Heart Anatomy: Chambers, Vessels, and Borders

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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?

  • 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?

  • 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?

  • 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?

<p>The pericardium. (D)</p> Signup and view all the answers

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?

<p>The diaphragmatic surface. (C)</p> Signup and view all the answers

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?

<p>Restricted cardiac motion during ventricular filling. (C)</p> Signup and view all the answers

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?

<p>The left recurrent laryngeal nerve. (A)</p> Signup and view all the answers

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?

<p>The SVC’s course through the superior mediastinum and its partial enclosure within the fibrous pericardium. (A)</p> Signup and view all the answers

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?

<p>Compression of the left recurrent laryngeal nerve and esophagus between the aortic arch and vertebral column. (B)</p> Signup and view all the answers

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?

<p>Stenosis of the tricuspid valve. (D)</p> Signup and view all the answers

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?

<p>Subxiphoid approach, angling the needle towards the left shoulder. (C)</p> Signup and view all the answers

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?

<p>The deep cardiac plexus posterior to the tracheal bifurcation. (A)</p> Signup and view all the answers

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?

<p>The sternal angle at the level of the T4/T5 intervertebral disc. (B)</p> Signup and view all the answers

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?

<p>Hoarseness due to paralysis of the vocal cords. (B)</p> Signup and view all the answers

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?

<p>Injection into the coronary sinus for retrograde distribution through the coronary veins. (B)</p> Signup and view all the answers

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?

<p>The thoracic duct. (B)</p> Signup and view all the answers

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?

<p>The relationship of the aortic arch to the brachiocephalic vessels. (B)</p> Signup and view all the answers

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?

<p>Shifting of the heart and great vessels due to increased hemithoracic pressure. (C)</p> Signup and view all the answers

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?

<p>The phrenic nerve. (C)</p> Signup and view all the answers

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?

<p>Orifices of great vessels. (A)</p> Signup and view all the answers

Which of the following would be most likely to result from complete transection of the vagus nerve.

<p>Increased heart rate. (B)</p> Signup and view all the answers

Which of the following is most closely associated with posterior mediastinum.?

<p>Aorta and esophagus. (A)</p> Signup and view all the answers

Which of the following is LEAST affected in constrictive pericarditis.

<p>Contractility. (C)</p> Signup and view all the answers

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.

<p>Tricuspid. It's the only one separating right atria from right ventricle. (B)</p> Signup and view all the answers

Assuming a normal healthy heartbeat, which of teh following BEST approximates the time blood is pushed OUT from teh heart in one minute.

<p>5L/min. (C)</p> Signup and view all the answers

Assuming a normal healthy heart, which of the following statements are most accurate.

<p>Veins carry deoxygenated blood TO the heart. (E)</p> Signup and view all the answers

Which of the following best describes the mediastinum.

<p>Area between pleura cavities. (A)</p> Signup and view all the answers

Which of the following correctly orders the ventricles and bloodflow.

<p>Right deoxygenated, left oxygenated. (E)</p> Signup and view all the answers

A 7200L day means:

<p>Cardiac output over one day. (D)</p> Signup and view all the answers

Which of the following correctly describes the area between the two plural cavities.

<p>Mediastinum. (D)</p> Signup and view all the answers

What are the layers affected during cardiac tamponade damage.

<p>Fibrous, parietal serous, viscose serous. (B)</p> Signup and view all the answers

Pericardium

<p>Both B and C. (C)</p> Signup and view all the answers

Which of the following are associated with Fibrous Pericardium.

<p>All are correct. (E)</p> Signup and view all the answers

The sternal angle is directly related to which of the following.

<p>All. (C)</p> Signup and view all the answers

What is most closely associated with the posterior mediastinum.

<p>All. (D)</p> Signup and view all the answers

Which of the following best describes the role of lymphatic trunks in the posterior mediastinum.

<p>B and C. (C)</p> Signup and view all the answers

During which stage does a thymus regresses.

<p>Childhood. (A)</p> Signup and view all the answers

The aortic pressure is dependent on all OF THE following except.

<p>Central Venous Pressure. (C)</p> Signup and view all the answers

Which of the following is likely to result from significant pericardial liquid accumulation.

<p>C and B. (C)</p> Signup and view all the answers

Describe what could happen as a result of fibrous tissues of visceral pericardium.

<p>Decreased motion for heart. (D)</p> Signup and view all the answers

Why would pulmonary veins be found at the posterior surface of the heart.

<p>Reflections of all the serous pericardium. (A)</p> Signup and view all the answers

An individual has had an issue damaging several of the nerves around the heart. Which ones MUST a doctor have on hand for testing.

<p>Vagus nerve and sympathetic. (A)</p> Signup and view all the answers

The primary function of the transverse pericardial sinus involves:

<p>Separating the vessels, veins, right atrium from arteries. (C)</p> Signup and view all the answers

The apex beat is:

<p>A and B. (B)</p> Signup and view all the answers

Flashcards

Heart Overview

Right side carries venous blood, left side carries arterial blood. Has four chambers and valves to prevent backflow.

Heart Main Function

Pumps amount of blood to meet body's needs. Cardiac output at rest: 5L/min (7200 L/day)

Artery Definition

Carries blood away from the heart. Blood is oxygenated, except in the pulmonary arteries

Vein Definition

Carries blood towards the heart. Blood is deoxygenated, except in the pulmonary veins.

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Tricuspid Valve

Located between right atrium and right ventricle.

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Pulmonary Valve

Located from right ventricle into pulmonary artery.

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Mitral Valve

Located from left atrium to left ventricle.

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Aortic Valve

Located from left ventricle into Aorta.

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Mediastinum

Area between the two pleural cavities.

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Superior Mediastinum

Top part of the mediastinum, above the sternal angle.

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Inferior Mediastinum

Division of the mediastinum below the sternal angle made up of the anterior, middle and posterior mediastinum

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Arteries of Superior Mediastinum

Brachiocephalic trunk, Left Common Carotid artery, Left Subclavian artery.

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Veins of Superior Mediastinum

Right and Left brachiocephalic veins, Superior Vena Cava (SVC)

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Pericardium

The membrane enclosing the heart.

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Pericardium Layers

Outer fibrous layer and inner double layer of serous membrane, protects the heart.

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Pericardial Sinuses

Recess in pericardium cavity formed by reflection of serous pericardium on posterior surface of the heart

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Transverse Sinus

Lies posterior to aorta and pulmonary trunk, anterior to superior vena cava.

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Oblique Sinus

Reflection surrounding veins

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Pericardial Arteries

Branches from the internal thoracic, pericardiacophrenic, and thoracic aorta.

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Pericardial Veins

Drains into the azygos system, internal thoracic, and superior phrenic veins.

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Surfaces of the Heart

Anterior, left pulmonary, diaphragmatic, right pulmonary.

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Apex Beat

Lowest and most lateral point on the chest wall where you can feel the heart beating.

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Normal Apex Beat Location

Typically located at the 5th intercostal space, midclavicular line (MCL).

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Pericardial Arteries

Branches from internal thoracic, musculophrenic, inferior phrenic and thoracic aorta

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Pericardial Veins

Drains into the azygos system of veins, internal thoracic veins and superior phrenic veins

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External Fibrous

Attached great vessels, central tendon of diaphragm. Sternum, parietal serous pericardium

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Internal Serous

Parietal lies fibrous while visceral lies heart.

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Study Notes

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
  • 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
  • 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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