1
Q
Thoracic Skeleton
A
12 pairs of C shaped ribs
2
Q
Ribs 1-7
A
join at sternum with cartilage end points (true ribs)
3
Q
Ribs 8-10
A
join sternum with combined cartilage at 7th rib (false ribs)
4
Q
Ribs 11 + 12
A
no anterior attachment; attached to T11 + T12 (floating ribs)
5
Q
Sternum: Manubrium
A
joins to clavicle and 1st rib; jugular notch
6
Q
Sternum: Angle of Louis
A
found T4-T5 & marks bifurcation of atria
7
Q
Sternum: Body
A
junction of manubrium with sternal body and attachment to 2nd rib
-sternal angle (Angle of Louis)
8
Q
Sternum: Xiphoid Process
A
distal portion of sternum
-most common area of fractures in the sternum (chest compressions)
9
Q
Fractured ribs 3-8 leads to:
A
Flail Chest (uneven)
10
Q
Thorax
A
formed by 12 pairs of ribs that join posteriorly with the thoracic spine and anteriorly with the sternum (except ribs 11 + 12)
11
Q
Thoracic Cavity
A
- lined with thin layer of tissue (pleura)
- one lung in each cavity
- mediastinum is between chest cavity (pleura)
- spinal cord protected by vertebral column
12
Q
Lung Function
A
oxygenation
13
Q
Mediastinum Components
A
heart, aorta, superior and inferior vena cava, trachea, major bronchi, espohagus
14
Q
Pneumothorax
A
collapsed lung
- cavity shrinks, decrease in pressure
- usually seen in traumas
15
Q
Mediastinal Shift
A
organs shift to where they do not belong
-caused by Pneumothorax
16
Q
Reference Lines
A
points for dictating pain or location (ex. mass) when documenting / diagnosing
17
Q
Anterior Chest Reference Lines
A
- mid-sternal line
- mid-clavicular line
18
Q
Posterior Chest Reference Lines
A
- vertebral line (midspinal)
- scapular line
19
Q
Lateral Chest Reference Lines
A
- anterior axillary line
- posterior axillary line
- mid-axillary line
20
Q
Anterior Thoracic Landmarks
A
-suprasternal notch (U shaped depression)
-sternum
-manubrium (angle of Louis)
-body
-xiphoid process
21
Q
Posterior Thoracic Landmarks
A
-vertebra prominens (C7 projection at the end of neck, anterior to T1)
-spinous processes (fractured easily)
-scapula (shoulder blade; helps arm with degree of motion)
22
Q
Superior Vena Cava
A
brings deoxygenated blood from head, eyes, neck and upper limbs to the R atrium of the heart
23
Q
Inferior Vena Cava
A
brings deoxygenated blood from the abdomen and lower extremities to the R atrium
24
Q
Right Atrium
A
receives deoxygenated blood from SVC + IVC
RA → tricuspid valve → RV
25
Right Ventricle
**receives deoxygenated blood from R atrium through tricuspid valve**
RV → pulmonary valve → pulmonary artery
26
Pulmonary Artery
carries R side (deoxygenated) blood to lungs for oxygenation
RV → PA → PV → LA
27
Pulmonary Vein
carries oxygenated blood from the lungs to the L side of the heart (L atrium)
PV → LA
28
Left Atrium
**receives oxygenated blood from pulmonary veins**
LA → mitral valve → L ventricle
29
Left Ventricle
**receives oxygenated blood from L atrium through mitral valve**
LV → aortic valve → aorta
30
Aorta
carries O2 rich blood to the rest of the body
LV → aortic valve → aorta
31
Trabeculae Carne
muscular columns projecting from inner surface of ventricles
-prevents suction of the blood due to pressure
32
Apex
PMI (point of max impulse)
33
cardiac output =
stroke volume x HR
34
Cor Pulmonale
pulmonary/chronic HTN causing R sided heart failure
-R sided heart failure not caused by L
35
Cardiac Tamponade
**compression of the heart caused by fluid collection in the pericardium (sac surrounding heart)**
- compression prevents the heart from filling w/ blood properly
- results in dramatic drop in BP (possibly fatal)
36
Peripheral Edema
**fluid in the lungs**
-displays as SOB
37
Jugular Venous Distension (JVD)
pump failure caused by heart failure
38
Position of the Heart
**about half the length of sternal body from T2-T6**
-from sternal angle to xiphoid process
39
Where to auscultate for: **Aortic Valve**
2nd intercostal space, R sternal border
40
Where to auscultate for: **Tricuspid Valve**
5th intercostal space, L sternal border
41
