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SGU: Heart

Anatomy of Heart

What is found in the middle mediastinum and where is its anatomical location? contains pericardium, heart, origins of the great vessels, various nerves and smaller vessels and begins at the angle of Louis (T4/5) and ends between T9 vertebra
What are the layers of the pericardium? fibrous pericardium (outer) and serous (inner, thin) pericardium which consists of parietal layer and visceral layer.
From what does the parietal and visceral pericardium derive from? parietal-somatopleuric mesoderm, visceral-splanchnopleuric mesoderm
What is the embryological origin of the fibrous pericardium? fusion of the pleuropericardial folds/membrane
What is the fibrous pericardium attached to? it's base is attached to the central tendon of the diaphragm and muscular area of the left side of the diaphragm. Anteriorly it is attached to the posterior surface of sternum by sternopericardial ligaments
What innervates the fibrous pericardium? the phrenic nerves
What is the blood supply of the fibrous pericardium? pericardiacophrenic vessels
What arteries supply the pericardium? internal thoracic, pericardiacophrenic, musculophrenic, and inferior phrenic arteries and thoracic aorta
What vein supplies the pericardium? azygos system and internal thoracic and superior phrenic veins.
Describe the location of the transverse pericardial sinus. space between pulmonary trunk and aorta/superior vena cava
Describe the location of the oblique pericardial sinus space between the posterior surface of heart and percardium overlying anterior aspect of oesophagus (surrounded by pulmonary veins)
Describe pericarditis inflammatory condition of the pericardium
Describe pericardial effusion fluid accumulation between the visceral and parietal layers of serous pericardium.
Describe cardiac tamponade blood in pericardial cavity due to a stab wound or MI rupture. Usually treated by pericardiocentesis
Describe the diaphragmatic surface of the heart left ventricle and small portion of the right. faces inferiorly. rests on the diaphragm
Describe the posterior surface of the heart left atrium, right atrium, proximal parts of the great veins.
Describe the anterior (sternocostal) surface of the heart right ventricle and some right atrium and some of the left ventricle
Describe ectopia cordis pericardium and heart are exposed through a defect in the chest wall due to a failure of lateral walls to fuse in week 4
Describe dextrocardia bending of the heart tube to the left instead of the right
The heart is displaced to the right and its vessles are reveresed, left to right. This is due to Dextrocardia: the heart tube bends to the left instead of to the
When the heart and the abdominal viscera are transposed to the opposite side of the body this is called dextrocardia with situs inversus
The left and right atrium are divided by the formation and modification of the septum primum and the septum secundum
During development of the interatrial septum, following growth of the septum primium it fuses with the fused endocardial cushions
During development of the interatrial septum, the rupture of the upper part of the septum primum forms the ostium secundum
During development of the interatrial septum, the fushion of the septum primum with the AV septum/fused endocardial cushion closes the ostium primum
During development of the interatrial septum, on the right side of the septum primum what appears in the roof of the common atrium? the septum secundum
During development of the interatrial septum, which septum is rigid and which is movable? septum primum:movable, septum secundum:rigid.
During development of the interatrial septum, the ostium secundum becomes an oblique passage between the 2 septa called the foramen ovale
During development of the interatrial septum, what is the high pressure atrium? right atrium
What causes the closure of the foramen oval? the pressure from the left atrium pushes the septum primum to the septum secundum and closes the foramen oval creating the interatrial septum
The anatomical closure of the foramen ovale? 3 months after birth
The functional closure of the foramen ovale? immediately after birth
After the closure of the foramen ovale, the lower margin of the septum secundum forms the annulus fossa ovalis
After the closure of the foramen ovale, the septum primum forms the fossa ovalis
A small probe can be passed from one atrium to the other. What is this condition and how does it happen? this is an atrial septal defect due to incomplete adhesion between the septum primum and the septum secundum
Baby girl has a large foramen oval. What is this CHD and why does it happen? Ostium secundum type:due to a short septum secundum or excessive resorption of septum primum
Patient has a small hole in the septum between the left and right atria that causes no hemodynamic differences. This is called and occurs b/c patent foramen ovale due to failure of fusion between septum primum and secundum
Baby patient is born with the heart outside the thoracic cavity. What is this called and why does it happen? Ectopia cordis caused by faulty development of the sternum and pericardium secondary to incomplete fusion of the lateral folds in the formation fo the throacic wall
Patient with down syndrome has a patent ostium primum and a cleft in the anterior cusp of the mitral valve. What is thiPas called and why does it happen? primum type of ASD due to failure of closure of ostium primum.
