Week 1- Cardiac Anatomy Flashcards
The heart is divided into right and left halves by a longitudinal septum. This creates two ________ but ____-_________ pumps.
parallel but non-interacting
What are the 2 most common issues when there is a hole between L/R? What does this cause?
- Inactivity/Dyspnea
- Mixture of oxygenated and deoxygenated blood resulting in decreased SaO2.
What are the (5) cardinal symptoms of cardiac dysfunction? What is a way to remember it?
- ) Fatigue
- ) Activity/Exercise limitation
- ) Congestion in lungs
- ) Edema
- ) SOB
-FACES
What are some structures located in the thoracic cavity. (5)
- CV System
- GI System
- Respiratory System/Endocrine
- Nervous System
- Lymphatics
What is the purpose of the Bony Thorax? (2)
- Cover/protect major organs of the CP system.
- Attachment of muscles.
What are the boundaries of the Bony Thorax? (3)
- 12 thoracic vertebrae dorsally
- Ribs laterally
- Sternum ventrally
Intercostal Space is the space between the ribs and are numbered according to the _______ rib.
SUPERIOR
What are the 3 parts of the sternum?
- Manubrium
- Body
- Xiphoid Process
What are the 3 structures that the Sternal Angle (Angle of Louis) helps to identify?
- Bifurcation of the trachea into R/L main stem bronchi deep to sternal angle.
- Points to beginning and end of arch of the aorta.
- Cardiac plexus
- Ribs __-__ = true ribs, attach to sternum via costal cartilage
- Ribs __-__ = false ribs, attach to the rib above
- Ribs __-__ = false free floating ribs
- Ribs 1-7
- Ribs 8-10
- Ribs 11-12
- What is the mediastinum?
- What are the contents of the mediastinum?
Space between 2 lungs bordered by the thoracic outlet, chest wall, vertebral column, lungs, and diaphragm.
-Contains all organs of the thorax EXCEPT the lungs.
Are the contents of the mediastinum immobile or mobile? Why does this matter?
Mobile, can become a major problem for obese patients. Abdominal contents press up against diaphragm making breathing difficult.
Describe the heart location and orientation.
- Heart lies OBLIQUELY in MIDDLE mediastinum.
- 2/3’s located to LEFT of sternum.
- Points slightly anteriorly.
- Extends from 2nd-5th intercostal space.
What are (6) anatomical lines of importance?
Anterior
- Midsternal Line
- Midclavicular Line
- Anterior axillary Line
Lateral
- Anterior Axillary Line
- Midaxillary Line
- Posterior Axillary Line
What are the layers of the pericardium and heart?
- Fibrous Pericardium
- Serous Pericardium (parietal and visceral)
- Epicardium
- Myocardium
- Endocardium
- Does movement of the diaphragm cause cardiac movement?
- What does the fibrous pericardium also do?
- Yes, fibrous pericardium attaches inferiorly to central tendon of diaphragm.
- Prevents overfilling of the heart.
What does the serous pericardium do?
Double layer allowing heart to oscillate (visceral and parietal).
Describe the 3 layers of the heart.
Epicardium
-Same as the visceral pericardium
Myocardium
-Middle Layer
Thickest region of the heart, contains the myocytes
Endocardium
-A thin layer of connective tissue. Covers the valves and is continuous with the endothelium layer of the vessels.
What are auricles?
- Small earlike extensions of the atrium that helps expand the volume of the right atria.
- Often a source of leads for pacemakers.
- What is the pacemaker of the heart?
- Where is it located?
- Is it innervated by the PNS or SNS more?
- SA Node
- Located just laterally to the junction where the superior vena cava enters the R atrium.
- Parasympathetic NS
Describe the pathway of heart impulses.
- SA Node
- AV Node
- Bundle of His
- L/R bundle branches
- Purkinje Fibers
- What allows the movement of blood from the RA into the RV?
- What is the effect of a defective valve?
- Tricuspid (AV) Valve
- Tricuspid valve regurgitation which can cause HF.
What is the function of the R Ventricle?
Eject blood through a low-pressure valve (pulmonary semilunar valve) into the pulmonary trunk.
What 2 structures help to hold valves in place and prevent backflow into the atrium?
- Papillary Muscle
- Chordae Tendineae
The pulmonary valve lies at the apex of the ______ ________ at the level of the 3rd costal cartilage.
conus arteriosus
Right Ventricle:
- The _________ tract is created by the tricuspid valve, chordae tendineae, papillary muscles, and the base of the right ventricular chamber.
