Cardiology Quiz on Coronary Circulation
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Questions and Answers

What is the principal venous return mechanism for the heart?

  • Inferior vena cava
  • Pulmonary veins
  • Coronary sinus and cardiac veins (correct)
  • Superior vena cava

    • Approximately what percentage of cardiac output does coronary blood flow represent at rest?

  • 10%
  • 5% (correct)
  • 15%
  • 8%

    • Which coronary artery is dominant in 67% of individuals?

  • Right coronary artery (correct)
  • Left coronary artery
  • Anterior descending artery
  • Circumflex artery

    • What structures does the left coronary artery primarily supply?

    <p>The rest of the myocardium not supplied by the right coronary artery</p> Signup and view all the answers

    Which percentage of the population does the right coronary artery supply the SA node?

    <p>60%</p> Signup and view all the answers

    What is the average coronary blood flow in ml/minute at rest?

    <p>225 ml/minute</p> Signup and view all the answers

    Which of the following statements about coronary artery occlusion is true?

    <p>These sites account for at least 85% of all occlusions.</p> Signup and view all the answers

    Which structure is NOT supplied by the right coronary artery?

    <p>Posterior wall of left atrium</p> Signup and view all the answers

    In the anatomical position, which of the following accurately describes the orientation of the arms?

    <p>Arms adjacent to the sides with palms facing anteriorly</p> Signup and view all the answers

    What does the median anatomical plane represent?

    <p>A vertical plane running from front to back in the midline</p> Signup and view all the answers

    How are the abdominal regions subdivided for differential diagnosis of pain?

    <p>Into nine regions and four quadrants</p> Signup and view all the answers

    Which of the following statements is true regarding the transverse plane?

    <p>It runs parallel to the floor and is perpendicular to both the median and coronal planes</p> Signup and view all the answers

    Which vessel is indicated by the arrow in a patient's aortic angiogram if it points to the left common carotid artery?

    <p>Brachiocephalic trunk</p> Signup and view all the answers

    What is the primary use of sub-dividing the abdominal areas?

    <p>For differential diagnosis of abdominal pain by area</p> Signup and view all the answers

    Which of the following best describes the frontal (coronal) plane?

    <p>It is a vertical plane that divides the body into anterior and posterior sections</p> Signup and view all the answers

    What area of the abdomen is typically referred to as the epigastric region?

    <p>The region above the umbilicus and between the lateral borders of the rib cage</p> Signup and view all the answers

    What anatomical structure is located posterior to the ascending aorta?

    <p>Transverse pericardial sinus</p> Signup and view all the answers

    Which vessels are separated by the transverse pericardial sinus?

    <p>Aorta and pulmonary trunk</p> Signup and view all the answers

    Where does the coronary sinus empty into the heart?

    <p>Right atrium</p> Signup and view all the answers

    What is the most prominent cardiac vein in terms of diameter?

    <p>Coronary sinus</p> Signup and view all the answers

    The origin of the coronary sinus is associated with which landmark?

    <p>Meeting point of the great cardiac vein and oblique vein of the left atrium</p> Signup and view all the answers

    Which structure partially covers the atrial orifice of the coronary sinus?

    <p>Thebesian valve</p> Signup and view all the answers

    Which structure is located superior to the left atrium?

    <p>Transverse pericardial sinus</p> Signup and view all the answers

    What is the primary function of the coronary sinus?

    <p>To collect cardiac venous blood</p> Signup and view all the answers

    Which veins drain into the coronary sinus?

    <p>Both A and C</p> Signup and view all the answers

    What is the primary drainage site for the anterior cardiac veins?

    <p>Anterior wall of the right atrium</p> Signup and view all the answers

    Which statement about the azygos vein is true?

    <p>It forms a collateral pathway between the SVC and IVC.</p> Signup and view all the answers

    What does the hemiazygos vein primarily drain?

    <p>Left side of the thorax and abdomen</p> Signup and view all the answers

    Which of the following veins is NOT associated with draining into the coronary sinus?

    <p>Hemiazygos vein</p> Signup and view all the answers

    Which veins form a connection between the posterior aspect of the IVC and the azygos system?

    <p>Ascending lumbar veins</p> Signup and view all the answers

    What is the main tributary to the azygos vein?

    <p>Posterior intercostal veins</p> Signup and view all the answers

    The venae cordis minimae, or Thebesian veins, drain into which chamber of the heart?

