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Mediastinum and Heart
Mediastinum and Heart
43
Anatomy
Graduate
07/27/2011

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Term

Mediastinum: Mediastinum contains all structures in the thorax except _____ and ____ , ____ parts of the great vessels, ____, esophagus, thymus, ANS, and ____.  Two divisions: ____ and ____

Definition

Mediastinum: Mediastinum contains all structures in the thorax except the lungs and pleura including the heart, thoracic parts of the great vessels, trachea, esophagus, thymus, ANS, and lymphatics.  Two divisions: superior and inferior

Term

Superior Division of Mediastinum: Superior to the ____ from sternal angle to ____ between T4-5.  Contains: ____, great vessels, ____ and ____ nerves, cardiac plexus, trachea, and ____.

Definition

 

Superior Division of Mediastinum: Superior to the pericardium from sternal angle to IV disc between T4-5.  Contains: thymus, great vessels, phrenic and vagus nerves, cardiac plexus, trachea, and esophagus.

 

Term

Inferior division of mediastinum– 3 Subdivisions:


Anterior:Space between the ____ and ____


Middle:  ____


Posterior:  Thoracic aorta, thoracic duct, ____ and ____ veins, esophagus, ____ plexus, ____ arteries, intercostal veins

Definition

Inferior division of mediastinum– 3 Subdivisions:


Anterior:Space between the thoracic wall and pericardium


Middle:  Heart


Posterior:  Thoracic aorta, thoracic duct, azygos and hemiazygos veins, esophagus, esophageal plexus, posterior intercostal arteries, intercostal veins

Term
  1. ____:
    • Tough external layer protects the heart against sudden overfilling.  
    • Fused with fibr0elastic coat of the great vessels entering and leaving the heart. 
Definition

 

 

  1. Fibrous pericardium
    • Tough external layer protects the heart against sudden overfilling.  
    • Fused with fibr0elastic coat of the great vessels entering and leaving the heart. 

 

 

Term

 

  1. ____:  2 layers – parietal and visceral pericardium
    • Parietal fused with the fibrous pericardium.  
    • Visceral pericardium is reflected onto the heart where it forms the epicardium.  

 

Definition
  1. Serous pericardium:  2 layers – parietal and visceral pericardium
    • Parietal fused with the fibrous pericardium.  
    • Visceral pericardium is reflected onto the heart where it forms the epicardium.  
Term
  1. ____: Space between parietal and visceral pericardium.  Normally contains a thin film of serous fluid.
Definition
  1. Pericardial cavity: Space between parietal and visceral pericardium.  Normally contains a thin film of serous fluid.
Term
Landmarks of the Pericardium (3)
Definition
  1. Landmarks
    • Pericardiacophrenic ligament binds fibrous pericardium to central tendon of the diaphragm.  
    • Transverse pericardial sinus:  Posterior to the pulmonary trunk and ascending aorta and anterior to the superior vena cava.  
    • Oblique pericardial sinus:  Pocket like recess in the pericardial cavity. 
Term
Innervation of the pericardium
Definition
    • Phrenic nerves (C3-C5): Sensory fibers, pain referred to the skin of the ipsilateral supraclavicular region.  
    • Sympathetic trunk: Vasomotor.  
Term
    • ____ artery, which often accompanies ____ nerve.  Major arterial supply
    • ____ vein:  Major venous drainage.
Definition
    • Pericardiophrenic artery, which often accompanies phrenic nerve.  Major arterial supply
    • Pericardiophrenic vein:  Major venous drainage.
Term

Heart:   Slightly larger than a clenched fist, 280-340 grams in men and 230-280 gm in women.  A muscle pump which receives deoxygenated blood from the body to the ____ side and pumps it to the lungs while the ____ side receives oxygenated blood and pumps it to the rest of the body.  

Definition

Heart:   Slightly larger than a clenched fist, 280-340 grams in men and 230-280 gm in women.  A muscle pump which receives deoxygenated blood from the body to the right side and pumps it to the lungs while the left side receives oxygenated blood and pumps it to the rest of the body.  

