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Anatomy - The Thorax
N/A
168
Anatomy
Graduate
02/03/2011

Additional Anatomy Flashcards

 


 

Cards

Term
There are 2 cavities in the thorax: what are they and what do they contain?
Definition

2 pulmonary cavities with the lungs

 

mediastinum with heart and vessels

Term
Map the structures of the thorax from larynx to the lungs
Definition

larynx - extends to cricoid cartilage

trachea - cricoid (C6) to T4/5

carina

Principal (right and left) bronchi - at sternal angle, opposite T4/5

 

Term
Why does the right bronchus become infected more than the left?
Definition
because it's wider - more stuff can get in
Term
___ is a muscular tube that extends from the pharynx to the stomach. Begins at level ___.
Definition
Esophagus - begins at C6
Term
3 constrictions of the esophagus. what is the clinical importance of these constrictions?
Definition

1. junction of pharynx and esophagus. 6 in from upper incisors.

2. aortic arch and left bronchus cross. 10 in from upper incisors

3. esophagus passes through diaphragm into stomach. 16 in from upper incisors

 

food can lodge here

common site for esophageal carcinoma

Term
The ___ is the largest lymphatic channel in the body. it ends in the ___ at t12-just below the diaphragm. It collects all the lymph in the body and drains into the ___ and ___ veins.
Definition

thoracic duct.

chyle cistern.

L internal jugular and L subclavian

Term
The thoracic duct passes through the diaphragm along the descending aorta and has 3 openings:
Definition

esophageal

vena cava

aortic

Term
Chylothroax
Definition

when the thoracic duct is cut and lmph enters the thoracic cavity

 

happens due to malignancy or trauma or is congenital

Term
The hemiazygous vein crosses the thorax to drain into the azygous vein at what level? the accessory hemiazygous vein crosses the thorax to drain into the azygous vein at what level?
Definition

T9

 

4/5 intercostal space

Term
The ___ brings deoxygenated blood from the upper body to the R atria. It collects blood from the right and left ___ veins.
Definition
sup vena cava, from subclavians
Term
The ___ brings deoxygenated blood from the lower body to the ___ vein, which drains into the superior vena cava.
Definition

inf vena cava

azygous

 

Term
The ascending aorta arises from ____ and extends to the ____, at which point it become the ____. This extends to the ____, where it becomes the ____.
Definition

L ventricle to 2nd R intercostal joint

becoems Aortic arch, which extends to 2nd L intercostal joint and becomes the descending aorta

Term
2 branches of ascending aorta
Definition
right and left coronary arteries
Term
3 branches of aortic arch
Definition

brachiocephalic

L common carotid

L subclavian

Term
4 branches of thoracic descending aorta
Definition

posterior intercostal arteries

subcostal artieries

phrenic arteries

visceral branches (esophageal)

Term
Parts of the subclavian artery and their branches
Definition

1st part - vertebral artery (neck), internal thoracic artery (pericardiophrenic, mediastinal, pericardial, sternal, anterior intercostal, perforating, musculophrenic, sup epigastric), thyrocervical artery (inf thyroid, suprascapular, superficial cervical)

 

2nd part - costocervical

 

3rd part - dorsal scapular

Term
Anomalies of aorta
Definition

retroesophageal right subclavian (esophagus sits in the middle of the arch)

double arch

variations of arteries branching off arch

Aneurism of ascending aorta

coarctation of aorta

Term
the ___ carries blood to the lung from the right ventricle to be oxygenated. the ___ brings blood back to the heart after it's been oxygenated
Definition
pulmonary artery, pulmonary vein
Term
The __ is the dome-shaped septume dividing the thorax from the abdominal cavity. It has two portions: ___ and ___.
Definition

diaphragm.

 

musculotendinous and centrally placed aponeurosis

Term
3 openings of diaphragm
Definition

1. caval opening (T8) - inferior vena cava, right phrenic nerve (!), lymphaticus

2. esophageal opening (T10) - gastric left artery and vein, lymphaticus, esophagus, vagus nerve (!)

