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What is located in the middle mediastinum?
- pericardium
- heart
- ascending aorta
- pulmonary trunk
- SVC
- arch of the azogus
- main bronchi
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What ribs does the pericardium lie behind
2nd to 6th coastal cartilage
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What vertebral levels does the pericardium lie?
T5-T8
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Attachments of the fibrous pericardium
- fused with the tunica adventitia of the great vessels
- posterior surface of the sternum by the sternopericardial ligaments
- fused with the central tendon of the diaphragm
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What does the fibrous pericardium protect the heart from?
overfilling
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The pericardial cavity
- between the parietal and visceral layers of the serous pericardium
- allows for frictionless movement of the heart
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What forms the epicardium
visceral pericardium
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Two sinuses in the middle mediastinum
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Arterial supply of the pericardium
- mainly the pericardiacophrenic artery, a branch of the internal thoracic
- small contributions from the musculophrenic artery, the terminal branch of the internal thoracic
- coronary arteries supply the visceral layer
- small branches off the aorta; bronchial, esophageal and phrenic
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venous drainage of the pericardium
- pericardiacophrenic vein
- azygus
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Nerve supply of the pericardium
- phrenic nerve, C5-C8; sensory, pain refereed to the shoulder
- vegas nerve
- sympothetic trunk
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Surgical importance of the transverse sinus
cardiac surgery, separates the inflow from the outflow
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What is paricarditis
- Inflammation of the pericardium
- causes chest pain
- can cause pericardial friction rub
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What is pericardial effusion?
- passage of fluid from the pericardial capillaries into the pericardial sinus
- caused by inflammation
- can compress the heart
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Cardiac tamponade
fluid enters the fibrous pericardium and since the pericardium is not elastic the fluid compresses the heart and decreases filling
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drainage of fluid from the pericardial cavity
- pericardiocentesis
- 5th or 6th intercostal space near the sternum
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level of the aortic arch
- standing; T4/T5
- supine; T2/T3
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The apex of the heart
- directed anteriorly and to the left, formed by the inferior part of the left ventricle
- posterior to the 5th intercostal space, 9cm from the median plane
- hear the sound of mitral valve closure
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The base of the heart
- the hearts posterior aspect
- mainly left atrium with a little right atrium
- faces posteriorly toward the vertebrae, T6-T9, separated by the esophagus and aorta
- superior to the bifurcation of pulmonary trunk and inferior to the coronary groove
- receives the pulmonary veins and both vena cave
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the four surfaces of the heart
- anterior; right ventricle
- diaphragmatic (inferior); left ventricle and some of the right. associated with the central tendon
- Left pulmonary; LV
- Right pulmonary surface; right atrium
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Four borders of the heart
- right; right atrium
- left; LV and some left atrial appendage (auricle)
- Inferior; right ventricle
- superior; right and left atria,
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The right auricle represents?
the primordial atrium
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Smooth part of the right atrium
the sinus venarum
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The coronary sinus is a derivative?
of the embryonic venous sinus
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Structure that separates the right atrium from the auricle
- sulcus terminals externally
- crista terminalis internally
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Musclular part of the right atrium
pectinate muscle
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level of the opening of the SVC
3rd costal cartilage
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level of the IVC opening
5th costal cartilage
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Outflow of the right ventricle
conus arteriosus (infundibulum)
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Muscular elevations of the RV
trabeculae
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what separates the muscular inflow of the RV from the smooth outflow?
the supraventricular crest
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three leaflets of the tricuspid valve
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Two parts of the intervetricular septum
- membranous part
- muscular part
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What carries the conduction form the IV septum to the papillary muscles
- the moderator band (septomarginal trabecula)
- to the anterior papillary muscle
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level of the pulmonary valve
3rd costal cartilage
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function of pulmonary sinus
to allow blood to get behind pulmonary valve leaflets so they do not stick to the walls
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The interior of the left atrium
- large smooth wall and a small pectinate muscle
- four pulmonary veins
- thicker wall then right atrium
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The smooth wall of the left atrium is formed by?
- absorption of parts of the embryonic pulmonary veins
- the rough wall is the primordial left atrium
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Outflow tract of the LV
aortic vestibule
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level of the mitral valve
fourth costal cartilage
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Level of the aortic valve
3rd costal cartilage
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Most prevalent congenital heart defect
VSD
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Most frequent valve abnormality
- aortic stenosis
- results in LV hypertrophy
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surface anatomy of the heart
- superior border; line from the inferior 2nd left costal cartilage to the superior part of the right 3rd costal cartilage
- right border; 3-6 costal cartilage
- inferior border;
- left
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Areas of auscultation for the heart?
- aortic valve; second intercostal space to the right of the sternum
- pulmonary valve ; second intercostal space to the left of the sternum
- tricuspid valve; fifth intercostal space on left sternal border
- mitral valve; apex of the heart, fit intercostal space
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The RCA supplies
- right atrium
- most of the right ventricle
- part of LV, diaphragmatic surface
- posterior IV septum
- SA node, 60%
- AV node, 80%
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LCA supplies
- the left atrium
- LV
- anterior IV septum
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lymphatic drainage of the heart
- lymph vessels of the heart pass to the subepicardial lymph plexus
- this vessels runs posterior and superior from the heart to the inferior tracheobronchial lymph nodes
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location of the SA node
- anteriolateral wall
- just deep to the epicardium at the junction of the SVC and the right atrium
- the superior end of the sulcus terminals
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location of the AV node
- posteroinferior of the intertribal septum
- near the opening of the coronary sinus
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Autonomic innervation of the heart?
- superficial and deep cardiac plexuses
- located anterior to the bifurcation of the trachea and posterior to the ascending aorta
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Sympathetic innervation of the heart
- T1-T5
- postsynaptic cell bodies in the cervical and superior thoracic paravertibral ganglia
- SA and AV node
- indirectly diolates coronary vessels
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Parasympathetic to the heart
- vagus nerve
- SA and AV node
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three most common spots of coronary occlusion
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