Term

Borders of the heart 

    1. Right:  ___, ___, ___
    2. Left:  ____ and ____
    3. Inferior:  Mainly by ____ and some of ____
    4. Superior:  ____, ____, ____, ____
    5. Base (posterior aspect): mainly by the ____
    6. Apex (inferolateral end): formed by ____
Definition

Borders of the heart 

 

    1. Right:  Right atrium, SVC, IVC
    2. Left:  Left ventricle and left auricle
    3. Inferior:  Mainly by right ventricle and some of left
    4. Superior:  Atria, aorta, pulmonary trunk, SVC
    5. Base (posterior aspect): mainly by the left atrium 
    6. Apex (inferolateral end): formed by left ventricle 

 

Term
Tissue layers of the heart (3)
Definition
    1. Epicardium (outer, formed by serous pericardium)
    2. Myocardium (middle, muscle layer)
    3. Endocardium (inner, endothelium and subendothelium connective tissue)
Term
  1. ____:  Complex framework of dense collagen forming one large ring divided into four smaller rings each of which contains a valve.  The myocardium is built around this fibrous ring which further serves as an electrical insulator. 
Definition
  1. Fibrous skeleton:  Complex framework of dense collagen forming one large ring divided into four smaller rings each of which contains a valve.  The myocardium is built around this fibrous ring which further serves as an electrical insulator. 
Term
    1. Right Atrium (RA)
      1. Thin walled upper chamber; receives deoxygenated blood from ____, ____ and ____.  
Definition

 

    1. Right Atrium (RA)
      1. Thin walled upper chamber; receives deoxygenated blood from SVC, IVC and the coronary sinus.  

 

Term

Right Atrium:

      1. Smooth posterior wall (____); anterior wall is rough with muscular ridges.  
        1. Two landmarks highlight this anatomical distinction.  A shallow vertical groove called the ____ is the external landmark and a vertical crest called the ____ is the internal landmark.
Definition

Right Atrium:

      1. Smooth posterior wall (sinus of the vena cava); anterior wall is rough with muscular ridges.  
        1. Two landmarks highlight this anatomical distinction.  A shallow vertical groove called the sulcus terminalis is the external landmark and a vertical crest called the crista terminalis is the internal landmark.
Term

RA:

The right ____ is a small muscular pouch that projects to the left from the right atrium and overlaps the ascending aorta. 

Definition

RA:

The right auricle is a small muscular pouch that projects to the left from the right atrium and overlaps the ascending aorta. 

Term

RA:

      1. ____: Translucent oval depression which is the remnant of the embryonic foramen ovale. 
Definition

RA:

      1. Fossa-ovalis: Translucent oval depression which is the remnant of the embryonic foramen ovale. 
Term
      1. ____ (____):  Opening in fossa ovalis (25% of people) results from incomplete closure of the ____, the embryonic communication between the left and right atria which normally closes after birth.  
        1. Small ASDs are not usually clinically significant
        2. Large ASDs can cause oxygenated blood from the ____ atrium to be shunted to the ____ atrium, overloading both it and the ____ ventricle causing dilation of the pulmonary trunk.
Definition

 

      1. Atrial Septal Defect (ASD):  Opening in fossa ovalis (25% of people) results from incomplete closure of the foramen ovale, the embryonic communication between the left and right atria which normally closes after birth.  
        1. Small ASDs are not usually clinically significant
        2. Large ASDs can cause oxygenated blood from the left atrium to be shunted to the right atrium, overloading both it and the right ventricle causing dilation of the pulmonary trunk.

 

Term
    1. Right Ventricle (RV)
      1. Superior left angle tapers into a cone-shaped pouch, the ____ or ____, which leads to the pulmonary trunk.  
        1. Interiorly, this region has a smooth wall whereas the remainder is roughened by a number of irregular papillary muscles and muscular ridges (____) giving a course sponge-like appearance. 
Definition

 

    1. Right Ventricle (RV)
      1. Superior left angle tapers into a cone-shaped pouch, the infundibulum or conus arteriousus, which leads to the pulmonary trunk.  
        1. Interiorly, this region has a smooth wall whereas the remainder is roughened by a number of irregular papillary muscles and muscular ridges (trabeculae carneae) giving a course sponge-like appearance. 

