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144 Cards in this Set

  • Front
  • Back
Where is the phrenic nerve located in the thorax?
Runs down from behind anterior scalene, to between pleura and pericardium, all the way down to diaphragm
What runs with the phrenic nerve between the pleura and pericardium?
Pericardiophrenic artery/vein
What is the Pericardium?
Membrane covering the heart
2 Divisions of pericardium:
Outer - fibrous - parietal
Inner - serous - visceral
What is the visceral pericardium also called?
What is the outer pericardium fused with?
Adventitia of blood vessels
What is the inferior border of the fibrous pericardium fused to?
What artery lies just anterior to the pericardial sac?
Internal thoracic artery
What happens to the internal thoracic artery at pericardial base & junction with diaphragm?
Splits into:
-superior epigastric artery (pierces diaphragm)
-Musculophrenic artery
What 2 important sinuses are located in the mediastinum?
-Oblique pericardial sinus

-Transverse pericardial sinus
What/where is the Oblique pericardial sinus?
A blind ended space on the back side of heart (between r/l pulmonary veins going into the heart).
What/where is the Transverse pericardial sinus?
A space passing under the pulmonary trunk and aortic arch.
Why isthe Transverse pericardial sinus important to surgeons?
They can insert index finger into the sinus, squeeze on aorta w/ thumb, to close these off when setting up a heart/lung machine.
What part of the heart CAN'T be seen from an anterior view? Why do we care?
Left atrium - important in radiology images
How is the heart location described in adults?
Retrosternal and Left Peristernal
How can the heart position differ in a child vs adult?
Might be closer to the middle of the chest.
What type of innervation does the phrenic nerve carry?
MIXED - both motor and sensory
3 important vessels seen coming off the heart from ant view: (left to right)
1. Superior vena cava
2. Ascending Aortic arch
3. Pulmonary trunk
Bottom of heart = ____

Top of heart = _____
Bottom = apex

Top = base
What is the PMI and where is it located?
PMI = point of maximal impulse, the apical heartbeat.
Located at 5th IC space, medial to the midclavicular line.
Where is Conus arteriosus loated?
At the outflow of the right heart - pulmonary trunk.
Where is the anterior interventricular sulcus? What lies within it?
Sulcus = between right/left ventricles; LAD of left coronary artery runs in it.
Where is the Coronary sulcus and what lies within it?
Coronary sulcus = between right auricle and ventricle; Right Coronary Artery (RCA) lies within it.
What is Ligamentum Arteriosum?
A ligament connecting the pulmonary trunk to aortic arch
What nerve runs just under ligamentum arteriosum?
Recurrent laryngeal nerve
What valve is located between RA and RV?
Right AV valve - tricuspid
What valve is located between LA and LV?
Left AV valve - bicuspid (mitral)
Where are the semilunar valves?
At outflow regions to
-lungs (pulm semilunar valve) -systemic circulation (aortic semilunar valve)
Which heart chamber is thickest?
Left ventricle - has to develop about 120 mm Hg
What do Chordae tendinae do?
Attach valve leaflets to papillary muscles
What causes the heart AV valves to close?
Contraction of papillary muscles
Where is the posterior interventricular sulcus? What lies within it?
Between the right/left ventricles on posterior heart; Contains interventricular branch of RCA
What are the right atrium walls like? Why?
Thin - only needs to generate about 15 mm Hg
What appendage sticks off right atrium? What's in it?
Right auricle - embryonic remnant that contains contractile muscle.
What type of muscle is in the atrial walls?
what does pectinate mean? what does it look like?
comb-like, orderly arrangement.
What 3 things empty into the right atrium?
-Superior vena cava
-Inferior vena cava
-Coronary sinus
What hole remnant is found in the right atrium?
Fossa ovalis
Quick review: what are the pericardial layers around the heart?
Outermost = fibrous
Inner = serous
-Serous outer folds over on itself and makes
-Serous Epicardial layer
Which pericardial layer is innermost?
Epicardial - runs along the surface of heart.
Where are the coronary arteries located in ref to pericardial layers?
Deep to the epicardium.
What is the big difference between Pericardium and Pleura?
Pericardium = fixed size
Parietal Pleura = stretchable
What heart layer is deep to the epicardium?
What is the Myocardium?
Thick layer of heart muscle
What layer is deep to the Myocardium?
What is the endocardium?
Thick endothelial lining of the ventricles
What is the importance of the Oblique Pericardial sinus
Its propensity for infection and tumors
Again: in which IC space is the heart apex located?
4th or 5th
In which IC space is the heart base located?
Where is the heart in ref to MCL?
So where is the PMI?
Which Vena cava has a valve? what is it called?
Only inferior vena cava - Eustachian valve
What muscles are found in the ventricles? How are they arranged?
Trabeculae carnea - irregular arrangements
Why is the irregular arrangement of trabeculae carnea good?
Because it allows 'wringing' for complete heart contraction.
-Also place for inserting a pacemaker wire.
So the 2 types of muscle in the ventricles are:
-Trabeculae carnea
-Papillary muscles
What valve is seen in the right ventricle?
Right AV Valve - tricuspid
What are the cusps of the Tricuspid valve?
What do the three cusps attach to?
3 sets of Chordae tendinae, which attach to 3 sets of papillary muscles.
What are the 2 components of the interventricular septum? How do you tell them apart?
-Membranous (white/smooth)
-Muscular (muscle/trabeculated)
How many cusps does the Pulmonary valve have?
What is the major difference between the pulmonary valve and tricuspid?
Pulmonary = passive

