Heart & Mediastinum

Front 1

the mediastinum, and is divided into four regions

Back 1

superior, anterior, middle, and posterior portions.

Front 2

Mediastinum Superiorly -

Back 2

the heart is suspended in the rib cage by the great vessels.

Front 3

Mediastinum Anteriorly

Back 3

the heart is related to: -part of the thymus & sternum

Front 5

Mediastinum Anterolaterally, laterally, posterolaterally

Back 5

the heart is related to the lung and its pleura

Front 6

Mediastinum Inferiorly

Back 6

the diaphragmatic portion of the pericardium is firmly fused with the central tendon of the diaphragm, with the inferior vena cava penetrating it on the right side.

Front 7

Mediastinum Posteriorly

Back 7

the heart is related to: a)part of the right lung; b)part of the left lung; c) the esophagus; d) the aorta

Front 9

From the embryonic tube-like heart it becomes highly twisted upon itself and soon, from the original single passage, 4 chambers evolve. They are:

Front 11

Ho Heart & Pleural cavity drawing

Front 12

a small space filled with fluid for lubrication during heart contraction.

Back 12

Pericardial cavity

Front 13

The heart is suspended, at its base, by

Back 13

the great vessels

Front 14

What major organ occupies an asymmetrical position, with its apex pointing anteriorly, inferiorly and towards the left?

Back 14

Heart

Front 15

Base of heart is located (intercostal space)

Back 15

second intercostals space

Front 16

Apex of heart (Intercostal space)

Back 16

fifth intercostals space

Front 17

Diaphragmatic border of heart crosses what junction?

Back 17

Crosses Xihisternal junction

Front 19

Ho Schematic of heart (E.T.)

Front 20

superficial groove delimiting atria from ventricles

Back 20

Coronary sulcus

Front 21

superficial grooves delineating right and left ventricles; they meet at a notch near the apex of the heart.

Back 21

Anterior and posterior interventricular sulci

Front 22

Part of the heart lying anteriorly and occupying most of the sternocostal surface

Back 22

Right ventricle

Front 23

Part of the heart sitting at the posterior aspect of the heart

Back 23

Left Atrium

Front 24

There is a double circulation consisting of the

Back 24

systemic circulation & pulmonary circulation. In the adult, the two systems are entirely separate.

Front 25

_______ circulation supplies the entire body except the lungs.

Back 25

systemic

Front 26

________ circulation supplies the lungs

Back 26

pulmonary

Front 27

four chambers of the heart?

Back 27

R & L atrium; R &L ventricle

Back 28

(1)

Front 29

the muscular wall separating the right form the left atrium

Back 29

interatrial septum

Front 30

Two important features of the interatrial septum...

Back 30

fossa ovalis & limbus of the fossa ovalis

Front 31

the remains of the aperture of the foramen ovale through which blood flows from right to left atrium before birth

Back 31

fossa ovalis

Front 32

the raised margin of the fossa located above and anteriorly to the fossa ovalis.

Back 32

limbus of the fossa ovalis

Front 33

Valves associated with the right atrium are:

Back 33

valve of the inferior vena cava & valve of the coronary sinus

Front 34

the falciform fold which is much larger in the fetus and directs blood from the inferior vena cava directly through the foramen ovale into the left atrium in fetal life

Back 34

valve of the inferior vena cava

Front 35

a small fold, which is incompetent in preventing backflow of blood.

Back 35

valve of the coronary sinus

Front 36

THE TRICUSPID VALVE is aka...

Back 36

right atrioventricular valve

Front 37

3 cusps of right atrioventricular valve:

Back 37

anterior, posterior, and septal

Front 38

a muscular ridge which extends inferiorly from near the ostium of the superior vena cava toward the front of the inferior vena cava and represents the line of junction between the primitive sinus venosus and the atrium proper

Back 38

crista terminales

Front 39

What are muscular ridges in the right auricle

Back 39

pectinate muscles

Front 40

ear-shaped pouch extending out antero-inferiorly from the heart.

