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171 Cards in this Set

  • Front
  • Back
the mediastinum, and is divided into four regions
superior, anterior, middle, and posterior portions.
Mediastinum Superiorly -
the heart is suspended in the rib cage by the great vessels.
Mediastinum Anteriorly
the heart is related to: -part of the thymus & sternum
Mediastinum Anterolaterally, laterally, posterolaterally
the heart is related to the lung and its pleura
Mediastinum Inferiorly
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.
Mediastinum Posteriorly
the heart is related to: a)part of the right lung; b)part of the left lung; c) the esophagus; d) the aorta
From the embryonic tube-like heart it becomes highly twisted upon itself and soon, from the original single passage, 4 chambers evolve. They are:
Ho Heart & Pleural cavity drawing
a small space filled with fluid for lubrication during heart contraction.
Pericardial cavity
The heart is suspended, at its base, by
the great vessels
What major organ occupies an asymmetrical position, with its apex pointing anteriorly, inferiorly and towards the left?
Heart
Base of heart is located (intercostal space)
second intercostals space
Apex of heart (Intercostal space)
fifth intercostals space
Diaphragmatic border of heart crosses what junction?
Crosses Xihisternal junction
Ho Schematic of heart (E.T.)
superficial groove delimiting atria from ventricles
Coronary sulcus
superficial grooves delineating right and left ventricles; they meet at a notch near the apex of the heart.
Anterior and posterior interventricular sulci
Part of the heart lying anteriorly and occupying most of the sternocostal surface
Right ventricle
Part of the heart sitting at the posterior aspect of the heart
Left Atrium
There is a double circulation consisting of the
systemic circulation & pulmonary circulation. In the adult, the two systems are entirely separate.
_______ circulation supplies the entire body except the lungs.
systemic
________ circulation supplies the lungs
pulmonary
four chambers of the heart?
R & L atrium; R &L ventricle
(1)
the muscular wall separating the right form the left atrium
interatrial septum
Two important features of the interatrial septum...
fossa ovalis & limbus of the fossa ovalis
the remains of the aperture of the foramen ovale through which blood flows from right to left atrium before birth
fossa ovalis
the raised margin of the fossa located above and anteriorly to the fossa ovalis.
limbus of the fossa ovalis
Valves associated with the right atrium are:
valve of the inferior vena cava & valve of the coronary sinus
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
valve of the inferior vena cava
a small fold, which is incompetent in preventing backflow of blood.
valve of the coronary sinus
THE TRICUSPID VALVE is aka...
right atrioventricular valve
3 cusps of right atrioventricular valve:
anterior, posterior, and septal
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
crista terminales
What are muscular ridges in the right auricle
pectinate muscles
ear-shaped pouch extending out antero-inferiorly from the heart.
right auricle
The ____ ____ pumps blood to the lungs
right ventricle
its wall is only one-third as thick as that of the left ventricle
right ventricle
the funnel shaped upper end of the right ventricle which gives rise to the pulmonary trunk.
conus arteriosus
fibrous cords extending from the A-V valves (tricuspid) to the ends of the protruding finger-like papillary muscles.
chordae tendineae
ridge-like bundles of muscles, which protrude into the cavity of the ventricle.
trabeculae carneae
A particularly prominent muscle of this group which passes from the interventricular septum to the base of the anterior papillary muscle is the
septomarginal trabecula
The valves associated with the right ventricle are:
right A-V valve or tricuspisd valve & pulmonary valve
The pulmonary valve lies _______ to the aortic valve and consists of _______ valve composed of 3 valvules: ____ ____ ____
anterior, semilunar, anterior, right, & left
What are the vessels emptying into the left atrium
pulmonary veins, two superior and two inferior
The ____ ____ on the left side of the atrial wall has a persisting embryological remnant
interatrial septum
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.
foramen ovale
Left auricle of the Left atrium has what kind of muscle
pectinate muscles
The ____ ____ has thick muscles to pump oxygenated blood to all parts of the body
left ventricle
The apex of ____ ____ is also the apex of the heart
left ventricle
The apex of the ____ ____ is located at the left fifth intercostal space, slightly medial to the mid-clavicular line.
left ventricle
cord-like strands which run from the A-V cusps to the papillary muscles and prevent the folding in of the cusps.
chordae tendineae, which is also present in the left ventricle
serve as attachment for the chordae tendineae which extend downward from the mitral valve.
