4 The Heart Anatomy by Chinien '¥ Name the three types of ribs: > there are 12 pair of ribs, 7 true rs, 3 false ribs and 2 floating ribs 2, Tiue ribs (1-7) > joins directly to manubrium of sternum b, Ealse ribs (8-10) > fuse to cartilage before ins to lower part of sternum ¢. Floating rss (11-12) + doesn’t join to sternum ¥ What causes Reynauds? ischemia of the hand) NB! 10% of people have a cervical rib, which goes posterior, causes Reynauds syndrome as it will compress subclavian artery (causes Label the ribs and vertebrae: '¥ Name the divisions of the sternum: ‘2. Manubrium (nas Angle of Louis) b. Body ©. Xiphoid process ¥ What is the manubrium and its catergories: ~ found in the midline of the thoracic cavity, that is surrounded by the left and right pleural sacs. 4. Superior 2. Inferior ‘a. Anterior b. Middle «. Posterior¥ Anatomy of mediastinum: ¥ Deser ibe the catergories of the mediastinum: 2. Superior (goes with T3 and TA) ‘+ Thymus (can lead to Thymoma caused by Myasthenia gravis, fatigue that worsens at night) + Trachea (goes behind heart) + Esophagus + Aortic arch ‘+ Brachiocephalic trunk (1) + Left common carotid artery + Left subclavian artery ‘+ Internal thoracic arteries ‘+ Superior vena cava ‘+ Loft superior intercostal vein “+ Brachiocephalic veins (2) + Phrenic n + Vagus n (very important nerves) © Vagus n gives: right (around subclavian a) left laryngeal branch (around root of aortic arch) © Phrenic n supplies diaphragm, supplied by C3, C4, C5 ‘+ Left recurrent laryngeal branch of the left vagus nerve + Thoracie duct ‘+ Lymph nodes and vessels+ Subeutanous tissue and fat b. Inferior i. Anterior: i Inferior portion of thymus i, Fat il Connective tissue iv. Florous pericardium . Lymph nodes Vi. Mediastinal branches of internal thoracic vessels vii. Sternopericardal ligaments i, Midd: i. Pericardial sac i, Heart i, Origins of great vessels: pulmonary trunk, ascending aorta, pulmonary veins, superior vena cava, inferior vena cava iv, Tracheal bifurcation . Main bronchi Descending aorta _Azygos vein on right which joins to IVC on left vil Esophagus ix. Thoracie duct (starts at Cysterna chy in abdomen) ii, Posterior: i. Descending thoracic aorta and its branches Azygos and hemiazygos venous systems ‘Thoracic duct & cisterna chyli Esophagus and esophageal plexus Iv, Vagus nerves Thoracic splanchnic nerves (greater, lesser, least) vi, Lymphatics > Mnemonic: on the DATE Vivian Slapped Larry '¥ What borders each mediastinum? Borders frst rio (superior) ~ TA (inferior) Content: thymus, trachea, esophagus, thoracic duct, aortic arch, veins (superior vena cava Superior brachiacephalc let superior intercostal, nerves (vagus, phrenic, lft recurrent laryngeal), ympnaties, ether smal arteries and veins Mnemonic: Try To Eat Toast And Vitamins Now Litle Olver Borders: Ta (superior) -T9 (inferior); sternum (anterior) -pericarcium (posterior) Content: remnants ofthe thymus, lymph nodes Bordors: Ta (superior) - 79 (intron; anterior aspect af pericardium (anterior) - posterior aspect of pericardium Middle interior Ccontent: phrenic nerve, heart, pericardium, ascending aeta, pulmonary tunk, superior vena cava, pericarsiacophrenic arteryBorders: 14 (superior) - 112 (inferior: posterior aspect of periarcium (anterior - spine (posterior) Content: descending thoracic aorta, azygos veins, hemianygos veins, accessory hemiarygos Posterior inferior vein, thoracic duc, cisterna chy, esophagus, esophageal plexus, vagus nerve, greater, lesser and least splanchnic nerves, lymphatics Mnemonic: nthe DATE Vivian Slapped Larry ‘¥ Describe the layers of the heart and how much fluids there? 1. Fibrous 2. Parietal 3. Visceral + lid: 10-20 mi of pericardial fluid + infection of pericardium leads to 2. pericarditis, you wil ear pericarcial ub ». pericarlal effusion due to pus, trauma or infection ¥ What pleroes T2, 78, 110,712 12.9 Bifurcation of trachea 78 > IVC pierces T10 esophagus pierces diaphragm 112 > Aorta pierces diaphragm ¥ Whereis the heart located? 