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144 Cards in this Set
- Front
- Back
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Where is the phrenic nerve located in the thorax?
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Runs down from behind anterior scalene, to between pleura and pericardium, all the way down to diaphragm
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What runs with the phrenic nerve between the pleura and pericardium?
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Pericardiophrenic artery/vein
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What is the Pericardium?
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Membrane covering the heart
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2 Divisions of pericardium:
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Outer - fibrous - parietal
Inner - serous - visceral |
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What is the visceral pericardium also called?
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Epicardium
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What is the outer pericardium fused with?
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Adventitia of blood vessels
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What is the inferior border of the fibrous pericardium fused to?
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Diaphragm
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What artery lies just anterior to the pericardial sac?
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Internal thoracic artery
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What happens to the internal thoracic artery at pericardial base & junction with diaphragm?
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Splits into:
-superior epigastric artery (pierces diaphragm) -Musculophrenic artery |
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What 2 important sinuses are located in the mediastinum?
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-Oblique pericardial sinus
-Transverse pericardial sinus |
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What/where is the Oblique pericardial sinus?
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A blind ended space on the back side of heart (between r/l pulmonary veins going into the heart).
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What/where is the Transverse pericardial sinus?
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A space passing under the pulmonary trunk and aortic arch.
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Why isthe Transverse pericardial sinus important to surgeons?
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They can insert index finger into the sinus, squeeze on aorta w/ thumb, to close these off when setting up a heart/lung machine.
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What part of the heart CAN'T be seen from an anterior view? Why do we care?
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Left atrium - important in radiology images
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How is the heart location described in adults?
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Retrosternal and Left Peristernal
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How can the heart position differ in a child vs adult?
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Might be closer to the middle of the chest.
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What type of innervation does the phrenic nerve carry?
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MIXED - both motor and sensory
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3 important vessels seen coming off the heart from ant view: (left to right)
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1. Superior vena cava
2. Ascending Aortic arch 3. Pulmonary trunk |
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Bottom of heart = ____
Top of heart = _____ |
Bottom = apex
Top = base |
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What is the PMI and where is it located?
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PMI = point of maximal impulse, the apical heartbeat.
Located at 5th IC space, medial to the midclavicular line. |
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Where is Conus arteriosus loated?
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At the outflow of the right heart - pulmonary trunk.
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Where is the anterior interventricular sulcus? What lies within it?
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Sulcus = between right/left ventricles; LAD of left coronary artery runs in it.
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Where is the Coronary sulcus and what lies within it?
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Coronary sulcus = between right auricle and ventricle; Right Coronary Artery (RCA) lies within it.
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What is Ligamentum Arteriosum?
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A ligament connecting the pulmonary trunk to aortic arch
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What nerve runs just under ligamentum arteriosum?
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Recurrent laryngeal nerve
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What valve is located between RA and RV?
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Right AV valve - tricuspid
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What valve is located between LA and LV?
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Left AV valve - bicuspid (mitral)
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Where are the semilunar valves?
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At outflow regions to
-lungs (pulm semilunar valve) -systemic circulation (aortic semilunar valve) |
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Which heart chamber is thickest?
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Left ventricle - has to develop about 120 mm Hg
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What do Chordae tendinae do?
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Attach valve leaflets to papillary muscles
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What causes the heart AV valves to close?
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Contraction of papillary muscles
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Where is the posterior interventricular sulcus? What lies within it?
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Between the right/left ventricles on posterior heart; Contains interventricular branch of RCA
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What are the right atrium walls like? Why?
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Thin - only needs to generate about 15 mm Hg
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What appendage sticks off right atrium? What's in it?
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Right auricle - embryonic remnant that contains contractile muscle.
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What type of muscle is in the atrial walls?
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Pectinate
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what does pectinate mean? what does it look like?
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comb-like, orderly arrangement.
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What 3 things empty into the right atrium?
