Escolar Documentos
Profissional Documentos
Cultura Documentos
b.
Pericardial sinuses are reections of the parietal serous pericardium around major vessels. There are two - the oblique sinus which is bounded by the pulmonary veins and superior and inferior vena cavae, and the transverse which is bounded by the pulmonary trunk/ascending aorta anteriorly and atria posteriorly.
2.
Describe the anatomic basis of cardiac tamponade a. Cardiac tamponade is the compression of the heart due to accumulation of uid (pericardial effusion) in the pericardial cavity. It can be caused by pericarditis. i. The compression of the heart muscle minimizes its ability to contract, and is characterized by weak/rapid pulse, dyspnea, JVD, and reduced cardiac output.
3.
Explain the characteristics and relationships of atria and ventricles a. The heart consists of two atria and two ventricles. b. The interatrial septum separates the two atria c. d. e. f. The interventricular (membranous and muscular parts) separates the two ventricles The atrioventricular separates the left ventricle from the right atrium The coronary sulcus is between the atria and ventricles, and contains the coronary sinus, beginnings of the coronary arteries, and the small cardiac vein. The interventricular sulci are between the ventricles. The anterior i.s. contains the left anterior descending (LAD) artery (aka anterior interventricular artery of the left coronary artery) and the great cardiac vein. The posterior i.s. contains the posterior interventricular artery of the right coronary artery and the middle cardiac vein. Right atrium i. Derived from the sinus venarum and primitive atrium which are separated by the crista terminalis that contains the sinuatrial (SA) node. 1. The sinus venosus receives the superior/inferior vena cavae and coronary sinus. It contains the fossa ovalis. a. The inferior v.c. and coronary sinus openings are guarded by the eustachian and thebesian valves, respectively. h. 2. The primitive atrium contains pectinate muscles and right auricle Right ventricle i. Made up of proper right ventricle (inow) and pulmonary vestibule (infundibulum) (outow) separated by supraventricular crest 1. Proper right ventricle: trabeculae carnea; anterior/posterior/septal papillary muscles connected to the tricuspid valve (separates right atrium from ventricle) cusps via chordae tendinea; trabeculae septomarginalis 2. (transmits right branch of AV bundle) Infundibulum: continues with pulmonary trunk guarded by semilunar pulmonary valve which divides into right/left pulmonary arteries, the left being connected to the aortic arch via the ligamentum arteriosum a. Pulmonary hypertension = pulmonary artery wall and its smaller vessels become damaged, resulting in narrowing of the lumen and hypertrophy of R. ventricle and restricting blood ow to lungs exertional dyspnea
g.
j.
nea) Left ventricle i. Made up of proper left ventricle (inow) and aortic vestibule (outow) 1. Proper left ventricle: trabeculae carnea; anterior/posterior papillary muscles connected to mitral (bicuspid) valve (connection to left atrium) via chordae tendineae a. Mitral stenosis (see above) b. Mitral valve prolapse Aortic vestibule: leads to ascending aorta guarded by semilunar aortic valve which surrounds the 3 aortic sinuses (of Valsalva), 2 of which contain ostia for the right/left coronary arteries a. Aortic stenosis = usually congenital, associated with hypertrophy of L. ventricle and regurgitation of blood into lungs exertional dyspnea, angina, syncope, cardiac murmur, dec. BP, rising carotid pulse
2.
4.
Verify the role of autonomic nervous system in the transmission of cardiac pain a. Sympathetic segmental contribution is responsible for referred cardiac pain - visceral afferents accompany the sympathetic bers (from T1-T4), the somatic afferents and visceral afferents both travel together in the dorsal root and converge on a single ascending secondary neuron. when the pain travels up the AL tract it is interpreted as originating from the somatic sensory nerves (because pain felt in the skin is more common) leading to the perception of a diffuse referred pain in the T1-T4 dermatomes.
5.
State the areas of distribution of the coronary arteries a. Ascending aorta right coronary artery right marginal and posterior interventricular arteries b. i. R.C. Artery = dominant; supplies SA and AV nodes, posterior and anterior surface of the heart Ascending aorta left coronary artery LAD and circumex i. LAD supplies anterior surface of ventricles, interventricular septum ii. Circumex supplies left atrium and upper left ventricle 1. Gives rise to posterior interventricular artery in left dominant coronary circulation
6.
Describe the course, sites of drainage and relationships of the cardiac veins a. Coronary sulcus: coronary sinus, small cardiac vein b. Anterior interventricular sulcus: great cardiac vein c. Posterior interventricular sulcus: middle cardiac vein
7.
Outline the location of the elements of the conduction system a. b. c. d. Sinuatrial (SA) node - adjacent to crista terminalis of right atrium Internodal tracts - connect SA and AV node Atrioventricular (AV) node - right interatrial septum, adjacent to ostium of coronary sinus Bundle of His - along posterior border of membranous interventricular septum i. Divides into left and right branches that perfuse the ventricles
g. Pulmonary Hypertension
i. ii.
An obliterative condition that affects small and medium pulmonary arteries Hyperplasia and scar tissue narrowing of the lumen increased pulmonary arterial pressure increased resistance to blood ow to the lungs alveolar hypoxia iii. Associated with hypertrophy of the R-ventricle and shrinkage of the L-ventricle iv. Exertional dyspnea is common, however syncope and substernal angina may also be seen
j.
l.
m. Cardiac Skeleton i. Maintains patency of the AV and semilunar valves ii. Provides attachment to cardiac muscles and cusps of the cardiac valves iii. Secure independent contraction of the atria and ventricles iv. Consists of: 1. Fibrous trigones 2. Right and left atrioventricular rings 3. Aortic ring 4. Pulmonary ring