Term
| Describe the pericardial cavity |
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Definition
| The pericardial cavity is similar to the pleural cavity, however with an extral layer – the fibrous pericardium surrounding the serous pericardium, which is composed of the parietal and visceral layer (continuous with each other) and a potential space in between. |
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Term
| Describe the innervation of the heart |
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Definition
| The heart is innervated by the phrenic nerves in the fibrous and parietal layers, and by the fibers from the sympathetic trunks in the muscle and vessels. |
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Term
| What is pericarditis and what nerves does it act on |
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Definition
| Pericarditis is inflammation of the pericardium and it acts on the phrenic nerves |
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Term
| What is the arterial supply of the heart |
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Definition
The heart is supplied by these arteries:
The pericardiacophrenic artery (subclavian -> internal thoracic ->)
The musculophrenic artery (terminal branch of internal thoracic)
The coronary artery
The bronchial, esophageal, and superior phrenic arteries. |
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Term
| Where does the fibrous pericardium attach to |
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Definition
| The fibrous pericardium attaches to the central tendon of the diaphragm (causing it to move with respiration), as well as the sternopericardial ligaments, and the adventitia (outermost layer) of the great vessels |
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Term
| What is cardiac tamponade |
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Definition
| Cardiac tamponade is pooling of great volumes of fluid within the pericardial cavity (often caused by a ruptured vessel), retarding the pumping action of the heart and venous return. It is a medical emergency |
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Term
| What is the cardiac notch and what is its significance |
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Definition
| The cardiac notch is the exposed pericardial area in the left lung where the left line of pleural reflection leaves the 4th intercostal space. Its clinical significance is that this is where a pericardiocentesis is done, often at the 5th-6th LICS – left infrasternal angle / intercostal space |
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Term
| Where can the bare area of the pericardium be accessed from |
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Definition
| The bare area of the pericardium can be accessed from the left infrasternal angle or from the 5th or 6th intercostal space. |
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Term
| What are the three branches off of the aorta |
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Definition
| The three branches from the aorta are the brachiocephalic trunk, the left common carotid artery, and the left subclavian artery. |
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Term
| From right to left, what order do the vessels attach to the heart |
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Definition
| Superior vena cava, aortic arch, pulmonary trunk |
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Term
| Describe the position of the heart (rotationally) within the thoracic cavity |
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Definition
| The heart is rotated such that the right ventricle projects onto most of the sterno-costal surface. This is the part of the heart most frequently injured. |
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Term
| Describe the position of the heart (laterally) within the thoracic cavity |
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Definition
| 1/3rd of the heart is right of the midline, while 2/3rd of the heart is left of the midline |
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Term
| Describe the location of the phrenic nerves versus the vagus nerves |
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Definition
| The phrenic nerves pass anterior to the root of the lungs, whereas the vagus nerves pass posterior to the root of the lungs |
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Term
| Name and describe the branches off the left main coronary artery |
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Definition
The LAD (left anterior descending) artery is known as the widowmaker because it is the most frequently diseased and clotted artery. It lies between the groove of the right and left ventricles.
The circumflex branch curls around the back of the heart |
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Term
| Name and describe the branches off the right main coronary artery |
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Definition
| The right marginal branch, posterior interventricular, SAS nodal artery (60% of population) and AV nodal artery (80% of population) |
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Term
| Name and describe the venous drainage of the heart |
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Definition
The coronary sinus conveys most of the venous blood from the wall of the heart itself into the right atrium
The great, middle, and small cardiac veins accompany the LAD, posterior interventricular, and right marginal arteries respectively.
The anterior cardiac veins bridge the sulcus of the right ventricle and atrium
The oblique vein of the left atrium
The venae cordis are the smallest veins of the heart |
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Term
| What is the transverse pericardial sinus formed by |
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Definition
| The transverse pericardial sinus is formed by holes that develop in the dorsal mesocardium |
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Term
| Where is the oblique pericardial sinus found |
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Definition
| The oblique pericardial sinus is found on the posterior wall of the pericardial cavity |
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Term
| What is significant about the septomarginal band |
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Definition
| The septomarginal band contains purkinje fibers from the conducting system of the heart |
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Term
| What is the trabeculae carnae |
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Definition
| The trabeculae carnae is the muscular wall between ventricles |
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Term
| What do the chordae tendinae and papillary muscles do |
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Definition
| They prevent the AV valves from blowing backwards |
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Term
| What are the orientations of the parts of the right and left AV valves, the pulmonic valve and the aortic valve |
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Definition
Right AV valve: anterior / posterior / superior
Left AV “mitral” valve: anterior / posterior
Pulmonic valve: right / left / anterior
Aortic valve: right / left / posterior |
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Term
| What are the sinuses of Valsalva |
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Definition
| The sinuses of Valsalva are the cusps in the aortic and pulmonic vessels that act as the three parts of the valves. |
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Term
| Where do the right and left coronary arteries arise from |
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Definition
| The right and left coronary arteries arise from the lunules (holes) inside the right and left cusps in the aortic valve. |
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Term
| What is the function of the fibrous skeleton of the heart |
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Definition
| It prevents overdistention of valve orifices, it provides valve cusp and myocardial fibers, and it acts as an electrical insulator |
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Term
| Where is the SA node located |
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Definition
| The SA node is located near the junction of the SVC with the right atrium |
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Term
| Where is the AV node located |
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Definition
| The AV node is located in the posteroinferior part of the interatrial septum near the opening of the coronary sinus |
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Term
| Where is the bundle of his located |
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Definition
| The bundle of his is located in the membranous IV septum |
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Term
| Where do the right and left bundle branches diverge |
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Definition
| The right and left bundle branches diverge where the membranous IV septum meets the muscular IV septum |
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Term
| Where do you ascultate the cardiac valves (APT-M) |
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Definition
Aortic valve: 2nd RICS
Pulmonic valve: 2nd LICS
Tricuspid valve: 4th LICS
Mitral valve: 5th LICS
(From top left: right, down, down and right) |
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Term
| What is the first heart sound and second heart sound |
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Definition
| The first heart sound ist he closing of the mitral and tricuspid valves, the second is the closure of the aortic and pulmonary valves |
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Term
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Definition
| Heart murmurs are longer duration heart sounds that may have no pathological significance. They may be indicative of serious heart disease and are a result of turbulent blood flow through a stenotic valve orifice (obstruction) or a valve unable to fully close (regurgitation) |
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Term
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Definition
| Cardiac pain is caused by ischemia and accumulation of metabolic products, stimulating pain fibers in the heart (which are insensitive to touch, cutting, cold, or heat) |
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Term
| Where do cardiac afferent fibers travel |
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Definition
| Cardiac afferent nerve fibers travel centrally middle, inferior, and thoracic cardiac branches of the sympathetic trunk and enter spinal cord segments T1 through T4/5 |
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Term
| Why do patients perceive heart pain as occurring in the superficial part of the body |
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Definition
| Patients perceive superficial heart pain because somatic heart afferents “cross talk” between somatic and visceral fibers in the dorsal root ganglia, so pain is experienced in those general visceral afferent innervated locations. |
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