Cardiovascular

Front 1

Embryological sinus venosus gives rise to

Back 1

Sinus venarum cavarum\sinus of the vena cava (part of atrium)

Front 2

Embryological common atrium gives rise to

Back 2

Atrium - the part separated from sinus venarum cavarum\sinus of the vena cava by the crista terminalis\terminal crest

Front 3

Embryological ventricle gives rise to

Back 3

Ventricle - the inflow part

Front 4

Embryological bulbus cordis gives rise to

Back 4

a. Trabeculated part of right ventricle, conus cordis, truncus arteriosus (the outflow part)

b. Separated from the inflow part (primitive ventricle) by supraventricular crest

Front 5

Truncus arteriosus gives rise to

Back 5

Aorta + Truncus pulmonalis

Front 6

Sinus venarum cavarum\Sinus of vena cava

Back 6

The portion of the cavity of the right atrium that receives the blood from the venae cavae. It is separated from the rest of the atrium by the crista terminalis.

Front 7

Crista terminalis

Back 7

A vertical crest on the interior wall of the right atrium

Lies to the right of the sinus of the vena cava, and separates this from the remainder of the right atrium

Front 8

Common atrium

Back 8

A single abnormal atrium in a 3-chambered heart in which an interatrial septum is absent

Front 9

Sinus venosus

Back 9

A cavity at the caudal end of the embryonic cardiac tube in which the veins from the intra- and extraembryonic circulatory arcs unite

In the course of development it forms the portion of the right atrium knows in adult anatomy as the sinus of the vena cava

Front 10

Bulbus cordis

Back 10

A transitory dilation in the embryonic heart where the arterial trunk joins the ventral roots of the aortic arches

Front 11

Truncus arteriosus
a. what
b. derivative, how

Back 11

a. The common arterial trunk, the opening out of both ventricles in early fetal life

b. Later destined to be divided into aorta and pulmonary artery by development of the spiral septum

Front 12

Spiral (bulbar) septum\Aorticopulmonary septum
a. what
b. distal part - derived from, does
c. proximal part - derived from, does
d. aided by which cell type

Back 12

a. A septum dividing the embryonic bulbus cordis into pulmonary and aortic outflow tracts from the developing heart

b. The distal spiral septum is derived from the right and left truncal endocardial cushions and so separates the pulmonary and aortic orifices

c. The proximal spiral septum is derived from conal ridges (endocardial cushions), it is the portion of the septum that is incorporated into the membranous part of the interventricular septum

d. Neural crest

Front 13

Atrioventricular canal cushions\Endocardial cushions

Back 13

A pair of mounds (hauger) of embryonic CT covered by endothelium

They bulge into the embryonic AT canal

They are located one dorsally and one ventrally

They grow together and fuse with each other and with the lower edige of the septum primum, thus dividing the originally single canal into right and left AV orifices

Front 14

Septum primum

Back 14

A crescenteric septum in the embryonic heart

Develops on the dorsocephalic wall of the originally single atrium and initiates its partitioning into right and left chambers

The tips of the septum grows toward and fuse with the atrioventricular canal cushions

Front 15

Infundibulum\Conus arteriosus

Back 15

The left or anterosuperior, smooth-walled portion of the cavity of the right ventricle

Begins at the supraventricular crest and terminates in the pulmonary trunk

Front 16

Crista supraventricularis

Back 16

The internal muscular ridge that separates the conus arteriosus from the remaining part of the cavity of the right ventricle

Front 17

Borders of the heart

Back 17

1. Margo dexter\Right border \ Margo acutus

2. Margo sinister\Left border \ Margo obtusus

Front 18

Incisura apicis cordis\Notch of cardiac apex

Back 18

A slight notch near the apex of the heart where the anterior interventricular sulcus reaches the diaphragmatic surface

Front 19

Surfaces of the heart

Back 19

1. Facies sternocostalis\Sternocostal surface

2. Facies diaphragmatica\Diaphgragmatic surface

3. Facies pulmonalis dextra\sinistra \ Right\Left pulmonary surfaces

Front 20

Components or systems of the heart

Back 20

1. Working myocardium

2. Excitomotor apparatus (EA)\conducting m.

3. Fibrous skeleton of the heart

Front 21

Endocardium - layers & composition

What special structures do they form?