Where to auscultate for: **Pulmonary Valve**
2nd intercostal space, L sternal border
42
Where to auscultate for: **Mitral Valve**
5th intercostal space, mid clavicular line
43
Systemic Circuit
BV transports blood to and from tissues
44
Pulmonary Circuit
BV carries blood to and from the lungs
45
Pericardium Characteristics
**double walled sac around the heart**
- superficial fibrous pericardium
- deep, 2 layer subserous pericardium
46
Pericardium Function
**protects and anchors the heart, prevents overfilling with blood, allows heart to work friction free**
-limits expansion to an extent
47
Pericardium: **Parietal Layer**
lines internal surface of fibrous pericardium (tissue)
48
Pericardium: **Visceral Layer**
**separated by fluid filled sac of serous fluid, covers heart muscle layer**
-aka epicardium
49
Pericardial Effusion
**build up of fluid within the heart's pericardium**
**no expansion = conduction defects**
- muffled heart sounds, SOB, edema
- must drain fluid to revert A-fib to normal rhythm
- check for lupus
50
Heart Wall contains:
- epicardium
- myocardium
- fibrous skeleton
- endocardium
51
Heart Wall: **Epicardium**
visceral layer of serous pericardium
52
Heart Wall: **Myocardium**
cardiac muscle forming bulk of heart
53
Heart Wall: **Fibrous Skeleton**
criss crossing interlacing layer of connective tissue
54
Heart Wall: **Endocardium**
endothelial layer of inner surface
55
Pericardial Sac
**encloses the heart**
**-tough fibrous covering layer**
**-secretory lining**: secretes pericardial fluid to reduce friction between pericardial layers
56
Pericarditis
**inflammation of pericardium**
- fluid in lung sac
- increased fluid = pressure and compression of heart
57
Complications of Pericarditis
**-increased fluid = pressure and compression of heart**
→ cardiac tamponade → heart cannot fill due to compression = decreased output
→ infection by Tuberculosis (TB): BCG vaccine prevents pulmonary TB in infants (weans over time)
58
Complications of Ventricular Hypertrophy
Ventricular Hypertrophy (enlarged heart) → less space to pump blood → LV fails
→ back flow (regurgitation) to LA → LA fails (O2 rich blood dumps into LA from pulmonary veins)
→ blood goes backward into lungs → RV fail → **Hepatomegaly + JVD**
59
Regurgitation
**back flow of blood**
ex. valve stops working and one-directional blood flow goes in the backwards direction
60
Vessels that return blood to the heart
pulmonary veins, IVC, SVC
61
Vessels that take blood away from the heart:
aorta, L common carotid, brachiocephalic, subclavian, pulmonary arteries
62
Vessels that supply/drain the heart (anterior view)
**Arteries**:
- R + L coronary (AV groove)
- marginal
- circumflex
- anterior ventricular arteries
**Veins:**
- small cardiac
- great cardiac
- anterior cardiac
63
Vessels that supply/drain the heart (posterior view)
**Arteries:**
- R coronary artery (AV groove)
- posterior interventricular artery
**Veins:**
- great cardiac vein
- posterior vein to L ventricle
- coronary sinus
- middle cardiac vein
64
Heart Valves Function
ensure unidirectional blood flow through the heart
65
Atrioventricular (AV) Valves
**prevent back flow into the atria when vessels contract**
-tricuspid + mitral (bicuspid)
66
Tricuspid Valve
**RA to RV**
-deoxygenated blood
67
Mitral Valve
**LA to LV**
-oxygenated blood
68
Chordae Tendonae
anchor AV valves to papillary muscles and prevent valves from being inverted
69
Semilunar Valves
**prevent regurgitation of blood into the ventricles (one way flow)**
-pulmonary valve + aortic valve
70
Pulmonary Valve
**RV to pulmonary trunk → lungs**
-deoxygenated blood
71
Aortic Valve
**LV to aorta → rest of body**
-oxygenated blood
72
Endocarditis
**inflammation of heart's inner linings of chambers/valves**
**destruction of chordae tendonae**
- decreased function in chordae tendonae = valve failure (leaks), ventricle not getting enough blood → hypertrophy
- also caused by M.I., connective tissue disorder, infection
73
Ventricle not getting enough blood causes a….