2nd intercostal space » Sth intercostal space ‘¥ What are the borders of the heart formed by? 1. Right > formed by right atrium 2. Left formed by left ventricle and eft auricle 3, Superior + lined by root oferta and pulmonary trunk 4, Inferior > extends along the right ventricle and part of the let ventricle atts apex. 5, Loner > formed by right ventrile and right atrium 6. Apex > formed by left ventricle ‘¥ Anatomy of the heartsiperevena cave + List the three types of sulcus: 1. Altiowentricular sulcus > separate aria and ventricles 2, Intorvontrieular sulcus > vertis interventricular septum 3, Coronary sulcus > contain right coronary arteries '¥ What are the signs of coarctation of aorta? + causes hypertension of upper and ower limbs + blood going to divert through superior aorta and go into intercostal arteries hence become dilated + ‘signs: radiofemoral delay, ‘¥ What is rib notching? ‘+ when intercostal vessels become dilated and enter te intercostal groove + thus causing a bigger notch inthe ribs ¥ When does hemopericardium occur? + blood accumulating in the pericardial sac posterior to heart, and expands to surround the entire heart + itwill cause compression in the heart, heart does not beat properly + called: cardiac tamponade + signs: hypertension (reduced CO, due to 4 in EDV and SV), distended neck veins, raised JVP (due to * backflow into venous system) 'Y Which arteries are involved in triple vessel disease? ‘+ major coronary arteries have blockages or stenosis, “+ arteries involved: left anterior descending a, lft circumflex a & right coronary a ¥ Name all the vessels of the heart: 1. Aorta ‘+ aortic sinus found above aortic valve, they are filed during diastole + high diastolic pressure leads to a J in coronary perfusion “+ causes diastolic hypertension leading to mycocardial ischemia 2. Pulmonary trunk 3. Pulmonary artery 2. Right pulmonary a -> goes to SAnode . Marginal a «. Posterior interventricular4. Left pulmonary a 4. sve ‘+ sinus venosum joins IVC and SVC (shiny part) [Link] ¥ What is the Crista terminalis? ‘+ Crista terminalis > ridge of myocardium within RA that extends along posterolateral wall of RA bjw orifice of CVC to ofifice of IVC, has Sinoatrial Node (SA) on top of it Right Superior venacava auricle orifice Right ventricle Crista terminalis Fossa ovalis Inferior vena cava pai iy Coronary sinus orifice Y High diastolic pressure leads to? + ain coronary perfusion ‘¥ What s the tricuspid valve attached to? ‘+ Tricuspid valve - attached to chordae tendinae + attached to papillary muscles ‘+ Rugged edges are called trabeculae carni ‘¥ What happens to papillary muscles during myocardial infarction? “+ necrosis occurs if RCA infarction happens as papillary m receives its own blood flow from the coronary arteries + leading to a rupture of the chordae tendineae and end up with murmur + hence cuspid regurgitation '¥ Which vessels are visible on the angiogram? Left coronary artery + left anterior descending + left circumflex Coronary sinus > main vein, main branch of great cardiac vein Thobesian veins > small cariae veins, drain on the right sie of heart Pericardial sulcus > space which is first here to your arteries, and anterior to SVC ¥ How to identity normal x-ray of the heart? + normal heart shadow is less than half the dlameter ofthe chest, + draw vertical line down the midline of sternum + draw a horizontal ine from maximum bulge of right border of heart tothe line we drew earlier ‘+ repeat the same for the left border¥ How do you access the Coronary angiogram? a, Radial artery ‘+ donot use when occlusion > do Allens test and then use Ulnar b. Femoral artery -¥ How do you access the Pulmonary angiogram? ‘+ Insert catheter into central veins > Right atrium to Left pulmonary a /Left auricle a. Antecubital a b. Brachial Anatomy by Ramjutton ‘¥ Name the planes in anatomy: 1. Frontal) coronal > divides body into anterior or posterior 2. Transverse - divides body into superior or inferior 3, Saggital > divides body into right or let "¥ Name the lines present in anatomy: ‘Anterior/front/ seeing nipples [R &L] 2. Anterior axillary line b. Midctavicular line . Midsternalline ‘Saggital view/ from side 2, Posterior axillary line b. Mid axiary line «. Anterior axillary tine Posterior/ back 2. Scapular line b. Vertebral line ¥ Transverse view: '¥ What makes the borders of the heart? c. Femorala + Rightlung is bigger1. Superior RA, LA, Vessels 2. Inferior - RV, LV. 3. Right - RA 4, Left LV (some LA) = a ‘+ Apex of heart points in an leftward anteroinferior direction '¥ Name the five surfaces of the heart: 1. Anterior (sternocostal) - RV 2. Posterior (base of pyramid) - LA 3. Inferior (diaphragmatic) - LV, RY 4, Right pulmonary - RA 6. Left pulmonary - LV "¥ How much fluid is present in pericardial sac? + has 5-10 cc of fluid ‘¥ Anatomy of heart¥ List the three sulcus: 1. Posterior inter-ventricular suleus 2. Anterior inter-ventricular sulcus 3. Coronary sulous, “+ Coronary arteries arises from the coronary sinus '¥ Which planes are present on an x-ray? 1. Anteroposterior (AP) 2. Posteroanterior (PA) 3. Lateral 1¥ Xrays of lungs: "¥ Venous system on x-ray:¥ Cardiac ultrasound:> P= 2 9 rm 4 ¥ Anatomy of respiratory system; MRI of the heart: