Heart and Great Vessels

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Questions for the Heart and Great Vessels - A Partial Study Guide

True/False - August 19, 2011

1. The pericardiacophrenic artery is on the same parasaggital plane as the chondral cartilages.
2. The phrenic nerve crosses anterior to the hilum of the lung.
3. The fibrous coat of the pericardium has endothoracic fascia on its external surface.
4. The parietal layer serous paricardium is directly adhered to the fibrous coat without a layer of endothoracic fascia.
5. The visceral pericardium secretes fluid into the pericardial cavity but not into the pericardial sac.
6. The blending of the fibrous coat with the great vessels is known as arterial mesocardium.
7. The blending of the fibrous coat with the pulmonary and caval veins is known as the venous mesocardium.
8. The pulmonary veins access the fibrous coat at the posterior lateral wall of the pericardial sac.
9. The venous and arterial mesocardia are immediately continuous with the parietal pericardium and the epicardium.
10. The superior boundary of the oblique sinus is contributed by the fibrous coat.
11. The pericardiophrenic artery, as it passes inferior to the root of the lung, lies within endothoracic fascia.
12. The periphery of the diaphragm is vascularized by the pericardiacophrenic artery and the central tendon is vascularized by the intercostal arteries.
13. The pericardiacophrenic artery, despite the name, does not supply the pericardial sac.
14. The right ventricle, despite the name, is primarily posterior to the left ventricle.
15. The apex of the heart is deviated to the left side at the level of the 4th rib.
16. The atria have little ears and the left lung has a little tongue.
17. The caval veins open into the left atrium.
18. The anatomy of the left atrioventricular valve is similar to that of the aortic valve.
19. Asymmetries between the left and right ventricles reflects the aortic arterial tree compared to the pulmonary arterial tree.
20. The valve of the inferior vena cava and the valve of the coronary sinus are located in the anterior wall of the right atrium.
21. The crista terminalis is on the inside of the right ventricle and the sulcus terminalis is located of the outside wall of the pericardial sac.
22. The fossa ovalis, if patent, allows blood to travel from the right atrium to the left atrium.
23. The tricuspid valve is a characteristic of the left ventricle.
24. The septomarginal trabecula is continuous with the posterior papillary muscle.
25. The chorda tendonae of a single papillary muscle attach to a single cusp.
26. The infundibulum, near the pulmonary valve, becomes membranous.
27. The chorda tendinae actively close the aortic valve.
28. The aortic valve, but not the pulmonary valve, has a noncoronary valve.
29. Nodules and lunules provide attachment sites for the chorda tendinae.
30. The coronary arteries perfuse the myocardium during systole.
31. The aortic sinuses fill with blood during diastole.
32. The lunules diverge during systole and converge during diastole.
33. The skeleton of the heart consists of fibrocartilage.
34. The conduction system of the heart is intrinsic and, thus, the heart can beat without influence from an exogenous source of neural commands.
35. The inferior extent of the sulcus terminalis marks the subepicardial location of the sinuatrial node.
36. The interventricular septum hosts purkinje fibers from the atrioventricular node that travel to the anterior papillary muscle of the right atrium.
37. A blockage of the proximal left coronary artery is expected to disrupt the conduction system of the heart.
38. The right coronary artery provides the primary blood supply to the anterior part of the interventricular septum.
39. The left coronary artery provides the primary blood supply to the anterior part of the interventricular septum.
40. Branches of the right and left coronary arteries, to a varying degree, anastomose at the apex of the heart.
41. The anterior cardiac veins drain directly into the left ventricle and the coronary sinus drains directly into the right atrium.
42. The great cardiac vein drains into (becomes) the coronary sinus.
43. The middle cardiac vein drains directly into the right atrium.

Questions for the Heart and Great Vessels - A Partial Study Guide

True/False

1. The pericardial sac is contained within the pericardial cavity.
2. The heart is outside the pericardial sac and inside the pericardial cavity.
3. The anterior surface of the pericardial is stabilized by the sternopericardial ligaments.
4. The base of the heart is secured at the central tendon of the diaphragm.
5. The posterior pericardial sac is stabilized by the pulmonary arteries.
6. Deep to the visceral pericardium is the epicardium.
7. The pulmonary veins drain into the right atrium.
8. The arterial mesocardium marks a reflection of
9. The arterial and venous mesocardia are analogous to the pleural reflections at the hilum of the lung.
10. Reflections of parietal serous pericardium defines the boundaries of the oblique sinus.
11. An infection that erodes through the pericardial cavity into the pleural cavity invades the endothoracic fascia and puts the phrenic nerve at risk.
12. The bicuspid valve passes deoxygenated blood whereas the tricuspid valve passes oxygenated blood.
13. The crista terminalis marks the location of the sulcus terminalis.
14. Pectinate muscles line the right ventricle.
15. The fossa ovalis marks a fetal communication between the right atrium and the left ventricle.
16. Chordae tendineae arising from a single papillary muscle attach to more than one cusp.
17. Perfusion by the coronary arteries occurs during diastole.
18. Blood fills the coronary sinus during systole.
19. The tricuspid valve has three nodules, three lunules, and three cusps.
20. The fibrocartilaginous skeleton of the heart provides
21. The heart's intrinsic nervous system can cause the heart to beat without extrinsic nervous influence.
22. The sinoatrial node is immediately deep to the endocardium.
23. The atrioventricular node is immediately superficial to the endocardium.
24. The atrioventricular bundle conveys nervous impulses to the papillary muscles.
25. The ostia of the right coronary artery is at the coronary sinus of the right coronary cusp of the pulmonary semilunar valve.
26. The anterior interventricular artery is supplied by the right coronary artery and the posterior interventricular artery is supplied by the left coronary artery.
27. The anterior cardiac veins first drain into the small cardiac vein and then the coronary sinus.
28. The middle cardiac vein lies in the anterior interventricular sulcus.

