What vertebrae does the base of the heart correspond with?
T5-T8
What heart disorder causes dysphagia?
Mitral valve disorder = leads to backflow of blood into left atrium = compresses esophagus = dysphagia
What are the layers of the pericardium?
Fibrous pericardium
Serous pericardium
- parietal layer
- visceral layer (epicardium)
Where is the transverse sinus?
Behind the aorta and pulmonary arteries, in front of the SVC.
What are the borders of the oblique sinus?
Pulmonary veins, IVC and pericardium around esophagus
What branches of the internal thoracic a. supply the pericardium?
- pericardiacophrenic a. (runs with the phrenic nerve)
- musculophrenic a.
What branches of the thoracic aorta supply the pericardium?
- bronchial
- esophageal
- superior phrenic
Where do the veins from the pericardium drain?
- pericardiacophrenic v.
- azygos v.
Where does the phrenic nerve refer pain to?
The neck area
What does pericarditis look like on an xray?
Bulbous "water bottle" heart
What does pericarditis sound like on auscultation?
the friction rub will sound like the "rustle of silk
What is Beck's Triad?
- hypotension
- JVD
- muffled (diminished) heart sounds
What is cardiac tamponade?
Heart compression due to pericardial effusion
What is hemopericardium?
Blood in the pericardial cavity
Why does cardiac tamponade cause hypotension?
The compression of the heart lowers the amount of blood that enters the heart and consequently exiting the heart = hypotension.
Where is pericardiocentesis performed?
- infrasternal angle
- 5/6 intercostal space near sternum
What is the crista terminalis called externally?
Sulcus terminalis
What is the border of the fossa ovalis called?
The limbus of the fossa ovalis.
What are auricles for?
Overflow of the atrium.
What is the conus arteriosus remnants of?
The bulbis cordis.
What is the largest papillary muscle in the right ventricle?
The anterior.
What is the moderator band also called and what does it do?
Septomarginal trabeculae
It contains the right branch of the AV bundle going to the anterior papillary muscle.
What is the smooth portion of the left ventricle called?
Aortic vestibule
What are the cusps of the pulmonary valve called?
Right, left, anterior
What are the cusps of the aortic valve called?
Right left, posterior
What is the DUB sound the closure of?
pulmonary and aortic valves
During diastole, what valves are open?
The AV valves
What is the LUB sound the closure of?
AV valves
When are the aortic and pulmonary valves open?
During systole
When do the ventricles fill?
Late diastole, when the atriums contract.
Where is the pulmonary valve located?
Medial, left 3rd costal cartilage
Where is the aortic valve located?
Medial left 3rd intercostal --- behind sternum.
Where is the tricuspid valve locatead?
Medial right 5th costal cartilage, behind sternum
Where is the mitral valve located?
Medial left 3rd intercostal
Where do you auscultate for the aortic valve?
2nd ICS, right parasternal
Where do you auscultate for the pulmonary valve?
2nd ICS, left parasternal
Where do you auscultate for the tricuspid valve?
5th ICS, parasternal
Where do you auscultate for the mitral valve?
5th ICS, mid-clavicular
In which valve insufficiency do we hear a heart murmur and a diminished heart murmur?
HM: pulmonary
DHM: aortic
What causes an aortic stenosis and what are its effects on the heart?
Degenerative calcification
Left ventricle hypertrophy
What happens in a pulmonary valve stenosis?
The valves get fused together
What vein of the heart is made of cardiac muscle and not smooth?
The coronary sinus.
Which veins drain blood from the heart directly into the atrium?
Thebesian veins
Where do the coronary arteries (first branches of the aorta) branch from?
The right and left aortic sinuses
What is the first branch of the RCA to? What does it supply?
The SA node
The pulmonary trunk and SA node
What coronary artery supplies blood to the apex of the heart
Right marginal
What does the PDA supply?
Posterior 1/3 of the interventricular septum.
Where does the AV node branch from the RCA?
The crux of the heart
What branches off of the LAD?
Diagonal a.
What does the LAD supply?
Anterior 2/3 of the IV septum
How many branches of the LCA are there?
2
What branches off of the left circumflex a?
The left marginal a.
What is the difference between collateral flow and an anastomosis?
Collateral is when blood is currently flowing through it.
An anastomosis is potential flow.
What cardiac vein runs with the right marginal artery?
The small cardiac v.
What two veins anastomosis in the IV sulcus?
The great cardiac vein via the front and the middle cardiac vein from the back.
What happens in cardiac atherosclerosis?
Lipid deposits form along the intima of the coronary arteries
What happens in an MI?
Sudden occlusion via embolism.
What are the most common sites of a pulmonary occlusion?
LAD > RCA > circumflex
In which coronary artery disease will we see collateral circulation and why?
Atherosclerosis --- lipid formation happens gradually so collateral circulation can form
MI --- sudden onset; collateral formation will have no time to form
How does coronary angioplasty work?
A catheter with a balloon is inserted than inflated to flatten plaque and restore blood flow.
What are the three forms of recanalization?
- angioplasty
- thombolytics
- intraventricular stent
Which recanalization method takes longest?
Thrombolytics, because it takes a while for the medication to kick in.
Which arterial vessels are used in CABG?
- internal thoracic
- radial
- gastroepiploic
- inferior epigastric
What veins are used in CABG?
- great saphenous
- small saphenous
Where is the SA node?
Between the crista terminalis and the SVC
What is Bachman's Bundle?
Conduction from the right to left atrium
Where is the AV node?
In the right atrial IA septum, close to the coronary sinus opening.
Where is the Bundle of His?
Membranous portion of the IV septum.
Where are the right bundle branches?
Muscular IV septum, septomarginal trabeculae, r. ventricle wall
Where are the left bundle branches?
Muscular IVS, l. ventricle wall
Where are the Purkinje Fibers?
Right Side: IVS + R. ventricle wall + anterior papillary muscles.
Left Side: IVS + L. ventricle wall + anterior and posterior papillary muscles
What shortcut allows for the anterior papillary muscle to contract at the same time as the septal and posterior?
The bundle through the moderator band.
Damage to the conduction system is mostly caused by _____?
Ischemia
Unilateral damage to the conduction system causes what?
Asynchronous contraction of ventricles.
What vessels do artificial pacemakers usually travel through?
Left subclavian > left brachiocephalic > SVC > right atrium > right ventricle
What muscles in the heart do pacemakers attach to?
Trabeculae carneae of the right ventricle.
Where do the parasympathetic innervations to the heart come from?
Vagus nerve (whose body is in the spine).
Where do sympathetic innervations come from?
T1-T4, which travel up the sympathetic chain ganglia to synapse at cervical and superior thoracic ganglia.
Visceral afferent fibers travel with what other fibers? What affect does this have on where sensation is coming from?
Sympathetic fibers into dorsal roots.
It will seem like it is coming from the T1-T4 dermatomes
Where are visceral afferent nerves from the heart referring pain to?
Medial upper limb, neck, shoulder and jaw.