    <p>Right atrium</p> Signup and view all the answers

    What is the primary function of chordae tendineae during ventricular systole?

    <p>To prevent the AV valves from eversion</p> Signup and view all the answers

    Which type of heart valve is associated with chordae tendineae?

    <p>Atrioventricular valves</p> Signup and view all the answers

    What happens to chordae tendineae during atrial systole?

    <p>They remain relaxed to allow AV valves to open</p> Signup and view all the answers

    If a patient's papillary muscles rupture, what risk does this pose for the heart?

    <p>Inversion of the AV valves</p> Signup and view all the answers

    What are the cup-shaped structures in arterial valves called?

    <p>Cuspids</p> Signup and view all the answers

    During which phase of the cardiac cycle are the atrioventricular valves closed?

    <p>Ventricular systole</p> Signup and view all the answers

    What is a common consequence of malfunctioning chordae tendineae?

    <p>Fluid accumulation in the lungs</p> Signup and view all the answers

    What structure directly connects papillary muscles to the heart valves?

    <p>Chordae tendineae</p> Signup and view all the answers

    What role did the ductus arteriosus play in fetal circulation?

    <p>It facilitated blood shunting from the pulmonary trunk to the aorta.</p> Signup and view all the answers

    Which structure remains after the closure of the foramen ovale post-birth?

    <p>Fossa ovalis</p> Signup and view all the answers

    What was the primary method of auscultation first introduced by Hippocrates?

    <p>Placing the ear directly on the chest.</p> Signup and view all the answers

    Where are heart sounds most effectively auscultated?

    <p>Distal to the valve through which blood has just passed.</p> Signup and view all the answers

    What happens to the ductus arteriosus after birth?

    <p>It becomes the ligamentum arteriosum.</p> Signup and view all the answers

    Which of the following is a technique in heart auscultation?

    <p>Listening at commonly known points.</p> Signup and view all the answers

    What kind of blood does the right atrium receive from the mother through the umbilical cord?

    <p>Oxygenated blood</p> Signup and view all the answers

    What is indicated by the term 'stethoscope'?

    <p>An instrument for viewing or listening to the chest.</p> Signup and view all the answers

    What is the main function of the azygos vein?

    <p>Form collateral circulation between the SVC and IVC</p> Signup and view all the answers

    Which cardiac structures do the venae cordis minimae primarily drain into?

    <p>Anterior wall of right atrium</p> Signup and view all the answers

    Which vein typically drains the left posterior ventricular area?

    <p>Oblique vein of the left atrium</p> Signup and view all the answers

    Which statement accurately reflects the hemiazygos vein?

    <p>It drains blood from the lumbar region</p> Signup and view all the answers

    What structure provides a connection between the posterior aspect of the IVC and the azygos vein?

    <p>Hemiazygos vein</p> Signup and view all the answers

    Which of the following veins are known to drain blood directly into the right atrium?

    <p>Coronary sinus</p> Signup and view all the answers

    What characterizes the tributaries of the azygos vein?

    <p>They usually arise from the ascending lumbar veins</p> Signup and view all the answers

    What is the purpose of the ductus arteriosus in fetal circulation?

    <p>To shunt blood from the pulmonary trunk to the aorta</p> Signup and view all the answers

    How does blood flow from the right atrium to the left atrium in a fetus?

    <p>Through the foramen ovale</p> Signup and view all the answers

    What eventually becomes the ligamentum arteriosum?

    <p>The ductus arteriosus</p> Signup and view all the answers

    Which area is most effective for auscultating heart sounds?

    <p>At points distal to the heart valves</p> Signup and view all the answers

    Which structure is left behind after the foramen ovale closes in postnatal circulation?

    <p>Fossa ovalis</p> Signup and view all the answers

    What is the primary function of the auscultation technique introduced by Hippocrates?

    <p>To listen to heart sounds directly</p> Signup and view all the answers

    What does the term 'stethoscope' derive from?

    <p>Greek words meaning 'to view the chest'</p> Signup and view all the answers

    What distinguishes fetal circulation from adult circulation?

    <p>Use of umbilical cord for oxygen absorption</p> Signup and view all the answers

    What is the primary artery supplying the right atrium?

    <p>Right coronary artery</p> Signup and view all the answers

    Which of the following cardiac structures is primarily supplied by the left coronary artery?

    <p>Anterior wall of left ventricle</p> Signup and view all the answers

    What percentage of the cardiac output is represented by coronary blood flow at rest?