3. Aortic opening (T12) - aorta, thoracic duct, azygous vein

Term
Arteries of the diaphragm
Definition

Superior surface:

1. pericardiophrenic and musculophrenic - branch of Internal thoracic

2. superior phrenic- branch of Thoracic aorta

 

Interior surface:

1. inferior phrenic - branch of abdominal aorta

Term
Veins of the diaphragm
Definition

Superior surface:

1.pericardiophrenic and musculophrenic - branch of internal thoracic vein

2. superior phrenic - branch of inferior vena cava

 

inferior surface:

1. inferior vena cava and left suprarenal vein (left side only)

Term
Nerve supply of diaphragm
Definition

phrenic nerve at C3-5. Motor and sensory supply

Intercostal nerve of lower 6 or 7 ribs - sensory supply for peripheral diaphragm

Term
If a person had a neck injury that damages the phreic nerve, what would be the result?
Definition
paralysis of diaphragm
Term
Lymphatic drainage of the diaphragm
Definition

superior surface: phrenic nodes --> parasternal nodes --> mediastinal nodes

 

INferior surface: lumbar nodes

 

lymphatic plexuses of sup and inf surface communicate freely

Term
Nerves of the thorax
Definition

Right and left vagus

Right and left phrenic

Recurrent pharyngeal

 

right pulmonary, cardiac, and esophageal plexi

Term
Characteristics of the thoracic sympathetic trunk

It is the most ____ structure in the posterior mediastinum.
It bears a ganglion for each spinal nerve, which receives a ____ containing preganglionic fibers and donates back a ____ bearing postganglionic fibers.
____ fibers are distributed to the skin with each thoracic spinal nerve
____ fibers from T1-5 are distributed to thoracic viscera, heart, great vessels, lungs, esophagus.
Mainly ____ fibers from T5-12 form splanchnic nerves which pierce the diaphragm and pass to the abdomen and relay and post ganglionic fibers to abdominal viscera
T5-T10 = ?
T10-11 = ?
T12 = ?
Definition

lateral

white ramus communicans, grey ramus communicans

sympathetic

post ganglionic

preganglionic

Greater splanchnic

lesser splanchnic

least splanchnic

Term
The true thoracic wall includes what 3 parts?
Definition

1. thoracic cage (skeleton)

2. Intrinsic muscles and those that connect the chest wall to the limbs, abdomen, and back

3. blood vessels, lymphatic vessels, nerves

Term
Trace the thoracic wall from inner to outer layers, starting with the lung
Definition
Lung --> pleural cavity --> visceral pleura --> parietal pleura --> endothoracic fascia with intercostal artery, vein, & nerve --> muscles (serratus anterior, external intercostal, internal intercostal, innermost intercostal) --> superficial fascia --> skin
Term
2 thoracic apertures. Outlet/inlet?
Definition

superior - made by first rib and upper manubrium

 

and inferior - made by 11th & 12th ribs, T12, 7-10th costal cartilage, and xiphoid process

 

Clinically, the superior aperture is the outlet, anatomically, it's the inlet.

Term
Thoracic outlet syndrome
Definition
Lots of muscles and nerves enter the thoracic cavity through the superior aperture. if they get caught, the person can experience pain and numbness of the upper limbs.
Term
True, False, and Floating ribs
Definition

True: connect directly to sternum (vertebrocostal ribs). 1st-7th

 

False: 8th-10th ribs. attach to costal cartilage, which attaches to the sternum (vertebrachondral ribs)

 

Floating ribs: (vertebral/free ribs) not connected to cartilage. 11th & 12th, sometimes 10th

Term
Function of the head, body, and tubercle of the ribs
Definition

Head: inferior facet to attach to corresponding # of T vertebra and the vertabra above. (#7 attaches to superior facet of T7 and inferior facet of T6)

 

Tubercle (and neck): articular part attaches to transverse process of corresponding vertebrae

 

Body: Inner surface has groove at lower border (costal groove with intercostal vein, artery, and nerve)

Term
"typical" ribs
Definition

3-9

 

have head, neck, tubercle, and body with a costal groove with the vein, artery and nerve

Term
Atypical ribs (distinguishing features)
Definition

1 - broadest, widest, shortest, has superior and inferior surface instead of external and internal, has scalene tubercle on sup surface for scalene muscles, groove for subclavian vein & artery

2 - more typical than 1, thinner less curved body, has tuberosity for serratus anterior

10 - closely resembles typical but is shorter

11&12 - short, no neck or tubercle

Term
Sternal bone marrow
Definition
Sternum possesses red hematopoietic marrow throughout life, so it's a common place for a bone marrow biopsy. It is sampled via manubriosternal biopsy.
Term
Sternal anomolies
Definition

1. cleft sternum - sternal bars don't fuse, so heart is not contained (ectopia cordis)

 

2. Small perforation from bars not entirely fusing - no symptoms

Term
About what age does the xiphoid process become ossified?
Definition
40
Term
Median sternotomy
Definition
cutting the midline of the sternum during surgery
Term
Another name for the sternal angle
Definition

angle of louis

 

at T4-5

Term
Transverse ridges of sternum
Definition

go accross the body

 

from where the sternal bars fused

Term
What level is each at?