- The _______ tract is created by the right ventricular free wall, ventricular septum and conus arteriosus (infundibulum).
- inflow
- outflow
Increased pulmonary pressures ↑ work load on the RV resulting in ____________.
cor pulmonale
What is the cardiac skeleton and its function?
4 rings of dense CT that surround the AV canals (mitral and tricuspid), aorta, and pulmonary trunk. They provide structure and support for the heart as well as electrical isolation between the atria and the ventricles.
- Whenever treating a patient with any rheumatoid pathologies (ex. RA), must think about accompanying ________ comorbidity.
- The sole presence of RA is now considered a _________ pathogenic factor for premature development of atherosclerosis, especially CAD with also a threefold increase in CV events.
- cardiac
- primary
Left Atrium:
- Forms most of the ______ of the heart.
- Forms the upper border of the heart.
- Lies just below the 2nd rib.
- Lies ________.
- Separated from the vertebral column by the esophagus and aorta.
- base
- dorsally
Left Ventricle:
- Almost conical: longer and narrower than RV.
- Walls are __x thicker than those of the RV.
- Separated from the RV by the __________ _________.
- Apex normally the thinnest portion of the LV.
- 3x
- intraventricular septum
Left Ventricle:
- The _______ tract is funnel-shaped and surrounded by the mitral valve annulus, leaflets and chordae tendineae.
- The ________ tract is formed by the smooth basal (muscular) portion of the interventricular septum, the anterior ventricular wall and the anterior mitral leaflet.
- inflow
- outflow
Why might we use calcium channel blockers?
They act to limit contractibility of cardiac myocytes, which helps to lower blood pressure. Can reduce functional capacity but decreases workload of the heart.
Describe whether each of these will increase or decrease conduction velocity.
- Sympathetic stimulation
- Vagal stimulation
- Ischemia/hypoxia
- Drugs (adrenergic/cholinergic)
- Sympathetic stimulation (increase)
- Vagal stimulation (decrease)
- Ischemia/hypoxia (decrease)
- Drugs (adrenergic/cholinergic) (increase or decrease)
What is the purpose of purkinje fibers?
Help transmit conduction to innermost layers of myocytes.
The aortic root begins at the base of the heart and is continuous with the outflow of the LV. What (3) structures are within the aortic root?
- aortic valve
- L/R main coronary arteries
When do coronary arteries receive blood? Why?
- Only during DIASTOLE!
- Coronary arteries are blocked during systole due to compression of coronary vessels by contracting myocardial tissue.
At rest, approximately ___-___% of O2 is extracted from blood in the coronary arteries.
60-70%
- Blood flow must match metabolic demand. If no increase in blood flow, then what occurs?
- How would nitroglycerin and Ca+ channel blockers be of benefit in this instance?
- Myocardial Ischemia
- CAD
- HTN → increased → cardiac hypertrophy
-They would reduce workload of the heart and require less blood flow.
List the main branches of the R and L coronary arteries.
Left Coronary Artery
- LAD (left anterior descending)
- Circumflex Artery
Right Coronary Artery
- Posterior Interventricular Artery
- Right Marginal Artery
- Sinoatrial Nodal Artery
Describe the pathway of the Right Coronary Artery.
- Arises above right cusp of aortic valve.
- Passes between auricular appendage of R atrium and pulmonary trunk.
- Travels down R atrioventricular groove.
- Goes around heart and into the posterior interventricular sulcus.
- Becomes the posterior descending artery and continues inferiorly.
What structures does the Right Coronary Artery perfuse? (5)
- wall of RV
- interventricular septum
- 25-35% of the LV
- SA node
- AV node
What are the 2 major branches of the Left Coronary Artery?
- LAD (left anterior descending)
- Circumflex Artery
Which branch of the Left Coronary Artery is called the “widow maker” and provides 70% of the perfusion of the LV?
LAD (left anterior descending)
Which branch of the Left Coronary Artery perfuses the posterior and lateral aspects of the LV, papillary muscles, and the SA node?
Circumflex Artery
Most of the veins of the heart drain into the ________ _____ which runs in the posterior aspect of the coronary sulcus and then drains through the valve of the coronary sinus, a semilunar flap, into the _______.
- coronary sinus
- right atrium
