina of trachea
A
ridge of cartilage where trachea splits into 2 bronchi, at sternal angle
25
main primary bronchi
Right main bronchus – bigger than left, higher chance of catching debris
Left main bronchus
26
lobar secondary bronchi
Right – superior, middle and inferior (3)
Left – superior and inferior (2)
Do not memorize bronchopulmonary segments
27
pulmonary arteries
carry deoxygenated blood from heart to lungs
28
pulmonary veins
carry oxygenated blood from lungs to heart
29
bronchial arteries
supply bronchi with blood from thoracic aorta
30
superior mediastinum
trachea and esophagus
| o Sternal angle and intervertebral disc between T4 and T5, separates superior from inferior
31
inferior mediastinum
o Middle mediastinum – heart
o Anterior mediastinum – fat, lymph tissue, thymus
o Posterior mediastinum – inferior-most, aorta, esophagus
32
pericardial sac
holds heart, has fibrous and serous layers
33
fibrous pericardium
strong dense collagen material that blends with tunica externa
34
serous pericardium
lines inner surface of fibrous pericardium
35
parietal layer of pericardium
of serous, outer, has space between it and visceral layer
36
visceral layer of pericardium, epicardium
follows heart contours, at root it is continuous with pericardium, single layer of epithelium
• The aorta attaches the heart to the body; essentially only anchor
• Pericardial effusion – when it ruptures and heart bleeds into the pericardial cavity, the heart can’t fill and is dangerous
37
endocardium
layer of heart muscle most susceptible to ischemia
38
transverse pericardial sinus
space about heart and around aorta
39
oblique pericardial sinus
below the heart, in serous pericardium near vena cava
40
musculophrenic artery
supplies pericardium
41
right coronary artery
arises from aorta superior to right cusp of valve, along groove
Sinoatrial nodal artery – passes between right atrium and superior vena cava to supply blood to SA node
Marginal artery – supplies right ventricular wall
Posterior interventricular artery (posterior descending artery, PDA) – supplies inferior wall, posterior intraventricular septum and papillary muscles
42
Sinoatrial nodal artery
branch of RCA, passes between right atrium and superior vena cava to supply blood to SA node
43
Marginal artery
branch of RCA, supplies right ventricular wall
44
Posterior interventricular artery (posterior descending artery, PDA)
branch of RCA, supplies inferior wall, posterior intraventricular septum and papillary muscles
45
left coronary artery
left cusp of aortic valve, shorter but supplies larger area
Anterior interventricular artery – LAD, left ventricle, anterolateral myocardium, apex, anterior intraventricular septum and papillary muscles
Circumflex artery -wraps left side to posterior and supplies left ventricle and left marginal branches
46
anterior interventricular artery
branch of LCA, "LAD" left ventricle, anterolateral myocardium, apex, anterior intraventricular septum and papillary muscles
** MI most often occurs here **
47
circumflex artery
wraps left side to posterior and supplies left ventricle and left marginal branches
48
coronary sinus
largest draining of heart muscle, collects and returns to right atrium
49
great cardiac vein
apex to IV groove, drains into coronary sinus
50
middle cardiac vein
apex to post intraventricular sulcus, drains into coronary sinus
51
small cardiac vein
acute margin of heart, runs with marginal artery
• Majority of coronary circulation is either right or left dominant, meaning where the posterior interventricular artery is coming from
o Most are right dominant (~70%)
drains into coronary sinus
52
anterior cardiac veins
drain directly into right atrium – anterior portion of the right ventricle goes directly to right atrium not through a sinus
53
right atrium
receives deoxygenated blood from systemic circulation
Auricle
Crista terminalis
Fossa ovalis
Ostium of the coronary sinus
Ostium of the superior & inferior vena cava
Right atrioventricular orifice
54
right ventricle
receives blood from right atrium, crescent shape, smaller
55
auricle
out pouch of tissue from fetal atrium on both atria
56
crista terminalis
internal vertical ridge that separate smooth from rough
57
ostium of coronary sinus
where coronary sinus enters flow
58
right AV orifice
oval aperture for communication between right atrium and right ventricle
59
trabeculae carneae
