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165 Cards in this Set

  • Front
  • Back
What are the two layers of the pericardium?
1. Fibrous pericardium
2. Serous pericardium
Where is the fibrous pericardium attached?
Anteriorly to the sternum, posteriorly to structures in the posterior mediastinum, inferiorly to the diaphragm
What layer is the fibrous pericardium?
Outer layer
What are the two layers of the serous pericardium?
Parietal: lines the inside of the pericardium
Visceral: covers the heart, also called epicardium
What is the pericardial cavity?
The space between the two layers of serous pericardium
What are the two pericardial reflections?
1. Transverse sinus
2. Oblique sinus
Where is the transverse sinus?
Posterior to the ascending aorta and pulmonary trunk, and anterior to the superior vena cava, separates venous from artery
Where is the oblique sinus?
A recess posterior to the heart, blocked by the serous pericardium
Pericardial effusions?
fluid from pericardial capillaries collecting in the pericardial cavity
Cardiac Tamponade?
Excessive fluid accumulation that exerts pressure in the heart and affects action of the heart
What is the base of heart?
It is where all the vessels attach
What is the apex of the heart?
Inferior most portion of the heart. It is pointy
What does the coronary sulcus do?
Separates atria from ventricles
What is a sulcus?
A depression or groove
What does the anterior interventricular sulcus separate?
Left ventricle from the right ventricle
Position of the right atrium?
Right most
Position of the left ventricle?
Left most
Position of the right ventricle?
Anterior most
Position of the left atrium?
Posterior most
What is a coronary artery?
Artery delivering blood to the heart
What branches from the right coronary artery?
1. Sinoatrial nodal a.
2. Marginal a.
3. Posterior interventricular artery
4. Atrioventricular node artery
What arises from the left coronary artery?
1. Anterior interventricular a.
2. Circumflex a.
Where does the rt and lt coronary arteries come from?
rt and lt aortic sinus
What is a left coronary-artery dominant heart?
Left gives rise to the posterior interventricular artery (15% of time, rt=67%, balanced=18%)
What are the 3 cardiac veins and what do they drain?
GMS:
Great cardiac v. = drains the apex, anterior interventricular sulcus to the left side of the coronary sulcus
Middle cardiac v.= drains the apex, posterior interventricular sulcus to the right side of the coronary sinus
Small cardiac v.= travels with marginal artery
What drains the cardiac veins?
Coronary sinus
What plane of the heart would you take to see all 4 chambers
Slightly angled transverse plane
What forms the endocardial tubes and in what week do they appear?
The tubes are formed by angioblastic cords in splanchnic mesoderm during the 4th week
What are the three layers of the endocardial tubes?
1. endocardium- future internal endothelial lining of heart
2. Myocardium- muscular wall of the heart
3. Epicardium- Becomes the visceral pericardium
What separates the myocardium from the endocardium?
Cardiac jelly
What are epicardium cells derived from?
Mesothelial cells
What does lateral folding of the embryo cause?
endocardial tube fusing, craniocaudally
What does headfolding of the embryo cause?
The heart and pericardial cavity to lie ventral to the foregut, and caudal to the oropharyngeal membrane
How is the endocardial tube formed?
Endocardial cells grow and make a column, then apoptosis hollows out the inside to form a tube
What does the dorsal mesocardium do?
suspends the developing heart from the pericardial cavity
When is the dorsal mesocardium degraded?
Week 4
What does the primitive atria give rise to?
Auricle
What does the endocardial tube elongate to form?
ATABS(V)V
A: Primitive Atria (gives rise to auricle)
T: truncus arteriosus: Located cranially
A: Atrioventricular canal: separates primitive atria from primitive ventricle
B: Bulbus cordis: just caudal to truncus arteriosus
S(V): Sinus venosus: Located caudally, receives the umbilical, vitelline, and common cardinal veins
V: Ventricles
What causes shifting of the endocardial tube?
Different rates of growth
How is heart bending accomplished?
