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2015-06-14 08:24:35

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  1. Superior thoracic aperture boundaries
    • Posterior border: Body of T1
    • Anterior border: costal cartilage of 1st rib and superior surface of manubrium
    • Lateral borders: 1st pair of ribs
  2. Structures that pass through superior thoracic aperture
    • Trachea
    • Esophagus
    • Thoracic duct
    • Apexes of lungs
    • Nerves: phrenic, vagus, recurrent laryngeal, and sympathetic trunks
    • Arteries: L and R common carotid arteries and L and R subclavian
    • Veins: Internal jugular veins, brachiocephalic veins, and subclavian veins
    • Lymph nodes and lymphatic vessels
  3. What are the borders of the inferior thoracic aperture?
    • Much larger than superior
    • Posterior border: 12th thoracic vertebra
    • Lateral border: 11th and 12th pairs of ribs
    • Anteriorly: Costal cartilages of ribs 7-10 and xiphisternal joint
  4. What major structures pass through the inferior thoracic aperture?
    • Through diaphragm: inferior vena cava and esophagus
    • Posterior to diaphragm through aortic hiatus: abdominal aorta and thoracic duct
  5. True, False, and Floating Ribs
    • 7 true ribs (1-7): costal cartilages articulate with sternum
    • 5 false ribs (8-12): common costal cartilages with sternum
    • 11 and 12 are floating ribs: no articulation with sternum
  6. 3 Parts of the Sternum
    • Manubrium
    • Body
    • Xiphoid process
  7. Sternoclavicular joint
    • Proximal end of clavicles and manubrium of sternum also 1st costal cartilage
    • Synovial saddle joint
  8. What are the 3 articulating ends of the sternoclavicular joint?
    • Proximal end of clavicle
    • Clavicular notch of manubrium
    • 1st costal cartilage
  9. What surrounds the sternoclavicular joint?
    • Joint capsule that surrounds it because it is a synovial joint
    • Lined with synovial membranes
    • Strengthened by ligaments
  10. Where is the Articular disc that separates the sternoclavicular joint into 2 compartments?
    Disc in between clavicular notch of manubrium and proximal end of clavicle
  11. What are the 4 ligaments that strengthen the sternoclavicular joint?
    • Interclavicular ligament
    • Anterior Sternoclavicular ligaments
    • Posterior sternoclavicular ligaments
    • Costoclavicular ligament
  12. What are the movements of the sternoclavicular joint?
    • Anterior/posterior
    • Superior/inferior
    • Very small rotational movement
  13. What are the main features of the Manubrium?
    • 2 articulations: clavicle, 1st costal cartilage, and half of 2nd costal cartilage
    • Suprasternal notch (jugular notch) superiorly
    • Facets for articulating with clavicle and 1st costal cartilage
    • Demifacets for articulating with half of 2nd costal cartilage
  14. Body of sternum articulations points
    • Lateral edges: facets articulations with costal cartilages 3-6
    • Demifacet for 2nd and 7th costal cartilages
  15. What is the sternal angle or angle of Louis?
    • Angle between manubrium and body of sternum
    • Level of intervertebral disc between T4-T5
  16. What major structures are around the angle of Louis?
    • Mnemonic: RATPLANT
    • Rib number 2
    • Aortic arch
    • Trachea (bifurcation into 2 bronchi)
    • Pulmonary trunk (bifurcation into R and L branches)
    • Left recurrent laryngeal under arch of aorta
    • Ligamentum arteriosum (connects aortic arch and pulmonary trunk)
    • Azygos system drains into superior vena cava
    • Nerves: cardiac plexus
    • Thoracic Duct (entering into L subclavian vein)
  17. What are the 3 extrinsic muscles of the thoracic cage?
    • Serratus anterior
    • Serratus posterior superior
    • Serratus posterior inferior
  18. Serratus anterior
    • O: ribs 1-8
    • I: Medial border of scapula (costal surface)
    • N: long thoracic nerve
    • Protract (pulls scapula forward around thorax and against thorax) and stabilizes scapula