projective ridges of muscle in ventricle
60
papillary muscle
attached to ventricle wall to stabilize valves
61
septomarginal trabecula (moderator band)
ridge of heart muscle that conducts to AV node, present in 60% of hearts; only in right ventricle to differentiate
62
chordae tendineae
attach the papillary muscles to valve, prevent prolapse during flow
63
tricuspid valve
3 cusps, in right ventricle
64
infundibulum or conus arteriosus
region before the pulmonary valve
65
left atrium
gets oxygenated blood from pulmonary veins
66
left ventricle
wall is much thicker than right ventricle
67
mitral valve
2 cusps, bicuspid valve in left side
68
parasympathetic innervation of heart
from medulla oblongata through the vagal nerves, decrease heart rate and force of contraction, dilate coronary arteries
69
sympathetic innervation of heart
increase heart rate and force of contraction, constricts arteries
70
visceral afferents and referred pain
visceral sensory send back to brain, sensitive to ischemia, leads to the pain of a MI or angina, could cross over with dermatomes in upper chest and left arm
• Referred pain to left neck and shoulder is from sympathetic T1-T5
71
SA node
“pacemaker” for rhythm, sweeps down atrium, contract
| ~100 bpm
72
AV node
above coronary sinus, receives from SA node, sends to Bundle of His
~40-60 bpm
73
Bundle of His
– ensure ventricular contraction begins at apex and ends near valves
• Right bundle branch – in moderator area
• Left bundle branch
~20-40 bpm
74
superior vena cava
receives blood from upper body and sends to heart
75
inferior vena cava
receives blood from lower body and sends to heart
passes through the diaphragm at T8
76
pulmonary veins
delivers blood from lungs to left atrium
77
pulmonary arteries
takes deoxygenated blood to lungs
78
aorta
takes oxygenated blood from heart to body
has ascending, descending, thoracic and abdominal areas
79
ligamentum arteriosum
remnant of the fetal ductus arteriosus (between aortic arch and pulmonary artery)
80
thoracic descending aorta
o Branches
Posterior intercostal arteries – 3-11 supply intercostals
A variable number of bronchial, esophageal, and tracheal arteries supply their respective structures; a pair of superior phrenic arteries to diaphragm
81
azygos vein
- receives the right posterior intercostal veins and converges with superior vena cava via the arch of the azygous
on right side of body
82
hemiazygos vein
receives left posterior intercostal veins and then joins with azygous vein; communicates with left renal vein , lower left
83
accessory hemiazygos vein
receives left posterior intercostal veins and then joins with azygous vein; communicates with left renal vein , upper left
84
thoracic duct
main lymph receiving channel, all body except right upper quadrant
o Enters venous system at junction of internal jugular and subclavian
85
twelve thoracic ganglia
o White ramus communicans – myelinated
| o Gray ramus communicans – unmyelinated
86
splanchnic nerves
greater (T5-9), lesser (T10-11), least (T12) – preganglionic sympathetic fibers en route to the abdomen
87
dermatomes
come off spinal segments, you can use dermatomes to see what nerves may be affected in spinal cord injury
o T4 -nipples
o T6 – xiphoid
o T10 – umbilicus
88
thymus
produces t cells
89
esophagus
posterior to trachea, leads to stomach, innervated by vagus
90
branches of aorta
o brachiocephalic (right)
o left common carotid
o left subclavian arteries
91
brachiocephalic veins
off superior vena cava, makes subclavian veins
92
vagus nerves
contribute to cardiac, pulmonary and digestive function, cranial nerve X (10)
o Right vagus nerve splits to right recurrent laryngeal nerve – loop back up; goes around subclavian vein
o Left vagus nerve splits to left recurrent laryngeal nerve – goes down trachea; on left side to the aorta
93
phrenic nerves
comes out of neck, anterior to root of lung down to diaphragm
o Derived from ventral rami of spinal nerves C3,4,5. (C345 - keep the diaphragm alive!)
o Innervate the skeletal muscle of the diaphragm
o Sensory to fibrous pericardium, parietal layer of the serous pericardium, mediastinal pleurae, and the inner portions of the diaphragmatic pleurae
94
right vagus nerve
splits to right recurrent laryngeal nerve – loop back up; goes around subclavian vein
95
left vagus nerve
splits to left recurrent laryngeal nerve – goes down trachea; on left side to the aorta