Back 40

right auricle

Front 41

The ____ ____ pumps blood to the lungs

Back 41

right ventricle

Front 42

its wall is only one-third as thick as that of the left ventricle

Back 42

right ventricle

Front 43

the funnel shaped upper end of the right ventricle which gives rise to the pulmonary trunk.

Back 43

conus arteriosus

Front 44

fibrous cords extending from the A-V valves (tricuspid) to the ends of the protruding finger-like papillary muscles.

Back 44

chordae tendineae

Front 45

ridge-like bundles of muscles, which protrude into the cavity of the ventricle.

Back 45

trabeculae carneae

Front 46

A particularly prominent muscle of this group which passes from the interventricular septum to the base of the anterior papillary muscle is the

Back 46

septomarginal trabecula

Front 47

The valves associated with the right ventricle are:

Back 47

right A-V valve or tricuspisd valve & pulmonary valve

Front 48

The pulmonary valve lies _______ to the aortic valve and consists of _______ valve composed of 3 valvules: ____ ____ ____

Back 48

anterior, semilunar, anterior, right, & left

Front 49

What are the vessels emptying into the left atrium

Back 49

pulmonary veins, two superior and two inferior

Front 50

The ____ ____ on the left side of the atrial wall has a persisting embryological remnant

Back 50

interatrial septum

Front 51

The valvule of the____ ____ is a remnant of one of the valves of the foramen ovale, which may persist in the adult as a thin concave flap of tissue on the anterior aspect of the interatrial septum.

Back 51

foramen ovale

Front 52

Left auricle of the Left atrium has what kind of muscle

Back 52

pectinate muscles

Front 53

The ____ ____ has thick muscles to pump oxygenated blood to all parts of the body

Back 53

left ventricle

Front 54

The apex of ____ ____ is also the apex of the heart

Back 54

left ventricle

Front 55

The apex of the ____ ____ is located at the left fifth intercostal space, slightly medial to the mid-clavicular line.

Back 55

left ventricle

Front 56

cord-like strands which run from the A-V cusps to the papillary muscles and prevent the folding in of the cusps.

Back 56

chordae tendineae, which is also present in the left ventricle

Front 57

serve as attachment for the chordae tendineae which extend downward from the mitral valve.

Back 57

papillary muscles

Front 58

prevent the cusps of the A-V valve from being everted into the atrium by the pressure developed in the contracting ventricle

Back 58

papillary muscles & chordae tendineae

Back 59

A-V valve; papillary muscles; cusps

Front 60

ridge-like bundles of muscles, which protrude into the cavity of the ventricle.

Back 60

trabeculae carneae

Back 61

interventricular septum

Front 62

Valves associated with the left ventricle:

Back 62

left atrioventricular valve (mitral valve) & aortic valve

Front 63

guards the left A-V ostium or orifice, that large opening through which oxygenated blood from the lungs passively descends into the left ventricle with relaxation of the ventricle and simultaneous opening of mitral valve.

Back 63

left atrioventricular valve (mitral valve)

Front 64

The left A-V valve is composed of 2 cusps:

Back 64

anterior & posterior

Front 65

A-V valve is attached by ____ ____ to their respective anterior and posterior papillary muscles.

Back 65

chordae tendineae

Front 66

Heart valves are considered by some to be ____ and receive their nutrition by absorption directly from the blood.

Back 66

avascular

Front 67

The aortic valve is located behind the pulmonary valve and is composed of three valvules:

Back 67

right, left, & posterior

Front 68

Each valvule of the aortic valve has a ____ and two thin edges or ____.

Back 68

nodulus; lunulae

Front 69

What is the valve that functions as does the pulmonary valve, preventing regurgitation of blood into the ventricle while the pressure in the aorta is high and that in the relaxing ventricle is low.

Back 69

aortic valve

Front 70

Coronary arteries and cardiac veins are variable in

Back 70

origin, course and termination

Front 71

This arrises from the ascending aorta between the left valvule of the aortic valve and the base of the aorta in a space termed the left aortic sinus.

