Anatomy Exam 4: Heart

Front 1

The central area of the thorax, located btwn the two pleural cavities is known as the what?

Back 1

mediastinum

Front 2

What are the borders of the mediastinum?

Back 2

-superior to inferior: superior thoracic aperture to diaphram
-anterior to posterior: sternum to vertebral bodies
-laterally: two pleural cavities

Front 3

The mediastiunum is divided into superior and inferior mediastinum, above and below the _______________

Back 3

sternal angle

Front 4

The inferior mediastinum is subdivided into what 3 mediastinums?

Back 4

anterior
middle
posterior

Front 5

The pericardium serves as the border for the (anterior/middle/posterior) mediastinum.

What does this mediastinum contains?

Back 5

middle mediastinum

contains:
pericardial sac
heart
origins of great vessels
phrenic nerves (C3,4,5)
pericardiacophrenic vessels

Front 6

The pericardium consists of two layers,what are they?

Back 6

Fibrous (outer) & serous (inner)

Front 7

The serous pericardium is further divided into the parietal and visceral layer, differentiate btwn the two

What is the potential space btwn the two layers called?

Back 7

parietal layer- lines inner surface of fibrous pericardium
visceral layer- tightly adherent to myocardium (epicardium)

pericardial cavity

Front 8

The arterial supply to the pericardium is mainly from what arteries?

Branches from what other 2 arteries may also contribute?

Back 8

mainly pericardiacophrenic arteries
(pericardiacophrenic from internal thoracic from subclavian*)

musculophrenic arteries & thoracic aorta may also contribute

Front 9

Innervation of pericardium

Back 9

Vagus nerve
Symphathetic trunks
Phrenic nerve

Front 10

Pain sensation from the pericardium is carried by what nerve?

Thus referred pericardium pain would likely be present where?

Back 10

phrenic nerve


neck/top of shoulder

Front 11

The serous pericardium forms 2 reflections where?

Back 11

1. around the aorta & pulmonary trunk
2. around the pulmonary veins & superior & inferior vena cava

Front 12

The reflection onto the pulmonary veins form the _____________________

Back 12

oblique pericardial sinus

Front 13

The two reflections form a passage behind the aorta & pulmonary trunk called the _________________________

Back 13

transverse pericardial sinus

*important surgical landmark, can put finger through sinus to separate and clamp ascending aorta & pulmonary trunk

Front 14

During development, the primordial arterial and venous ends are brought together to from __________________

Back 14

transverse pericardial sinus

Front 15

During developement, as the _____________ expand, the pericardial reflection is carried out around them to form the oblique pericardial sinus

Back 15

pulmonary veins

Front 16

Recognize structures on the anterior heart

Back 16

Front 17

Recognize structures on the posterior heart

Back 17

notice vena cava runs straight vertically

Front 18

The base of the heart is directed posteriorly & consits of the ________________, a portion of the right atrium, and the proximal parts of the _____ veins

Back 18

left atrium

great veins

Front 19

The apex of the heart is directed anteriorly and to the left and formed by the inferolateral part of the ___________

Back 19

left ventricle

Front 20

The heart has 4 surfaces and 4 chambers, what are they?

Back 20

surfaces: anterior, diaphragmatic, right and left pulmonary

chambers: right and left atriums, right and left ventricles

Front 21

Differentiate btwn the inferior and obtuse margins of the heart

Back 21

inferior margin- sharp edge btwn anterior & diaphragmatic surfaces

obtuse margin- separates the anterior and left pulmonary surfaces

Front 22

Identify the features w/i the Right Atrium
-Crista terminalis (sulcus terminalis)
-Sinus venarum (smooth posterior wall of artium)
-Fossa ovails & limbus
-pectinate muscule
-opening of superior vena cava & valve
-opening of inferior vena cava & valve
-right A-V orifice

Back 22

*sinus venarum is from sinus venosus
*fossa ovalis from foramen ovale
(probepatency = flap of tissue from foramen ovale that is not sealed, help shut by blood, present in 25% of people)

Front 23

Identify features w/i the Right Ventricle
-trabeculae carneae
-tricuspid valve (anterior, posterior, & septal cusps)
-chordae tendineae
-papillary muscle
-septomarginal trabecula (moderator band)
-conus arteriosus
-pulmonary valve (anterior, right, left cusps, nodule & lunule)

Back 23

cusps are named for their embryological position*

Front 24

Identify features w/i left atrium:
-pectinate muscle
-openings for pulmonary veins
-interatrial septum (valve of foramen ovale)
-left A-V opening

Back 24

*valve of foramen ovale less pronounced

Front 25

Features w/i left ventricle:
-trabeculae carnae
-left A-V valve/ bicuspid valve, mitral valve (anterior and posterior cusps)
-chordae tendineae
-anterior and posterior papillary muscle
-aortic vestibule
-aortic valve (posterior, right, & left cusps, nodule & lunule)

Back 25

Front 26

The ventricle wall of the (left/right) ventricle is MUCH thicker than the other.

Back 26

Left ventricle thicker

Front 27

Blood flow through the heart:
right side
left side

Back 27

right side -
body--> sup/inf VC--> right atrium-->tricuspid valve-->right ventricle-->pulmonary valve-->pulmonary trunk/aa-->lungs
left side-
lungs-->pulmonary veins-->L atrium--> bicuspid(mitral) valve--> L ventricle--> aortic valve--> body

Front 28

When atria contract, blood is forced into ventricles and AV valves are (closed/open)

when ventricles contract blood is forced to exit via aorta & pulmonary trunk, AV valves are (closed/open)

Back 28

atria contract= open

ventricle contracts= closed

Front 29

The _______________act to prevent valve prolapse.