Patient has an absent ineratrial septum. What is this called and why does it happen? common atrium ASD
Defective absorption of sinus venosus into right atrium is what kind of ASD? sinus venosus
Blood flows from the left atrium to the left ventricle through the mitral/bicuspid valve
The septum of the ventricles have two parts. They are the muscular and membranous part
Most common CHD is caused by and called membranous ventricular septal defect. Caused by failure of tissue from endocardial cushions to fuse with the primordial IV septum and the bulbar septum
The left atrium receives blood from four pulmonary veins
What keeps the AV valves closed during ventricular contraction? papillary muscles pulling on chordae tendineae
Blood from the body returns to the heart through the superior and inferior vena cavae
Blood from the walls of the heart return to the heart through the coronary sinus
The tricuspid valve is between the right atrium and ventricle
The sulcus terminalis cordis is a shallow verticle groove which extends from the right side of the opening of the superior vena cava to the right side of the opening of the inferior vena cava
Internally the right atria is divided by the crista terminalis
The pulmonary vavle is the semilunar valve between the right ventricle and pulmonary artery
The semilunar valves have how many cusps? 3
The only valve with two cusps is the mitral valve/bicuspid
What occurs during systole? ventricles contract, AV valves close and semilunar valves open.
What occurs during diastole? ventricles relax and fill, AV valves open and semilunar valves close.
Where are the AV and semilunar valves located? tricuspid: right 5 rib/sternum mitral:right fourth intercostal, aortic: medial to the pulmonary on the left 3rd intercostal
Where on the body do you listen for the tricuspid valve? left/right of the lower part of the sternum near the fifth intercostal space
Where on the body do you listen for the mitral valve? over the apex of the heart in the left fifth/fourth intercostal space at the midclavicular line
Where on the body do you listen for the pulmonary valve? medial end of the left second intercostal space
Where on the body do you listen for the aortic valve? medial end of the right second intercostal space
What are the four defects in tetrology of fallot? pulmonary stenosis: narrow pulmonary trunk, right ventricular hypertrophy, interventricular septal defect, overriding aorta:asymmetrical partitioning of truncus arteriosus, cyanosis due to right to left shunt
The right coronary artery splits into posterior descending artery, right marginal branch, atrial branch
The left coronary artery splits into left anterior descending artery, circumflex branch (which has a marginal branch)
What are the veins of the heart? anterior cardiac vein, great cardiac vein, middle cardiac vein and small cardiac vein.
Where is the the anterior cardiac veins? cross coronary sulcus and goes down anterior wall of right atrium over coronary artery
Describe the path of the small cardiac vein lower anterior section of coronary sulcus between right atrium and ventricle
Which artery does the small vein follow? right coronary artery. Begins with marginal artery of right coronary
Which artery and vein are in the anterior interventricular sulcus? anterior interventricular artery (LDA) of left coronary and great vein
Which vein accompanies the circumflex branch of the left coronary? posterior cardiac vein
Which artery accompanies the middle cardiac vein? posterior interventricular artery of the right coronary (PDA)
Which artery does the right marginal vein follow? marginal branch of the right coronary artery
Describe a coronary angioplasty (PTCA) long tube is inserted into the femoral artery in the thigh through aorta to coronary. A wire is used to cross stenosis and ballon open up artery.
Describe coronary bypass graft great saphenous vein in lowerlimb used to bypass blocked sections of the coronary.
