Cardiovascular Anatomy

Thoracic positions, coronary arteries origin, circulatory system

List the anatomicl terms of location
-above / below ? 
-front and back?
-toward / away midline
-closer/ further away

-superior / inferior

-anterior/ posterior

-medial / lateral

-proximal / distal

What are the 4 borders of the heart?

superior, inferior, left and right

What are the 5 surfaces of the heart?

• anterior

• base

• right pulmonary

• left pulmonary

• diaphragmatic surface

• apex

How many coronary arteries are there?

2 - right and left

Name the coronary arteries

Left main coronary artery
Right coronary artery 

Where is the auscilation point for the aortic valve?

3rd intercostal space. right sternal edge

Auscilation point of the Pulmonary valve?

3rd intercostal space. left sternal edge

Auscilation point of the tricuspid valve?

4th or 5th intercostal space. left sternal edge

Auscilation point of the mitral valve ?

5th intercostal space. mid-clavicular line.

At which point in the cycle can you hear murmur suggesting AS?

systole

Where in cycle can hear murmur suggesting AR?

diastole

Where in cycle can hear murmur suggesting mitral stenosis?

diastole

Where in cycle can hear murmur suggesting mitral regurg?

systole

mnemonic for systolic murmurs

ASMR

mnemonic for diastolic murmur

ARMS

Which surface of heart does the circumflex branch run down?

from anterior to basal surface 

Which side of the heart does the LAD run down? 

anterior surface (through the groove)

Which wall regions are supplied by the Posterior Interventricular branch of RCA

Which organ and does the heart sit on 

Diaphragm 
-tendonous hard part 

Where in the body is the heart located? 

middle mediastinum

left from sternum 

Where does the right coronary artery arise from?

right aortic sinus

Where does the left coronary artery arise from?

left aortic sinus

Subdivisions of the right coronary artery

Posterior Interventricular branch of RCA (posterior descending artery) - only in right/co-dominant
Marginal branch of the RCA 

What does cardiac dominance refer to?

Which coronary artery supplies the posterior descending artery (PDA)

Which two arteries can supply the PDA?

the right coronary artery (RCA)

the left circumflex artery

Which does the posterior descending artery (PDA) / posterior interventricular artery emerge from?

In the majority of individuals, the PDA emerges from the RCA.

In 5-10 % of people, the PDA emerges from the circumflex branch of the LCA.

In 10-20% of people, PDA emerges from both the RCA and and left circumflex

Subdivisions of the left coronary artery

-Left anterior descending artery (LAD) (Left anterior interventricular artery)
-Left circumflex artery 

What is cardiac codominance?

when the posterior descending artery is supplied by both the RCA and the left circumflex artery

Alternative name for the LAD (left anterior descending artery)

left anterior interventricular artery

Alternative name for the posterior descending artery (PDA)

posterior interventricular artery

Where does the left main coronary artery originate from?

left aortic sinus (of valsalva) at the base of the ascending aorta

Where does the right coronary artery originate from?

the right aortic sinus (of valsalva) at the base of the ascending aorta

where do the RCA and LCA then run following the aorta?

run along the atrioventricular coronary sulcus

what is the atrioventricular coronary sulcus ?

groove separating the atria from the ventricles

·Which artery does the PDA arise from in a right dominant and a left dominant individual?

• right dominant: from the RCA

• left dominant: from the circumflex artery of the LCA

List the aortic arteries

Brachiocephalic artery / trunk

Left common carotid artery

Left subclavian artery

Name the great vessels

Aorta

Pulmonary artery

Pulmonary vein

Vena cava

List the subdivisions of the vena cava

Superior vena cava (SVC)

Inferior vena cava (IVC)

List the subdivisions of the pulmonary arteries

Left pulmonary artery

Right pulmonary artery

List the subdivisions of the pulmonary veins

Left pulmonary veins

Right pulmonary veins

Which arteries can be seen from the anterior surface of the heart ?

Right coronary artery: marginal branch, start of posterior descending branch?

Left coronary artery: left anterior descending branch, diagonal branch, start of the circumflex branch

What is the name of the structure connecting the aorta and pulmonary trunk?

ligamentum arteriosum

What artery branches run along the posterior surface of heart (base)

circumflex branch (LCA)

posterior descending artery (RCA)

Which is the main cardiac vein

coronary sinus

What are the main coronary veins on the anterior right side of heart running alongside the RCA?

anterior cardiac vein

small cardiac vein

Where and via which structure do the coronary veins drain blood back into the heart?

coronary sinus drains back into the RA.

What are the main coronary veins on the anterior left side of heart running alongside the LCA?

great cardiac vein

What are the main coronary veins on the posterior right side of heart?

small cardiac vein

middle cardiac vein

coronary sinus

What are the main coronary veins on the posterior left side of heart?

great cardiac vein

posterior vein of left ventricle

coronary sinus

What is the mediastinum?

mass of tissue (heart, aorta, vena cava, pulmonary veins, pulonary arteries, pericardium) in thorax between the pleura and lungs

What is the mediastinum divided into?

superior mediastinum

inferior mediastinum

How is the heart connected to the diaphragm?

via the pericardio-phrenic ligament which connects the fibrous layer of the pericardium to the diaphragm

What is the heart surrounded by?

The pericardium

How many layers does the pericardium have?

2 -

Outer fibrous layer

Inner serous layer

Describe the composition of the inner serous layer of the pericardium

Single continuous material folded back on itself creating two layers?

parietal layer (outer) touching the fibrous layer

visceral layer (inner) touching the myocardium

pericardial fluid exists between these two layer

How many sublayers in the serous pericardium

2

Describe the sublayers of the serous pericardium

parietal layer

visceral layer

What is the purpose of the pericardium?

• anchors heart to the mediastinum

• protect from infection

• provide fluid to lubricate movement / reduce friction

• prevent overfilling

What is the purpose of the fibrous outer layer of the pericardium?

tough, protective layer which:

-anchors the heart

-prevents overfilling

Name the outer layer of the serous pericardium called?

Parietal layer

Name the inner layer of the serous pericardium called

Visceral layer

Where does the pericardium connect to superiorly and inferiorly?

it is fused superiorly to the adventitia of the great vessels

fused superiorly to the central tendon of the diaphragm

What is the thickness of the pericardium

1-2 mm

What other structures are in the pericardium?

pericardial sinuses

What are the pericardial sinuses

impressions/ spaces in the pericardium

Name the pericardial sinuses

oblique pericardial sinus

transverse pericardial sinus

Name the major structures in the Right Atrium?

musculi pectinati (pectinate muscles)

fossa ovalis (remnant of foramen ovale)

crista terminalis

sinus venarum

eustachian valve

What is the fossa ovalis?

What is the function of the musculi pectinati in the RA?

increase contraction power of the RV which is necessary as the blood is low pressure

What is the sinus venarum of the RA

the smooth-walled, posterior part of the adult right atrium where the superior and inferior vena cava drain deoxygenated blood into the heart

What is the trabeculae carnae?

trabeculations in the myocardium

What does the trabeculae carnae in the RV prevent?

valve suction