Back 29

chordae tendinae (tendinious cords)

Front 30

Closure of the A-V valves produces the (first/second) heart sound

Closure of the aortica and pulmonary valves produces the (first/second) heart sound

Back 30

first (lubb) sound

second (dubb) sound

Front 31

The pulmonary & aortic valves are open during (aortic/ventricular) contraction, allowing blood to escape

Back 31

ventricular contraction

Front 32

After ventricular contraction, the recoil of blood fills the ________ & __________ sinuses, forcing the valves closed (& preventing backflow into ventricles)

Back 32

aortic & pulmonary sinuses

Front 33

The proper examination of the heart includes:

Back 33

visual inspection
palpation
percussion
ausculation
****know where you are!!

Front 34

Where are the heart borders in relation to surface anatomy?

Back 34

Upper limit:
3rd costal cartilage (R)
2nd intercostal space (L)
Right margin:
3rd to 6th costal cartilage
Left marigin:
2nd(near sternum) to 5th intercostal (near midclavicularline) space
Lower Limit:
6th costal cartilage at sternum (R) to 5th intercosta space near midclavicular line (L)

Front 35

Where do you listen to heart sounds on chest and w/i heart?

(hint: A PeT Monkey)

Back 35

Aortic valve
-medial end of R 2nd intercostal space
Pulmonary valve
-medial end of L 2nd intercostal space
Tricuspid valve
-slightly L of sternum near 5th intercostal space
Mitral valve
-L 5ht intercostal space at mid-clavicular line

Front 36

T/F
heart sound are best heard upstream from the flow of blood through the valve

Back 36

FALSE!

best heard DOWNSTREAM from flow!

Front 37

calcific aortic stenosis is primarily age related but will usually occur earlier & more aggressively when?

Back 37

in someone w/ a congenital valve malformation

Front 38

What may calcific aortic stenosis cause?

Back 38

systolic murmur, L ventricle hypertrophy, angina, syncope, heart failure, arrhythmia

Front 39

What is mitral stenosis?

What are 99% of cases secondary to?

Back 39

narrowing of the orific of the mitral valve

rheumatic fever

Front 40

In Mitral stenosis, blood flow from the L atrium to L ventricle is restricted, leading to what?

what may develop as a result of increased workload?

Back 40

blood pressure increaese in L atrium & pulmonary arteries

R ventricular hypertrophy

Front 41

The myocardium is supplied by what arteries?

Back 41

coronary arteries (R & L)

Front 42

What are the branches off the left (left main stem) and right coronary arteries?

Back 42

Left-
Anterior interventricular branch (LAD)
circumflex branch
left marginal branch
Right-
SA nodal branch (60% of time)
right marginal branch
posterior interventricular branch (PDA)(80% of time)

Front 43

How can you tell if a heart is right or left dominant/dominant coronary artery?

Back 43

Right dominant-
posterior interventricular branch arises from the RIGHT coronary artery (most people)

Left dominant-
posterior interventricular branch arises from an enlarged circumflex branch of the LEFT coronary artery

Front 44

Blood from the myocardium returns to the right atrium via the __________

Back 44

cardiac veins

Front 45

Cardiac veins:
Anterior, small, middle, & great

All drain into the coronary sinus except _______

Back 45

anterior cardiac vein does not

Front 46

What can happen when a coronary artery is blocked?

Back 46

angina pectoris= intermittent chest pain cuased by REVERSIBLE cardiac ischemia
or
myocardial infarction= localized area of myocardial necrosis induced by IRREVERSIBLE local ischemia (1.4 million per year in US)

Front 47

What is the most common cause of death in the US?
1/2 million or more deaths per year

Back 47

Coronary artery disease (CAD)

**50% of ppl die w/o receiving treatment

Front 48

Where are the 3 most common sites of coronary artery occlusion?

Back 48

1. anterior interventricular branch of LCA (40-50%)
2. RCA (30-40%)
3. circumflex branch of LCA (15-20%)

Front 49

2 most common treatments for occlusion?

Back 49

angioplasty
-use catheter to compact arterial walls, expanding lumen
coronary artery bypass surgery
-use another vessel to bypass occlusion

Front 50

T/F
Atherosclerosis leads to the formation of plaque along the walls of blood vessels

Back 50

FALSE!!!!!

plaque forms WITHIN the vessel wall

Front 51

What is the cardiac skeleton and what is its function?

Back 51

dense, fibrous CT, sits btwn atria & ventricles & forms a rings around each of the 4 heart valves
Functions:
-maintain structural integrity of openings
-provide attachment point for valve cusps
-electrically isolates atria from ventricles

Front 52

T/F
The heart consist of neural tissue

Back 52

FALSE
consists of specialized myocardial cells NOT neural tissue

Front 53

The heart is it's own conducting system & does not need input from the nervous system to beat rhythmically, HOWEVER the rate or force of contraction may be influenced by outside input via _____________

Back 53

cardiac plexus

Front 54

The cardiac plexus gets its main contributions from what?

Back 54

vagus nerve and cardiac branches from sympathetic trunk (T1-T4 cord levels)

-has deep and superficial parts

Front 55

The heart's conducting system consists of what?

Back 55

sinoatrial node (SA node)
atrioventricular node (AV node)
AV bundle
R & L bundle branches
Purkinje fibers