papillary muscles
prevent the cusps of the A-V valve from being everted into the atrium by the pressure developed in the contracting ventricle
papillary muscles & chordae tendineae
A-V valve; papillary muscles; cusps
ridge-like bundles of muscles, which protrude into the cavity of the ventricle.
trabeculae carneae
interventricular septum
Valves associated with the left ventricle:
left atrioventricular valve (mitral valve) & aortic valve
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.
left atrioventricular valve (mitral valve)
The left A-V valve is composed of 2 cusps:
anterior & posterior
A-V valve is attached by ____ ____ to their respective anterior and posterior papillary muscles.
chordae tendineae
Heart valves are considered by some to be ____ and receive their nutrition by absorption directly from the blood.
avascular
The aortic valve is located behind the pulmonary valve and is composed of three valvules:
right, left, & posterior
Each valvule of the aortic valve has a ____ and two thin edges or ____.
nodulus; lunulae
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.
aortic valve
Coronary arteries and cardiac veins are variable in
origin, course and termination
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.
left coronary artery
area between the left valvule of the aortic valve and the base of the aorta in a space termed the
left aortic sinus
Shortly after emerging on the anterolateral surface of the heart] the artery divides into two branches
interventricular branch & circumflex branch
The anterior interventricular branch gives origin to the
left marginal branch.
The ____ ____ passes around to the posterior surface of the heart in the coronary groove.
circumflex branch
It terminates as the posterior (left) ventricular branch on the diaphragmatic surface of the heart.
circumflex branch
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.
right coronary; middle cardiac vein; interventricular
Anterior cardiac vein- which opens directly into the R. atrium
The ____ has its own blood supply and venous drainage.
heart
Typically, there are ____ coronary aa.
two
arteries and veins; Often, these vessels are embedded in fat.
Specific ____ travel with specific ____
arteries, veins
Sinuatrial (S.A.) node (commonly called the
pacemaker
SA node has Specialized cardiac fibers which are very vascular and are associated with autonomic nerve fibers. What are they?
(Purkinje fibers)
Located In right atrial wall between right auricle and superior vena cava at the upper end of the crista terminales.
Sinuatrial (S.A.) node
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.
atrial musculature; atrioventricular ostia; atrioventricular (A-V)
Atrioventricular (A-V) Node composed of
specialized cardiac fibers
Atrioventricular (A-V) Node location
In interatrial septum near the ostium of the coronary sinus
Atrioventricular bundle is aka
("Bundle of His")
The S.A. node is supplied by the ____ ____ nerve and right coronary artery
right vagus
A group of pale colored muscle fibers (Purkinje fibers) of unusual morphology and characteristics, which are specialized for conduction of impulses to myocardial fibers.
Atrioventricular bundle ("Bundle of His")
Histologically there is little difference between the A-V bundle and the A-V node. T/F
T
Atrioventricular bundle ("Bundle of His") fibers are specialized for ____ rather than ____.
fibers are specialized for conduction rather than contraction.
Atrioventricular bundle ("Bundle of His") is located
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.
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.
right crus; right crus
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.
left crus
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.
A-V bundle; "milking action"
Partial interruption of conduction along the A-V bundle is termed
bundle block
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 ____ ____.
bundle block; cardiac inefficiency
The aorta is divided into three division
ascending aorta; aoric arch; descending thoracic aorta
What part of the aorta is enclosed within the pericardial sac and gives origin to the right and left coronary arteries.
Ascending aorta
What part of the aorta lies in the superior mediastinum just behind the lower part of the manubrium sterni, most commonly has three branches
aortic arch
What are the branches of the aortic arch
brachiocephalic a; left common carotid artery; left subclvian artery
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
descending thoracic aorta
What are the branches of the descendign thoracic aorta
bronchial, esophageal, and posterior intercostal arteries.
What is the first and largest branch of the aortic arch
brachiocephalic artery (trunk)
What does the brachiocephalic artery give rise to?
right common carotid artery and the right subclavian artery
What four branches arise from the subclavian artery, located deep to the right sternoclavicular joint
vertebral a; cosocervical trunk; thyrocervical trunk; internal thoracic artery
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
vertebral artery
What is the artery that gives origin to the follwing branches: branches are the inferior thyroid, transverse cervical, and suprascapular arteries
thyrocervical trunk
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.
internal thoracic artery
What artery is is paralleled by the parasternal lymph nodes and lymph vessels and terminates as the musculophrenic artery and superior epigastric artery.
internal thoracic artery
What artery arises most commonly from the aortic arch. Its branches are identical to the right branches of the subclavian
left subclavian artery
Look at Pulmonary trunk
Look at Pulmonary arteries
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
Superior vena cava
The ___ returns venous blood to the right atrium
SVC
right and left brachiocephalic veins are formed by the convergence of the
internal jugular & subclavian vens.