Ventricle and bulbous cordis grow more rapidly causes the tube to bend, leads to atrium and sinus venosus moving cranially, the ventricle moves caudally, bulbous cordis shifts to the right
What are the final heart positions after bending?
Atrium: dorsocranial location, widens laterally
Ventricle: caudal
Bulbus cordis: right side
When do the four septations occur?
concurrently
When does septation begin and end?
4th week to the 8th week
What forms endocardial cusions which project into the lumen?
Cell proliferation within the dorsal and ventral walls of the atrioventricular canal
What creates the septum intermedium?
Fused endocardial cushions
What does the septum intermedium separate?
The atrioventricular canal into left and right portions
What is the sinus venarum?
Smooth part of the posterior inner wall of the right atrium
What is the auricle?
Atrial appendage
What muscle does the auricle contain and what is it a convenient site for?
Pectinate mm which terminates on the crista terminalis... surgical access
What opens into the right atria?
VICTS:
Venae cordae minimae
Inferior VC
Coronary sinus
Tricuspid valve (anterior posterior and septal cusp)
Superior VC
What is an embryological remnant of the foramen ovale?
Fossa ovale
Where is the fossa ovalis located?
Interatrial septum to of the right atrium. it is a shallow translucent oval depression
What is an atrial septal defect?
Failure of the fossa to close allowing oxygenated blood from the left atrium to enter the right atrium.
How many openings does the left atrium have into the principal cavity?
4. 2 superior, 2 inferior, left and right
How many cusps does the mitral valve have?
bicuspide, anterior and posterior cusps
What separates the 2 forming atria?
The septum primum ( thin crescent shaped membrane, grows from the roof of the atrium fuses with endocardial cushions)
Septum secondum- thick septum
What is the foramen primum?
space between the septum primum and endocardial cushions, allows O2 blood to pass from rt to lt atrium
What is the foramen secondum?
Coalesced perforations in the septum primum as the foramen primum closes. Allows O2 to pass from the right atrium to left atrium
Characteristics of the septum secondum?
thick, originates from cranial wall of atrium
What is the foramen ovale?
Opening between free edge of septum secondum and septum primum.
What drains into the sinus venosus horns?
Common cardinal vitelline and umbilical veins
What forms the coronary sinus?
the shrunken left horn of the sinus venosus
What do veins that drain to the right horn anastomose to become?
Superior vena cava
What does the right horn become?
smooth walled portion of the right atrium
What does the primitive right atrium become?
right auricle and pectinate mm of the right atrium
What forms the smooth walled portion of the left atrium?
the root of the pulmonary vein
Papillary mm, where do they arise, attach and anchor?
Arise from the ventricular wall, attach to the leaflets of the tricuspid valve via chordae tendinae, anchor the cusps
What is the trabeculae carnea?
Irregular muscular elevations projecting from ventricular walls.
What is the conus arteriosus (infundibulum)?
Funnel shaped, smooth walled tube leading to the pulmonary trunk
What does a valve cusp consist of?
a nodule, lunule and sinus
Where is the pulmonary vale located and how many semilunar cusps does it have?
Apex of the conus arteriosus, 3 cusps
Which ventricle has finer and more numberous trabeculae carnae?
Left ventricle
How do the ventricles and great vessels form?
Bulbar and truncal ridges form on opposite internal walls of the bulbus cordis and truncus ateriosus, ridges proliferate in a spiral fashion, they meet at the midline to form the aorticopulmonary septum
What does the aorticopulmonary septum create?
Distinct aorta and pulmonary artery
What does the bulbus cordis form in each ventricle?
Conus arteriosus in the rt, aortic vestibule in the lt
When does partitioning of the bulbus cordis and truncus arteriosus occur?
at the 5th week
When do the ventricles separate?
4th week
What does the muscular interventricular septum develop from?
Base of the primitive ventricle
What is the interventricular foramen?
Space between the muscular interventricular septum and fused endocardial cushions
Membranous interventricular septum forms from what three sources?