Back 21

1. Endothelial

2. Subendothelial (collagenous fibres)

3. Fibromuscular (collagenous, elastic CT, smooth muscle cells, thicker in atria)

4. Subendocardial (loose CT, contain branches of the conducting system (Purkinje fibers\Subendocardial rami of AV bundles)

Endocardium forms heart valves

Front 22

Composition and attachment of heart valves

Back 22

Duplication of endocardium with internal fibrous lamina (collagenous + elastic fibers) and endothelium superficially)

Attached to fibrous anuli\fibrous rings

(no blood or lymph supply)

Front 23

Myocardium - the layers in the ventricles

Back 23

1. Spiral (vortex (L. whirlpool))

2. Circular

3. Longitudinal

Front 24

How many times thicker is the myocardium in the left ventricle than in the right?

Back 24

3x

Front 25

Atrial myocardium
a. Number of layers
b. Name of the internal layer

Back 25

a. 2 layers
b. The internal is the pectinate muscles (muscli pectinati)

Front 26

Pericardium - parts

Back 26

1. Fibrous pericardium (Pericardium fibrosus)
a. Sternopericardial ligaments (Ll. sternopericardiaca)
b. Pleuropericardial fold (Membrana bronchopericardiaca)

2. Serous pericardium (pericardium serosum)
a. Parietal layer (lamina parietalis) of pericardium
b. Visceral layer (lamina visceralis) of epicardium
Subserosa (tela subserosa): loose CT, fat, vessels

Front 27

Cavitas pericardii
a. Spaces
b. Liquor pericardii ?

Back 27

a. sinus obliquus, sinus transversus

b. 20 mL

Front 28

Puncture of pericardium is obtained via

Back 28

Left parasternal 4th\5th intercostal space (watch for vasa thoracica int.)

Front 29

Pleuroparicardial fold\membrana bronchopericardiaca
a. what
b. effect
c. formed by

Back 29

a. A tissue fold jutting (stikke frem i) into the right or left embryonic pericardioperitoneal canal

b. It separates the developing pericardium from the pleural cavity

c. Formed by the growth of the common cardinal veins to the midline of the body

Front 30

Pericardioperitoneal canal\Pleural canal
a. what
b. develops into

Back 30

a. The portion of the embryonic celom that joins the pericardial cavity to the peritoneal cavity

b. Develops into the pleural cavities

Front 31

Sinus obliquus\Oblique pericardial sinus

Back 31

The recess in the pericardial cavity posterior to the base of the heart bounded laterally and superiorly by the pericardial reflections on the pulmonary veins and inferior vena cava, and posteriorly by the pericardium overlying the anterior aspect of the esophagus

Front 32

Sinus transversus\Transverse pericardial sinus

Back 32

a passage within the pericardial sac, between the aorta and pulmonary trunk cranioventrally, and the left atrium and SVC dorsally.
(Formed as a result of the flexure of the heart tube, partially approximating the great venous and arterial vessels)

Front 33

Clinical application of pericardial sinuses

Back 33

Can be used used as entrance to open heart surgery and to pass ligatures in afterward

Front 34

Mesocardium??

Back 34

find answer

Front 35

Neurovascular supply of pericardium

Back 35

Phrenic nerve
Pericardiophrenic vessels

Front 36

2 Disposing factors for hypoxia of left ventricular subendocardial layers

Back 36

1. The thicker muscular wall of the left ventricle cause increased risk of hypoxia

2. The worse blood supply of the subendocardial layers also cause increased risk of hypoxia

Front 37

Biochemical cardial tests

Back 37

1. Troponins
2. CK MB
3. Myoglobin

Front 38

By-passing - used vessels

Back 38

1. Venous grafts: great saphenous vein
2. Arterial grafts: radial artery (Allen's test)
3. Artery lifting (internal thoracic artery, left gastroomental artery)