The ____ arises in the abdomen by union of the two common iliac veins. It empties into the right atrium.
IVC
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.
Azygos vein
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.
Azygos vein
The ____ vein terminates by emptying into the SVC shortly before the SVC terminates in the right atrium.
Azygos (The azygosmay empty directly into the right atrium; however, the former described termination is most common.)
Pulmonary veins
There are five major groups of structures in the superior mediastinum. They are:
Thymus; great veins; arch of the aorta & branches; Trachea & Esophagus; & Nerves
The ____ is most anterior or superficial in the superior mediastinum
thymus
What reaches its maximal relative size in children of about two years of age.
thymus
After puberty, the ____ gradually diminishes in size leaving a small pad composed mostly of fat with little thymic tissue left in the adult.
thymus
What are the three sets of great veins and one large single vein which return blood through the superior mediastinum to the right atrium:
a.
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.
aortic arch
Originating from the convexity of the aortic arch, from proximal to distal positions, are the
brachiocephalic, left common carotid, and left subclavian arteries.
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).
trachea
Posterior to the trachea is the
esophagus
The ___, ___, & ___ nerves all have a course through the superior mediastinum.
vagi, phrenic, and sympathetic
The ___ (C3, 4 and 5) and ___ nerves descend from the neck posterior to the brachiocephalic veins.
phrenic, vagus
The ___ nerves accompanied by the pericardiacophrenic vessels descend anterior to the lung roots and along the pericardium until they reach the diaphragm.
phrenic
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.
right vagus
The ___ ___ nerve gives the left recurrent laryngeal nerve, which loops around the arch of the aorta.
left vagus
The ____ ____ is that portion of the thoracic cavity behind the pericardial sac, and bounded laterally by the mediastinal pleura of both sides.
posterior mediastinum
The major contents fo the posterior mediastinum include
trachea & bronchi; esophagus
What extending from the pharynx (originating at the lower border of the cricoid cartilage), to the stomach.
Esophagus
Major anatomical relaitonships of the thoracic esophagus???????????
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)
blood supply of the esophagus is derived from four major sources:
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.
The blood supply of the esophagus is divided into ____ (muscular) and ____ (submucosal) vascular plexuses.
extrinsic & intrinsic
What are the Major vascular elements of the posterior mediastinum
descending aorta & azygous-hemiazygos venous systems
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.
descending aorta
What are the branches of the descending aorta
Parietal - posterior interscostal (to all spaces except 1 or 1&2 rib), superior phrenic arteries; & visceral - bronchial arteries & esophageal arteries
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.
Azygos system
the____ vein terminates by arching over the right primary bronchus to join the superior vena cava.
azygos
the ____ receives as tributaries the intercostal veins of the right side (except the 1st), mediastinal, esophageal, and communicating branches of the hemiazygos system.
azygos
What is formed on the left side in a manner similar to the azygos system.
hemiazygos system
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.
hemiazygos system
What vein has the following major tributaries are the lower left intercostals, the mediastinal, and esophageal systems.
hemiazygos system
What are the Major lymphatic channels of the posterior mediastinum
Thoracic duct & (right bronchomediastinal trunk [optional])
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.
Thoracic duct
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.
thoracic duct
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.
anterior; medial; left subclavian; left internal jugular
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.
thoracic sympathetic trunks
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.
splanchnic nerves
ascending aorta; aortic arch; descending thoracic aorta
It is enclosed within the pericardial sac and gives origin to the right and left coronary arteries.
the ascending aorta
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.
aortic arch
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.
descending thoracic aorta
the first and largest branch of the aortic arch
brachiocephalic artery (trunk)
the brachiocephalic artery gives origin to the
right common carotic artery & right subclavian artery.
How many branches arise from the subclavian artery?
four
Name the branches from the subclavian artery and their location
they are located deep to the right sternoclavicular joint: vertebral artery; costocervical trunk; thyrocervical trunk; internal thoracic artery
(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
vertebral artery
(branch of the brachicephalic artery) the ____ ____ whose two major branches are the deep cervical and supreme cervical arteries; [optional]
costocervical trunk
(branch of the brachicephalic artery)the ____ ____ whose branches are the inferior thyroid, transverse cervical, and suprascapular arteries
thyrocervical trunk
(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.
internal thoracic