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-Superior vena cava
-Inferior vena cava -Coronary sinus |
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What hole remnant is found in the right atrium?
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Fossa ovalis
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Quick review: what are the pericardial layers around the heart?
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Outermost = fibrous
Inner = serous -Serous outer folds over on itself and makes -Serous Epicardial layer |
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Which pericardial layer is innermost?
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Epicardial - runs along the surface of heart.
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Where are the coronary arteries located in ref to pericardial layers?
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Deep to the epicardium.
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What is the big difference between Pericardium and Pleura?
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Pericardium = fixed size
Parietal Pleura = stretchable |
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What heart layer is deep to the epicardium?
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Myocardium
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What is the Myocardium?
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Thick layer of heart muscle
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What layer is deep to the Myocardium?
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Endocardium
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What is the endocardium?
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Thick endothelial lining of the ventricles
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What is the importance of the Oblique Pericardial sinus
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Its propensity for infection and tumors
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Again: in which IC space is the heart apex located?
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4th or 5th
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In which IC space is the heart base located?
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2nd
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Where is the heart in ref to MCL?
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Medial
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So where is the PMI?
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LEFT PARASTERNAL AREA MEDIAL TO MCL
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Which Vena cava has a valve? what is it called?
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Only inferior vena cava - Eustachian valve
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What muscles are found in the ventricles? How are they arranged?
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Trabeculae carnea - irregular arrangements
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Why is the irregular arrangement of trabeculae carnea good?
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Because it allows 'wringing' for complete heart contraction.
-Also place for inserting a pacemaker wire. |
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So the 2 types of muscle in the ventricles are:
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-Trabeculae carnea
-Papillary muscles |
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What valve is seen in the right ventricle?
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Right AV Valve - tricuspid
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What are the cusps of the Tricuspid valve?
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-Anterior
-Septal -Posterior |
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What do the three cusps attach to?
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3 sets of Chordae tendinae, which attach to 3 sets of papillary muscles.
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What are the 2 components of the interventricular septum? How do you tell them apart?
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-Membranous (white/smooth)
-Muscular (muscle/trabeculated) |
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How many cusps does the Pulmonary valve have?
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4
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What is the major difference between the pulmonary valve and tricuspid?
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Pulmonary = passive
Tricuspid = muscled |
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Going back to atrium, what is the edge of the pectinate muscles called?
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Crista terminalis
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What important nervous tissue structure is located in the muscle at the bottom of the right ventricle?
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Moderator band
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What are the cusps of the pulmonary valve named?
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Right, left, and anterior
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What empties into the left atrium?
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the pulmonary veins
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What valve passes from left atrium to ventricle? What are its cusps named?
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Bicuspid or mitral valve.
Anterior/posterior cusps |
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What 2 parts of interventricular septum can be seen in the left ventricle?
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Muscular
Membranous |
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What 2 parts of Membranous Interventricular septum exist in the left ventricle?
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-Interventricular (between ventricles)
-Atrioventricular (between left ventricle and right atrium!) |
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What are the 3 cusps of the Aortic valve called?
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Right/Left, Posterior
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Where is the only pectinate muscle in the left atrium found?
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in the left AURICLE
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What are the outflow valves of the heart?
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-Pulmonary
-Aortic |
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Which outflow valve is located most anteriorly? What are its cusps named again?
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Pulmonary - R/L, ANTERIOR
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Which outflow valve is located most posteriorly? What are its cusps named?
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Aortic - R/L, Posterior
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What are the R/L cusps of the aortic arch associated with?
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R/L coronary arteries!
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What is the phase called when the AV valves are shut and Semilunar (outflow) valves open?
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Systole
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What is the phase called when AV valves are open and outflow valves shut?
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Diastole
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Where are the AV valves located in a superior view of the heart w/ atria removed?
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Posterior to the Aortic valve
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What is it called when valves can't open completely?
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Stenosis
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What is it called when valves don't shut completely?
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Insufficiency
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What might cause valve stenosis?
