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Questions and Answers
A patient presents with a tumor impinging on structures within the superior mediastinum. Compression of which structure would MOST directly lead to jugular venous distension and facial edema, neglecting potential collateral venous pathways?
A patient presents with a tumor impinging on structures within the superior mediastinum. Compression of which structure would MOST directly lead to jugular venous distension and facial edema, neglecting potential collateral venous pathways?
- The arch of the aorta.
- The brachiocephalic trunk.
- The superior vena cava. (correct)
- The left common carotid artery.
Following a stab wound to the chest, a patient exhibits signs of cardiac tamponade. Which of the following best describes the anatomical layers affected in this condition, listed from superficial to deep?
Following a stab wound to the chest, a patient exhibits signs of cardiac tamponade. Which of the following best describes the anatomical layers affected in this condition, listed from superficial to deep?
- Fibrous pericardium, parietal serous pericardium, visceral serous pericardium (epicardium), myocardium (correct)
- Parietal serous pericardium, visceral serous pericardium (epicardium), fibrous pericardium, myocardium
- Parietal serous pericardium, fibrous pericardium, myocardium, visceral serous pericardium (epicardium)
- Fibrous pericardium, visceral serous pericardium (epicardium), parietal serous pericardium, myocardium
During a complex cardiothoracic surgery, the transverse pericardial sinus is intentionally isolated. Which anatomical relationship is MOST critical for the surgical team to understand to avoid iatrogenic injury during this maneuver?
During a complex cardiothoracic surgery, the transverse pericardial sinus is intentionally isolated. Which anatomical relationship is MOST critical for the surgical team to understand to avoid iatrogenic injury during this maneuver?
- The sinus is anterior to the pulmonary veins and posterior to the aorta.
- The sinus is posterior to the pulmonary trunk and anterior to the inferior vena cava.
- The sinus is posterior to the superior vena cava and anterior to the aorta and pulmonary trunk.
- The sinus is anterior to the superior vena cava and posterior to the aorta and pulmonary trunk. (correct)
A surgeon is preparing to perform a minimally invasive procedure targeting the anterior mediastinum. What is the MOST accurate and clinically relevant anatomical boundary that defines the anterior mediastinum’s posterior limit, crucial for avoiding damage to critical structures?
A surgeon is preparing to perform a minimally invasive procedure targeting the anterior mediastinum. What is the MOST accurate and clinically relevant anatomical boundary that defines the anterior mediastinum’s posterior limit, crucial for avoiding damage to critical structures?
A patient with a history of chronic lung disease presents with right ventricular hypertrophy and dilation. Given the altered cardiac morphology, which surface of the heart would exhibit the MOST significant change in its relationship with the diaphragm?
A patient with a history of chronic lung disease presents with right ventricular hypertrophy and dilation. Given the altered cardiac morphology, which surface of the heart would exhibit the MOST significant change in its relationship with the diaphragm?
A pathologist is examining a heart specimen and notes significant fibrosis of the visceral serous pericardium (epicardium). Considering the functional implications, what direct effect would this MOST likely have on cardiac physiology?
A pathologist is examining a heart specimen and notes significant fibrosis of the visceral serous pericardium (epicardium). Considering the functional implications, what direct effect would this MOST likely have on cardiac physiology?
A patient is diagnosed with a rare congenital anomaly where the ligamentum arteriosum is abnormally short and exerts excessive traction. Which neural structure is MOST at risk due to its close proximity to this ligament, potentially leading to hoarseness?
A patient is diagnosed with a rare congenital anomaly where the ligamentum arteriosum is abnormally short and exerts excessive traction. Which neural structure is MOST at risk due to its close proximity to this ligament, potentially leading to hoarseness?
During the dissection of a cadaver, it's observed that a previously placed central venous catheter has perforated the superior vena cava and entered the pericardial space. Which combination of anatomical relationships would MOST likely explain this aberrant catheter trajectory?
During the dissection of a cadaver, it's observed that a previously placed central venous catheter has perforated the superior vena cava and entered the pericardial space. Which combination of anatomical relationships would MOST likely explain this aberrant catheter trajectory?
A patient presents with dysphagia and hoarseness following an aortic arch aneurysm repair. Imaging reveals compression between the aortic arch and adjacent structures. Which of the following anatomical relationships BEST explains the constellation of symptoms?
A patient presents with dysphagia and hoarseness following an aortic arch aneurysm repair. Imaging reveals compression between the aortic arch and adjacent structures. Which of the following anatomical relationships BEST explains the constellation of symptoms?
Consider a scenario where the cardiac output decreases while the central venous pressure increases. A lesion in which specific region of the heart would DIRECTLY lead to this hemodynamic profile?
Consider a scenario where the cardiac output decreases while the central venous pressure increases. A lesion in which specific region of the heart would DIRECTLY lead to this hemodynamic profile?
A patient undergoing pericardiocentesis experiences inadvertent phrenic nerve stimulation, causing diaphragmatic contraction. Which approach would MOST likely avoid this complication, considering the nerve's anatomical course relative to the pericardium?
A patient undergoing pericardiocentesis experiences inadvertent phrenic nerve stimulation, causing diaphragmatic contraction. Which approach would MOST likely avoid this complication, considering the nerve's anatomical course relative to the pericardium?
An experimental surgical procedure aims to selectively denervate the heart while preserving vagal tone to the pulmonary system. Which specific anatomical structure would require meticulous dissection to achieve this outcome?
An experimental surgical procedure aims to selectively denervate the heart while preserving vagal tone to the pulmonary system. Which specific anatomical structure would require meticulous dissection to achieve this outcome?
A thoracic surgeon needs to access the posterior mediastinum for the resection of a neurogenic tumor. Which specific anatomical landmark provides the MOST reliable surface projection for defining the superior extent of this mediastinal compartment?
A thoracic surgeon needs to access the posterior mediastinum for the resection of a neurogenic tumor. Which specific anatomical landmark provides the MOST reliable surface projection for defining the superior extent of this mediastinal compartment?
During a mediastinoscopy, aberrant lymph node enlargement is discovered compressing the left vagus nerve superior to the aortic arch. Which subsequent physiological change is MOST likely to manifest?
During a mediastinoscopy, aberrant lymph node enlargement is discovered compressing the left vagus nerve superior to the aortic arch. Which subsequent physiological change is MOST likely to manifest?
A researcher is developing a novel drug delivery system targeting the myocardium. Which approach would MOST efficiently deliver the therapeutic agent, considering the heart's unique vascular supply and drainage?
A researcher is developing a novel drug delivery system targeting the myocardium. Which approach would MOST efficiently deliver the therapeutic agent, considering the heart's unique vascular supply and drainage?
A patient presents with an enlarged thymus gland causing compression of the adjacent structures within the superior mediastinum. Which of the following structures, when compressed, would MOST directly impede lymphatic drainage from the left side of the body?
A patient presents with an enlarged thymus gland causing compression of the adjacent structures within the superior mediastinum. Which of the following structures, when compressed, would MOST directly impede lymphatic drainage from the left side of the body?
A patient with a known history of Marfan syndrome presents with sudden-onset chest pain. Aortic dissection is suspected. Which anatomical relationship is MOST critical to evaluate via imaging to determine the extent and potential complications of the dissection?
A patient with a known history of Marfan syndrome presents with sudden-onset chest pain. Aortic dissection is suspected. Which anatomical relationship is MOST critical to evaluate via imaging to determine the extent and potential complications of the dissection?
Following a motor vehicle accident, a patient exhibits tracheal deviation to the right and signs of tension pneumothorax on the left. Which anatomical shift within the mediastinum MOST directly contributes to the observed tracheal deviation?
Following a motor vehicle accident, a patient exhibits tracheal deviation to the right and signs of tension pneumothorax on the left. Which anatomical shift within the mediastinum MOST directly contributes to the observed tracheal deviation?
A medical device is designed to deliver targeted radiation therapy to the right atrium for the treatment of atrial fibrillation. Which of the following anatomical structures poses the GREATEST risk of collateral damage during the procedure, considering proximity to the right atrium?
A medical device is designed to deliver targeted radiation therapy to the right atrium for the treatment of atrial fibrillation. Which of the following anatomical structures poses the GREATEST risk of collateral damage during the procedure, considering proximity to the right atrium?
During autopsy it is found that the patient has a defect resulting in mixing of blood between the pulmonary veins and arteries while external morphology is normal. Which valves woul be most critically examine to test this hypothesis?
During autopsy it is found that the patient has a defect resulting in mixing of blood between the pulmonary veins and arteries while external morphology is normal. Which valves woul be most critically examine to test this hypothesis?
Which of the following would be most likely to result from complete transection of the vagus nerve.
Which of the following would be most likely to result from complete transection of the vagus nerve.
Which of the following is most closely associated with posterior mediastinum.?
Which of the following is most closely associated with posterior mediastinum.?
Which of the following is LEAST affected in constrictive pericarditis.
Which of the following is LEAST affected in constrictive pericarditis.
A congenital condition involves structural abnormalities that prevent blood from flowing effectivly between right atrium and right ventricle. Which valve is most likey damaged and why.
A congenital condition involves structural abnormalities that prevent blood from flowing effectivly between right atrium and right ventricle. Which valve is most likey damaged and why.
Assuming a normal healthy heartbeat, which of teh following BEST approximates the time blood is pushed OUT from teh heart in one minute.
Assuming a normal healthy heartbeat, which of teh following BEST approximates the time blood is pushed OUT from teh heart in one minute.
