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General > Cardiovacular Anatomy Outcomes > Flashcards

Cardiovacular Anatomy Outcomes Flashcards

1
Q

Describe the surface anatomy of the heart.

A

anterior (sternocostal).
Base (posterior).
Inferior (diaphragmatic).

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2
Q

How would you palpate for the cardiac apex?

A

In the 5th left intercostal space in the midclavicular line (mitral area).

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3
Q

What are the cardiac borders?

A

Right border
Left lateral border.
Inferior border.

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4
Q

Describe the detailed anatomy of the pericardium.

A

Fibrous pericardium is lined internally by parietal serous pericardium.

The anterior surface of the heart is covered by an invisible layer of epicardium which secretes pericardial fluid.

The pericardial cavity lies between the 2 layers of serous pericardium.

The most proximal segments of the pulmonary trunk and aorta are enclosed in the pericardium.

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5
Q

Describe the pathogenesis (development) of and danger of cardiac tamponade.

A

Pericardial cavity fills with blood (haemopericardium).

The pressure around the heart can then prevent cardiac contraction, known as cardiac tamponade.

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6
Q

Describe the procedure of pericardiocentesis.

A

Drainage of fluid from the pericardial cavity.

A needle is inserted via the infrasternal angle, and directed superoposteriorly, while aspirating continuously.

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7
Q

What is the surgical use of the transverse pericardial sinus in cardiopulmonary bypass?

A

Used to identify and isolate the great vessels in order to commence open heart surgery.

The surgeons finger tip emerges from the sinus, anterior to the SVC.

SVC, aorta, pulmonary trunk.

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8
Q

Name and define the cardiac septae.

A

Internal wall dividing the heart into left and right.

Interventricular septum and interatrial.

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9
Q

How are the positions of the cardiac septae indicated on the surface of the heart?

A

By grooves/sulci.

i.e. the interatrial groove and the interventricular groove.

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10
Q

What is the coronary sinus?

A

Short venous conduit within the atrioventricular groove (posteriorly), which receives deoxygenated blood from the cardiac veins and drains into the right atrium.

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11
Q

What arteries and veins lie within the posterior interventricular groove?

A

Usually a branch of the right coronary artery (posterior interventricular artery) and the posterior interventricular vein.

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12
Q

What arteries and veins lie within the anterior interventricular groove?

A

Branch of the left coronary artery, the left anterior descending, or anterior interventricular artery.

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13
Q

Describe the coronary groove. Which artery can be found in it?

A

It is the surface making for the tricuspid valve/right atrium and right ventricle.

The right coronary artery lies within it.

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14
Q

Where do the coronary arteries arise from?

A

The ascending aorta.

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15
Q

what are the 4 cardiac chambers?

A

Right and left atria.

Right and left ventricles.

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16
Q

What are the internal features of the cardiac chambers?

A

Right atrium: opening of SVC, IVC and coronary sinus. The oval fossa. Crista terminalis. Muscle bands of the wall of the auricle. Tricuspid valve.

Right ventricle: tricuspid and pulmonary valve. moderator band.

Left atrium: openings of superior and inferior pulmonary veins. May have foramen ovale. Mitral valve.

Left ventricle: aortic and mitral valve.

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17
Q

Name and describe the 4 aortic valves (names, locations, designs and heart sounds).

A

Tricuspid: between right atrium and ventricle. 1st heart sound. It has 3 cusps: anterior, posterior and septal.

Pulmonary: between right ventricle and pulmonary trunk. 3 cusps: anterior, right and left. 2nd heart sound.

Mitral: between left atrium and ventricle. 2 cusps: anterior and posterior. It also has valve leaflets, tendinous cords and papillary muscles. 1st heart sound.

Aortic: between left ventricle and aorta. 3 cusps: right, left and posterior and sinuses. 2nd heart sound.

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18
Q

Where would you auscultate the aortic valve?

A

2nd right intercostal space, edge of the sternum.

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19
Q

Where would you auscultate the pulmonary valve?

A

2nd left intercostal space, edge of the sternum.

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20
Q

Where would you auscultate the tricuspid valve?

A

4th left intercostal space, edge of the sternum.

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21
Q

Where would you auscultate the mitral valve?

A

5th left intercostal space, mid-clavicular line.

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22
Q

Summarise the cardiac cycle.

A

Diastole: blood returns to the RA via the IVC/SVC, and from the pulmonary veins to the LA.

T&M valves open to fill R&L ventricles.

Impulse originates at the SA node, to the AV node. Atrial contraction completes ventricular filling.

Impulse travels to bundle of his, and throughout the ventricles. Ventricles contract, closing tricuspid and mitral valves and opening aortic and pulmonary, ejecting blood from the heart.

Ventricles relax, and aortic and pulmonary valves shut (2nd heart sound).