Body, sternal angle, xiphoid
Definition

sternal angle - T4-5

body - T5-9

xiphoid - T10

Term
What's the most common cause of sternal fractures?
Definition
car accident
Term
6 joints of the thorax
Definition

1. vertebrae (intervertebral) - between vertebral bodies and between articular processes

2. costovertebrale joints - between true ribs and vertebrae

3 - costochondral joints - between false ribs and cartilage

4 - sternoclavicular

5. sternocostal

6. manubriosternal and xiphisternal (are sometimes fused in elderly)

Term
Where do rib fractures usually occur?
Definition

in front of sternal angle - weakest point

 

very rarely break the first rib bc it's attached to the clavicle

Term
Complications of rib fractures
Definition
can tear diaphragm or herniate intestine
Term
what is separation of ribs?
Definition
ribs separate from the costal cartilage and move upward. Painful and can irritate vasculature
Term
Dislocation of ribs
Definition
ribs separate from sternum
Term
Why would separation of ribs be more common in older people than younger?
Definition
younger people have more flexible cartilage
Term
Supernumerary ribs
Definition
extra ribs - cervical or lumbar
Term
5 muscles of the upper limb
Definition
pectoralis major, pectoralis minor, serratus anterior, latissimus dorsi, subclavian
Term
4 muscles of the thoracic wall
Definition
intercostal, subcostal, transverse thoracic, levator costorum
Term
Pec Major - origin, insertion, innervation, action
Definition

Origin of clavicular head: Anterior surface of medial half of clavicle

Origin of sternocostal head: anterior surface of sternum, superior 6 costal cartilages

Insertion: lateral lip of intertubercular groove

Innervation: Medial and lateral pectoral nerves

Action: together, both heads adduct and medially rotate humerous. Clavicular head (alone) flexes glenohumeral joint. Sternocostal head (alone) extends glenohumeral joint

Term
Pectoralis minor
Definition

Origin: 3rd to 5th ribs near costal cartilage

Insertion: coracoid process of scapula

Innervation: Medial pectoral nerve

Action: lowers lateral angle of the scapula and pulls shoulders forward

Term
What do surgeons use the pec minor as a landmark for?
Definition
axillary artery & brachial plexus - passes through pec minor and supplies the upper limbs
Term
Serratus anterior
Definition

Origin: lateral surfaces of 1st-8th ribs

Insertion: anterior surface of medial border of scapula

Innervation: Long thoracic nerve

Artery: Lateral thoracic

Action: Protracts scapula and holds is against thoracic wall when you push outward = "Boxer muscle"

Term
What would be the effect of paralyzation of the long thoracic nerve?
Definition
scapula would protrude backward from body
Term
Subclavian
Definition

Origin: 1st rib, near costal cartilage

Insertion: inferior surface of the middle clavicle

Innervation: Nerve to the subclavius (5th and 6th)

Artery: Clavicular branch of thoracoacromial

Action: draws clavicle down and forward, stabilizes clavicle in movement of upper limb

Term
Transverse thoracics
Definition

Origin: inner surface of xiphoid process, lower part of body and adjacent costal cartilage (5,6,7)

Insertion: posterior surface of the 2-5th costal cartilage close to their costal ends

Innervation: intercostal nerve

Action: Depress costal cartilage in forced expiration

Term
Subcostalis
Definition

thin musculoaponeurotic slips around the inner surface of the lower ribs

 

Origin: inner surface of the rib near its angle

Insertion: inner surface of the 2-3 rib below

Innervation: intercostal nerve

Action: Depress ribs

Term
The space between two ribs and their costal cartilage is called? When all is in there? How are they named?
Definition

Intercostal space

Intercostal muscles and membrane

Named according to the superior rib (11 spaces total)

Term
External intercostal
Definition
elevate rib during forced inspiration
Term
Internal intercostal
Definition
interchondral part elevates the rib, interosseous part depresses the rib during forced expiration
Term
3 intercostal muscles
Definition
external, internal, innermost
Term
2 movements of the thorax
Definition

Pump handle - oblique-downward orientation allows their elevation to increase the AP diameter of the thorax and push the sternum forward

 

Bucket handle - ribs are pulled up by the intercostal muscles, which increases the transverse diameter of the thorax

Term
How many intercostal nerves are there?
Definition

12 - T1-T11 are ventral rami

T12 (subcostal)- passes into anterior abdominal wall inferior to 12th rib

Term
Characteristics of typical intercostal nerves
Definition

3rd-6th intercostal nerves are "typical"

Passes along the costal groove

 

5 branches:

1. rami communicans (sympathetic ganglia)

2. collateral branch (at the angle, intercostal muscle)

3. Muscular branch (intercostal muscles)

4. Lateral cutaneous branch (mid-axillary line supplies skin over pectoral and scapular region)

5. anterior cutaneous branch (anterior aspect of thorax and abdomen)

Term
Atypical intercostal nerves
Definition

1 & 2 - on the internal surface of the 1st and 2nd ribrib

1st has no anterior cutaneous branch

2nd has large lateral cutaneous branch (axilla)

 

7th to 11th - continues as thoracoabdominal nerve (abdominal skin and muscles)

 

12th or subcostal - inferior to 12th rib

Term
Arteries of the thoracic wall
Definition

posterior intercostal (11) plus one subcostal -- all branch from thoracic aorta

 

anterior intercostal (9)

Term
The internal thoracic artery splits at the 6th/7th rib to form the ___ and ____.
Definition
musculophrenic and superior epigastric
Term
Veins of the thoracic wall
Definition

Posterior intercostal (11): 1st drains into brachiocephalic vein

2nd, 3rd, sometimes 4th drains form superior intercostal vein, which drains into azygous

All others drain into azygous or hemiazygous

 

Anterior Intercostal (9) - all drain into internal thoracic

Term
Lymph nodes of thoracic wall
Definition

Parasternal nodes (on edge of sternum between costal cartilage)

 

Diaphragmatic nodes - 1 on each side of xiphoid

 

Intercostal nodes - between each rib on the transverse processes of the vertebrae

Term
Mammary gland tissue lies in the ___ fascia, is a modified sweat gland, and is supported by strands of fibrous tissue called the _____. Extends from approximately __-__ ribs.
Definition

superficial

suspensory ligaments

2-6

Term
Why is the lymphatic flow of the breast clinically significant?
Definition
metastatic dissemination occurs principally through lymph
Term
Why does breast cancer often result in an orange-peel appearance?

Why would breast cancer cause dilated superficial veins?

Why would it cause nipple retraction?

Why would it cause skin dimpling?
Definition

lymphatic drainage of cancer may cause lymph edema (excess fluid in subcu) which causes orange-peel

 

Fast-growing tumor has large vascular demand which dilates blood vessels

 

Carcinomal involvement of mammary ducts may cause duct shortening and retraction or inversion of nipple.

 

Dimpling of skin over a carcinoma is caused by involvement of suspensory ligaments.

Term
Suspensory ligaments are AKA?
Definition
Cooper's ligaments
Term
Fibrocystic change and fibroadema
Definition

Fibrocystic change - occurs in ~80% of women and is related to cyclic changes in maturation and involution of glandular tissue

 

Fibroadema - 2nd most common tumor of breast after carcinoma. Benign neoplasm of glandular epithelium and is usually accompanied by a significant increase in connective tissue stroma

Term
How do the breasts develop in embryology?
Definition
The milk ridge is a linear thickening of ectoderm and extends from the axila obliquely to the inguinal region. In humans, the area of the pectoral region thickens and forms the breast, nipple, and areola
Term
Extra breasts and extra nipples
Definition

polymastia - 90% of the time it's just inferior to the normal breast. 5% in axilla, 5% in abdomen

 

Polythelia - extra nipples anywhere along the mammary ridge from axila to groin

Term
slight, temporary enlargement of breasts in males at puberty (70%)
Definition
gynecomastia
Term
Approximately what percent of breast cancer is in men?
Where does it tend to infiltrate?
Definition

1.5%

pectoral fascia, pec major, apical nodes

Term
Describe the pleura of the thoracic wall
Definition

1. visceral - covers lung

2. parietal - covers body wall, is pain-sensitive, has 4 parts:

a. costal

b. mediastinal

c. diaphragmatic

d. cervical - cupula, covers apex of lung

 

Suprapleural membrane - extends above clavical to C7

 

Term
Pleurisy (pleuritis)
Definition
inflammation of the pleura with exudation (escape of fluid) into cavity. causes pleural surfaces to be roughened and makes sound that can be heard upon auscultation
Term
Potential space between viceral and parietal pleura. usually contains a thin fluid that keeps tension off lugns
Definition
pleural cavity
Term
Costadiaphragmatic recess
Definition

potential space at the posteriormost tips of the cavity, located at the junction of the costal pleura and diaphragmatic pleura. It measures approximately 5 cm vertically, and extends from the eighth to the tenth rib along the mid-axillary line.

 

fills during forced inspiration.

 

used for thoracocentesis

Term
costamediastinal recess
Definition
potential space at the border of the mediastinal pleura and the costal pleura. It helps the lungs to expand during deep inspiration, although its role isn't as significant as the costodiaphragmatic recess, which has more volume. The lung expands into the costomediastinal recess even during quiet inspiration. The costomediastinal recess is most obvious in the cardiac notch of the left lung.
Term
Bare area
Definition
area not covered by pleura - used for centesis
Term
Pleurodesis
Definition
obliteration of the pleural cavity by disease such as pleuritis
Term
Where do injuries to pleura usually occur?
Definition

most common: cervical pleura because it extends above the clavicles

 

Also:

- Right part of infrasternal angle at xiphoid process

- Right and left costovertebral angles, during kidney surgery

Term
Air in pleural cavity
Blood in pleural cavity
fluid in pleural cavity
blood and air in pleural cavity

How do you remove these?
Definition

Pneumothorax, hemothorax, hydrothorax, hemopneumothorax

 

by thoracentesis (pleurocentesis or pleural tap) - done above superior border of inferior rib to avoid VAN

Term
How are chest tubes inserted?
Definition

short incision made at 5th/6th intercostal space at midaxillary line (nipple level)

 

Tube directed superiorly to collect air, inferiorly to collect fluid/blood

 

Done to remove large amounts of exudate

Term
examination of pleural cavity with endoscope
Definition
thoracoscopy
Term
Atelectasis - what is it and what are the different kinds?
Definition

Collapse of a lung (pulmonary collapse) - occurs if distention is not maintained bc of the lungs' inherent elasticity.

 

Primary atelectasis - lungs never inflate at birth

Secondary atelectasis - collapse of previously inflated lung

Segmental atelectasis - segment of lung collapses due to blocked bronchus - other segments compensate for collapsed one

 

Term
Contents of each hilum (lung root)
Definition

principle bronchus

one pulmonary artery

two pulmonary veins (sup and inf)

bronchial arteries

bronchial veins

branches of vagus nerve

Term
How is the pulmonary ligament formed and where is it located?
Definition
visceral and parietal pleura extend downward from mediastinum surface of hilum
Term
Which lung is narrower and longer?
Definition
left
Term
Most common variation in lung lobes
Definition
azygous "accessory" lobe
Term
4 indentations in right lung
2 indentations in left
Definition

superior vena cava, trachea, esophagus, azygous vein

 

left: aorta, cardiac impression

Term
The secondary bronchi form the lobes of the lung, so there are # secondary bronchi on the right and # on the left.
Definition
3 on right, 2 on left
Term
Bronchopulmonary segments - how are the formed? how many are there on each side?
Definition

Formed by tertiary (segmental) bronchi - one tertiary bronchi + one pulmonary artery per segment.

 

9 on right lung

8 on left

Term
Pneumectomy, lobectomy, segmentectomy
Definition

pneumectomy - removal of one whole lung

lobectomy - removal of one lobe of a lung

segmentectomy - removal of one segment

Term
Cancers of the lung

___ arises in epithelium of larger bronchi and tneds to form masses

____ originates in the peripheral areas of the lungs as solitary nodules that develop from bronchial mucous glands and alveolar epithelial cells

___ contains small epithelial cells that originate in the main bronchi and grow aggressively in cords of grapelike clusters

___ are either lesions of lower trunk brachial plexus or lesions of cervical sympathetic chain ganglia
Definition

bronchopulmonary - cancer of bronchus

 

squamous cell carcinoma - arises in epithelium of larger bronchi and tneds to form masses

 

adenocarcinoma - originates in the peripheral areas of the lungs as solitary nodules that develop from bronchial mucous glands and alveolar epithelial cells

 

small-cell carcinoma - contains small epithelial cells that originate in the main bronchi and grow aggressively in cords of grapelike clusters

 

Pancoat's (superior pulmonary sulcus tumor) - are either lesions of lower trunk brachial plexus or lesions of cervical sympathetic chain ganglia

 

 

Term
Symptoms of Pancoat's tumor
Definition
drooping eyelid, excessive sweating, vasodiltation - due to pressure on nerve
Term
What is pneumoconiosis and what are the 3 different types?
Definition

deposition of substantial amounts of particles in lungs. causes irritation, inflammation, breathing disorder, cough, chest pains, lung cancer

 

anthracosis - accumulation of carbon

silicosis - crystalline silica dust

asbestosis - asbestos fibers

Term
Blood supply for lungs
Definition

R & L bronchial artery

R & L pulmonary artery

2R and 2L pulmonary veins

Term
Pulmonary embolism and what causes it
Definition

obstruction of pulmonary artery by a blood clot - results in obstruction of blood flow to whatever part of lung is supplied by the affected artery and causes lung atrophy

 

cause: blood clot, flat globule, or bubble travels in the blood to the lungs from a leg vein - often happens following compound fracture.