    <p>5%</p> Signup and view all the answers

    Which node is supplied by the right coronary artery in 80% of people?

    <p>AV node</p> Signup and view all the answers

    What is the primary venous return route for blood from the myocardium?

    <p>Coronary sinus</p> Signup and view all the answers

    Which coronary artery is often dominant in individuals for supplying the inferior wall of the left atrium?

    <p>Left coronary artery</p> Signup and view all the answers

    What common feature is observed at the sites of coronary artery occlusion?

    <p>They account for most occlusions</p> Signup and view all the answers

    Which anatomical position correctly describes the orientation of the head and gaze?

    <p>Head directed anteriorly with gaze also forward</p> Signup and view all the answers

    What is the main purpose of the anatomical planes?

    <p>To provide reference points for medical imaging</p> Signup and view all the answers

    Which area is indicated by the number 8 in the abdominal regions?

    <p>Epigastric region</p> Signup and view all the answers

    Which vessel is indicated by the arrow if it points to the left subclavian artery in an aortic angiogram?

    <p>Right common carotid artery</p> Signup and view all the answers

    In which anatomical plane does the frontal (coronal) plane lie?

    <p>Vertical and perpendicular to the median plane</p> Signup and view all the answers

    What is the significance of the subcostal plane in anatomy?

    <p>It divides the abdominal regions for organ identification</p> Signup and view all the answers

    What anatomical structure is located anterior to the left common carotid artery?

    <p>Aorta</p> Signup and view all the answers

    Which anatomical region is typically painful in cases of appendicitis?

    <p>Right iliac region</p> Signup and view all the answers

    What is the main purpose of the pericardium?

    <p>To cover and protect the heart</p> Signup and view all the answers

    Which component of the pericardium is in direct contact with the heart?

    <p>Visceral layer of serous pericardium</p> Signup and view all the answers

    What is the consequence of performing pericardiocentesis incorrectly?

    <p>Puncture of the lung</p> Signup and view all the answers

    Which pericardial sinus is a blind ending passageway located on the posterior surface of the heart?

    <p>Oblique pericardial sinus</p> Signup and view all the answers

    What should be avoided when performing pericardiocentesis from the infrasternal angle?

    <p>The internal thoracic artery and its branches</p> Signup and view all the answers

    Which of the following is a feature of the fibrous pericardium?

    <p>It serves as a protective layer around the heart</p> Signup and view all the answers

    Which method is utilized to avoid the lungs during pericardiocentesis?

    <p>Subxiphoid approach under ultrasound guidance</p> Signup and view all the answers

    What role does the pericardial sinus play in coronary artery surgery?

    <p>It is used to access coronary arteries for bypass grafting</p> Signup and view all the answers

    Which statement accurately describes the position of the transverse pericardial sinus?

    <p>Located posterior to the ascending aorta and pulmonary trunk.</p> Signup and view all the answers

    What anatomical feature partially covers the atrial orifice of the coronary sinus?

    <p>Thebesian valve.</p> Signup and view all the answers

    Which feature is prominently associated with the coronary sinus?

    <p>It is the most prominent cardiac vein in diameter.</p> Signup and view all the answers

    What separates the arterial vessels from the venous vessels in the heart?

    <p>Transverse pericardial sinus.</p> Signup and view all the answers

    What significant role does the coronary sinus play in the heart's physiology?

    <p>It acts as a primary collector of cardiac venous blood.</p> Signup and view all the answers

    Study Notes

    Revisions

    • Professor Dr Panagiotis Karanis is the Professor and Director of Anatomy Centre at UNic Medical School.

    Introduction to Anatomy

    • This is a course introduction to anatomy.

    The anatomical position

    • The anatomical position describes the standard position for the body used as a reference during anatomical study and movement.
    • The head, eyes, and toes should be directed forward.
    • Arms should be to the side, with palms facing forward.
    • Legs should be close together and feet parallel.

    Anatomical planes

    • Median: Vertical plane, dividing the body into left and right halves.
    • Frontal (Coronal): Vertical plane, dividing the body into anterior (front) and posterior (back) portions.
    • Horizontal (Transverse): A plane parallel to the ground, dividing the body into superior (upper) and inferior (lower) portions.
    • Sagittal: Vertical plane parallel to the median plane, dividing the body into left and right sections.

    There are nine abdominal regions and four abdominal quadrants in the

    • There are 9 regions and 4 quadrants to help identify specific abdominal areas.
    • The regions and quadrants are used in differential diagnosis of abdominal pain.

