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Anatomy Midterm 2 ch 4


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Generally, what is found in the mediastinum?
⬢ Thoracic viscera, but not the lungs. ⬢ This includes: connective tissue, fat, blood, nerves, lymphatic vessels, lymph nodes.
What are the boundaries of the superior and inferior mediastinum?
• Superior – Anteriorly: thoracic aperture to sternal angle. Posteriorly: T4-T5. • Inferior – T4-T5 to diaphragm.
Where is the heart found?
Middle portion of the inferior mediastinum.
What is in the superior mediastinum?
⬢ Thymus. ⬢ Superior vena cava, brachiocephalic veins. ⬢ Aortic arch, Brachiocephalic artery, internal thoracic artery, left common carotid and subclavian arteries. ⬢ Vagus and phrenic nerves (C3,4,5 keep the diaphragm alive). ⬢ Trachea and esophagus. ⬢ Left recurrent laryngeal nerve (branch of vagus), plus esophageal and tracheal plexes of the vagus nerve. ⬢ Thoracic duct.
What are the main structures of the posterior compartment of the inferior mediastinum?
⬢ Esophagus ⬢ Azygos and hemiazygos veins ⬢ Thoracic duct ⬢ Descending aorta ⬢ Vagus nerve
What is an aortic aneurism and what are some possible symptoms for this condition?
⬢ It is a dilatation of the aorta. ⬢ Symptoms: ⬢ Chest fullness. ⬢ Cough. ⬢ Difficulty swallowing (dysphagia). ⬢ High blood pressure. ⬢ Horse voice.
What are some of the conditions that might include the symptom of “chest pressure”?
⬢ Esophageal spasm. ⬢ Tearing of the aorta (dissection). ⬢ Pericarditis (inflammation of the pericardium).
Can someone in their 20’s have a heart attack?
What are the functions of the pericardium?
⬢ Protection ⬢ Lubrication ⬢ Prevents infection spreading ⬢ Limits size of the heart (distention) ⬢ Helps the R and L ventricle to contract together (diastolic coupling).
Describe the location of the transverse and oblique pericardial sinuses.
⬢ Transverse: posterior to pulmonary trunk and aorta; anterior to the superior vena cava. ⬢ Oblique: posterior to the base of the heart (cul-de-sac).
How does high blood pressure affect the size of your heart?
⬢ High blood pressure typically increases the size of your heart.
Describe the anatomical location of the R ventricle, R atrium, L ventricle and L atrium in your chest.
R ventricle and R atrium face the anterior chest wall. L ventricle and L atrium are on the back side of the heart.
Where is the apex of the heart typically found (where you can feel its point of maximal impulse PMI)?
L 5th intercostal space, mid-clavicular line.
What would cause the heart to be contained to only the midline of the body?
Pathological increase in lung volume (due to emphysema).
Can the heart be oriented to the right, instead of the left?
Yes; all of your organs can be switched from right to left, or just the heart.
Describe the unique features of each cardiac chamber.
⬢ R atrium: smooth posterior wall, muscular anterior wall, fossa ovalis, opening for superior and inferior vena cava, and tricuspid valve. ⬢ L atrium: smooth-walled, openings for 4 pulmonary veins and mitral valve. ⬢ R. ventricle: tracbeulae carneae, tricuspid valve, opening for pulmonic valve, 3 papillary muscles, moderator band. ⬢ L. ventricle: mitral valve, trabeculae carneae, 2 papillary muscles, opening for aortic valve, thick walls.
What is the fossa ovalis?
Remnant of the foramen ovale which allowed blood to by- pass the lung system as a fetus. 25% of the population has a patent, or somewhat open, fossa ovalis.
What are the 3 types of cardiomyopathy (pathology of the muscle of the heart), and the cause of each?
• Dilated – weakened muscle; could be from exhaustion from high blood pressure. • Hypertrophic – from high blood pressure or congenital abnormality. • Restrictive – stiffening of the muscle due to deposits of iron, copper or proteins.