Front 39

PTCA - abbreviation

Back 39

Percutaneous transfemoral coronary angioplasty

Front 40

Valves in right atrium with synonyms

Back 40

1. Valve of IVC (Eustachian valve)
2. Valve of coronary sinus (Thebesian valve)

Front 41

Thebesian circulation
a. What
b. Where
c. Open into, synonyms (3)

Back 41

a. The system of smaller veins in the myocardium - called smallest cardiac veins\Thebesian veins.

b. Most numerous in right atrium, least in left ventricle

c. Open into openings of smallest cardiac veins (Thebesian\Lannelongue foramina) in the wall of the right atrium

(They drain the myocardium and pass through the endocardial layer to empty directly into the right atrium)

Front 42

Limbus (border, edge) fossa ovalis
a. synonym
b. what

Back 42

a. Vieussens anulus
b. A muscular ring surrounding the fossa ovalis in the wall of the right atrium of the heart

Front 43

Foramen ovale

Back 43

The oval opening at the free margin of the septum secundum.

The persistent part of the septum primum acts as a valve during fetal life and normally postnatally becomes fused to the septum secundum to close it.

Front 44

Crista terminalis of right atrium

Back 44

A vertical crest on the interior wall of the right atrium that lies to the right of the sinus of the vena cava (sinus venarum cavarum) and separates this from the remainder of the right atrium

Front 45

Pectinate muscles

Back 45

Prominent ridges of atrial myocardium located on the inner surface of much of the right atrium and both auricles

Front 46

The floor of fossa ovalis is a remnant of

Back 46

Septum primum

Front 47

Atrioventricular triangle (trigonum nodi atrioventricularis)
a. what
b. where
c. synonym

Back 47

a. A roughly triangular area on the septal wall of the right atrium that mark the site of the AV node

b. Between the
1. septal cusp of the tricuspid valve,
2. coronary sinus orifice, in area of
a. Sinus septum (a small folding forming the medial end of the IVC, it is developed from the dorsal wall of the embryonic sinus venosus)
b. Eustachian ridge (small continuation of sinus septum)
3. tendon of Todaro (an inconsistent tendinous structure that extends from the right fibrous trigone of the heart toward the valve of IVC)

c. Triangle of Koch

Front 48

Cusps of tricuspid valve

Back 48

Anterior, posterior, septal

Front 49

Papillary muscle
a. what
b. how many

Back 49

a. One of the group of myocardial bundles which terminate in the chordae tendinae (that attach to the cusps of the AV valves.

b. Each ventricle has an anterior and a posterior papillary muscle, the right ventricle also has a septal papillary muscle (inconstant).

Front 50

False chordae tendinae (chordae tendinae falsae\spuriae)
a. what
b. what do they do

Back 50

a. Tendinous cords that do not attach to the leaflets of the AV valves.

b. They connect papillary muscles to each other or to the ventricular wall (including the IVS), or merely pass between two points on the ventricular wall (including the septum).

Front 51

Trabeculae carnae of right and left ventricles
a. what
b. synonym

Back 51

a. Muscular bundles on the lining walls of part of the ventricles of the heart
b. Rathke bundles

Front 52

Supraventricular crest

Back 52

The internal muscular ridge that separates the conus arteriosus from the remaining part of the cavity of the right ventricle

Front 53

Conus arteriosus
a. synonyms (2)
b. what
c. <-, ->

Back 53

a. Smooth parth (pars glabra) of right ventricle\Infundibulum

b. The left or anterosuperior, smooth-walled portion of the cavity of the right ventricle.

c. <- Supraventricular crest, -> pulmonary trunk

Front 54

Pulmonary valve
a. Semilunar cusps\valvulae
b. Nodules of semilunar Cusps (Arantius nodule)
c. Lunula of semilunar cusps of aortic\pulmonary valves

Back 54

a. Anterior, left, right

b. A nodule at the center of the free border of each semilunar valve (both at pulmonary artery and aorta)

c. The free border of a cusp of the semilunar valves on each side of the nodules of the semilunar cusps

Front 55

Cusps of mitral valve

Back 55

Anterior & posterior

Front 56

Commissural cusps (Cuspides commissurales)