Right bulbar ridge, the left bulbar ridge, and proliferation of the fused endocardial cushions
What is Hemopoiesis?
Development of blood
What type of cells do blood cells develop from?
Endothelial cells
What are the 3 primary sites of hematopoieses and during what times?
Yolk sac (3rd week - 2nd month)
Liver (starts 5th week, primary site 3-6 months)
Bone marrow (begins in 4th month and is primary from 7th month till birth)
Where does primitive blood circulation occur?
Yolk sac, chorion, embryo
What are the 3 major pairs of fetal arteries?
DUV:
Dorsal aortae (O2 to embryo)
Umbilical (Carry Deox blood from embryo to placenta)
Vitelline- O2 blood to the yolk Sac
What enlarges to form the aortic sac?
Cranial truncus arteriosus
How many aortic arches are there and what do they connect?
6 pairs, connect aortic sac to the dorsal aortae
Which aortic arch pairs degenerate?
1, 2, 5
What does the 3rd aortic arch become?
Proximal- common carotid arteries
Distal + Dorsal Aorta - Internal carotid arteries
What does the 4th aortic arch become?
Left- arch of the aorta
Right- proximal part of right sublcavian artery
What does the 6th aortic arch become?
Right of 6th degrades, Proximal- pulmonary arteries
Distal left- Ductus arteriosus
What does the ductus arteriosus do?
Allows blood between the aorta and pulmonary trunk, should become ligamentum arteriosum
What is the reason for the superior location of the right laryngeal nerve?
Degeneration of the 6th right arch allows the nerve to move superiorly in the body
What does the aortic sac become?
Arch of the aorta & Brachiocephalic artery
What are the 3 pairs of embryo veins?
Cardinal (from embryo), vitelline (from yolk sac), umbilical (carries O2 blood to embryo from placenta)
What forms the superior vena cava?
The right anterior cardinal and right common cardinal veins
What doe the following cardinal veins drain?
Anterior
Posterior
Common
Anterior- cranial
Posterior- caudal
Common- drains anterior and posterior
What does the Vitelline vein form in the:
duodenum?
Liver?
Cranial to liver, rt vitelline vein remains what?
Duodenum- portal vein
liver- hepatic vein
cranial to liver- hepatic inferior vena cava
What happens to the umbilical left and right?
Right degenerates,
left degnerates in region of liver and cranial to liver, Caudal to liver it enlarges to carry all blood from the placenta
What is the ligamentum teres?
What the left umbilical becomes after birth
What is the ductus venosus, and what does it become after birth?
The ductus venosus is a shunt between the umbilical vein and IVC. It becomes the ligamentum venosum
What is the path of blood through the heart?
SVC & IVC -> rt atrium -> rt ventricle -> pulmonary trunk -> pulmonary veins -> lt atria -> lt ventricle -> Aorta
What is the fetal circulation?
Most: umbilical -> ductus venosus -> SVC & IVC -> rt atrium -> foramen ovale -> lt atrium and on

Some rt atrium -> rt ventricle -> pulmonary trunk -> ductus arteriosus and into the aorta (90%) or into pulmonary circulation (10%)
What is the ductus arteriosus?
Shunt from the pulmonary trunk to the aortic arch
After birth what two things happen in circulation due to pressure changes in the chest due to breathing?
Foramen ovale closes (becomes the fossal ovalis) and the ductus arteriosus constricts (bradycinine) and eventually atrophies to ligamentum arteriosum
Adult circulation with valves?
Rt atrium -> tricuspid -> rt ventricle -> pulmonary valve -> arteries to veins to lt atrium -> mitral valve -> lt ventricle -> aortic valve
Sympathetic innervation of the heart?
Preganglion in T1-5 in the IMLCC

Postganglion from superior, middle and inferior cervical ganglia
Parasympathetic innervation of the heart?
Preganglionic fibers in vagus (CN X)
SA location and what does it receive innervation from?