Which heart valve is found between the following:
a) R atrium and ventricle – Tricuspid b) L atrium and ventricle – Mitral c) R ventricle and the pulmonary trunk - Pulmonic d) L ventricle and aorta – Aortic.
Name the 3 cusps of the tricuspid valve.
Anterior, Posterior and Septal.
Name the 3 cusps of the pulmonic and aortic valves.
Pulmonic – anterior, right and left. Aortic – right, left and non.
Which valve can you survive without?
Pulmonic – used to replace the aortic valve if necessary.
Why does emphysema lead to right sided heart failure and peripheral swelling?
Emphysema creates high pressures (resistance) in the pulmonary vessels. The right ventricle is not equipped to contract against high pressure, and will dilate over time from working too hard. The tricuspid valve is no longer able to close properly because the right ventricle is enlarged. The blood intended for the lungs starts to back up into the venous system (jugular veins, liver, legs, scrotum etc.). This creates peripheral swelling, and the right side of the heart fails to contract properly.
Where can you listen (with a stethoscope) for the 4 valves of the heart?
Aortic – upper border of the sternum – R side Pulmonic – upper border of the sternum – L side Tricuspid – lower border of the sternum– L side Mitral valve – mid-claviclar line, 4th intercostal space – L side
What causes the “lub” and “dub” sounds of the heart?
Lub = AV valve closure Dub = Semilunar valve closure
Damage to which valve would cause acute shortness of breath and why?
Regurgitation of the aortic semilunar valve or mitral valve. Blood is backing up to the lungs (via pulmonary veins) from the left atrium and ventricle as it regurgitates backwards against the typical flow of blood.
What symptoms, or attributes of the patient, would suggest that the aortic valve has only 2 cusps instead of 3, and that this valve is no longer functioning effectively?
Fatigue and shortness of breath (not acute) when the patient is 40 or 50 years of age. This type of congenital bicuspid aortic valve typically hardens (calcifies) earlier in life than a normal valve.
If a part of the heart does not have a sufficient delivery of blood and oxygen, what symptom often occurs?
Chest pain (chest heaviness, chest pressure, squeezing inside the chest).
What are the two main branches of the left coronary artery, and where would you look for each on the heart?
Left anterior descending (or ant. interventricular) will wrap around the apex of the heart. Left circumflex travels around to the lateral aspect of the heart.
Which coronary artery feeds the AV and SA nodes in the majority of people?
Right coronary artery.
What does coronary dominance refer to?
Whether the right coronary artery or the circumflex branch of the left coronary artery feeds the posterior interventricular septum.
What is a myocardial bridge?
When an epi-cardial vessel dives underneath the muscle of the heart.
What is angina?
Inadequate blood flow to meet the needs of the heart muscle under specific demands. Chest pressure, chest heaviness and squeezing under the sternum are the typical symptoms.
Why do people often have “heart attacks” in the morning?
Platelets are stickier in the morning, therefore it is easier for them to cause a blockage.
What does the term “widow maker” refer to?
A blockage in the left anterior descending artery.
What is coronary vasospasm?
Spasm of the coronary vessels which blocks the flow of blood to the heart muscle and presents as a heart attack, even in someone young with no cardiac risk factors. May be due to stress. More common in women.
Blockage of which blood vessel might cause an inferior and lateral heart attack?
Left circumflex or right coronary artery.
Which arteries do each of the main cardiac veins travel with?
Coronary sinus – left circumflex Great cardiac vein – left anterior descending Middle cardiac vein – posterior interventricular Small cardiac vein – marginal branch of right coronary artery.
What is tachy-brady syndrome?
Irregular beating of the heart with episodes in which the heart stops beating. Patient is weak and dizzy.
Name the main components of the cardiac conduction system in the order they communicate with each other.
Sinuatrial node – Atrioventricular node – bundle of His – R and L bundle branches – purkinje fibers.

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