205: The Heart

0.5 heart width / thoracic width

(widest length of heart is about 1/2 the length of widest part of thorax)

What is the cardiothoracic (CT) ratio?

Mid-sternal line

Identify the line

Mid-clavicular line

Identify the line

Right atrium

What is shown at #1?

Right ventricle

What is shown at #2?

Border of sternum

What is shown at #3?

Manubrium

What is shown at #4?

Costal cartilage

What is shown at #5?

Right atrium

What is shown at #1?

Right ventricle

What is shown at #2?

Pulmonary vein

What is shown at #3, 5, and 7?

Left atrium

What is shown at #4?

Base of heart

What is shown at #6?

Superior mediastinum

What mediastina is the following found in:

roots of great vessels, aortic arch, ligamentum arteriosum, thoracic duct

Through the sternal angle

Where is the transverse thoracic plane defined?

Anterior mediastinum

What mediastina is the following found in:

Thymus, retrosternal fat, nerves

Posterior mediastinum

What mediastina is the following found in:

descending aorta, esophagus, vagus n.

T4-T5 interspace

The superior mediastinum is found above what vertebrae space?

Phrenic nerve

Identify the nerve

C3, 4, 5

What vertebrae does the phrenic nerve come from?

right ventricle

what heart chamber lie directly behind the sternum?

middle mediastinum

which mediastina does the heart reside?

pericardium

what structure encases the heart?

phrenic n.

what nerve runs between the percardium and the parietal pleura of the lungs and anterior to the roots of the heart?

vagus n.

what nerve runs posterior to the roots of the heart?

left

2/3 of the heart sits on the _____ side of the sternum

pericardiacophrenic vessels

what vessels supply the pericardium?

Parietal pericardium

What is shown at #1 and 4?

Visceral pericardium

What is shown at #2?

Pericardial cavity

What is shown at #3?

To reduce friction

Why do mesothelial layers produce serous fluid?

pericardial effusion

fluid in pericardial cavity

pericardial effusion

patient presents with muffled heart sounds , weakened beat, jugular distension, low arterial pressure. what is the diagnosis?

pericardial effusion

identify the pathology

-muffled heart sounds due to blood insulation, weakened beat

-jugular distension due to reduced venous return

-low arterial pressure due to reduced stroke volume/cardiac output

Becks triad:

cardiac temponade

acute build up of excess fluid in pericardial cavity:

jugular distention

pressure on the heart's right atria from fluid in the pericardial sac will cause:

low atrial pressure

reduced stroke vol/cardiac output will cause =

transverse pericardial sinus

permits expansion of great vessels during systole, should, during bypass surgery, these vessels should be clamped off

aorta

pulmonary trunk

what two vessels are isolated by the transverse pericardial sinus?

Transverse sinus

What permits expansion of great vessels during systole?

thebesian veins

these structures are capillary beds within the myocardium that connect adjacent arteries and veins:

myocardium

thebesian veins are located in which heart layer?

oblique sinus

permits expansion of left atrium during exhalation

coronary artery disease

identify the pathology within the lumen of the artery:

left atrium

what heart chamber lies as the base of the heart?

right atrium

identify the structure

right auricle

identify the structure

right ventricle

identify the structure

superior vena cava

identify the structure

inferior vena cava

identify the structure

left ventricle

identify the structure

left auricle

identify the structure

left atrium

identify the structure

pulmonary veins

identify the structure

pulmonary trunk

identify the structure

Apex of heart

identify the structure

pulmonary arteries

identify the structure

right coronary artery

identify the structure

Ligamentum arteriosum

identify the structure

left coronary artery

Identify structure B

right marginal artery

identify the structure

anterior interventricular artery

identify the structure

left marginal artery

identify the structure

left circumflex artery

identify the structure

posterior interventricular artery

identify the structure

atrial branch of RCA

identify the structure

SA nodal branch of RCA

identify the structure

Oblique vein of LA

identify the structure

small cardiac vein

identify the structure

small cardiac vein

what vein runs with the right marginal artery?

right marginal artery

what artery runs with the small cardiac vein?

great cardiac vein

identify the structure

great cardiac vein

what vein runs alongside the anterior interventricular artery

anterior interventricular artery

what artery runs alongside the great cardiac vein?

middle cardiac vein

identify the structure

middle cardiac vein

what vein runs alongside the posterior interventricular artery?

posterior interventricular artery

what artery runs alongside the middle cardiac vein?

coronary sinus

identify the structure

anterior cardiac veins

identify the structure

Terminology: cardiac is used for veins (with the exception of coronary sinus) and coronary is used for arteries

Terminology: cardiac is used for (arteries/veins) and coronary is used for (arteries/veins)

right atrium

all veins that drain the heart will drain into the:

coronary artery disease

damage to coronary arteries, most

commonly due to buildup of cholesterol

deposits (atherosclerotic plaque)

- Leading cause of death in US for men and women

1. Coronary artery collateralization (new capillary growth)

2. Reverse blood flow occurs in thebesian veins under conditions of low perfusion pressure

3. "Endogenous" bypass via vasa vasorum ("vessel of a vessel")

What are the three reperfusion strategies for coronary artery disease?

anterior interventricular artery

what is the most common artery to suffer coronary occlusion?

right coronary artery

what is the 2nd most common artery to suffer coronary occlusion?

great saphenous vein

internal thoracic artery

radial artery

name 3 blood vessels that can be used in coronary bypass grafts:

Left anterior descending artery ~40-50%

Right coronary artery ~30-40%

Circumflex branch ~15-20%

What are the coronary artery occlusion percentages?

Reverse the direction bc of valves

When using the great saphenous vein, what must be done for CABG?

Radial artery

What vessel has the greatest longevity for CABG?

Pectinate muscles

identify the structure

Sinus venarum

identify the structure

Limbus of fossa ovalis

identify the structure

valve of inferior vena cava

identify the structure

coronary sinus valve

identify the structure

Right atrioventricular valve (tricuspid)

identify the structure

crista terminalis

identify the structure

fossa ovalis

identify the structure

foramen ovale

a fetal shunt from right atrium to left atrium

ductus arteriosus

a fetal shunt from pulmonary truck to aorta