 

Term

RV:


Papillary muscles:  Conical projections distally attached to the ventricular wall and proximally attached to ____ which are themselves attached to the free edges of the tricuspid valve; contracts during ____ to tense the chordae tendineae, preventing the cusps from opening.  

        1. Anterior:largest; primarily responsible for ____.
        2. Posterior: smaller 
        3. Septal:  smallest 

 

Definition

RV:

      1. Papillary muscles:  Conical projections distally attached to the ventricular wall and proximally attached to chordae tendineae which are themselves attached to the free edges of the tricuspid valve; contracts during systole  to tense the chordae tendineae, preventing the cusps from opening.  
        1. Anterior:largest; primarily responsible for valve closure.
        2. Posterior: smaller 
        3. Septal:  smallest 
Term

RV:


Prominent trabeculae carneae crosses the ventricle from the septum to the base of the anterior papillary muscle, this is the ____.  Carries the right bundle branch 

Definition

RV:


Prominent trabeculae carneae crosses the ventricle from the septum to the base of the anterior papillary muscle, this is the moderator band.  Carries the right bundle branch 

Term

Valves

        1. Right atrioventricular valve (____ valve), 3 cusps
        2. Pulmonary valve:  Lies at the apex of the ____ prevents backflow of blood into RV following systole  
Definition

RV:

        1. Right atrioventricular valve (tricuspid valve), 3 cusps
        2. Pulmonary valve:  Lies at the apex of the conus arteriosus prevents backflow of blood into RV following systole  
Term

RV:


Contraction is primarily of the free anterior wall moving towards the ____.  Blood takes a U shaped path through the ____ to leave via the ____.  

Definition

RV:


Contraction is primarily of the free anterior wall moving towards the septum.  Blood takes a U shaped path through the right ventricle to leave via the pulmonary trunk.  

Term

Left atrium:


Long tubular ____ forms the superior part of the left border of the heart.  

Definition

Left atrium:


Long tubular left auricle forms the superior part of the left border of the heart. 

Term

Left Atrium


Walls slightly ____ than the right atrium.  Interior mm is smooth except in the ____, which has muscular ridges.  

Definition

Left Atrium


Walls slightly thicker than the right atrium.  Interior mm is smooth except in the auricle, which has muscular ridges.

Term

Left atrium


____ can form on the walls of the left atrium which can break off, pass into circulation, and occlude peripheral arteries.  Thrombus that obstructs a vessel is called an ____

Definition

Left atrium


Thrombi can form on the walls of the left atrium which can break off, pass into circulation, and occlude peripheral arteries.  Thrombus that obstructs a vessel is called an embolus

Term

Left Atrium

      1. Superior/anterior part is formed by the ____ which leads to the aorta.  Smooth walls are mainly fibrous.  
      2. Interior of remainder is covered with ____ which are finer and more numerous than the RV.  
Definition

Left Atrium

 

      1. Superior/anterior part is formed by the aortic vestibule which leads to the aorta.  Smooth walls are mainly fibrous.  
      2. Interior of remainder is covered with trabeculae carneae which are finer and more numerous than the RV.  

 

Term
      1. Valves
        1. ____ is like the pulmonary valve but cusps are thicker.  Aortic sinuses are formed ____ to each valve by dilation of the wall; prevents the cusps from sticking to the walls of the artery and failing to close.  
        2. ____ (or ____) valve, smaller than the tricuspid valve (2 cusps v 3). 
Definition
      1. Valves
        1. Aortic valve is like the pulmonary valve but cusps are thicker.  Aortic sinuses are formed superior to each valve by dilation of the wall; prevents the cusps from sticking to the walls of the artery and failing to close.  
        2. Mitral (or bicuspid) valve, smaller than the tricuspid valve (2 cusps v 3). 
Term

____ (___):  common in membranous portion of the septum.  Most common cardiac defect (25% of all congenital heart dz.)

Definition

Ventricular septal defect (VSD):  common in membranous portion of the septum.  Most common cardiac defect (25% of all congenital heart dz.)