Term
Nerves of the lung and pleura - pulmonary plexus. What does it contain?
Definition

Parasympathetic afferent and efferent fibers from the vagus nerve

 

Sympathetic - 2nd-5th thoracic spinal nerves

 

Term
Parasympathetic supply to lung and pleura from vagus nerve
Definition

motor to the bronchial muscles and causes bronchospasm

 

secrotomotor to mucus glands of bronchial tree - increases glandular secretion

 

sensory fibers for stretch reflex and cough reflex

 

inhibitory to pulmonary vessels

Term
Sympathetic nerves of lung and pleura - what do they do?
Definition
inhibitory to smooth muscle (bronchodilators), motor to pulmonary vessels (vasoconstrictor) and inhibitory to alveolar glands
Term
The ___ nerve runs posterior to the hilum of the lungs, the ___ nerve runs anterior
Definition
vagus, phrenic
Term
How is the mediastinum divided?
Definition

An imaginary line runs from the sternal angle to T4/T5 IV disk to separate the superior and inferior mediastinum

 

The inferior mediastinum is further divided into:

1. anterior mediastinum - in front of pericardium to sternum. contains lymph and lower part of thymus

2. Middle mediastinum - pericardium. contains heart and ascending aorta.

3. posterior mediastinum - behind pericardium to vertebrae. contains esophagus, descending aorta, azygous and hemiazygous veins, thoracic duct

Term
Layers of pericardium
Definition

1. Fibrous - protects lung

2. serous - 2 parts:

a. parietal layer - covers visceral

b. visceral layer - encloses heart

Term
The ___ is the area between the parietal and visceral pericardium. Fxn?
Definition
pericardial cavity - helps eliminate friction
Term
Pericarditis, pericardial effusion, cardiac temponade
Definition

pericarditis - inflammation of pericardium - causes chest pain, in severe cases can be calcified

 

pericardial effusion - blood goes into pericaridal caivity. fibrous pericardium cannot expand so too much fluid compresses heart = cardiac temponade. treated by pericardiocentesis, which is done in teh 5th-6th IC space where there is no pleura (bare area) or at infrasternal angle at xiphoid process

Term
Arterial, venous, and nerve supply of the pericardium
Definition

Artery: pericardiacophrenic artery - branch of internal thoracic

Vein: Pericardiacophrenic vein drains into brachiocephalic or internal thoracic veins

Nerve: Phrenic (C3-5) - pain sensation

Vagus - function uncertain

Sympathetic trunks - vasomotor

Term
Chambers of the heart and what separates them
Definition

2 atria, 2 ventricles

interatrial septum

interventricular septum

Term
Apex, base, and 4 surfaces of the heart
Definition

apex - formed by ventricle at 5th IC space. 9cm from medial plane at mid-clavicular line

Base - T6-T9, formed by left atrium

 

Surface: sternocostal (right ventricle)

diaphragmatic (left ventricle)

Left surface (left ventricle)

right surface (right atrium)

Term
Grooves of the heart and what they contain
Definition

1. coronary sulcus - coronary sinus (main component), circumflex branch of LCA, RCA, small cardiac vein. Located between right atrium and ventricle

2. anterior interventricular groove - aterior interventricular branch of LCA, great cardiac vein

3. Posterior interventricular groove - posterior interventricular artery branch of RCA, middle cardiac vein. Located at diaphragmatic surface

Term
Parts of Right atrium
Definition

Sinus venarum - smooth part

atrium proper - rough part, contains pectinate muscles

suclus terminalis - separates sinus and atrium proper on outside

crista terminalis - separates sinus and atrium proper on inside

Term
Parts of right ventricle
Definition

Infundibulum (conus arteriosus) - smooth part

Ventricle proper - rough part, everything besides infundibulum

supraventricular crest - muscular ridge, like crista terminalis

septomarginal trabecula - moderator band, part of conducting system

Term
Parts of left atrium
Definition

Mostly smooth

Rough part = auricle - contains pectinate muscles

interatrial septum - divides forament and limbus fossa

Foramen ovale - opening

limbus fossa ovalis - membrane that covers foramen ovale

Term
Parts of left ventricle
Definition

Proper (rough) - most of ventricle - contains trabechulae muscle

aortic vestibule (smooth)

Interventricular septum - upper part is membranous, lower part is muscular

Term
2 atrioventricular valves. What holds the cusps?
Definition

Tricuspid - right side. 3 cuspid valves. at 4/5th intercostal space

 

Mitral (bicuspid) - left side. 2 valves. 4th costal cartilage.