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Scarring or calcification - prevents the valve from opening.
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When would mitral valve stenosis occur?
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When the AV valves should be OPENING -> Diastole
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What happens to bloodflow when a valve is stenotic?
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It is slower
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So what would be the result of mitral valve stenosis?
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It would take longer for the left ventricle to fill, so the left atrium would hypertrophy as it has to work harder to move the blood.
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What would be the result of AV valve insufficiency?
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Retrograde flow of blood into the atria
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What pattern is the steth moved in to ausculatate heart sounds?
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Z shaped: APTM
Aortic, Pulmonary, Tricuspid, Mitral |
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When listening to heartbeats:
-What is 1st sound heard? -What is 2nd sound heard? |
1st = Aortic/pulmonary valves
2nd = Tricuspid/Mitral valves |
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In which IC space is:
-Aortic/Pulm valves? -Tricusp/Mitral valves? (for auscultation) |
AP = 2
TM = 4/5 |
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What is heard in the 4/5 IC space, just medial to MCL?
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The PMI - point of maximal impulse, aka Apical Heartbeat.
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When is the PMI or Apical heartbeat heard in the 6th IC space?
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In CHI when the left ventricle is enlarged.
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What are the VERY FIRST BRANCHES of the aorta?
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Coronary arteries
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In what layer of the heart do the coronary arteries run?
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Deep to epicardium, superficial to myocardium.
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What are the 2 main coronary arteries?
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Right coronary artery
Left coronary artery -associated with R/L cusps of the aortic valve. |
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What does the RCA lie within?
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Right AV sulcus
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What 6 parts of the heart are supplied by the RCA?
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-Right atrium
-Most of Right Ventricle -Diaphragmatic surface of Left Ventricle -SA node (60-70% of popultn) -AV node -Part of Interventric Septum |
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What is the RCA also a MAJOR supplier of?
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Posterior surf of heart
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What is the first branch of the RCA?
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Right atrial branch - runs under the auricle
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What important artery branches from the Right Atrial branch of RCA?
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SinoAtrial (SA) Nodal Branch
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Where is the SA node located?
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At the junction of SVC and Right atrium, backside of heart.
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Why is the Right Atrial branch so important then?
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Because it is the major blood supply to the conduction system of the heart.
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What is the 2nd branch of RCA? Where does it run?
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Right Marginal branch - runs down the right border of heart.
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What vein runs with the Right marginal branch?
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Small cardiac vein
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What is the 3rd branch of RCA? Where does it run?
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Posteror Interventricular Artery - runs down backside of heart.
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So 3 important branches of RCA:
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1. Right atrial
2. Right marginal 3. Posterior interventricular |
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Where does the Left Coronary Artery arise?
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Left aortic sinus of ascending aorta
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What areas of the heart are supplied by the LCA?
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-Left atrium
-Most of left ventricle -Most of Interventricular septum -AV Bundle |
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2 Main important branches of LCA:
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1. Left anterior descending (LAD)
2. Circumflex branch |
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What are the important coronary veins to know? (5)
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GSMOC
-Great cardiac vein (w/ LAD) -Small cardiac vein (w. RCA) -Middle cardiac vein (posterior) -Oblique Vein of L. Atrium -Cardiac Sinus |
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Where does the oblique vein of l. atrium come from/go?
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Extends over left atrium to merge w/ and form Coronary Sinus
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What is the Coronary Sinus?
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The place where all used coronary blood drains to go back to the heart for reoxygenation.
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What are the 2 main supplies of innervation to the heart?
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-Postsynaptic Sympathetic fibers
-Presynpatic Parasympath. fibers |
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What ganglia do the sympathetic fibers come from?
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-Sup/mid/inf cervical ganglia
-Paravertebral thoracic ganglia T1-T4 |
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What is the Stellate ganglia?
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Product of fusion of the Inferior cervical ganglion w 1st paravertebral T1 ganglion.