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23
Q

Summarise the role of nerves in the heart.

A

Autonomic innervation (reach heart via cardiac plexus):

  1. Sympathetic-increase heart rate and contractility.
  2. Parasympathetic- decrease heart rate.

Visceral afferent nerves:

  1. pain fibres travel to spinal cord along sympathetic nerves.
  2. visceral afferents travel in the vagus nerves.
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24
Q

How do sympathetic nerve fibres get from the CNS to the organs?

A

CNS–> presynaptic/preganglionic fibre–> sympathetic chain ganglion (synapse)–> postsynaptic fibre–> organ.

The neurotransmitter at the ganglion is acetylcholine.
At the organ: noradrenaline.

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25
Q

What is a cardiopulmonary splanchnic nerve?

A

These are sympathetic nerves which supply the heart and lungs.

i.e. postsynaptic fibres from cervical and upper thoracic sympathetic chains.

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26
Q

Define cardiac plexus.

A

It is composed of sympathetic fibres, parasympathetic fibres and visceral afferent fibres.

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27
Q

How do sympathetic nerve fibres get from the CNS to the organs?

A

CNS–> presynaptic/preganglionic fibre–> sympathetic chain ganglion (synapse)–> postsynaptic fibre–> organ.

The neurotransmitter at the ganglion is acetylcholine.
At the organ: acetylcholine.

28
Q

Define pain (in anatomical/physiological terms).

A

Stimulation of a sensory receptor, which sends an afferent action potential to the brain. The brain feels pain according to which part of the brain is stimulated by the AP.

29
Q

List the anatomical complexities in the diagnosis of central chest pain.

A

Radiating, referred ad=bd acute/chronic pain.

It may come from somatic or visceral origins.

30
Q

List the features of somatic pain.

A

Sharp, stabbing, well localized.

31
Q

What is meant by somatic pain?

A

Pain originating from muscles, joints, bones, invertebral discs, fibrous pericardium and nerves.

32
Q

What is meant by visceral pain?

A

Pain originating from organs, e.g. heart and great vessels, trachea, oesophagus, abdominal viscerae.

33
Q

List the features of visceral pain.

A

Dull, aching, nauseating, poorly localized.

34
Q

Summarise, in general terms, the route a somatic sensory action potential takes to reach consciousness.

A

Skin mechanoreceptors in a dermatome will be stimulated in response to pain.

The AP is propagated centrally, and via the pain pathway crosses into the spinal cord.

The sensation of pain reaches consciousness at the cerebral cortex.

35
Q

give examples of somatic pathology that give rise to central chest pain.

A

Herpes zoster.
Muscle, joint or bone pain: slipped thoracic invertebral disc.
Parietal pleura and fibrous pericardium: pleurisy and pericarditis.

36
Q

define the anatomical subdivisions of the mediastinum.

A

Superior and inferior.

Inferior is further divided into: anterior, middle and posterior.

37
Q

What structures are found within the posterior mediastinum?

A

Azygous vein, sympathetic chains, thoracic duct, vagus nerves, aorta, trachea and 2 main bronchi, and the oesophagus.

38
Q

Summarise, in general terms, the route a visceral afferent action potential takes to reach consciousness

A

Visceral afferents travel alongside sympathetic nerves to organs.

Visceral afferent APs pass bilaterally to the thalamus and hypothalamus, and then diffuse areas of the cortex.

39
Q

Define and explain in general terms radiating pain.

A

Pain is felt both at the site of the pathology, and spreading away from that location.

i.e. if pain originates in a somatic structure, pain may radiate along that dermatome.

40
Q

Define and explain in general terms referred pain

A

Pain is felt ONLY at a site remote from the actual area or injury/disease.

Due to afferent fibres from soma and viscera entering the spinal cord at the same levels.

The brain chooses to believe pain signals originating in an organ, are actually coming from the soma.

41
Q

To which areas does pain radiate/refer from the heart?

A

upper limbs, especially left, or from back, neck or jaw.

42
Q

Define “myocardial infarction” and relate to surfaces and arterial supply of the heart.

A

MI= necrosis of part of the myocardium due to occlusion of its arterial blood supply.

Defined clinically according to which surface of the heart has been affected, anterior MI (LAD), inferior MI (right coronary), anterolateral MI (left circumflex).

43
Q

Define right and left and co-dominance in relation to the coronary arteries.

A

Refers to the territory supplied by the coronary arteries.

44
Q

Which coronary artery gives rise to the posterior interventricular artery?

A

Right coronary artery.

45
Q

State the 4 most common places for coronary artery occlusion (from most common to least).

A
  1. The anterior interventricular branch (LAD) of the left coronary artery.
  2. The right coronary artery.
  3. Circumflex branch of the left coronary artery.
  4. The left main stem coronary artery.
46
Q

Define CABG and state the vessels most commonly used as grafts.