SA node (wall of rt atrium) receives symp & parasym innervation from cardiac plexus
Pathway electrical signal follows
SA node to AV to bundle branches to muscles
AV node location, bundle and branches
In the interatrial septum, AV bundle or bundle of HIS then the Right and left branches finally to the terminal subendocardial network
What is an atrial septal defect (ASD)? cyanotic?
Functioning opening between right and left atria, results in blood flow from left to right - due to failure of the septum primum to press against septum secondum - acyanotic
What are 2 causes of Atrial septal defects?
Abnormal resorption of septum primum
Inadequate development of septum secondum
What is a ventricular septal defect (VSD)? cyanotic?
Functional opening between the ventricles, most common cardiac defect- acyanotic
What is more common, membranous VSD or muscular VSD?
Membranous VSD
How does blood flow in VSD and the ASD? What does these do to infants?
from left to right - fatigue easier
What is the reason for VSD?
failure of tissue from endocardial cushions to fuse with aorticopulmonary septum
What are the four features of the tetralogy of Fallot?
PARV
Pulmonary stenosis: obstruction of right ventricle outflow
Aorta overrides VSD
Right ventricular hypertrophy
Ventricular septal defects
How does blood flow in the tetralogy and what does this lead to? And what is the shape of the heart in CXR?
Blood flow is from right to left, infant is cyanotic... Boot shaped appearance due to right ventricle hypertrophy
What is an explanation of tetralogy of Fallot?
Unequal division of the bulbus cordis by aorticopulmonary septum (gives large aorta and small pulmonary trunk)
What is persistent truncus ateriosus?

What defect is it accompanied by?
blood flow from both ventricles leaves by the same vessel i.e. pulmonary artery and aorta are not separated. Always accompanied by VSD
What is the embryological explanation for persistent truncus arteriosus?
Failure of truncal and bulbar ridges to develop hence:
1. no division of vessel
2. No membranous interventricular septum
What is transposition of the great vessels?
Aorta arises from right ventricle, pulmonary trunk arises from the left ventricle. Blood flows from system to right side to system. or pulmonary vessels lt heart to pulmonary vessels
Transposition of Great Vessels:
Baby cyanotic?
What is necessary for survival?
Embryological explanation?
Yes
Mixing blood through:
1: Patent ductus arteriosus
2. Open foramen ovale
3. VSD
Aorticoplulmonary septum does not spiral
What happens to the ductus arteriosus after birth?
1. Lungs are aerated
2. muscle in wall of ductus contracts
3. ductus arteriosus closes
Physiologically in a few hours
Anatomically at 3 months
4. Forms ligamentum arteriosum
Why would the ductus arteriosus remain open?
Symptoms?
Muscle does not contract properly
Symptoms:
1. Machine murmur
2. Hypertrophy of left ventricle
3. No cyanosis
4. Growth retardation
What is detrocardia, and when is it a high risk condition?
Heart is on the rt side. High risk is when it occurs without sinus inversus
What is sinus inversus?
All organs are reversed
What is coarctation of the aorta? and where/why does it occur?
A constriction of the aorta, distal to the origin of the left subclavian (around entrance of ductus arteriosus) due to presence of ductus arteriosus tissue in the region of the arch of the aorta
What are signs of coarctation of the aorta?
High BP in upper extremities, low BP in lower extremities, rib notching b/c of large intercostal artery size
What is angina pectoris?

What is it described as?
Chest pain due to myocardial ischemia. Due to progressive occlusion of coronary arteries by arterioschlerosis.
Crushing or heavy pain substernally or left side brought on by exercise
What is a myocardial infarction?
heart attack: when ischemia progresses to a point where heart muscles have been perfused by too little blood for too long and dies
What are women more likely to have with MIs instead of coronary artery disease?
Abnormalities of coronary endothelial tissue
What doe women present with when they have a heart attack?
shortness of breath, nausea, vomiting, sleeplessness, back or jaw pain, fatigue
How many cell layers is diffusion sufficient for?