Back 71

left coronary artery

Front 72

area between the left valvule of the aortic valve and the base of the aorta in a space termed the

Back 72

left aortic sinus

Front 73

Shortly after emerging on the anterolateral surface of the heart] the artery divides into two branches

Back 73

interventricular branch & circumflex branch

Front 74

The anterior interventricular branch gives origin to the

Back 74

left marginal branch.

Front 75

The ____ ____ passes around to the posterior surface of the heart in the coronary groove.

Back 75

circumflex branch

Front 76

It terminates as the posterior (left) ventricular branch on the diaphragmatic surface of the heart.

Back 76

circumflex branch

Front 77

The ____ ____ artery courses to the posterior or diaphragmatic surface of the heart where it descends in the posterior interventricular sulcus in company with the ____ ____ as the posterior ____ branch.

Back 77

right coronary; middle cardiac vein; interventricular

Back 78

Anterior cardiac vein- which opens directly into the R. atrium

Front 79

The ____ has its own blood supply and venous drainage.

Back 79

heart

Front 80

Typically, there are ____ coronary aa.

Back 80

two

Back 81

arteries and veins; Often, these vessels are embedded in fat.

Front 82

Specific ____ travel with specific ____

Back 82

arteries, veins

Front 83

Sinuatrial (S.A.) node (commonly called the

Back 83

pacemaker

Front 84

SA node has Specialized cardiac fibers which are very vascular and are associated with autonomic nerve fibers. What are they?

Back 84

(Purkinje fibers)

Front 85

Located In right atrial wall between right auricle and superior vena cava at the upper end of the crista terminales.

Back 85

Sinuatrial (S.A.) node

Front 86

Contraction of the myocardium, initiated at the S.A. Node, spreads rapidly through the ____ ____ resulting in the atria injecting blood through the ____ ____ into the two ventricles. As the contraction spreads through the atrial musculature it reaches the _______ node.

Back 86

atrial musculature; atrioventricular ostia; atrioventricular (A-V)

Front 87

Atrioventricular (A-V) Node composed of

Back 87

specialized cardiac fibers

Front 88

Atrioventricular (A-V) Node location

Back 88

In interatrial septum near the ostium of the coronary sinus

Front 89

Atrioventricular bundle is aka

Back 89

("Bundle of His")

Front 90

The S.A. node is supplied by the ____ ____ nerve and right coronary artery

Back 90

right vagus

Front 91

A group of pale colored muscle fibers (Purkinje fibers) of unusual morphology and characteristics, which are specialized for conduction of impulses to myocardial fibers.

Back 91

Atrioventricular bundle ("Bundle of His")

Front 92

Histologically there is little difference between the A-V bundle and the A-V node. T/F

Back 92

T

Front 93

Atrioventricular bundle ("Bundle of His") fibers are specialized for ____ rather than ____.

Back 93

fibers are specialized for conduction rather than contraction.

Front 94

Atrioventricular bundle ("Bundle of His") is located

Back 94

Extending from the A-V node into the pars membranacea of the interventricular septum and there it divides into: right crus of the A-V bundle and left crus of the A-V bundle.

Front 95

The ____ ____ extends downward just deep to the endocardium of the interventricular septum and crosses the cavity of the right ventricle via the septomarginal trabecula (formerly moderator band) to the papillary muscles. The ____ ____ of the A-V bundle ends in the outer right ventricular wall.

Back 95

right crus; right crus

Front 96

The ____ ____ of the A-V bundle also passes distally just deep to the endocardium and proceeds to the papillary muscles and the left ventricular wall.

Back 96

left crus

Front 97

The ____ ____ thus transmits impulses initiated in the sinuatrial (S.A.) node to the apex of the ventricles before looping up. This pathway of transmission assures a ____ ____ of the ventricles toward the ostia of the aorta and pulmonary trunk.