Back 56

Two small cusps (leaflet) that form the two outer of the three scallops (kamskjell) constituting the posterior cusp of the mitral valve

Front 57

Commissures of the semilunar cusps of the pulmonary valve

Back 57

a. Incisures lying at the fibrous ring between the different cusps

b.
1. Anterior commissure - right & left semilunar cusps
2. Right commissure - dorsal & right semilunar cusps
3. Left comissure - dorsal & left semilunar cusps

Front 58

a. Cusps\valvulae of aortic valve

b. Other featuers (4)

Back 58

a. Right, left, posterior

b. Arantius nodules\nodules of semilunar cusps, lunulae, commissurae, aortic sinus (Valsalva sinus)

Front 59

Aortic sinus (Valsalva sinus)

Back 59

The space between the superior aspect of each cusp of the aortic valve and the dilated portion of the wall of the ascending aorta, immediately above each cusp

Front 60

Back 60

1. Anulus trunci pulmonalis
2. (Tendo infundibuli (fibrous connection between right side of anulus trunci pulmonalis & anulus aorticus)
3. Anulus aorticus
4. AV septum
5. Membranous part of IVS
6. Anulus fibrosus dexter
7. Todaro tendon (tendon of valve of IVC of Todaro)(tendo valvulae IVC Todaroi)
8. Anulus fibrosus sinister
9. Trigonum fibrosum dexter
10. Triognum fibrosum sinister

Front 61

Fibrous skeleton of heart
a. what
b. forms

Back 61

a. A complex framework of dense collagen

b.
1. form four fibrous rings (annuli fibrosi) which surround the ostia of the valves
2. A right and left fibrous trigone (formed by connecting the rings)
3. The membranous portion of the interatrial and interventricular septa

Front 62

Fibrous skeleton of heart\cardiac skeleton - functions

Back 62

1. Contribute reinforcement of the valvular ostia while providing attachment for the leaftlets and cusps of the valves

2. Providing origin and insertion for the myocardium

3. Electric "insulator", only provide passage for the AV bundle of conductive tissue through the right fibrous trigone and membranous IVS

Front 63

Right fibrous trigone of heart\Trigonum fibrosum dextrum

Back 63

The part of the fibrous skeleton of the heart located between the aortic fibrous ring and rings surrounding the right and left AV ostia

(1 Left fibrous trigone
2. Right fibrous trigone
3. Anulus fibrosus aorticus
4. Anulus fibrosus trunci pulmonalis
5. Anulus fibrosus sinister
6. Anulus fibrosus dexter)

Front 64

Left fibrous trigone of heart\Trigonum fibrosum dextrum

Back 64

The part of the fibrous skeleton of the heart located in the interval between the left side of the AV ring and the aortic ring

(1 Left fibrous trigone
2. Right fibrous trigone
3. Anulus fibrosus aorticus
4. Anulus fibrosus trunci pulmonalis
5. Anulus fibrosus sinister
6. Anulus fibrosus dexter)

Front 65

Draw the cardiac skeleton - include
1. Annuli fibrosi dexter & sinister
2. Anulus fibrosus aorticus, anulus trunci pulmonalis
3. Trigonum fibrosum dexter & sinister

Back 65

1 Left fibrous trigone
2. Right fibrous trigone
3. Anulus fibrosus aorticus
4. Anulus fibrosus trunci pulmonalis
5. Anulus fibrosus sinister
6. Anulus fibrosus dexter

Front 66

Draw the cardiac skeleton - include
1. Annuli fibrosi dexter & sinister
2. Anulus fibrosus aorticus, anulus trunci pulmonalis
3. Trigonum fibrosum dexter & sinister

Back 66

1 Left fibrous trigone
2. Right fibrous trigone
3. Anulus fibrosus trunci pulmonalis
4. Anulus fibrosus aorticus
5. Anulus fibrosus sinister
6. Anulus fibrosus dexter

Front 67

Coronary veins - systems

Back 67

1. Emptying into coronary sinus
2. Anterior cardiac veins\Anterior veins of right ventricle (venae ventriculi dextri anteriores)
3. Smallest cardiac veins (Thebesian circulation)(Venae cordis minimae)

Front 68

Valves in coronary veins?

