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The Heart
Final Exam
78
Anatomy
Graduate
12/06/2011

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Cards

Term
Fibrous Pericardium
Definition
-thick collagen layer with little ability to distend acutely (prevents heart from expanding further)
-fuses superiorly to tunica adventita of great vessels, inferiorly to central tendon of diaphragm, and anteriorly to sternum
-phrenic nerve and pericardiophrenic artery descend through mediastinum lateral to f.pericardium and are in jeopardy during surgery to the heart
Term
Visceral Layer of Serous Pericardium
Definition
-epicardium
-layer of simple squamous epithelium (mesothelium)
-beneath-coronary arteries/veins/nerves travel along surface of heart in thin collagen bed, adipose tissue too
Term
Parietal Layer of Serous Pericardium
Definition
-at base of aorta and pulmonary trunk, mesothelium of visceral layer is reflected and becomes continuous with parietal layer
Term
Pericardial Cavity
Definition
-btw visceral and parietal layer with pericardial fluid allowing friction-free movement of heart
Term
Transverse Sinus
Definition
-recess of pericardial cavity
-posterior to aorta and pulmonary trunk, ant to SVC
-if pericardial sac open, can pass finger through sinus from one side of heart to other
Term
Oblique Sinus
Definition
-recess of pericardial cavity that ends in cul de sac surrounded by pulmonary veins
Term
Innervation of Pericardium
Definition
-phrenic nerve
-pain sensation referred to dermatome (ipsilateral supraclavicular region)
Term
Arterial Supply of Pericardium
Definition
-pericardiophrenic artery (branch of internal thoracic)
-branches of musculophrenic
-coronary and branches
Term
Venous Drainage of Pericardium
Definition
-pericardiophrenic vein drains to brachiocephalic
Term
Cardiac Tamponade
Definition
-heart compression
-accumulation of fluid within pericardial cavity resulting in compression of the heart since the fibrous pericardium is in-elastic
-clinical findings: hypotension, compression of SVC (distension of neck veins on inspiration, kussmaul sign)
-can quickly progress to cardiogenic shock and death
Term
Pericardiocentesis
Definition
-removal of fluid from pericardial cavity
-sternal approach: left side intercostal space 5/6 (cardiac notch)
-subxiphoid approach: left infrasternal angle
Term
Base of Heart (posterior surface)
Definition
-mainly left atrium, which receives pulmonary veins and is related to vertebral bodies T6-9
Term
Apex of Heart
Definition
-inferior lateral portion of L ventricle at intercostal space 5 along midclavicular line
-maximal pulsation of heart occurs here
Term
Anterior (sternocostal) surface of heart
Definition
-consists mainly of right ventricle
Term
Inferior (diaphragmatic) surface of heart
Definition
-consists mainly of L ventricle and related to central tendon of diaphragm
Term
Left (pulmonary) surface of heart
Definition
-consists mainly of L ventricle and occupies cardiac impression in left lung
Term
Right surface of heart
Definition
-consists mainly of R atrium located btw SVC and IVC
Term
Right Border of Heart
Definition
-consists of right atrium SVC and IVC
Term
Left border of heart
Definition
-consists of left ventricle, left atrium, pulmonary trunk, aortic arch
Term
Inferior border of heart
Definition
-consists of right ventricle
Term
Superior border of heart
Definition
-consists of right atrium, left atrium, SVC, ascending aorta, pulmonary trunk
Term
Right Atrium
Definition
-receives venous blood from SVC, IVC, and coronary sinus
Term
Right Auricle
Definition
-conical, muscular pouch on R atrium
Term
Pectinate Muscles
Definition
-form trabeculated part of R or L atrium
Term
Sinus Venarum
Definition
-smooth part of the right atrium
Term
Crista Terminalis
Definition
-marks the junction btw trabeculated part and smooth part of right atrium
Term
Sulcus Terminalis
Definition
-external shallow groove that also marks (along with crista terminalis)the junction btw trabeculated and smooth parts of right atrium
Term
Atrial Septum
Definition
-consists of an interatrial portion and an atrioventricular (AV)portion
Term
Fossa Ovalis
Definition
-oval depression on interatrial portion consisting of valve of the fossa ovalis
Term
Trabeculae Carneae
Definition
-irregular muscular ridges
-form the trabeculated part of the right ventricle (inflow tract)
Term
Conus Arteriosus (infundibulum)
Definition
-smooth part of right ventricle (outflow tract)
Term
Supraventricular Crest
Definition
-Cshaped internal muscular ridge
-marks the junction btw trabeculated and smooth parts of right ventricle
Term
Right Ventricle
Definition
-trabeculated inflow tract receives blood from right atrium posteriorly through the tricuspid valve
-smooth outflow tract expels blood superiorly and to the left into the pulmonary trunk
Term