Tricuspid = muscled
Going back to atrium, what is the edge of the pectinate muscles called?
Crista terminalis
What important nervous tissue structure is located in the muscle at the bottom of the right ventricle?
Moderator band
What are the cusps of the pulmonary valve named?
Right, left, and anterior
What empties into the left atrium?
the pulmonary veins
What valve passes from left atrium to ventricle? What are its cusps named?
Bicuspid or mitral valve.
Anterior/posterior cusps
What 2 parts of interventricular septum can be seen in the left ventricle?
What 2 parts of Membranous Interventricular septum exist in the left ventricle?
-Interventricular (between ventricles)
-Atrioventricular (between left ventricle and right atrium!)
What are the 3 cusps of the Aortic valve called?
Right/Left, Posterior
Where is the only pectinate muscle in the left atrium found?
in the left AURICLE
What are the outflow valves of the heart?
Which outflow valve is located most anteriorly? What are its cusps named again?
Pulmonary - R/L, ANTERIOR
Which outflow valve is located most posteriorly? What are its cusps named?
Aortic - R/L, Posterior
What are the R/L cusps of the aortic arch associated with?
R/L coronary arteries!
What is the phase called when the AV valves are shut and Semilunar (outflow) valves open?
What is the phase called when AV valves are open and outflow valves shut?
Where are the AV valves located in a superior view of the heart w/ atria removed?
Posterior to the Aortic valve
What is it called when valves can't open completely?
What is it called when valves don't shut completely?
What might cause valve stenosis?
Scarring or calcification - prevents the valve from opening.
When would mitral valve stenosis occur?
When the AV valves should be OPENING -> Diastole
What happens to bloodflow when a valve is stenotic?
It is slower
So what would be the result of mitral valve stenosis?
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.
What would be the result of AV valve insufficiency?
Retrograde flow of blood into the atria
What pattern is the steth moved in to ausculatate heart sounds?
Z shaped: APTM
Aortic, Pulmonary,
Tricuspid, Mitral
When listening to heartbeats:
-What is 1st sound heard?
-What is 2nd sound heard?
1st = Aortic/pulmonary valves

2nd = Tricuspid/Mitral valves
In which IC space is:
-Aortic/Pulm valves?
-Tricusp/Mitral valves?
(for auscultation)
AP = 2