  19. Serratus posterior superior
    • O: Spinous process of C7-T3
    • I: Upper borders of ribs 2-5
    • N: 2-5 Intercostal nerves
    • Elevates ribs; assists with inspiration
  20. Serratus posterior inferior
    • O: Spinous processes of T11-L2
    • I: Ribs 9-12
    • N: 9-12 intercostal nerves
    • Depresses lower ribs; assists with expiration
  21. What are the 3 layers of intercostal muscles?
    • External intercostal
    • Internal intercostal
    • Inner most intercostal
  22. External intercostal muscle
    • Fibers oriented inferiorly and medially
    • Forms aponeurosis called external intercostal membrane medially
    • Inspiration
  23. Internal intercostal muscles
    • Fibers oriented superiorly and medially (opposite to external)
    • Connect directly to sternum
    • Assist in expiration
  24. Innermost intercostal muscles
    • Fibers oriented superiorly and medially (opposite to external)
    • Expiration
  25. Mnemonic for muscle fiber directions of intercostal muscles
    • hands in pockEts (direction of external intercostal muscles)
    • hands on tIts (direction of internal and innermost intercostal muscles)
  26. Endothoracic fascia
    • Deep to inner most intercostal muscles
    • Separates intercostal muscles from pleural cavities
  27. What is the neurovascular bundle between internal intercostals and innermost intercostal in subcostal groove underneath each rib?
    • (Mnemonic: VAN superior to inferior)
    • Intercostal vein
    • Intercostal artery
    • Intercostal nerves
  28. What are the layers of the intercostal spaces in the thorax? (Superficial to Deep)
    • External intercostal
    • Internal intercostal
    • Intercostal vein, artery, and nerve
    • Innermost intercostal
    • Endothoracic fascia
    • Parietal pleura
    • Visceral pleura
    • Lung
  29. What are the 3 minor muscles of the thoracic cage?
    • Levatores costarum muscles
    • Subcostales muscles
    • Transversus thoracis muscles
  30. Levatores costarum muscles
    • 12 pairs of muscles from transverse processes of vertebrae to rib below it
    • Elevation of ribcage
  31. Subcostales muscles
    • Rib to 2 ribs below it
    • Internal surface of ribs
  32. Transversus thoracis muscles
    • O: Inferiorly on body of sternum and xiphoid process
    • I: Internally on costal cartilages 2-6
    • Pull ribs down
  33. What are the 4 chambers of the heart?
    • 2 atria
    • 2 ventricles
  34. Where do the right and left sides of the heart pump blood to?
    • Right atrium and ventricle pump to pulmonary circulation
    • Left side pumps oxygenated blood to systemic circulation (more muscular because it needs to travel farther)
  35. Blood flow in heart
    • Receives deoxygenated blood from systemic circulation via superior and inferior vena cava
    • Enters Right Atrium
    • Right Atrium Contracts and blood is pushed through Tricuspid Valve
    • Enters Right Ventricle
    • Right Ventricle contracts and blood is pushed through Pulmonary Valve
    • Enters pulmonary circulation and oxygen diffuses into blood through alveoli in lungs
    • Blood pumped to Left Atrium
    • Left Atrium Contracts and blood is pushed through Bicuspid Valve (Mitral valve)
    • Enters Left Ventricle
    • Left Ventricle contracts and blood is pushed through Aortic Valve to systemic circulation
    • Blood enters arteries around body and go into capillary beds where gases, nutrients, and other things are exchanged
    • Enters venules
    • Enters veins and returns to heart via vena cava
  36. What are the 5 great vessels around the heart?
    • immediately lead to or away from heart)
    • Superior vena cava
    • Inferior vena cava
    • Pulmonary artery (Pulmonary trunk)
    • Pulmonary Vein
    • Aorta
  37. What are the borders of the mediastinum?
    • Central compartment in thorax that separates the 2 pleural cavities
    • Lateral border: medial aspects of pleural cavities
    • Inferior border: Diaphragm
    • Superior border: superior thoracic aperture (thoracic inlet)