Murmur
74
Incidental Murmur
**in children - may go away with age**
- must listen for sounds between “lub-dub” (S1 and S2)
ex. rumbling between 1st + 2nd, or between 2nd and 1st
75
Increased pressure from contraction closes \_\_\_\_\_\_
valve
76
Pressure gradient problems leads to \_\_\_\_\_\_\_
valve complications
77
Mitral Valve Prolapse
**mitral valve is no longer one way flow to the ventricle**
**-instead, opens towards atria → regurgitation**
-diagnose by echocardiogram
**-concerning for pregnancy**: more pressure in the heart = high risk pregnancy
78
Interatrial Septum
divides LA and RA
79
Interventricular Septum
divides RV and LV
80
L side has _____ pressure than R side
higher
81
Septal Defect Complications
hole in heart → less blood to LV = hypoxia
→ cyanosis (peripheral - toes, fingers)
increased pressure RA → heart failure
82
Foramen Ovale
**hole in interatrial septum that shunts oxygenated blood from R to L atria**
-in utero
83
Fossa Ovalis
**remnant of foramen ovale; depression in the RA of the heart**
-post natal
84
Patent Foramen Ovale (PFO)
foramen ovale does not close after birth
-causes murmur due to septal defect
85
Ductus Arteriosus
**bypasses non-functional lungs in fetus, pumping blood away from the lungs**
- right ventricle
- in utero
86
Patent Ductus Arteriosus (PDA)
oxygenated blood from aorta enters pulmonary artery & mixes with deoxygenated blood
-both systolic and diastolic murmurs
87
Ligamentum Arteriosum
attaches aorta to pulmonary artery
remnant of ductus arteriosus; serves no function in adults
-post natal
88
Ventricular Septal Defect (VSD)
superior part of interventricular septum fails to form; blood mixes between RV + LV
89
Transposition of the Great Vessels
**aorta comes from RV, pulmonary trunk comes from L**
- result of bulbus cordis not dividing properly
- deoxygenated blood passes through systemic circuit
- oxygenated blood passes through pulmonary circuit
- pulmonary artery is not pulmonary artery
90
Coarcitation of Aorta
**part of aorta is narrowed → increase work on LV**
1/1500 births
91
Tetralogy of Fallot
multiple defects
- pulmonary trunk is too narrow and PV stenosed
- ventricular septal defect
- aorta opens from both ventricles
- RV wall thickened from overwork
92
Pulmonary Stenosis
pulmonary semilunar valve is narrowed (stenosis) → decreased blood flow to lungs
93
High Frequency Sounds
**related to opening**
-closure sounds = S1 + S2
94
Low Frequency Sounds
**related to closing**
**-early and late diastolic filling events of LV**
-S3 + S4
95
S1 + S1 Sounds
Lub-Dub
- audible with stethoscope
- contraction
96
S3 + S4
usually not audible under normal conditions
97
Ventricular Systole
**when mitral valve and tricuspid valve close**
**contraction**
S1 + S2
98
Ventricular Diastole
**occurs w/ closure of aortic and pulmonary valves**
**relaxation**
S2 + S1
99
Most heart sounds are associated with closing. Hearing the valve opening means it is \_\_\_\_\_\_\_\_
stenotic
100
Factors affecting S1
**-structural integrity of valve** → inadequate joining of mitral valve (**SOFT S1**) or loss of leaflet tissue (**SOFT S1**)
**-velocity of valve closure** → position of mitral valve can be altered by atrial and ventricular systole
**-status of ventricular contraction** → increased myocardial contractility = increased LV pressure [exercise, high output state] (**LOUD S1)** or decreased contractility due to M.I. or myocarditis (**SOFT S1**)
**-heart rate** → tachycardia (**LOUD S1**) [shorter PR interval, wide valves due to short diastole increase myocardial contractility
**-transmission characteristics** → obesity, emphysema, pericardial effusion decreases intensity of auscultory events, thin chest wall increases intensity
101
Conditions causing **LOUD S1**
- mitral stenosis
- mitral valve prolapse
- exercise
- tricuspid stenosis
- atrial septal defect
- anomalous pulmonary venous connection with increased tricuspid flow
102
Mitral Stenosis
LOUD S1
increased L arterial pressure, mitral valve trying to close, flaps are thicker, turbulent blood flow due to narrow space
103
Mitral Valve Prolapse
LOUD S1
floppy leaflet snaps into prolapsed position and makes a loud click
increases regurgitation
104
Exercise
LOUD S1
increased HR, increased ventricular pressure
105
Tricuspid Stenosis
LOUD S1
thickened tricuspid leaflets, increased turbulence (narrow)
106
Atrial Septal Defect
LOUD S1
exists in foramen ovale during fetal development
**normal conditions**: shunt blood to RA → LA
**hole doesn't close**: increased volume to RA → increased flow across pulmonic valve
107
Anomalous Pulmonary Venous Connection w/ Increased Tricuspid Flow