 

cusps held by chordae tendinae.

Term
Semilunar valves and what holds them together
Definition

Pulmonary semilunar - at 3rd costal cartilage

 

Aortic semilunar - at 3rd intercostal space.

 

Held by papillary muscles

Term
Heart sounds
Definition

S1 ("lub") - closing of tricuspid and mitral valves

 

S2 ("dub") - closing of semilunar valves

Term
2 types of valvular heart disease - stenosis and insufficiency/regurgitaiton.

What are they and what causes them?
Definition

Stenosis - failure of the valve to open fully, causing resistance to flow. slows blood flow from atrium to ventricle. Is congenital or due to Ca2+ buildup due to rheumatic fever or radiation.

 

Insufficiency/regurgitation - failure of valve to close completely, causing blood flow back in the chamber. Mitral valve prolapse is most common. Also common in young women.

 

In both cases, the turbulent blood flow causes murmurs

Term
Types of pulmonary stenosis (3)
Definition

valvar - valve leaflets are thickened and/or narrowed.

 

supravalvar - pulmonary artery just above the pulmonary valve is narrowed

 

infundibular - muscle under the valve area is thickened, narrowing outflow from the right ventricle

Term
Types of aortic stenosis (3)
Definition

valvar - valve opening only has one or two leaflets instead of three

subaortic - narrowing just below the valve

supra-valvar - narrowing just above the valve

Term
3 layers of the heart wall
Definition
endocardium, myocardium, epicardium
Term
Branches and distribution of right coronary artery
Definition

Branches: Marginal

posterior interventricular (descending) - supplies 1/3 of interventricular septum

nodal branch -

AV nodal branch

Terminal branch

 

Distribution:

right atrium

most of right ventricle

diaphragmatic surface of left ventricle

1/3 of IV septum

SA node in about 60% of people

AV node in about 80% of people

Term
Where do the coronary arteries originate?
Definition
aortic sinus in ascending aorta
Term
How do you determine what the dominant artery is in a patient?
Definition
If the posterior artery comes from the RIGHT coronary artery, than the RIGHT coronary artery is dominant (as it is in about 67% of people). If it comes from the left, the left is dominant.
Term
Branches and distribution of Left coronary artery
Definition

1. anterior interventricular artery - follows anterior interventricular groove (LAD)

2. circumflex artery - left marginal artery branches off. sometimes SA/AV node branches off

 

Distribution:

Left atrium

2/3 of interventricular septum

most of left ventricle

most of right ventricle

Term
What is the "main" vein of the heart and what are its tributaries?
Definition

Coronary sinus - drains into right atrium

 

Tributaries -

great cardiac vein - follows anterior interventricular groove with LAD

middle cardiac vein - follows posterior interventricular groove with posterior interventricular artery

small cardiac vein - follows right marginal vein

small cardiac vein

Term
What are the contents of the anterior interventricular groove?
Definition
great cardiac vein and LAD
Term
What is the names of the small branches that enter directly into the right atrium?
Definition
venae cardis minimae
Term
3 branches of coronary sinus. what do these veins do?
Definition

small, middle, and great cardiac veins

 

drain the blood of the heart and take it to the right atrium where it is oxygenated

Term
Heart rate and ejection volume are controlled by ANS. What nerves?
Definition

Parasympathetic:

Vagus nerve - slows heart rate, reduces force of contraction, constricts arteries

 

Sympathetic:

Cardiac accelerator and thoracic splanchnic nerves (T1-T5) - increase heart rate, impulse contraction, force of contration, and blood flow

Term
Flow of Conducting system of heart
Definition

Conducting system is specialized muscles that conduct impulses through the heart

 

SA node (pacemaker) - located at junction of superior vena cava and crista terminalis

-->

AV node - located at IV septum

-->

AV bundle - follows membranous IV septum

-->

left bundle in left ventricle, causes papillary muscle to contract

right bundle in right ventricle, causes papillary muscle to contract

Term
What causes coronary artery disease and what are the symptoms?
Definition

blockage of artery from clots or lipid deposition

results in that part of the heart not receiving blood. painful

Term
What is angina pectoris
Definition
chest pain cuased by insufficient blood flow, often due to coronary artery disease
Term
What causes a myocardial infarction? Where are the most common sites?
Definition

occurs due to a sudden occlusion of a coronary artery by an embolus. area of heart loses blood flow (infarcted) and will eventually lead to tissue necrosis with tissue being replaced by scarring.