    • Posterior border: bodies of thoracic vertebrae
    • Anterior border: sternum
  38. What structure separates the superior and inferior portions of the mediastinum?
    Superior aspect of the pericardium
  39. How is the inferior portion of the mediastinum subdivided?
    • Anterior
    • Middle
    • Posterior
  40. What are the major structures that pass through the mediastinum?
    • Trachea
    • Esophagus
    • Great vessels of heart and heart
    • Phrenic nerve
    • Thymus
    • Thoracic duct: Largest structure of lymphatic system; Drains into brachiocephalic vein
    • Lymph nodes of central chest
  41. Position of the heart
    • Angled just left of midline
    • Sits on top of diaphragm
    • Apex of heart is in bottom left corner
  42. Diphragmatic surface of heart
    Inferior surface of heart; in contact with diaphragm
  43. Right and Left Pulmonary surfaces of heart
    Right and left sides of heart, in contact with right and left lungs respectively
  44. Costosternal surface of heart
    Anterior surface of heart, in contact with sternum
  45. Base of the heart
    Posterior surface
  46. What structure is visible in the anterior view of heart?
    Seeing mostly the right ventricle
  47. What are the different valves in the heart?
    • Atrioventricular valves: Tricuspid and Bicuspid
    • Semilunar valves: Pulmonary and Aortic
  48. Atrioventricular valves
    • Tricuspid valve: Between right atrium and ventricle (ri= right)
    • Bicuspid (Mitral) valve: Between left atrium and left ventricle
  49. Semilunar valves
    • Pulmonary Valve: Between right ventricle and pulmonary artery
    • Aortic Valve: Between left ventricle and aorta
  50. Superior vena cava
    • Right and Left Brachiocephalic converge and form superior vena cava
    • External and Internal jugular veins drain into brachiocephalic on both sides
  51. Pulmonary trunk
    Splits into Right and Left pulmonary artery to lungs (deoxygenated blood)
  52. Pulmonary veins
    Superior and Inferior pulmonary veins on both sides into left atrium
  53. What are the 3 branches of the aorta?
    • Arches over pulmonary trunk; Anterior to Posterior
    • Right brachiocephalic trunk: Splits into right common carotid artery and right subclavian artery
    • Left common carotid artery
    • Left subclavian artery
    • Continues inferiorly as descending thoracic artery
  54. Right and Left Coronary sinuses
    • Give rise to right and left coronary arteries
    • Come off base of aorta just after the aortic valve
  55. Coronary sulcus
    • Groove between atrium and ventricles
    • Coronary arteries run in this sulcus
  56. Interventricular sulci
    (anterior and posterior) grooves between right and left ventricles
  57. Right coronary artery
    • Runs in right coronary sulcus laterally, inferiorly, and posteriorly
    • Supplies right atrium, right ventricle, sinoatrial node (SA) and atrioventricular node (AV)
  58. What are the 2 branches of the right coronary artery?
    • Right marginal branch
    • Posterior interventricular artery (posterior descending artery): Runs in posterior interventricular sulcus
  59. What are the 3 branches of the Left coronary artery?
    • Anterior interventricular artery (left anterior descending artery)
    • Circumflex artery: Left marginal branch comes off
    • Supplies left atrium and left ventricle
  60. What is coronary dominance?
    Depends on which artery supplies the posterior interventricular artery
  61. Left coronary dominance
    posterior interventricular artery arises from circumflex artery (L)
  62. Right coronary dominance (most people)
    posterior interventricular artery arises from right coronary artery
  63. Codominance (coronary dominance)
    Equal supply of posterior interventricular artery from both circumflex artery (L) and right coronary artery
