CH 24 & 25; Cardio

Right Pleural Cavity

Contains the right lung with 3 lobes (upper, middle, lower).

Left Pleural Cavity

Contains the left lung with 2 lobes (upper, lower).

Mediastinum

Central compartment containing:

• Esophagus

• Trachea

• Thymus

• Lymph nodes

• Heart

Parietal Pleura

Pleuralines the inner ribs, pericardium, and the superior surface of the diaphragm. Provides a protective layer and reduces friction.

Visceral Pleura

Pleura covers the outer surface of the lungs

Pleural Space

A fluid-filled gap between parietal and visceral pleura, allowing for lung movement during respiration.

Diaphragm

Main muscle responsible for inhalation; contracts and flattens, increasing thoracic cavity volume.

External Intercostals

Elevate ribs, expanding the thoracic cavity.

Internal Intercostals

Pull ribs down, aiding in forced expiration.

External & Internal Oblique, Transversus Abdominis, Rectus Abdominis:

Assist in compressing the abdominal cavity and expelling air.

the diaphragm and intercostals contract, causing ribs and sternum to elevate.

During inhalation…

decreasing pulmonary pressure and forcing air into the lungs.

The thoracic cavity increases in size…

Sternum

Composed of Manubrium, body, xyphoid process

Manubrium

The upper part, articulating with the clavicles and first ribs

Body

The middle part, articulating with ribs 2-7.

Xyphoid Process

The lower, cartilaginous tip.

Approximately the size of a fist, mainly located in the left chest, protected by the sternum

Size and Location of heart

Epicardium

Outer layer, part of the pericardium.

Myocardium

The muscular middle layer responsible for contractions.

Endocardium

The inner lining that covers heart chambers and valves.

Right Atrium

receives deoxygenated blood from the body.

Left Atrium

receives oxygenated blood from the lungs.

Thinner walls

separated by interatrial septum.

Right Ventricle

pumps deoxygenated blood to the lungs.

Left Ventricle

pumps oxygenated blood to the rest of the body.

Thicker walls

separated by interventricular septum.

Tricuspid Valve:

Three leaf-like cusps allowing one-directional flow from the right atrium to the right ventricle.

Mitral (Bicuspid) Valve

Two cusps allowing flow from the left atrium to the left ventricle.

Aortic Valve

Opens to allow blood flow from the left ventricle into the aorta.

Pulmonary Valve

Allows blood flow from the right ventricle to the pulmonary arteries.

Right Coronary Artery

Bifurcates into posterior descending artery and posterior marginal artery, supplying right ventricle and atrium.

Left Coronary Artery

Includes the left anterior descending (LAD), known as the "widow maker," supplying both ventricles and circumflex artery supplying left ventricle and atrium.

Systole

Contraction phase where blood is pumped out of the heart.

Diastole

Relaxation phase where the heart fills with blood.

SA Node (Sinoatrial Node)

Located in the right atrium; initiates electrical impulses, acting as the heart's pacemaker.

AV Node (Atrioventricular Node)

Located in the interatrial septum; receives impulses from the SA node and transmits them to the ventricles.

Bundle of His

Located in the interventricular septum, divides into left and right bundle branches.

Purkinje Fibers

Spread impulses throughout the ventricles for coordinated contraction.

Rib Shears (Bethune)

Used for cutting ribs.

Rib Stripper/Elevator (Matson)

Used to elevate ribs during thoracotomy

Vascular Instrument Set & Thoracotomy Instrument Set

Specific instruments for thoracic surgery.

Swan-Ganz Catheters

Monitor pulmonary artery pressures.

Arterial Catheters

Measure blood pressure directly.

Electrocardiography Equipment

Monitors heart rhythm.

Oxygen Saturation Equipment

Measures oxygen levels in the blood.

Temperature Equipment

Monitors body temperature during surgery.

Blunt Trauma

Resulting from deceleration injuries, falls, or car accidents.

Penetrating Trauma

Includes gunshot and knife wounds.

Pneumothorax:

Air enters the pleural cavity, collapsing the lung.

Pleural Effusion

Accumulation of blood or fluid in the pleural cavity

Tamponade

Fluid buildup in the pericardium or mediastinum, compressing the heart.

Bronchoscopy

Used for foreign object retrieval, biopsy of bronchial tissues, and positioning of endotracheal tubes.

Bronchoscopy Types

• Rigid (for larger objects)

• flexible (for smaller objects).

Mediastinoscopy

Evaluates mediastinal masses for lung carcinoma using a rigid scope introduced into the superior mediastinum.

Thoracotomy

Open surgery of the thoracic cavity requiring Positioning with a double-lumen endotracheal tube and appropriate surgical setup.

Lobectomy

Surgical removal of a lobe of the lung, often performed for metastatic cancer or benign tumors.

Pneumonectomy

Involves removal of an entire lung, typically due to malignancy or extensive disease.

Decortication

Surgical removal of the fibrous layer of the lung to facilitate lung expansion.

• Surgical removal of a portion of the parietal pleura

Coronary Artery Bypass Grafting (CABG)

Bypasses narrowed segments of coronary arteries to improve blood flow.

• grafts: Greater saphenous vein, internal mammary artery, radial artery.

Mitral Valve Repair/Replacement

Addresses stenosis or regurgitation.

Aortic Valve Replacement (AVR)

Involves the removal of the diseased valve

and replacement with a prosthetic valve.

Heparin Sodium

Anticoagulant used during surgical procedures to prevent clotting.

Protamine Sulfate

Reverses the effects of heparin.

Lidocaine

Administered for ventricular arrhythmias.

Epinephrine

Used for cardiac stimulation during emergencies.

Coronary Artery Disease (CAD)

• Leading Cause of Death: Affects millions annually.

• Risk Factors: Include age, gender, race, genetics, hypertension, smoking, diet, and

obesity.

Atherosclerosis:

A buildup of calcium and lipids in arterial walls, leading to narrowed lumens and potential myocardial infarction (MI).

Atrial Septal Defect (ASD)

Hole between the right and left atria; leads to shunting of blood

Ventricular Septal Defect (VSD)

Hole between the ventricles; allows mixing of oxygenated and deoxygenated blood.

Patent Ductus Arteriosus (PDA)

Ductus arteriosus fails to close after birth, causing abnormal blood flow.

Coarctation of the Aorta

Narrowing of the aorta that can lead to hypertension and heart failure.

Equipment Setup

• Large backtable for instruments.

• Fluid warmer for intravenous fluids.

• Cardiac instruments and monitoring equipment on standby.

Monitoring

Continuous assessment of vital signs, oxygen saturation, and signs of complications such as bleeding or infection

Pain Management

Management: Use of analgesics for postoperative pain control.

Antibiotics

Administered to prevent infection post-surgery

lungs

• designed to oxygenate blood

• blood travels through the lungs

• large volumes of blood can be lost