Assuming a normal healthy heart, which of the following statements are most accurate.
Assuming a normal healthy heart, which of the following statements are most accurate.
Which of the following best describes the mediastinum.
Which of the following best describes the mediastinum.
Which of the following correctly orders the ventricles and bloodflow.
Which of the following correctly orders the ventricles and bloodflow.
A 7200L day means:
A 7200L day means:
Which of the following correctly describes the area between the two plural cavities.
Which of the following correctly describes the area between the two plural cavities.
What are the layers affected during cardiac tamponade damage.
What are the layers affected during cardiac tamponade damage.
Pericardium
Pericardium
Which of the following are associated with Fibrous Pericardium.
Which of the following are associated with Fibrous Pericardium.
The sternal angle is directly related to which of the following.
The sternal angle is directly related to which of the following.
What is most closely associated with the posterior mediastinum.
What is most closely associated with the posterior mediastinum.
Which of the following best describes the role of lymphatic trunks in the posterior mediastinum.
Which of the following best describes the role of lymphatic trunks in the posterior mediastinum.
During which stage does a thymus regresses.
During which stage does a thymus regresses.
The aortic pressure is dependent on all OF THE following except.
The aortic pressure is dependent on all OF THE following except.
Which of the following is likely to result from significant pericardial liquid accumulation.
Which of the following is likely to result from significant pericardial liquid accumulation.
Describe what could happen as a result of fibrous tissues of visceral pericardium.
Describe what could happen as a result of fibrous tissues of visceral pericardium.
Why would pulmonary veins be found at the posterior surface of the heart.
Why would pulmonary veins be found at the posterior surface of the heart.
An individual has had an issue damaging several of the nerves around the heart. Which ones MUST a doctor have on hand for testing.
An individual has had an issue damaging several of the nerves around the heart. Which ones MUST a doctor have on hand for testing.
The primary function of the transverse pericardial sinus involves:
The primary function of the transverse pericardial sinus involves:
The apex beat is:
The apex beat is:
Flashcards
Heart Overview
Heart Overview
Right side carries venous blood, left side carries arterial blood. Has four chambers and valves to prevent backflow.
Heart Main Function
Heart Main Function
Pumps amount of blood to meet body's needs. Cardiac output at rest: 5L/min (7200 L/day)
Artery Definition
Artery Definition
Carries blood away from the heart. Blood is oxygenated, except in the pulmonary arteries
Vein Definition
Vein Definition
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Tricuspid Valve
Tricuspid Valve
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Pulmonary Valve
Pulmonary Valve
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Mitral Valve
Mitral Valve
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Aortic Valve
Aortic Valve
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Mediastinum
Mediastinum
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Superior Mediastinum
Superior Mediastinum
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Inferior Mediastinum
Inferior Mediastinum
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Arteries of Superior Mediastinum
Arteries of Superior Mediastinum
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Veins of Superior Mediastinum
Veins of Superior Mediastinum
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Pericardium
Pericardium
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Pericardium Layers
Pericardium Layers
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Pericardial Sinuses
Pericardial Sinuses
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Transverse Sinus
Transverse Sinus
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Oblique Sinus
Oblique Sinus
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Pericardial Arteries
Pericardial Arteries
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Pericardial Veins
Pericardial Veins
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Surfaces of the Heart
Surfaces of the Heart
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Apex Beat
Apex Beat
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Normal Apex Beat Location
Normal Apex Beat Location
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Pericardial Arteries
Pericardial Arteries
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Pericardial Veins
Pericardial Veins
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External Fibrous
External Fibrous
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Internal Serous
Internal Serous
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Study Notes
- MD121: Heart overview and borders
- Dr. Rachel Beatty: [email protected]
Learning Outcomes
- Outline the borders, contents and subdivisions of the mediastinum
- Describe the pericardium
- Demonstrate the borders of the heart
- Describe the surfaces and relations of the heart
- Understand the great vessels and their relationship to the pericardium and superior mediastinum
- Demonstrate the chambers, great vessels, appendages visible in situ
Heart Overview
- The right side of the heart is venous
- The left side of the heart is arterial
- The heart has four chambers, with two on each side
- Atria flow into ventricles
- Valves between chambers and outflow tracts prevent backflow
Arteries
- Arteries carry blood away from the heart, and have oxygenated blood
- The exception is the pulmonary arteries
Veins
- Veins carry blood towards the heart, and have deoxygenated blood
- The exception is the pulmonary veins
Main Function
- The heart pumps the amount of blood to meet the body's needs
- Cardiac output at rest is 5L/min
- 5L per min [x 60 x 24 = 7200 L/day]
Flow of Blood
- Blood starts in the lower limb
- Deoxygenated blood flows through the pulmonary arteries to the lungs
- Oxygenated blood flows through the pulmonary veins
- Oxygenated blood travels to the general body
Heart Valves
- Valves prevent backflow
- Deoxygenated blood flows from the IVC + SVC -> Right Atrium -> Right Ventricle -> Lungs
- Oxygenated blood flows from the Lungs -> Left Atrium -> Left Ventricle -> Aorta
Tricuspid Valve
- The Tricuspid Valve is found from the right atrium into the right ventricle
Pulmonary Valve
- The Pulmonary Valve is found from the right ventricle into the pulmonary artery
Mitral Valve
- The Mitral Valve, or Bicuspid Valve, is found from the left atrium to the left ventricle
Aortic Valve
- The Aortic Valve is found from the left ventricle into the aorta
The Pulmonary Circuit
- Includes: Alveolus, capillaries, right and left pulmonary veins and arteries, aorta, pulmonary trunk, inferior and superior vena cava, descending aorta
Location of Heart in Thoracic Cavity
- The area between the two pleural cavities is the mediastinum
- Includes: Thyroid gland, trachea, right and left lung, first rib, mediastinum, left plural cavity, base of heart, diaphragm, and apex of heart
Subdivisions of the Mediastinum
- Includes: Sternal angle, T1-T12, Rib 1, and Respiratory diaphragm
- Anterior, middle, and posterior mediastinum
- Superior and inferior mediastinum.
