Cardiology

OBJ: Describe the differences between pulmonary circ and systemic circ. Identify structures of the heart externally and within the chambers of the heart. Describe the layers of pericardium. Describe the flow of blood through the heart and to the body. Be able to identify the valves of the heart and their respective point of auscultation. Describe the conduction system of the heart and its location throughout the heart. Describe the coronary blood flow and identify branches of right and left coronary arteries. Enderstand the clinical significance of the following: Endocarditis, Pericardiocentesis, MI.

What side of the heart is considered part of the Pulmonary Circuit?

Right side of the heart

What kind of blood does the pulmonary circuit deliver? Pressure?

Deoxygenated Blood is delivered to the lungs

Lower pressure

What side of the heart is considered part of the Systemic circuit?

Left side of the heart

What kind of blood does the Systemic circuit deliver? Pressure?

Pumps Oxygenated blood throughout the body

Highly pressurized

What is the Mediastinum?

A space between the right and left lungs where the heart is found.

What area is considered the Superior Mediastinum?

The area that extends above the transverse thoracic line

What area is considered the Inferior Mediastinum?

The area that extends below the transverse thoracic line.

Wht are the three parts of the Inferior Mediastinum?

Anterior, Middle, and Posterior Mediastinum

What are the contents of the Anterior Mediastinum?

Lymphatic vessels, brancehs of internal thoracic vessels, part of the thymus.

What are the contents of the Middle Mediastinum?

Heart, Ascending Aorta, Pulmonary trunk, SVC, Arch of Azygos Vein, Main Bronchi

Within the pericardium

What are the contents of the Posterior Mediastinum?

Esophagus, thoracic aorta, azygos/hemiazygos veins, thoracic duct, vagus nerves, sympathetic trunk, splanchnic nerves.

Posterior to the pericardium

What is Pericardium?

A double layered fibrous membrane that encloses the heart.

Helps to stabilize the heart during contraction

Where is the Fibrous Pericardium located? What is it made from?

Continuous with the central tendon of the diaphragm

Dense irrelgular connective tissue

Two layers of the pericardium are considered a part of the Serous Pericardium what are they?

The Parietal Layer and the Visceral Layer (Epicardium)

Where is the Pericardial Cavity located?

Its a potential space that can e found between the parietal and visceral layers of the serous pericardium.

What is contained within thhe Pericardial cavity? What is its purpose?

A thin film of Serous Fluid.

Helps the heart to beat without causing friction

What happens during a Pericardial Effusion?

Excess serous fluid inside the pericardial cavity

What happens during a Cardiac Tamponade?

Too much fluid in the pericardial cavity causing increased pressure on the heart and keeps the chambers from filling properly.

This is a medical emergency

What procedure can be used to treat Pericardial effusions and Cardiac tamponades?

Pericardiocentesis a procedure to remove excess fluid from the pericardial cavity.

There are three layers of the heart wall. What are they called?

Epicardium (outside), Myocardium, Endocaridum (inside)

What is the Epicardium and what is it composed of?

The VIsceral Serous Pericardium.

Mesothelium (simple squamous epithelial cells), adipose cells and connective tissue

What is the Myocardium made of? What is it?

Made up of uninulcleated muscle cells that facilitate cell-to-cell communication through intercalated discs.

Made of cardiac muscle. It is a thick muscular layer containing cardiomyocytes

What does the Endocardium form?

The inner lining of the atria and ventricles.

The endocardium has three sub layers what are they and what are they made of?

The Endothelium layer- is made of simple squamous cells

The Subendothelial connective tissue- is made of smooth muscle fibers

The Subendocardial connective tissue- contains Purkinje fiber

What is Endocarditis?

A bacterial infection of the blood causing inflammation of the inner lining of the heart.

Can attach to heart valves or other damaged heart tissue

What are some symptoms of Endocarditis?

Janeway lesions = painless red, purple, or brown spots on hands/feet

Osler nodes = painful red or purple bumps or hyperpigmentation on fingers and toes

Petechiae = tiny spots in the sclera or inside the mouth

LUQ abdominal pain

New heart murmur

There are four chambers of the heart what are they named?