PV drains blood to RA instead of LA → mixes with deoxygenated blood → increased volume and increased pressure on tricuspid
108
Conditions causing **SOFT S1**
- mitral regurgitation
- calcific mitral stenosis (immobile mitral valve)
- severe atrial regurgitation
- left bundle branch block (LBBB) (decreased LV contractility)
109
S2 Split
**normally during inspiration**
**AV closes before PV**
-usually seen in RBBB (conduction issue)
110
Wide Split S2
**deeper inhalation**
**AV closes a while before PV**
-usually seen in Pulmonary Stenosis
111
Paradoxical Split S2
**seen during expiration but disappears on inspiration**
**PV closes before AV**
- think pediatric cardiomyopathy
- Aortic Stenosis, LBBB, HCM (hypertrophic cardiomyopathy)
112
Fixed Split S2
**no change in S2 w/ deeper inspirations**
-Atrial Septal Defect (ASD), R Ventricular failure
113
S3 Sounds
**rare extra heart sound that occurs soon after normal “lub-dub” (heard between S2 and S1)**
**-associated with LV heart failure**
-normal in children and young people w/o abnormalities
114
S4 Sounds
very difficult to hear
**caused by vibration of ventricular wall during atrial contraction**
**-associated with stiffened ventricle (low ventricular compliance)**
-heard in patterns w/ Ventricular Hypertrophy + Myocardial Ischemia (tissue dies + no function)
115
Heart Murmurs
**abnormal sounds produced due to abnormal flow of turbulent blood through abnormal heart valves**
ex. stenosis or incompetence
- increased velocity = murmur sounds
116
When blood is forced through a stenotic valve, produces an abnormal ______ sound
whistling
117
When blood forced backward through an incompetent valve (regurgitation), it produces a ________ sound
swishing or gurgling murmur
118
Rheumatic Fever
**autoimmune disease triggered by streptococcus bacterial infection**
- antigen-antibody complexes damage the valve
- stenotic valve dysfunction often caused by a missed strep infection
- most common strep = Impetigo
119
Systolic Murmur
**produced during systole of ventricle (contraction) between S1 and S2**
- innocent murmurs
- common in children and young adults
- ex. Aortic Stenosis + Mitral Incompetence
120
Diastolic Murmur
**produced during diastole of ventricle (relaxation) between S2 and S1**
-ex. Aortic Incompetence + Mitral Stenosis
121
**ASS - BACKWARDS**
A = P
T = M
**A**ortic **S**tenosis is **S**ystole
Aortic _Stenosis_ = **systole**
Pulmonary _Stenosis_ = **systole**
Tricuspid _Stenosis_ = **diastole**
Mitral _Stenosis_ = **diastole**
Aortic _Regurgitation_ **= diastole**
Pulmonary _Regurgitation_ **= diastole**
Tricuspid _Regurgitation_ **= systole**
Mitral _Regurgitation_ **= systole**
122
Ventricular Septal Defect (VSD)
commonly caused by congenital defect; hole in the heart between LV + RV that may never be identified
- undiagnosed → gets louder w/ age
- LV shunts blood to RV, increasing RV pressure
- may be associated w/ other defects: Tetralogy of Fallot
123
VSD Complications
LV shunts blood to RV, increasing RV pressure
RV hypertrophy → R side failure
regurgitation in R side causes blood to pool in venous system
L side oxygen poor → cyanosis
124
Electrical Conduction System
AV Node
SA Node
Bundle of HIS
Bundle Branch
Purkinje Fibers
125
AV Node blocked → _______ will start its own electrical impulse (supraventricular rhythm)
Bundle of HIS
126
Supraventricular rhythm becomes so irregular / not in sync, causing \_\_\_\_\_\_\_\_\_\_
Ventricular Tachycardia
127
Cardiac cells produce their own \_\_\_\_\_\_\_\_\_\_
electrical impulse
128
\_\_\_\_\_\_\_\_\_ will shock the heart until the optimal rhythm is achieved
Pacemaker
129
RBBB
affects electrical conductivity of the heart
130
Contraction begins at \_\_\_\_\_\_
apex
131
Autonomic Innvervation
**sympathetic** - increase rate/force of contractions
**parasympathetic** - slow HR by Vagus nerve stimulation
132
Flow of Fetal Blood Circulation:
1. Oxygenated / nutrient rich blood from PLACENTA travel through UMBILICAL VEIN
2. UMBILICAL VEIN passes through the LIVER (still oxygenated) and combines with IVC (deoxygenated)
3. Mixed blood enters the heart through RA
4. SVC brings deoxygenated blood to RA, pumping from RA to RV to PULMONARY TRUNK to DUCTUS ARTERIOSUS then DESCENDING AORTA
5. Some mixed blood enters RV but most enters LA through FORAMEN OVALE
6. LA pumps to LV
7. LV pumps to AORTA
8. Any blood that entered the PULMONARY TRUNK instead of FORAMEN OVALE or RV can re-enter the AORTA through the DUCTUS ARTERIOSUS
9. ILLIAC ARTERIES are mostly now deoxygenated after blood moves through tissues and returns to UMBILICAL VEIN for oxygenation
Anatomy 1 - MD
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