Tricuspid Valve (Right Atrioventricular Valve)
Definition
-anterior, posterior, and septal cusps tethered to papillary muscles by chorda tendinae
-base attached to fibrous skeleton
-btw right atrium and ventricle
Term
Chordae Tendineae
Definition
-cords that extend from the free edge of tricuspid valve (or mitral valve) to papillary muscles
-prevents eversion of tricuspid valve (or mitral valve) into right atrium (or left atrium)
-prevents regurgitation of ventricular blood into right atrium (or left atrium) during systole
Term
Papillary Muscles
Definition
-anterior, posterior, septal (no septal in left ventricle)
-conical muscular projections from ventricular wall and are attached to chordae tendineae
Term
Interventricular Septum
Definition
-consists of membranous part (located in a sup-post position and continuous with fibrous skeleton) and a muscular part
Term
Septomarginal Trabecula (moderator band)
Definition
-curved muscular bundle that extends from interventricular septum to the anterior papillary muscle
-contains part of right bundle branch of the bundle of His to the anterior papillary muscle
Term
Pulmonary Semilunar Valve
Definition
-anterior, right, and left cusps
-lies at apex of conus arteriosus
-prevents blood from returning to right ventricle
Term
Left Atrium
Definition
-receives oxygenated blood from the lungs through the pulmonary veins
Term
Left Auricle
Definition
-tubular muscular pouch on left atrium
Term
Semilunar Depression
Definition
-left atrium -indicates valve of fossa ovalis
Term
Left Ventricle
Definition
-trabeculate inflow tract receives oxygenated blood from left atrium through mitral valve
-smooth outflow tract expels blood superoanteriorly into ascending aorta
Term
Aortic Vestibule
Definition
-smooth part of left ventricle (outflow tract)
Term
Mitral Valve (Bicuspid Valve, Left Atrioventricular Valve)
Definition
-located btw left atrium and ventricle
-composed of two cusps(anterior, posterior) tethered to papillary muscles (anterolateral, posteromedial) by chorda tendineae
-attached to fibrous skeleton at base
Term
Aortic Semilunar Valve
Definition
-posterior, right, and left cusps
-lies at apex of aortic vestibule
-prevents blood from returning to left ventricle
Term
Fibrous Skeleton of Heart
Definition
-dense framework of collagen w/in heart that keeps orfices of AV valves and semilunar valve patent (no backflow)
-provides attachment for leaflets/cusps
-serves as origin/insertion sites of cardiac myocytes and forms an electrical barrier btw atria and ventricles so that they contract independantly
Term
Heart Sounds
Definition
-S1 "lub" = closure of tricuspid and bicuspid valves
-S2 "dub" = closure of pulmonary and aortic valves
Term
Auscultation Sites
Definition
**use intercostal spaces as indicator of area
-Left AV Valve= cardiac apex left intercostal space 5
-Right AV Valve= over sternum intercostal space 5
-pulmonary valve= lateral to sternum at L intercostal space 2, or over sternum intercostal space 4
-aortic valve= lateral to sternum right intercostal space 2
Term
Arterial Supply of Heart
Definition
-right and left coronary arteries supply oxygenated arterial blood to heart - they fill with blood during diastole
-have maximal blood flow during diastole and minimal blood flow during systole
Term
Right Coronary Artery (RCA)
Definition
-arises from right aortic sinus of ascending aorta and courses in coronary sulcus
-blood supply is considered right side dominant if post interventricular artery arises from RCA
-supplies: right atrium and ventricle, diaphragmatic left ventricle, posterior 1/3 of IV septum, 60% SA node, 80% AV node
-branches: SA nodal, right marginal, AV nodal, posterior interventricular, septal branches
Term
Left Main Coronary Artery (LMCA)
Definition
-arises from left aortic sinus from ascending aorta
-blood supply considered left side dominant(less common) if post interventricular artery arises from LMCA
-branches: left circumflex artery, intermediate ramus, anterior interventricular artery (left ant descending LAD)
Term
Left Circumflex Artery (LCx)
Definition
-supplies post surface of left ventricle
branches:
-anterior marginal artery
-obtuse marginal artery
-atrial branches
-posterior marginal artery
Term
Anterior Interventricular Artery
Definition
supplies both ventricles and IV septum
branches:
-anterior diagonal artery
-septal branches
Term
Coronary Sinus
Definition
-largest vein draining heart and drains directly into right atrium
-at opening of coronary sinus, crescent-shaped valve remnant present (thebesian valve)
Term
Great Cardic Vein
Definition
-follows anterior interventricular artery and drains into coronary sinus
Term
Middle Cardiac Vein
Definition
-follows posterior interventricular artery and drains into coronary sinus
Term
Small Cardiac Vein
Definition
-follows right marginal artery and drains into coronary sinus