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What nerve carries preganglionic parasympathetic fibers to the heart?
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Vagus
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What do the right and left vagus nerves do in the thorax?
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Travel thru cardiac plexus at trachea bifurcation, no synapse, to Heart
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Where in the heart are intrinsic ganglia for the Vagus nerves located?
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-SA node
-AV node -Coronary arteries |
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What is the effect of Parasympathetic innervation of the heart via vagus nerves?
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-Decreased heart rate
-Constriction of coronary aa. -Decreased force of contraction |
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Where do the presynaptic sympathetic fibers for heart innervation originate?
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In the lateral horn of the spinal cord, T1-L2
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Where can the Postsynaptic sympathetic fibers for heart innervation originate?
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T1-T4, or any of the 3 cervical ganglia.
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Where do the postsynaptic sympathetic fibers for the heart travel?
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Through the sympathetic plexus, to the heart
-SA node -AV node -Coronary arteries |
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What is the effect of Sympathetic stimulation of the heart?
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-Increased heart rate
-Dilated coronary arteries -Increased force of contraction |
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What is the design for pre/postsynaptic fibers of the:
-Sympathetic NS? -Parasympathetic NS? |
Symp: Short pre, Long postganglionic fibers
Para: Long preganglionic fibers, Short post |
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How are the Right/Left Vagus nerves situated in ref to the trachea?
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LARP
Left is Anterior Right is Posterior |
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In contrast to the few visceral afferents carried by the Vagus, what visc afferents are carried by sympathetic fibers?
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Sensory and Pain fibers - sent via T1-T4 to spinal cord, then up to brain w/out synapsing.
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What is the main difference in Vagus nerve and Sympathetic nerves?
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PNS: innervates actual organ
SNS: innervates smooth muscle in blood vessels |
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What is Cardiac referred pain?
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The perception of pain as coming from superficial body parts, tho actually from the heart.
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Why does referred cardiac pain happen?
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B/c the visceral afferents in the sympathetic portion of the spinal cord enter with other somatic afferents and cutaneous nerves.
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Specifically what somatic afferents enter the spinal cord with cardiac visceral afferents?
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-Shoulder
-upper limb -Substernal -Pectoral |
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What cutaneous nerves enter the spinal cord w/ cardiac affernts?
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-Medial cutaneous nerves of arm
-Lateral cutaneous branches of 2/3rd intercostal spaces. |
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How does mixing of somatic and visceral afferents occur?
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The brain misinterprets the signals.
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Where are most of the visceral fibers of the heart? What is the result?
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On the left spinal cord - so referred pain is mostly perceived as being on the left side of the body.
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Why isn't visceral pain from lungs referred?
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B/c these fibers are carried by the Vagus nerves, and no somatic afferents mix with them.
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Within what layer of the heat is the Conduction system?
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Deep to the endothelium
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What nerve fibers supply the Sinoatrial node?
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Parasymp and Symp (already discussed)
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What is the SA node responsible for?
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Initiating and regulating impulses for contraction
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So what is the SA node called?
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The pacemaker
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Where does the impulse started by the SA node spread?
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-Thru musculature of the Atria
-Thru Internodal tracts to AV node |
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Where is the AV node located?
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In the interATRIAL septum near the coronary sinus opening.
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What is the function of the AV node?
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To pass along the signal from SA node to the ventricles
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What receives the impulse from the AV node?
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AV bundles of His
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Where does the impulse go from the Bundle of His?
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Splits into
-Right bundle branch -Left bundle branch |
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Where does the signal go from the Right bundle branch?
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Into the moderator band in trabeculae carnea of the right ventricle
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Where does the signal go from the Left bundle branch?
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Through the interventricular septum to divide anteriorly and posteriorly in the left ventricle.
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What branches off of the Bundle branches?
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Purkinje fibers
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Which side has more purkinje fibers?
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Left ventricle - needs more b/c it is much larger/thicker.
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