    Abdominal regions - descriptions

    • Right hypochondriac: below the ribs, cartilage of ribs
    • Epigastric: over, above, stomach, belly
    • Left hypochondriac: below, under, cartilage of ribs
    • Right lumbar: lumbar vertebra
    • Umbilical: navel
    • Left lumbar: lumbar vertebra
    • Right iliac: iliac crest (on hipbone)
    • Hypogastric: below, under, stomach, belly
    • Left iliac: iliac crest (on hipbone)

    Why are these sub-divisions useful?

    • The sub-divisions help with differential diagnosis of abdominal pain by area.
    • Several conditions can cause pain from different abdominal regions.

    Q: A patient complains...

    • The given image shows a grid for abdominal regions.
    • Question 2 refers to region 2; number 8 refers to the region known as the Right Iliac region.

    Cardiovascular System

    Aortic angiogram

    • An angiogram is used to investigate the aortic dissection.
    • The arrow in the angiogram points to the Left common carotid artery.

    Coverings of the heart: pericardium

    • The pericardium is a layered sac surrounding the heart.
    • The layers are: fibrous pericardium, parietal layer of serous pericardium (and visceral layer of serous pericardium).

    Layers of pericardium and heart wall

    • The pericardium has fibrous and serous layers.
    • Myocardium is the heart muscle.
    • Endocardium is the innermost lining.

    Heart

    • The heart has multiple structures and components (listed in detail on image).

    Pericardiocentesis

    • It is a procedure to remove fluid around the heart for treatment.
    • It is done by passing a needle from the infrasternal angle, supero-posteriorly, in the 5th or 6th intercostal space on the left side.
    • The needle should be aimed away from lungs and pleura.

    Pericardial sinuses

    • There are oblique and transverse pericardial sinuses.
    • The transverse pericardial sinus is positioned behind the aorta and pulmonary trunk, and ahead of the superior vena cava.

    Right atrium

    • The right atrium includes: Right auricle, Superior vena cava, SA node, AV node, Interatrial septum, Fossa ovalis, Coronal sinus, Inferior vena cava, Crista terminalis, Sulcus terminalis, Pectinate muscle.

    Coronary sinus

    • It's a major vein in the heart.
    • It empties directly into the right atrium near the inferior vena cava and tricuspid valve.

    Right ventricle

    • The right ventricle consists of Atrioventricular groove, Tricuspid valve, Chordae tendineae, Papillary muscles, Interventricular septum, Trabeculae carneae, Trabecula septomarginalis (moderator band), Pulmonary valve, Pulmonary trunk.

    Chordae tendinae

    • Cord-like tendons connecting papillary muscles to the tricuspid and mitral valves.
    • They prevent the eversion of heart valves during ventricular contraction.

    Q: A patient undergoes...

    • The pin in the image points to the Middle cardiac vein.

    Azygos

    • It is a major systemic vein located near vertebral bodies.

    Auscultation

    • It's listening to sounds of the heart or lungs using a stethoscope.

    Surface projections of heart valves

    • Different valves of the heart have specific locations that can be used during an exam.
    • Their location is usually associated with intercostal spaces and areas to the left/right side of sternums.

    5 Areas for listening...

    • There are 5 areas on the chest where heart sounds are best heard.
    • Each area relates to a specific valve (tricuspid, aortic, mitral, pulmonic, etc..).

    Fetal Circulation

    • During fetal development, the circulatory system has temporary structures not found in the adult circulatory system
    • These include the ductus arteriosus, foramen ovale, and ductus venosus to regulate blood flow to and around the lungs.

    Coronary Arteries

    • The coronary arteries provide blood to the heart.
    • They arise from parts of the aorta.
    • They branch and supply different parts of the heart muscle.

    Coronary Arteries Distribution

    • The right coronary artery (RCA) typically dominates blood supply to the right side of the heart.
    • The left coronary artery (LCA) generally supplies the left side and septum of the heart.

    Coronary Artery Occlusion

    • Common areas where occlusions of the coronary arteries occur.
    • These can lead to myocardial infarction.

    Blood supply to conducting system

    • Special arteries supply heart's conductive system.
    • These branches from the LCA and RCA help conduct electricity necessary for heart function.

    Cardiac Veins

    • There are many cardiac veins that help collect blood draining from the heart wall.
    • The majority of cardiac veins drain to the coronary sinus, which then empties into the right atrium.

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