Term
Minor Veins Draining to Coronary Sinus
Definition
-oblique vein
-loft posterior ventricular vein
-left marginal vein
Term
Anterior Cardiac Veins
Definition
-found on anterior aspect of right ventricle and drain directly into right atrium
Term
Small Cardiac Veins
Definition
-begin within wall of heart and drain directly into nearest heart chamber
Term
Innervation of Heart
Definition
-superficial cardiac plexus located inferior to aortic arch, anterior to right pulmonary artery
-deep cardiac plexus located posterior to aortic arch, anterior to tracheal bifurcation
-both contain parasympathetic(vagus) and sympathetic components
Term
Parasympathetic Innervation
Definition
-vagus nerve
-postganglionic axons release acetylcholine (short-lived) that acts on SA/AV nodes, atrial myocytes, and smooth muscle coronary arteries
*functions to decrease HR, conduction velocity through AV node, and contractility of atrial myocytes = vasoconstriction and energy conservation

visceral afferent: baroreceptors (BP changes) and chemoreceptors (arterial O2 changes)
Term
Sympathetic Innervation
Definition
-norepinephrine (long-lived) activates SA/AV nodes, atrial/ventricular myocytes, smooth muscle of coronary arteries
-increases HR, conduction velocity through AV node, contractility of atrial and ventricular myocytes
*vasodilation
Term
Cardiac Referred Pain
Definition
-afferent sensory neurons associated with sympathetics
-T1-T5 spinal cord segments (dermatomes)
-pain sensation is "classic" down left arm
Term
Sinoatrial Node
Definition
-pacemaker of the heart located at junction of SVC and right atrium just beneath epicardium
-from here, impulse spreads throughout right atrium and to AV node via anterior middle and posterior internodal tracts and to left atrium via bachmann bundle
-if all SA node activity destroyed, AV node will assume pacemaker role
Term
Atrioventricular Node
Definition
-located on right side of AV portion of atrial septum near ostium of coronary sinus in subendocardial space
-AV septum correspondes to triangle of koch(contains AV node and proximal penetrated portion of bundle of his)
Term
Bundle of His
Definition
-travels in subendocardial space on right side of interventricular septum and divides into right and left bundle branches
Term
Right/Left Bundle Branches
Definition
-Left Bundle: thicker, divides into anterior and posterior segment, terminate on purjinke myocytes
-Right Branch: portion enters septomarginal trabecula (moderator band) to supply anterior papillary muscle, terminate on purkinje myocytes
Term
Athersclerosis
Definition
-calcifications/plaque buildup within tunica intima of blood vessels
-early stages have fatty streaks
-associated with majority of MI's
-hemorrhage, rupture can lead to formation of thrombus
-coronary artery athersclerosis leads to angina pectoris, MI, CHF
Term
Angina Pectoris
Definition
-sudden onset of predordial (anterior surface of body over heart and stomach) pain
Term
Miocardial Infartcion (MI)
Definition
-ischemic necrosis of myocardium of heart
-complications: hemopericardium caused by rupture of free ventricular wall, arterial emboli, pericarditis, ventricular aneurysm, postmyocardial infarction syndrome (autoimmune pericarditis)
Term
Transmural Infarct
Definition
- MI unifocal and solid, follows distribution of specific coronary artery
-often causes shock, pericarditis common
-caused by occlusive thrombus
-volume of collateral arterial flow is cheif factor that affects progression
Term
Subendocardial Infarct
Definition
-MI multifocal and patchy, follows circumferential distribution
-caused by hypoperfusion of heart (aortic stenosis, hemorrhagic shock, hypoperfusion during cardiopulmonary bypass)
Term
Congestive Heart Failure
Definition
-inability of heart to pump blood at a rate commensurate with the requirements of the body tissues, or it can so only from elevated filling pressures
-most commonly from progressive deterioration of myocardial contractile function (from ischemic heart disease or HTN)
-reduced cardiac output, damming back of blood into venous system
Term
Right Ventricile Failure
Definition
-RV susceptible to failure if increase in afterload on RV
-most often occurs with cor pulmonale induced by intrinsices diseases of lung or pulmonary arterial HTN (pulmonary heart disease)
-symptoms: peripheral edema, jugular vein distention, tricuspid valve murmur
Term
Left Ventricle Failure
Definition
-occurs due to impared left ventricle function caused by MI
-hypertrophy - blood backup - pulmonary edema, coughing
-symptoms: overweight, poor diet, perodic angina, nausea
Term
Mitral Valve Prolapse
Definition
-incompetetent "floppy" valve, concerned with mitral regurg
-common in young females
-symptoms: chest pain, fatigue, might show no symptoms
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