Term

 

Right coronary artery (RCA)

      1. From the right aortic sinus along the coronary groove between the____ and the ____  inferior to the border of the heart where it gives off a ____ branch that runs towards the apex of the heart.  After giving off this branch, the RCA turns to the left in the posterior part of the ____, enters the posterior ____ groove, gives off its largest branch, the ____ branch.  
      2. Descends toward the apex of the heart and anastomoses with the ____ branch of the LCA.
      3. Typically supplies: RA, RV, IV septum, AV node, and SA node and bundle.  Variably supplies part of the LA and LV.  

 

Definition

Right coronary artery (RCA)

      1. From the right aortic sinus along the coronary groove between the right auricle and the right ventricle  inferior to the border of the heart where it gives off a right marginal branch that runs towards the apex of the heart.  After giving off this branch, the RCA turns to the left in the posterior part of the coronary groove, enters the posterior interventricular (IV) groove, gives off its largest branch, the posterior IV branch.  
      2. Descends toward the apex of the heart and anastomoses with the anterior IV branch of the LCA.
      3. Typically supplies: RA, RV, IV septum, AV node, and SA node and bundle.  Variably supplies part of the LA and LV.
Term
    1. Left coronary artery (LCA)
      1. Arises from the left aortic sinus and passes between the ____ and ____ to reach the coronary groove.  
      2. Divides into ____ branch and ____ branch.  
        1. Larger ____ branch passes along the IV groove to the apex of the heart and anastomoses with the ____ branch of the RCA.  
        2. The smaller circumflex branch follows the ____ groove around the left border of the heart to the posterior surface of the heart.  Terminates to the left of the post IV groove.  Circumflex has a ____ branch that follows the left border of the heart. 
      3. Typically supplies: LV, LA, and IV septum, including the AV bundle.  Variably supplies: SA and AV nodes.
Definition

 

    1. Left coronary artery (LCA)
      1. Arises from the left aortic sinus and passes between the left auricle and pulmonary trunk to reach the coronary groove.  
      2. Divides into IV branch and circumflex branch.  
        1. Larger IV branch passes along the IV groove to the apex of the heart and anastomoses with the posterior IV branch of the RCA.  
        2. The smaller circumflex branch follows the coronary groove around the left border of the heart to the posterior surface of the heart.  Terminates to the left of the post IV groove.  Circumflex has a marginal branch that follows the left border of the heart. 
      3. Typically supplies: LV, LA, and IV septum, including the AV bundle.  Variably supplies: SA and AV nodes.

 

Term
    1. Variations of the coronary arteries
      1. In ~ 50% of cases the ____ is dominant as it crosses the left side and supplies the LV wall and septum.  
      2. In ~20% of cases the ____ is dominant branching to the right side of the heart.  
      3. In 30% of the cases the coronary arteries are balanced.  Some people may have only one coronary artery.  
      4. In about 4% of the cases there is a(n) ____ artery (3 vessels). 
Definition

 

    1. Variations of the coronary arteries
      1. In ~ 50% of cases the RCA is dominant as it crosses the left side and supplies the LV wall and septum.  
      2. In ~20% of cases the LCA is dominant branching to the right side of the heart.  
      3. In 30% of the cases the coronary arteries are balanced.  Some people may have only one coronary artery.  
      4. In about 4% of the cases there is an accessory coronary artery (3 vessels). 

 

Term

Coronary veins

    1. Venous return mainly empties into the ____. The ____ receives the great vein at its left side and the middle and small cardiac veins at its right end.  ____ drains venous blood into the right atrium.
Definition

Coronary veins

    1. Venous return mainly empties into the coronary sinus. The coronary sinus receives the great vein at its left side and the middle and small cardiac veins at its right end.  Coronary sinus drains venous blood into the right atrium.
Term

Coronary veins

    1. ____ vein:  Main tributary of the coronary sinus.  Begins near the apex of the heart and ascends in the ____ groove with the ____ artery.  Drains the areas supplied by the LCA.
Definition

Coronary veins

 

    1. Great cardiac vein:  Main tributary of the coronary sinus.  Begins near the apex of the heart and ascends in the anterior IV groove with the anterior IV artery.  Drains the areas supplied by the LCA.