  64. Coronary sinus
    • On posterior, inferior surface of heart
    • Lies in coronary sulcus between left atrium and left ventricle
    • Returns blood to right atrium from walls of heart
  65. What are the 4 tributaries of the coronary venous drainage?
    • Great cardiac vein
    • Middle cardiac vein
    • Posterior cardiac vein
    • Small cardiac vein
  66. Great cardiac vein
    Runs up anterior interventricular sulcus and winds around back to drain into coronary sinus
  67. Middle cardiac vein
    • Runs along posterior interventricular sulcus
    • Joins coronary sinus
  68. Posterior cardiac vein
    • Runs on left margin of heart
    • Meets great cardiac vein to drain into coronary sinus
  69. Small cardiac vein
    • Runs on in coronary sulcus on right side of heart
    • Drains into coronary sinus
    • Right marginal vein drains into small cardiac vein
  70. Right atrioventricular orifice
    • Right atrium sends blood to right ventricle through this
    • Closed by Tricuspid valve
  71. Sulcus Terminalis
    • Vertical external groove, externally marks 2 divisions of right atrium
    • Separates right atrial pectinate muscles from the sinus venarum
    • Superior border is the horizontal plane where sinoatrial node resides
    • Inferior border is the horizontal plane where atrioventricular node resides
  72. Crista Terminalis
    • Corresponds to sulcus terminalis, but internal
    • Smooth muscular ridge between sinus venarum and pectinate muscles in right atrium
  73. Right auricle
    • Overlaps ascending aorta
    • Pectinate muscles extend into here
  74. Sinus venarum
    • Smooth, posterior wall of right atrium
    • Develops from the sinus venosus of embryonic heart
  75. Pectinate muscles
    Rough, anterior wall of right atrium
  76. Interatrial septum
    Between right and left atria
  77. Fossa ovalis
    • Oval shaped depression in interatrial septum
    • Remnant of foramen ovale, which in the fetus allows blood to pass from right to left atrium, bypassing lungs because they are not yet functional
  78. Openings in right atrium
    • Superior vena cava
    • Inferior vena cava
    • Coronary sinus: just medial to inferior vena cava opening
  79. Right Ventricle
    • Makes up a lot of anterior surface of heart in anatomical position
    • Blood goes from right atrium through atrioventricular orifice into right ventricle
  80. Tricuspid valve
    • Prevents backflow of blood between right atrium and ventricle
    • 3 cusps: Anterior, Posterior, Septal
  81. Chordae tendineae
    • Connect tricuspid valve to papillary muscles
    • Prevent aversion of the tricuspid valve
  82. Papillary muscles
    • Attach to tricuspid valve via chordae tendineae to prevent backflow during ventricular contraction
    • Anterior (largest)
    • Posterior
    • Septal (variable in size, sometimes absent)
  83. Trabeculae carneae
    • Rounded, muscular columns
    • Either fixed along entire length or fixed at both ends and free in middle like a bridge
    • Similar to pectinate muscles in right atrium; helps prevent aversion of tricuspid valve and helps heart pump more efficiently by preventing suction
    • Inflow tract of right ventricle
  84. Conus arteriosus (infundibulum)
    Outflow tract out of right ventricle, leading into pulmonary trunk
  85. Pulmonary valve
    • 3 cusps: Left, right, and anterior
    • Pulmonary sinuses (pockets in cusps)
    • During relaxation, blood fills sinuses and cause pulmonary valve to close and prevents backflow
    • At apex of infundibulum
    • Closes opening to pulmonary trunk
  86. Interventricular septum
    • Separates left and right ventricles
    • Muscular ventricular septum (most of septum)
    • Membranous ventricular septum (superior and posteriorly)
    • Thin and fibrous
  87. Septomarginal trabecula
    • Comes off septum and attaches to base of anterior papillary muscle
    • Carries right bundle of AV bundle to anterior wall of right ventricle
  88. Parts of left atrium
    • Posterior: Smooth
    • Anterior: Continuous with left auricle; Pectinate muscles; No crista terminalis like right atrium that separate two halves
    • Interatrial septum: Other side of fossa ovalis, remnant of foramen ovale in fetus
  89. Left atrium
    • Left auricle
    • Smaller than right atrium, but thicker walls
    • 4 veins entering left atrium (pulmonary veins)
    • Carry oxygenated blood from lungs
  90. Left Ventricle
    • Posterior to right ventricle and anterior to left atrium
    • Blood passes through left atrioventricular orifice
    • Wall is much thicker than right ventricular wall because it must pump blood to entire body
    • Only 2 Papillary muscles in left ventricle
  91. Mitral valve (Bicuspid)
    • Anterior cusp (larger)
    • Posterior cusp
    • Attached to papillary muscles via chordae tendinae
    • Resembles a bishop’s mitre
  92. Trabeculae carnae in left ventricle
    • Same 3 types of trabeculae carnae as right ventricle
    • Tethered at one end (Papillary muscles)
    • Tethered along entire length
    • Tethered only at 2 ends
  93. Aortic vestibule
    • Left ventricular outflow tract
    • Continuous with ascending aorta
    • Posterior to right ventricular outflow tract
  94. Ascending aorta
    Right and Left coronary comes off right at beginning just above aortic valve
  95. Aortic valve
    • 3 semilunar cusps: Right, Left, and Posterior cusps
    • Sinuses of right and left coronary arteries open into right and left cusps of aortic valve
  96. Aortic sinuses
    Blood pools from ascending aorta during diastole and fills coronary arteries with blood