Back 68

No

Front 69

Coronary lymph drainage

Back 69

3 plexuses
2 trunks
a. left to right lymphatic duct
b. right to thoracic duct

Front 70

Right coronary artery
a. <-
b. branches, % of AV and SA branches

Back 70

a. <- right aortic sinus (Valsalva sinus)
b.
1. conus cordis (conus arteriosus) b. -> Vieussen's circle (arterial circle formed by right and left conus arteriosus branches at the start of the pulmonary trunk)
2. Atrial bb
a.Sinuatrial node branch - 65%
3. Right marginal branch (r. marginalis dexter (RMD))
4. Posterior interventricular branch (r. interventricularis posterior (RIP))
6. AV nodal branch (80%)
7. Right posterolateral branch (r. posterolateralis dexter (RPLD) (to back of left ventricle)

Front 71

Left coronary artery
a. <-
b. branches

Back 71

a. <- right aortic\valsalva sinus, (continues 2-3cm before branching)
b.
1. anterior interventricular branch (r. interverntricularis anterior (RIA)
a. Conus arteriosus branch (r. coni arteriosi) -> Vieussen's circle
b. Diagonal branch (r. diagonalis (RD)
2. Cricumflex branch (r. circumflexus (RC))
a. Atrial branches
b. Left marginal branch (r. marginalis sinister (RMS))
c. Left posterolateral branch (r. posterolateralis sinister (RPLS))
d. Intermediate branch (r. intermedius (RIM)) (from bifurcation of LCA)

Front 72

Auscultation points\Testut points

Back 72

1. Mitral valve -> left medioclavicular line in 5th intercostal space

2. Tricuspid valve -> left parasternal line in 4th intercostal

3. Aortic valve -> right parasternal line in 2nd intercostal space

4. Pulmonary valve -> left parasternal line in 2nd intercostal space

5. Erb's point (for murmurs) -> left parasternal line in 3rd intercostal space

Front 73

SA nodal branch
a. path when arising from RCA, %
b. path when arising from LCA, %

Back 73

a. SA nodal branch <- ascending atrial branch <- anterior stem of RCA (65%)

b. SA nodal branch <- circumflex branch <- LCA (35%)(run around the base of SVC to reach the SA node)

Front 74

Sinuatrial node
a. Synonyms
b. Location

Back 74

a. Flack\Keith\Keith-Flack node
b. Under the epicardium at the upper end of sulcus terminalis

Front 75

Bachmann bundle

Back 75

Division of the theoretical anterior internodal tract that continues into the left atrium, thus providing a specialized path for interatrial conduction

(the anatomic reality of this structure has been disputed)

Front 76

Wenckebach bundle

Back 76

Middle internodal tract

Front 77

Thorel bundle

Back 77

Posterior internodal tract

Front 78

Back 78

Front 79

Kent bundle
a. what, where
b. cause
c. treated by

Back 79

Accessory pathway between atria a. and ventricle (left: type A pre-excitation, right: type B pre-excitation)

b. Presence cause WPW syndrome

c. Treated by catheter ablation

Front 80

AV block

Back 80

1. 1st degree, > 0.2s
2. 2nd degree,
a. Type 1 Mobitz\Wenckebach - progressive
b. Type 2 Mobitz\Hay - regular loss of AV conduction
3. 3rd degree - total

Front 81

AV bundle (His, Gaskell, Keith)
a. What
b. Path

Back 81

a. The bundle of modified cardiomyocytes that begins at the AV node as the trunk of the AV bundle and passes through the right AV fibrous ring to the membranous part of the IVS where the trunk divides into two branches, the right bundle (crus dextrum) of the AV bundle and the left (Tawara bundles)

The two crura ramify in the subendocardium of their respective ventricles

Front 82

Purkinje fibers\Subendocardial branches of AV bundles

Back 82

Interlacing fibers formed of modified cardiomyocytes. They are the terminal ramifications of the conducting system of the heart found beneath the endocardium of the ventricles