 

Term

Coronary veins

    1. ____ vein:  Ascends in the posterior IV groove with the posterior IV artery. 
Definition

Coronary veins

 

    1. Middle cardiac vein:  Ascends in the posterior IV groove with the posterior IV artery. 

 

Term

Coronary veins

    1. ____ vein: runs in the coronary groove with the marginal branch of the RCA. 
      1. Middle and small ____ veins drain most of the heart supplied by the RCA.
Definition

Coronary veins

    1. Small cardiac vein: runs in the coronary groove with the marginal branch of the RCA. 
      1. Middle and small cardiac veins drain most of the heart supplied by the RCA.
Term

Coronary conduction system

    1. Specialized for ____ and rapidly ____ through the heart. 
Definition

Coronary conduction system

 

    1. Specialized for initiating an impulse and rapidly conducting that impulse through the heart. 

 

Term

Coronary conduction system

    1. ____ node (____ node):  Pacemaker of the heart; 60-100 beats is the normal HR range. 
      1. ____ node located at the superior end of the crista terminalis at the junction of the ant/med aspect of the SVC.  
      2. ____ node supplied by both divisions of the ANS.  
        1. Under resting conditions, the ____ nervous system acts to restrain HR by acting on the  node. 
Definition

Coronary conduction system

 

    1. Sinoatrial node (SA node):  Pacemaker of the heart; 60-100 beats is the normal HR range. 
      1. SA node located at the superior end of the crista terminalis at the junction of the ant/med aspect of the SVC.  
      2. SA node supplied by both divisions of the ANS.  
        1. Under resting conditions, the parasympathetic nervous system acts to restrain HR by acting on the SA node. 

 

Term

Coronary conduction system

    1. ____ node (____ node):  Located in the interatrial septum. Impulses from both atria converge on the ___ node and then pass to the ventricles.  
      1. Impulse slows down in this area to allow maximal ventricular filling, called ____.  
Definition

Coronary conduction system

 

    1. Atrioventricular node (AV node):  Located in the interatrial septum. Impulses from both atria converge on the AV node and then pass to the ventricles.  
      1. Impulse slows down in this area to allow maximal ventricular filling, called AV delay.  

 

Term

Coronary conduction system

    1. ____ (____).  Originates in the AV node and runs through the membranous part of the IV septum.  Only bridge between the atria and ventricles.  This divides into ____and ____ branches.  Each branch permeates deep into the endocardium portion of the ventricles to ensure coordinated contraction of both ventricles
Definition

Coronary conduction system

 

    1. Atrioventricular bundle (AV bundle).  Originates in the AV node and runs through the membranous part of the IV septum.  Only bridge between the atria and ventricles.  AV bundle divides into right and left bundles branches.  Each branch permeates deep into the endocardium portion of the ventricles to ensure coordinated contraction of both ventricles

 

Term

Coronary Innervation

    1. The ____ nervous system supplies parasympathetic and sympathetic innervation to the heart.  Both come from the ____ plexus which lies ____ to the bifurcation of the trachea, ____ to the arch of the aorta and ____ to the bifurcation of the pulmonary trunk.
Definition

 

Coronary Innervation

    1. The autonomic nervous system supplies parasympathetic and sympathetic innervation to the heart.  Both come from the cardiac plexus which lies anterior to the bifurcation of the trachea, posterior to the arch of the aorta and superior to the bifurcation of the pulmonary trunk.  

 

Term

Coronary innervation

    1. Stimulation of the ____ nervous system causes increase in HR and force of contraction.  
Definition

Coronary innervation

 

    1. Stimulation of the sympathetic nervous system causes increase in HR and force of contraction.  

 

Term

Coronary innervation

    1. Stimulation of the ____ nervous system, via the ____ nerve to the SA Node, slows the HR and decreases the force of contraction.
Definition

Coronary innervation

 

    1. Stimulation of the parasympathetic nervous system, via the right vagus nerve to the SA Node, slows the HR and decreases the force of contraction.

 

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