Back 97

A-V bundle; "milking action"

Front 98

Partial interruption of conduction along the A-V bundle is termed

Back 98

bundle block

Front 99

As a result of ____ ____, the atria may beat at one speed and the ventricles at a lower speed resulting in the atria attempting to force blood into already full ventricles. Alternatively, the ventricles may contract before they are properly filled resulting in ____ ____.

Back 99

bundle block; cardiac inefficiency

Front 100

The aorta is divided into three division

Back 100

ascending aorta; aoric arch; descending thoracic aorta

Front 101

What part of the aorta is enclosed within the pericardial sac and gives origin to the right and left coronary arteries.

Back 101

Ascending aorta

Front 102

What part of the aorta lies in the superior mediastinum just behind the lower part of the manubrium sterni, most commonly has three branches

Back 102

aortic arch

Front 103

What are the branches of the aortic arch

Back 103

brachiocephalic a; left common carotid artery; left subclvian artery

Front 104

What part of the aorta extends from the termination of the aortic arch at the level of the disc between T4 and T5 to the lower border of the body of the twelfth thoracic vertebra

Back 104

descending thoracic aorta

Front 105

What are the branches of the descendign thoracic aorta

Back 105

bronchial, esophageal, and posterior intercostal arteries.

Front 106

What is the first and largest branch of the aortic arch

Back 106

brachiocephalic artery (trunk)

Front 107

What does the brachiocephalic artery give rise to?

Back 107

right common carotid artery and the right subclavian artery

Front 108

What four branches arise from the subclavian artery, located deep to the right sternoclavicular joint

Back 108

vertebral a; cosocervical trunk; thyrocervical trunk; internal thoracic artery

Front 109

What artery enters the foramen transversarium of the sixth cervical vertebra and ascends to become one of two major sources of blood to the brain

Back 109

vertebral artery

Front 110

What is the artery that gives origin to the follwing branches: branches are the inferior thyroid, transverse cervical, and suprascapular arteries

Back 110

thyrocervical trunk

Front 111

What artery arises from the inferior surface of the subclavian artery and courses deep to the transversus thoracis muscle giving off anterior intercostal arteries at each intercostal space.

Back 111

internal thoracic artery

Front 112

What artery is is paralleled by the parasternal lymph nodes and lymph vessels and terminates as the musculophrenic artery and superior epigastric artery.

Back 112

internal thoracic artery

Front 113

What artery arises most commonly from the aortic arch. Its branches are identical to the right branches of the subclavian

Back 113

left subclavian artery

Front 114

Look at Pulmonary trunk

Front 115

Look at Pulmonary arteries

Front 116

What vein lies anterior to the trachea in the superior mediastinum and is formed at the thoracic inlet by the joining of right and left brachiocephalic veins

Back 116

Superior vena cava

Front 117

The ___ returns venous blood to the right atrium

Back 117

SVC

Front 118

right and left brachiocephalic veins are formed by the convergence of the

Back 118

internal jugular & subclavian vens.

Front 119

The ____ arises in the abdomen by union of the two common iliac veins. It empties into the right atrium.

Back 119

IVC

Front 120

What vein arises in the abdomen by the merging of the lumbar intervertebral veins and ascends high in the abdomen close to the aorta and enters the thorax posterior to the diaphragmatic crura.

Back 120

Azygos vein

Front 121

In the thorax the ____ vein ascends to the right of the midline and receives posterior intercostal veins at each intercostal space. It lies deep to the parietal pleura and is invested by endothoracic fascia.

Back 121

Azygos vein

Front 122

The ____ vein terminates by emptying into the SVC shortly before the SVC terminates in the right atrium.

Back 122

Azygos (The azygosmay empty directly into the right atrium; however, the former described termination is most common.)

Front 123

Pulmonary veins

Front 124

There are five major groups of structures in the superior mediastinum. They are:

Back 124

Thymus; great veins; arch of the aorta & branches; Trachea & Esophagus; & Nerves

Front 125

The ____ is most anterior or superficial in the superior mediastinum

Back 125

thymus

Front 126

What reaches its maximal relative size in children of about two years of age.