TM = 4/5
What is heard in the 4/5 IC space, just medial to MCL?
The PMI - point of maximal impulse, aka Apical Heartbeat.
When is the PMI or Apical heartbeat heard in the 6th IC space?
In CHI when the left ventricle is enlarged.
What are the VERY FIRST BRANCHES of the aorta?
Coronary arteries
In what layer of the heart do the coronary arteries run?
Deep to epicardium, superficial to myocardium.
What are the 2 main coronary arteries?
Right coronary artery
Left coronary artery
-associated with R/L cusps of the aortic valve.
What does the RCA lie within?
Right AV sulcus
What 6 parts of the heart are supplied by the RCA?
-Right atrium
-Most of Right Ventricle
-Diaphragmatic surface of Left Ventricle
-SA node (60-70% of popultn)
-AV node
-Part of Interventric Septum
What is the RCA also a MAJOR supplier of?
Posterior surf of heart
What is the first branch of the RCA?
Right atrial branch - runs under the auricle
What important artery branches from the Right Atrial branch of RCA?
SinoAtrial (SA) Nodal Branch
Where is the SA node located?
At the junction of SVC and Right atrium, backside of heart.
Why is the Right Atrial branch so important then?
Because it is the major blood supply to the conduction system of the heart.
What is the 2nd branch of RCA? Where does it run?
Right Marginal branch - runs down the right border of heart.
What vein runs with the Right marginal branch?
Small cardiac vein
What is the 3rd branch of RCA? Where does it run?
Posteror Interventricular Artery - runs down backside of heart.
So 3 important branches of RCA:
1. Right atrial
2. Right marginal
3. Posterior interventricular
Where does the Left Coronary Artery arise?
Left aortic sinus of ascending aorta
What areas of the heart are supplied by the LCA?
-Left atrium
-Most of left ventricle
-Most of Interventricular septum
-AV Bundle
2 Main important branches of LCA:
1. Left anterior descending (LAD)
2. Circumflex branch
What are the important coronary veins to know? (5)
-Great cardiac vein (w/ LAD)
-Small cardiac vein (w. RCA)
-Middle cardiac vein (posterior)
-Oblique Vein of L. Atrium
-Cardiac Sinus
Where does the oblique vein of l. atrium come from/go?
Extends over left atrium to merge w/ and form Coronary Sinus
What is the Coronary Sinus?
The place where all used coronary blood drains to go back to the heart for reoxygenation.
What are the 2 main supplies of innervation to the heart?
-Postsynaptic Sympathetic fibers
-Presynpatic Parasympath. fibers
What ganglia do the sympathetic fibers come from?
-Sup/mid/inf cervical ganglia
-Paravertebral thoracic ganglia T1-T4
What is the Stellate ganglia?
Product of fusion of the Inferior cervical ganglion w 1st paravertebral T1 ganglion.
What nerve carries preganglionic parasympathetic fibers to the heart?
What do the right and left vagus nerves do in the thorax?
Travel thru cardiac plexus at trachea bifurcation, no synapse, to Heart
Where in the heart are intrinsic ganglia for the Vagus nerves located?
-SA node
-AV node
-Coronary arteries
What is the effect of Parasympathetic innervation of the heart via vagus nerves?
-Decreased heart rate
-Constriction of coronary aa.
-Decreased force of contraction
Where do the presynaptic sympathetic fibers for heart innervation originate?
In the lateral horn of the spinal cord, T1-L2
Where can the Postsynaptic sympathetic fibers for heart innervation originate?
T1-T4, or any of the 3 cervical ganglia.
Where do the postsynaptic sympathetic fibers for the heart travel?
Through the sympathetic plexus, to the heart
-SA node
-AV node
-Coronary arteries
What is the effect of Sympathetic stimulation of the heart?
-Increased heart rate
-Dilated coronary arteries
-Increased force of contraction
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
How are the Right/Left Vagus nerves situated in ref to the trachea?
Left is Anterior
Right is Posterior
In contrast to the few visceral afferents carried by the Vagus, what visc afferents are carried by sympathetic fibers?
Sensory and Pain fibers - sent via T1-T4 to spinal cord, then up to brain w/out synapsing.
What is the main difference in Vagus nerve and Sympathetic nerves?
PNS: innervates actual organ

SNS: innervates smooth muscle in blood vessels
What is Cardiac referred pain?
The perception of pain as coming from superficial body parts, tho actually from the heart.
Why does referred cardiac pain happen?
B/c the visceral afferents in the sympathetic portion of the spinal cord enter with other somatic afferents and cutaneous nerves.
Specifically what somatic afferents enter the spinal cord with cardiac visceral afferents?
-upper limb
What cutaneous nerves enter the spinal cord w/ cardiac affernts?
-Medial cutaneous nerves of arm
-Lateral cutaneous branches of 2/3rd intercostal spaces.
How does mixing of somatic and visceral afferents occur?
The brain misinterprets the signals.
Where are most of the visceral fibers of the heart? What is the result?
On the left spinal cord - so referred pain is mostly perceived as being on the left side of the body.
Why isn't visceral pain from lungs referred?
B/c these fibers are carried by the Vagus nerves, and no somatic afferents mix with them.
Within what layer of the heat is the Conduction system?
Deep to the endothelium
What nerve fibers supply the Sinoatrial node?
Parasymp and Symp (already discussed)
What is the SA node responsible for?
Initiating and regulating impulses for contraction
So what is the SA node called?
The pacemaker
Where does the impulse started by the SA node spread?
-Thru musculature of the Atria
-Thru Internodal tracts to AV node
Where is the AV node located?
In the interATRIAL septum near the coronary sinus opening.
What is the function of the AV node?
To pass along the signal from SA node to the ventricles
What receives the impulse from the AV node?
AV bundles of His
Where does the impulse go from the Bundle of His?
Splits into
-Right bundle branch
-Left bundle branch
Where does the signal go from the Right bundle branch?
Into the moderator band in trabeculae carnea of the right ventricle
Where does the signal go from the Left bundle branch?
Through the interventricular septum to divide anteriorly and posteriorly in the left ventricle.
What branches off of the Bundle branches?
Purkinje fibers
Which side has more purkinje fibers?
Left ventricle - needs more b/c it is much larger/thicker.