A

Used in the treatment of coronary heart disease.

Grafts may be anastomosed to the coronary artery, distal to the narrowing, and therefore bypassing it.

commonly used vessels: radial artery, internal thoracic/mammary artery, great saphenous vein.

47
Q

Detail the anatomy of the conducting system of the heart and state the blood supply to the nodes and bundle branches.

A

SA node. Blood supply from SA nodal branch from the RCA.

AV node. AV nodal branch originating from the RCA, near the origin of the posterior interventricular artery.

L&R bundle branches: right: PIV artery, left: LAD.

48
Q

What can happen if conducting tissue is damaged by ichaemia?

A

Arrhythmia.

AV node damage will lead to complete heart block.

Bundle branch damage will lead to bundle branch block.

49
Q

What lies within the anterior mediastinum? Describe it.

A

Between the sternum and the fibrous pericardium.

Thymus gland. In childhood it produces T lymphocytes.

After puberty it is replaced by adipose tissue.

50
Q

What lies within the middle mediastinum? Describe it.

A

The pericardium, the heart and the parts of the great vessels that connect with the heart.

51
Q

Describe the azygous vein.

A

It arches anteriorly superior to the hilum to drain into the SVC.

Intercostal veins drain posteriorly into the azygous vein.

It can be ruptured in chest trauma.

52
Q

Describe the surface anatomy of the arch of the aorta and the venous angles.

A

3 branches.

  1. Brachiocephalic trunk.
  2. Left common carotid artery.
  3. Left subclavian artery.

R&L lymphatic ducts drain lymph into the R&L venous angles. They are also used for central venous access.

53
Q

How does lymph drain from the left lung?

A

Bronchopulmonary lymph nodes surround the main bronchus at the lung root. These drain to the left lymphatic duct/ the thoracic duct at the left venous angle.

54
Q

Which parts of the body drain into the thoracic duct? Describe it.

A

It is the largest lymphatic vessel. It starts at T12 and extends to the left venous angle at the route of the neck, where it drains into the systemic circulation.

It collects most of the lymph in the body (except from the RIGHT: thorax, arm, head and neck).

55
Q

Where is the left venous angle located?

A

It is located at the junction of the left internal jugular and subclavian vein.

56
Q

What surface anatomy marks the venous angles?

A

the L&R sternoclavicular joints.

57
Q

Which type of nerve fibres are carried by the vagus nerve?

A

It is a cranial nerve carrying both motor and sensory fibres.

58
Q

Which fibres remain within the vagus nerve after the recurrent laryngeal branch is given off (root of the neck on the right and chest on the left).

What does this asymmetry enable?

A

Parasympathetic nerve fibres only.

Mediastinal pathology having the potential to affect the functioning of only the left recurrent laryngeal nerve.

59
Q

name in the correct sequence and identify all the components of the superior mediastinum .

A

From anterior to posterior:

  1. brachiocephalic veins & SVC.
  2. Arch of the aorta.
  3. Trachea
  4. Oesophagus.
  5. Thoracic duct.

From lateral to medial:

  1. Phrenic nerves
  2. Vagus nerves
  3. Recurrent laryngeal nerves.
60
Q

What do phrenic nerves supply?

A

diaphragm, mediastinal parietal pleura, fibrous pericardium, diaphragmatic parietal pleura, diaphragmatic parietal peritonerum.

61
Q

Why can diaphragmatic pathology present as shoulder tip pain?

A

It may irritate the parietal peritoneum lining the inferior surface of the diaphragm, which is supplied by the phrenic nerve.

supraclavicular nerves C3, 4 supply the dermatomes over the shoulder tip and enter the spinal cord at the same levels as the phrenic nerve.

62
Q

Describe the recurrent laryngeal nerves.

A

Branches of the vagus nerve which supply the pharynx and larynx.

They contain both somatic motor and sensory nerves.

63
Q

Why might a patient with dysphagia and hoarseness have a mediastinal mass?

A

The left recurrent laryngeal nerve supplies the muscle of the larynx.

A mediastinal mass may compress the laryngeal nerve leading to hoarseness and dysphagia.

64
Q

State and identify the anatomy relevant to taking the patients pulse (including JVP and auscultating carotid bruits).

A

Neck: bifurcation of the common carotid artery - also site of auscultation of carotid bruit.

Upper limb: brachial artery and radial artery.

Lower limb: femoral artery, popliteal artery, posterior tibial and dorsalis pedis.

65
Q

how are major arteries and veins used clinically?

A

radial artery: cannulation for ABG.

Brachial artery: measuring BP.

Femoral: intravascular interventions.

Subclavian: insertion of cardiac pacing wire underultrasound guidance.

Femoral vein: insertion of central line and intravascular interventions.

Internal jugular vein: insertion of central vein under ultrasound guidance.

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