Back 126

thymus

Front 127

After puberty, the ____ gradually diminishes in size leaving a small pad composed mostly of fat with little thymic tissue left in the adult.

Back 127

thymus

Front 128

What are the three sets of great veins and one large single vein which return blood through the superior mediastinum to the right atrium:

Back 128

a.

Front 130

The ____ ____ ascends from the heart into the superior mediastinum almost reaching the upper border of the manubrium. It then courses obliquely posteriorly and to the left over the left primary bronchus to continue as the descending aorta, anterior to, and slightly to the left of the vertebral column.

Back 130

aortic arch

Front 131

Originating from the convexity of the aortic arch, from proximal to distal positions, are the

Back 131

brachiocephalic, left common carotid, and left subclavian arteries.

Front 132

The ____ descends in the neck posterior to the aortic arch and bifurcates into right and left primary bronchi at the level of the sternal angle in the cadaver (lower in the living).

Back 132

trachea

Front 133

Posterior to the trachea is the

Back 133

esophagus

Front 134

The ___, ___, & ___ nerves all have a course through the superior mediastinum.

Back 134

vagi, phrenic, and sympathetic

Front 135

The ___ (C3, 4 and 5) and ___ nerves descend from the neck posterior to the brachiocephalic veins.

Back 135

phrenic, vagus

Front 136

The ___ nerves accompanied by the pericardiacophrenic vessels descend anterior to the lung roots and along the pericardium until they reach the diaphragm.

Back 136

phrenic

Front 137

The ___ ___ nerve passes between the subclavian artery and vein and gives the right recurrent laryngeal nerve, which loops around the subclavian artery to ascend along the trachea to the larynx.

Back 137

right vagus

Front 138

The ___ ___ nerve gives the left recurrent laryngeal nerve, which loops around the arch of the aorta.

Back 138

left vagus

Front 139

The ____ ____ is that portion of the thoracic cavity behind the pericardial sac, and bounded laterally by the mediastinal pleura of both sides.

Back 139

posterior mediastinum

Front 140

The major contents fo the posterior mediastinum include

Back 140

trachea & bronchi; esophagus

Front 141

What extending from the pharynx (originating at the lower border of the cricoid cartilage), to the stomach.

Back 141

Esophagus

Front 142

Major anatomical relaitonships of the thoracic esophagus???????????

Back 142

mediastinal pleura and lungs (lateral); heart (left of atrium); trachea and left primary bronchus; vertebral column (posterier); thoracic duct (lateral); recurrent laryngeal nerves and the esophageal plexus (Lateral) ; aortic arch and the descending aorta (anterior)

Front 143

blood supply of the esophagus is derived from four major sources:

Back 143

Branches of the inferior thyroid artery; Esophageal branches of the right and left bronchial arteries; Esophageal branches of the aorta; Branches of the abdominal aorta or of the celiac trunk.

Front 144

The blood supply of the esophagus is divided into ____ (muscular) and ____ (submucosal) vascular plexuses.

Back 144

extrinsic & intrinsic

Front 145

What are the Major vascular elements of the posterior mediastinum

Back 145

descending aorta & azygous-hemiazygos venous systems

Front 146

What begins at the T4 level, where it contacts the vertebral column. It is initially located to the left of the column; as it descends it approaches the midline.

Back 146

descending aorta

Front 147

What are the branches of the descending aorta

Back 147

Parietal - posterior interscostal (to all spaces except 1 or 1&2 rib), superior phrenic arteries; & visceral - bronchial arteries & esophageal arteries

Front 148

What begins as the superior continuation of the right ascending lumbar vein of the abdomen. It lies on the right anterolateral surface of the vertebral column, anterior to the intercostal arteries.

Back 148

Azygos system

Front 149

the____ vein terminates by arching over the right primary bronchus to join the superior vena cava.