Superior Mediastinum
- Trachea, brachiocephalic trunk, SVC, Level of Sternal angle (T4/T5), Arch of aorta, L common carotid artery, and L subclavian artery
- Vessels of the Superior Mediastinum include:
- Arteries:
- Right Common Carotid
- Left Common Carotid
- Right Subclavian
- Left Subclavian
- Brachiocephalic Trunk
- Veins:
- Right IJV
- Left Internal Jugular Vein
- Right Subclavian
- Left Subclavian
- Brachiocephalic Veins
- Arteries:
- Nerves of the Superior Mediastinum:
- The left vagus nerve gives rise to:
- The left recurrent laryngeal nerve
- Wraps around arch of aorta, under the ligamentum arteriosum
- The left vagus nerve gives rise to:
- Shows Courses of Vagi and Phrenic Nerves
Anterior Mediastinum
- Has the Thymus gland, generally found in children
- Extends from cricoid to retrosternal area
- Gradually regresses during childhood
Posterior Mediastinum
- Contents include: Thoracic aorta, azygous system of veins, oesophagus, trachea, thoracic duct, sympathetic trunks
Middle Mediastinum
- Contents include: Pericardium, roots of great vessels and heart
- Sternal Angle opposite T4 forms the superior border
Pericardium
- Contains the Fibroserous Pericardium: Attached to Great Vessels, Central Tendon of Diaphragm, Sternum (Sternopericardial ligament), Parietal layer of serous pericardium.
- Serous Pericardium (2 layers): Parietal & Visceral. Parietal lines fibrous and Visceral lines heart (Epicardium). Fluid layer between the 2 layers = pericardial cavity = potential space.
- The pericardial cavity contains pericardial fluid, which facilitates gliding movements (beating of heart)
- Is a membrane enclosing the heart, consisting of an outer fibrous layer and an inner double layer of serous membrane.
- Is made of 3 layers:
- Parietal pericardium
- Myocardium
- Endocardium
Pericardial Sinuses
- Are recesses in pericardium cavity formed by the reflection of serous pericardium on the posterior surface of the heart
- The Oblique sinus surrounds veins
- Transverse sinus lies posterior to aorta and pulmonary trunk and anterior to the superior vena cava
Pericardial Vessels & Nerves
- Arteries: branches from the internal thoracic, pericardiacophrenic, musculophrenic, inferior phrenic and the thoracic aorta
- Veins: pericardial veins drain into the azygos system of veins, the internal thoracic veins and superior phrenic veins
- Nerves: the vagus nerve, sympathetic trunks and phrenic nerves
- Pain from parietal pericardium is carried in somatic afferent fibres in phrenic nerves. Therefore, pericardial related pain may be referred to the supraclavicular region or lateral neck
Heart in situ - Pericardium Removed
- Includes: Brachiocephalic trunk, subclavian artery and vein, right and left brachiocephalic vein, phrenic nerve and pericardiacophrenic artery, superior vena cava, mediastinal pleura, aorta
Surfaces and Borders of the Heart
- Heart position defined as the lowest, most lateral point on the chest that can be felt when the heart beats
- Normally located as the 5th left, ICS, MCL.
- Requires apex beat be found and accessed to determine position and assess if is normal
Views
- Anterior Surface
- Base
- Left Pulmonary Surface
- Right Pulmonary Surface
- Inferior Margin (Acute)
- Obtuse Margin
- Diaphragmatic Surface
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