Describe the pathway of the cardiac conduction system SA node - AV node - Bundle of His - Left and right bundle branches - purkinje
What roots give rise to the sympathetics of the heart? T1-4
What roots give rise to the parasympathetics of the heart? CN10
The cardiac plexus has which fibers? parasymp and symp., viceral afferents
Function of symp in heart? increase heart rate and dilate vessels
Function of parasymp in heart? decrease heart rate and constrict vessels
Location of superficial cardiac plexus? between aortic arch and pulmonary trunk, On aortic arch between phrenic and vegus nerves
Location of deep cardiac plexus? between aortic arch and the tracheal bifurcation
Branches of the vagus nerve that supply the deep cardiac plexus superior cervical (L&R), inferior cervical (R) and recurrent laryngeal from thoracic (L&R)
Branches of the sympathetic that supply the superficial cardiac plexus superior cervical (right), middle cervical (L&R), inferior cervical (L&R), T1-5 (L&R)
What are the vessel-forming cells? mesenchymal cells that differentiate into endothelial cell precursors called angioblasts
What are the blood forming cells? hemocytoblasts
What gives rise to blood cells? hemangioblasts
The extraembryonic splanchic mesoderm gives rise to which part of the CV system? vasculogenesis, development of embryonic blood vessels
Where does blood form? blood islands in the yolk sac
Early heart tissue induced by endoderm
Mesoderm splits into what parts of the heart? somatic and splanchic
What is the space between somatic and splanchin parts of the heart? pericardial cavity
180 degree rotation of the anterior embryo places the heart? posterior to the oropharyngeal membrane
What forms endocardial primordia on both sides of the foregut? vesicles in the pre-cardiac splanchnic mesoderm
How does the heart tube form? fustion of the endocardial primordia along the midline
What does the endocardial lining become after formation of the tubular heart? endocardium
What is the embryonic origin of the primordial myocardium? splanchnic mesoderm.
What are the layers of the heart tube. thin endocardial tube separated by and thick muscular myocardium primordium by cardiac jelly.
After heart tube constricts and dilates what are its different section? bulbus cordis, ventricle, atrium, sinus venosus.
Why does the heart tube fold? Bulbus cordis and ventricle grow faster than the atrium and sinus venosus
What does the sinus venosus give rise to? left-coronary sinus, right-sinus venarum of right atrial wall
What does the bulbos cordis give rise to? conus arteriosus of right ventricle and aortic vestibule of left ventricle
What does the truncus arteriosus give rise to? pulmonary trunk and aorta
Path of blood into primordial heart the umbilical, vitalline and common cardinal veins drain into sinus venosus - atrium - ventricle - bulbus cordis - truncus arteriosus - aortic sac - aortic arches
What separates the atria and ventricles? endocardial cushions form from dorsal and ventral swelling
Where is the endocardial cushions derived from? neural crest
Describe the partitioning of the sinus venosus right horn becomes larger and orifice moves to the right. Becomes part of right atrium. Left horn becomes coronary sinus
How do the pulmonary veins develop? branched vein is an outgrowth of atrium wall and then main branch reabsorbed. left auricle is rough and part of primordial atrium
Describe the closing of the ventricular septum muscular septum grows from floor, membranous septum grows from endocardial cushions and bulbar ridges,
Describe the partitioning of the bulbus cordis and truncus arteriosus bulbar and truncal ridges form and undergo spiraling and formation of aorticopulmonary septum when ridges fuse, division of aorta and pulmonary trunk
Describe perinatal circulation very little flow, lung non-functional, right to left passages through foramen oval and ductus arteriosus
What changes in the heart occur at birth? closure of the interatrial septum, closure of ductus arteriosus & venosus
BAby has patent ductus arteriosus. Description and Causes? failure of the ductus arteriosus to involute and form ligmentum arteriosum. Blood from aorta going to pulmonary artery. Acyanotic CHD. Potentially caused by mommy with rubella during late pregnancy or premature baby or baby born at high altitude.
Baby with turners syndrome and upper limb extension is most subseptible to what condition? coarctation of the aorta
what is the most common cause of cyanotic heart disease in infants with Atrial septal defects that is lethal if there was no ASD? transposition of great vessels
What is truncus arteriosus and what kind of CHD is it? cyanotic increased pulmonary flow CHD where a failure of the truncal ridges and aorticapulmonary septum to develop normally and to divide the truncus arteriosus in the aorta and pulmonary trunk. A single arterial trunk branches to supply the entire body.
Created by: mnoronha



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