 

LAD (40-50%)

RCA (30-40%)

Circumflex (15-20%)

Term
Development of the heart:

Two endocardial heart tubes arise from _____ (tissue). As lateral folding occurs, these fuse to form the _____. The myocardium and epicardium develop from the mesoderm surrouding this structure.
Definition
cardiogenic mesoderm. primitive heart tube.
Term
The truncus arteriosus (ventra aorta) forms the ___ and ___ of the baby by formation of the aorticopulmonary septum.
Definition
aorta and pulmonary trunk
Term
the bulbis cordis forms the ____ and the ____ in the baby.
Definition
Conus arteriosus (smooth part of right ventricle) and aortic vestibule (smooth part of left ventricle)
Term
The primitive ventricle forms the ___ in the baby.
Definition
trabeculated (rough) part of the right and left ventricles
Term
The primitive atrium forms the ____ in the baby.
Definition
trabeculated part of the right and left atrium (rough parts)
Term
The sinus venosus forms the ____, ___ and ___ in the baby.
Definition
sinus venarum (smooth part of right atrium), coronary sinus, and oblique vein of left atrium
Term
4 main septa of the heart
Definition
AP (aorticopulmonary), interventricular, interatrial, atrioventricular
Term
The dorsal and ventral AV endocardial cushions fuse to form the ____ in the baby.
Definition
AV septum.
Term
Partitioning of the primitive atrium: (a) grows toward the AV endocardial cushions from the roof of the primitive atrium.

(b) forms between the free edge of the (a) and the AV cushions, allowing a passage between the right and left atria. It is closed by growth of the (a).

(c) forms in the center of the (a)

(d) is an oval opening in the (c) that provides a communication between the atria.

(e) forms to the right of the (a) and fuses with it to form the atria septum, which separates the right and left atria
Definition

a - septum primum

b - foramen primum

c - foramen secondum

d- foramen ovale

e - septum secondum

Term
The ____ develops as an outgrowth of muscular wal lin the floor of the primitive ventricle and grows toward the AV septum (Endocardial cushion) but stops to create the IV foramen, leaving it incomplete. The ___ forms by fusion of the bulbar ridge of the endocardial cushion and the aorticopulmonary septum. It closes the IV foramen, completing the septum.
Definition
Muscular IV septum, Membranous IV septum
Term
2 kinds of dextrocardia:

___ is when the major visceral organs are reversed or mirrored from the normal position.

___ is when the heart is transposed.
Definition

situs inversus dextrocardia

 

isolated dextrocardia

Term
What is a common atrial septal defect?
Definition
incomplete closure of the oval foramen, resulting in a hole in the fossa ovale. Can allow blood to shunt between atria and can result in pulmonary hypertension.
Term
The ___ facilitates gas and nutrient exchange between maternal and fetal blood. The blood itself does not mix.
Definition
the placenta
Term
What happens to each structure after birth?

Foramen ovale
Ductus arteriosus
Ductus venosus
Umbilical arteries
Umbilical vein
Definition

Foramen ovale - closes after birth, by one year. become fossa ovalis

ductus arteriosus - closes after birth, becomes ligamentum arteriosum at about 3 mos

ductus venosus - ligamentum venosum

Umbilical arteries - medial umbilical ligaments

Umbilical vein - legamentum teres

Term
The tracheoesophageal septum divides the foregut into three portions: ventral, laryngotracheal tube, and dorsal. What does each part contain?
Definition

ventral part: doesn't say

Laryngotracheal tube: larynx, tracheo, bronchi, lungs

Dorsal: oropharynx, esophagus

Term
Maturation of the lungs is divided into 4 periods:

Pseduoglandular period (___-___)
Canalicular period (___-___)
Terminal saccular period (___-___)
Alveolar period (___-___)
Definition

Pseudoglandular = 6-16 weeks

Canalicular = 16-26 weeks

Terminal saccular (26 weeks - birth)

Alveolar = 36 weeks to 8 years

Term
___ is a disorder in which newborn infants cough and choke during eating due to aspiration of food and saliva in the lung because trachea and esophagus do not fully separate during developement.
Definition
Tracheoesophageal fistula
Term
___ is incomplete development of lung tissue that can be caused by herniation of abdominal organs, which fill up that space that the lungs should develop in.
Definition
pulmonary hypoplasia
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