The left and right Atriums

The left and right Ventricles

Where does the right atrium recieve blood form? What kind of blood is it?

Receives venous blood from the superior vena cava, inferior vena cava, and the coronary sinus

Deoxygenated

What structures are associated with the right atrium

RightAuricle = muscular pouch projection from right atrium. Muscular wall composed of pectinate muscles

Cris-Terminalis = smooth ridge of tissue ta that extends from SVC to the IVC

Interatrial Septum = separates right and left atria. Has a thumbprint-like depression called the fossa ovalis (or oval fossa)

Where does the right ventricle recieve blood from? What kind of blood is it?

Recieves blood from the right atrium via the tricuspid valve

Deoxygenated

What structures are within the Right Venricle?

Chordae tendineae attach to the cusps of the tricuspid valve (like cords to a parachute)

Papillary muscles are projections of the ventricular wall that the chordae tendineae attach to 

Moderator band connects anterior papillary muscle to interventricular septum

Trabeculae carneae = irregular muscular ridges

What structures are associated with the Left Atrium?

forms most of the base of the heart.

Left Auricle muscular = pouch projection from right atrium. Muscular wall composed of pectinate muscles

Interatrial Septum = separates right and left atria. Has a thumbprint-like depression called the fossa ovalis (or oval fossa)

How does blood enter the Left Atrium? What kind of blood is it?

Blood enter through the valveless right and left pulmonary veins.

Oxygenated

How does blood enter the Left Ventricle? What kind of blood is it?

Blood enters from the left atrium through the Mitral (Bicuspid) valve.

Oxygenated

What structures are associated with the Left Ventricle?

Much thicker musclular wall

Chordae tendineae attach to the cusps of the tricuspid valve (like cords to a parachute)

Papillary muscles are projections of the ventricular wall that the chordae tendineae attach to 

Moderator band connects anterior papillary muscle to interventricular septum

Trabeculae carneae = irregular muscular ridges

Blood leaves the Left Ventricle though what and goes where?

Leaves through the Aortic semilunar valve.

Goes through the aorta and throughout the body

Blood leaves the right ventricle through what and goes where

Leaves through the pulmonary valve and goes to the lungs to become oxygenated

What is the cause of S1 or the LUB sound?

Closing of the AV valves at the beginning of systole as ventricular pressure rises

(AV — Atrioventicular = Tricuspid and mitral)

What is the cause of S2 or the Dub sound?

Closing of the semilunar valves at the beginning of diastole

What is Diastole?

Muscle relaxation which allows the chambers to fill with blood

There are four areas of auscultation where are they adn what can you hear?

The Aortic valve — 2nd right intercostal space to apex of the heart

The Pulmonary valve — 2nd left intercostal space to the left of the sternal border

The Tricuspid valve — near left of the sternal border

The Mitral valve — apex of the heart in 5th intercostal space around midclavicular line

All cardiac veins take what kind of blood and empty into where?

Take Deoxygenated blood and empty into the Coronary sinus which empties into the right atrium

What arteries must I know that are on the anterior view of the heart?

RCA — Right coronary artery

Right marginal branch of RCA

LCA — Left coronary artery

Circumflex branch of LCA

Anterior interventricular branch of LCA

Left marginal artery

What arteries must I know that are on the Posteror / inferior view of the heart?

Circumflex branch of LCA within coronary sulcus

Posterior interventricular branch of RCA

What is a Myocardial Infarction or an (MI)

Heart attack caused by an obstruction of blood flow to the cardiac muscle

What is an Ischemia?

decreased blood flow to the heart muscles

What is Hypoxia?

decreased oxygen to the heart muscles

What is Infarct?

Death of tissue due to lack of blood supply

Which artery is nicknamed the “Widow Maker”

The LAD or left anterior descending artery

What procedure can restore blood flow to your heart?

A Coronary Artery Bypass Graft or (CABG)