Back 149

azygos

Front 150

the ____ receives as tributaries the intercostal veins of the right side (except the 1st), mediastinal, esophageal, and communicating branches of the hemiazygos system.

Back 150

azygos

Front 151

What is formed on the left side in a manner similar to the azygos system.

Back 151

hemiazygos system

Front 152

What differs from the azygos in that it drains only the lower portion of the left thoracic region, terminating at approximately the level of T8 crossing the midline to join the azygos.

Back 152

hemiazygos system

Front 153

What vein has the following major tributaries are the lower left intercostals, the mediastinal, and esophageal systems.

Back 153

hemiazygos system

Front 154

What are the Major lymphatic channels of the posterior mediastinum

Back 154

Thoracic duct & (right bronchomediastinal trunk [optional])

Front 155

What is the largest lymphatic channel of the body, it drains most of the thoracic wall, the entire body below the level of the diaphragm, and the left side of the head and neck, plus the left arm.

Back 155

Thoracic duct

Front 156

The ___ ___ originates within the abdominal cavity by the union of the lumbar lymphatic ducts. It enters the thorax by passing through the aortic hiatus of the diaphragm (behind the aorta). The caudal end of the duct is frequently characterized by a sac-like dilation, the cysterna chyli.

Back 156

thoracic duct

Front 157

The Thoracic duct can be found against the ____ surface of the vertebral column. As it ascends it crosses to the left side of the column to run along the ____ side of the left subclavian artery and enters the neck, where it terminates by entering the ____ ____ vein at the angle between this vein and the ___ ___ ___ vein.

Back 157

anterior; medial; left subclavian; left internal jugular

Front 158

The ___ ___ lie along the lateral aspect of the vertebral bodies, lateral to the azygos and hemiazygos vessels of the respective sides, and anterior to the intercostal vessels.

Back 158

thoracic sympathetic trunks

Front 159

The ___ ___ arise from the medial side of each trunk. As they descend they converge slightly to leave the thorax by piercing the crurae of the diaphragm.

Back 159

splanchnic nerves

Back 160

ascending aorta; aortic arch; descending thoracic aorta

Front 161

It is enclosed within the pericardial sac and gives origin to the right and left coronary arteries.

Back 161

the ascending aorta

Front 162

lies in the superior mediastinum just behind the lower part of the manubrium sterni, most commonly has three branches; the brachiocephalic artery, the left common carotid artery, and the left subclavian artery.

Back 162

aortic arch

Front 163

extends from the termination of the aortic arch at the level of the disc between T4 and T5 to the lower border of the body of the twelfth thoracic vertebra. Its branches are the bronchial, esophageal, and posterior intercostal arteries.

Back 163

descending thoracic aorta

Front 164

the first and largest branch of the aortic arch

Back 164

brachiocephalic artery (trunk)

Front 165

the brachiocephalic artery gives origin to the

Back 165

right common carotic artery & right subclavian artery.

Front 166

How many branches arise from the subclavian artery?

Back 166

four

Front 167

Name the branches from the subclavian artery and their location

Back 167

they are located deep to the right sternoclavicular joint: vertebral artery; costocervical trunk; thyrocervical trunk; internal thoracic artery

Front 168

(branch of the brachicephalic artery) the ____ ____ which enters the foramen transversarium of the sixth cervical vertebra and ascends to become one of two major sources of blood to the brain

Back 168

vertebral artery

Front 169

(branch of the brachicephalic artery) the ____ ____ whose two major branches are the deep cervical and supreme cervical arteries; [optional]

Back 169

costocervical trunk

Front 170

(branch of the brachicephalic artery)the ____ ____ whose branches are the inferior thyroid, transverse cervical, and suprascapular arteries

Back 170

thyrocervical trunk

Front 171

(branch of the brachicephalic artery) the ____ ____ artery (formerly internal mammary) which arises from the inferior surface of the subclavian artery and courses deep to the transversus thoracis muscle giving off anterior intercostal arteries at each intercostal space.

Back 171

internal thoracic