Front 83

Purkinje cardiomyocytes - characteristics

Back 83

1. Larger
2. Lighter cytoplasm, with central granulations
3. Transverse striated peripheral portion

Front 84

Septomarginal trabecula
a. what
b. synonym

Back 84

a. One of the trabeculae carneae (muscular bands\ridges) in the right ventricle that carries part of the right branch of the AV bundle from the septum to the anterior papillary muscle

b. moderator band

Front 85

Sympathetic cardiac innervation
a. nerves

Back 85

1. Superior, middle and inferior cervical cardiac nerves (from sympathetic trunk ganglia with same name, inf = stellate)
2. Thoracic cardiac nerves (T2-T5)

(All are cardiopulmonary splanchnic nerves)
(also carry afferent fibers : T1-T5)

Front 86

Sympathetic cardiac innervation - effect

Back 86

Positive
1. Dromotropic (speed of conduction, esp. in AV node)
2. Bathmotropic (modification of threshold of excitation)
3. Inotropic (contractility)
4. Chronotropic (rate)

effects

Front 87

Parasympathetic innervation of heart - nerves

Back 87

Branches from vagus nerve
1. Sup. (base of skull) & inf. (root of neck) cervical cardiac branches
2. Thoracic cardiac branches

(have reflex afferent fibers as well)

Front 88

Anterior cardiac veins

Back 88

2-3 small cardiac veins in the anterior wall of the right ventricle that open directly into the right atrium independently of the coronary sinus

Front 89

Anterior cardiac veins

Back 89

2-3 small cardiac veins in the anterior wall of the right ventricle that open directly into the right atrium independently of the coronary sinus

Front 90

Valve of Vieussens

Back 90

A prominent valve in the great cardiac vein where it turns around the obtuse margin to become the coronary sinus

Front 91

Cardiac veins draining into coronary sinus
Accompanying artery

Back 91

1. Great cardiac vein (circumflex branch of LCA, anterior interventricular branch of LCA)
2. Middle cardiac vein (posterior interventricular branch of RCA)
3. Small cardiac vein (RCA in coronary sulcus) (right marginal vein drains into it)

Front 92

Cardiac veins draining into coronary sinus
Accompanying artery

Back 92

1. Great cardiac vein (circumflex branch of LCA, anterior interventricular branch of LCA)
2. Middle cardiac vein (posterior interventricular branch of RCA)
3. Small cardiac vein (RCA in coronary sulcus)

Front 93

Trusts - Duties of Trustee

The trustee had a duty to make sure the beneficiary wasn't drinking SPOILED CABS.

Back 93

The trustee is the legal owner of trust property, who holds it for the benefit of the beneficiaries. Legal title to, and responsibility for, the management of the trust res resides in the trustee. The beneficiaries are the beneficial owners of the trust assets, but cannot ordinarily affect or alter the dispositive or administrative provisions of the trust.

A trustee cannot be a minor, mentally incompetent person, a nondomiciliary alien, a felon, or someone who does not possess the requisite ability because of substance abuse, dishonesty, or improvidence. The court may also refuse to allow someone who does not read and write English to serve as the trustee. A corporation can serve as a trustee also. Any interested party may seek removal or suspension of a trustee for insolvency or threatened insolvency or unsuitability. Any other power to remove trustees must be granted in the trust instrument. A trustee who has accepted the position cannot resign as of right; his resignation must be accepted by the court.

The duties are SPOILED CAB.

Hint 93

refrain from SELF-DEALING (duty of loyalty)

PROTECT the corpus of the trust by preserving principal and diversifying the trust portfolio.

refrain from usurping OPPORTUNITIES available to trust (duty of loyalty)

INFORM settlor and beneficiaries of transactions involving more than 25% of trust assets and wait for objections prior to executing the transaction

LITIGATE on behalf of the trust when necessary

EXERCISE degree of care, skill and prudence which would be exercised by a reasonably prudent person in managing his/her own property

avoid DELEGATION of duties involving judgment, discretion or power of appointment (proper administration)


COMPLY with terms & duties under trust

detailed ACCOUNTING, including earmarking and

refrain from BORROWING funds from the trust (duty of loyalty)

SEGREGATING trust assets separately from personal assets