7
What are the three layers of the heart wall?
Endocardium, pericardium, epicardium
What cell type and Connective Tissue (CT)? is endocardium?
Myocardium?
Epicardium?
Endo: simple squamous epith., think layer of CT
Myo: Spiral, multilayered
Epi: Squamous epith. w/in CT is adipocytes, nerve bundles, and coronary arteries that penetrated the myocardium
What is a modified myofiber in the heart? How does it look different?
Purkinje fiber, larger not striated more gap junctions, stains paler
What are cardiac valves composed of, and what are they lined with?
Composed of dense central core of collagen and elastic fibers, lined with squamous epithelium
What are the layers of a artery?
Intima, media, externa
What does the artery intima consist of?
layer of endothelial cells with a thin subendothelial layer of loose CT followed by an internal elastic membrane
What does the artery media consist of?
Concentric layers of smooth muscle cells with elastic fibers, collagen III fibers, glycoproteins and proteoglycans. The outermost layer is the external elastic membrane
What does the artery externa consist of?
Collagen (I) and elastic fibers. This layer becomes continuous with CT of the organ
What is a vasa vasorum?
The blood vessels in the externa of large vessels
What are distinguishing features of elastic arteries? What is a prominent elastic artery?
1. Large with a lot of elastic fibers in the tunica media
2. Intima is relatively thick and the internal elastic membrane is difficult to distinguish
3. Elastic fibers in the media allow the artery to expand during systole
Aorta
What are the distinguishing features of muscular arteries (4)?
1. Layers of smooth muscle in the media
2. Intima has a thin subendothelial layer
3. 30-40 layers of smooth muscle in large arteries with elastic and reticular fibers intermixed
4. Innervated by sympathetic postganglionic axons to control blood flow
Features of arterioles?
1. 1-2 layers of smooth muscle
2. Subendothelial layer is thin, the elastic laminae are absent,
What is an anteriovenous anastomoses?
Allows flow from arterioles to venules bypassing the capillaries
What is the difference between tunica adventitia and tunica externa?
Externa is the generic name, and adventitia is the name when in a defined tissue
Feature of capillaries?
1. Permit metabolite exchange between blood and tissue
2. single layer of endothelial cells ~ 50 microns long
3. Diameter = diameter of RBC
4. Slow flow rate
What are the three types of capillaries?
1. continuous
2. fenestrated
3. sinusoid
What are features of continuous capillaries?
Occluding junctions between cells, material moved both ways in pinocytotic vesicles. e.g. CNS
What are features of fenestrated capillaries?
Thin patches of fenestrae which are covered with proteoglycans, no plasma membrane but the basal lamina is continuous. found in tissues where more rapid exchange is needed (intestine kidney)
What are features of sinusoid capillaries?
Large fenestrae without diaphragms, large spaces between cells and basal lamina is non-continuous, cells macromolecules etc are free to move in and out e.g. spleen
Locations of sinusoidal capilary?
bone marrow and spleen
How does venous blood return to heart? 2 ways
Via contractions of media but mostly compression from surrounding muscles and tissues
3 layers of large veins?
Well developed intima, a thin media, a relatively large externa
What is a vein valve a projection of?
tunica intima
What is the lymphatic system?
A system of thin walled endothelial lined channels that collect excess interstitial fluid and eventually return it to the venous system
What do lymphatic capillaries begin as?
closed ended vessels of a single layer of endothelium and incomplete basal lamina
What do veins and lymphatics have a lot of to prevent backflow?
valves
What is the chief propulsive force in lymphatics?
Muscle contractions
What is found in the largest lymph vessels?
Muscle in the middle that runs both longitudinally and circularly, also has vasa vasorum and a neural network
Thrombus vs embolus?
Thrombus - a solid mass of platelets and/or fibrin that forms in a vessel
Embolus - a piece of a thrombus that has broken free and is carried toward the brain by the blood stream
Cause of an aneurysm?
Hardening of arteries, age