1. The internal thoracic, but not the phrenic nerve passes along the margin of the mediastinum.
2. The internal thoracic artery is lateral to the sternocostal joint and medial to the costochondral joint.
3. The sternopericardial ligaments contribute to the stability of the heart.
4. The inferior border of the pericardial sac is adhered to the central tendon of the diaphragm by way of the endothoracic fascia.
5. The outermost layer of the the pericardium, the fibrous coat, is adhered to the fibrous layer of parietal pleura.
6. The parietal layer of serous pericardium is redundant with, and continuous with the visceral pericardium.
7. The heart is within the pericardial sac and outside the pericardial cavity.
8. The epicardium (visceral pericardium) lines the outside of the myocardium while the endocardium lines the inner surface of the myocardium..
9. The fibrous coat of the pericardium is attached to the great vessels, the diaphragm, the inferior vena cava, and the pulmonary veins.
10. The fibrous pericardium, by way of the sternopericardial ligaments is tethered to the sternum.
11. Which of the following questions is a nightmare? Discuss the contents of the pericardial cavity. Discuss the contents of the pericardial sac. Ans: the latter.
12. The pericardiacophrenic vessels and the phrenic nerve are both located within the endothoracic fascia.
13. The oblique sinus is bounded superiorly by reflections of parietal pericardium known as the arterial mesocardium.
14. The transverse sinus is located between the venous mesocardium and the arterial mesocardium.
15. The pericardiacophrenic artery is derived the right subclavian artery on the right and the brachiocephalic artery on the left.
16. The internal thoracic arteries branch from the subclavian arteries.
17. The apex of the heart is oriented inferior, anterior, and to the left.
18. The base of the heart, relative to the apex, is oriented superior, posterior, and to the right.
19. The auricle is part of the ventricle.
20. The tricuspid valve leads to the left ventricle and the bicuspid valve leads to the right ventricle.
21. The pulmonary arteries carry oxygenated blood to the lungs.
22. The pulmonary veins carry de-oxygenated blood to the right atrium.
23. The left ventricle has thicker walls than does the right ventricle.
24. The arch of the aorta is at the level of T4.
25. The valve of the inferior vena cava is immediately to the right of the ostia for the coronary sinus.
26. The fossa ovale is a remnant of the foramen ovalis.
27. The crista terminalis, resembling the crown of a rooster, is easily demonstrated on the external margin of the right ventricle.
28. Pectinate muscles are unique to the right ventricle.
29. Trabeculae carne are unique to the right atrium.
30. Papillary muscles actively close the tricuspid valve.
31. Backflow closes the tricuspid valve and the papillary muscles prevent eversion of the tricuspid valve.
32. The chordae tendinae of a single papillary muscle extend to a single tricuspid valvule.
33. The pulmonary semilunar valve passes blood to the left atrium.
34. The left atrium, like the right atrium, contains pectinate muscles.
35. The septomarginal trabecula is within the left ventricle.
36. The heart is perfused during diastole.
37. The papillary muscles actively open the bicuspid valve.
38. The semilunar valves, at the center of each lunule, has three nodules.
39. The aortic semilunar valve closes at the beginning of diastole.
40. Arterial elasticity distal to the aortic semilunar valve partly mediates perfusion of the heart.
41. The fibrocartilagenous skeleton of the heart supports the bases of the heart valves.
42. The heart has an intrinsic nervous system that, nevertheless, is modulated by an extrinsic nervous system.
43. Intimately applied to the epicardium is the sinoatrial node.
44. Intimately appled to the endocardium is the atrioventricular node.
45. Purkinje fibers from the AV node follow the septomarginal trabecula to the posterior papillary muscle.
46. The sinuatrial artery is typically the first branch of the left coronary artery.
47. The marginal artery, a branch of the right coronary, follows the anterior margin of the heart.
48. The left coronary artery gives rise to the anterior interventricular artery and the circumflex artery.
49. The circumflex artery typically continues as the posterior interventricular artery.
50. The coronary sinus is located in the atrioventricular groove between the left atrium and left ventricle.
51. The great cardiac vein is along the anterior interventricular sulcus.
52. The small cardiac vein is along the right margin of the heart.
53. The anterior cardiac veins drain directly into the left atrium.
54. The middle cardiac vein is along the posterior interventricular sulcus.
55. The ligamentum venosum is a vestige of the ductus venosus that, in turn, was shunt between the umbilical vein and the left hepatic vein.
56. The ductus arteriosus, a vestige of the ligamentum arteriosum, provided a shunt between the pulmonary trunk and the right pulmonary vein.
57. The foramen ovale, in fetal life, provides a shunt between the atria.

Definition and Short Answer

1. What nerve contributes to pain sensation of both the diaphragm and the pericardium?
2. What specific vascular damage would lead to an irregular heart rate?

Essay

1. A stab wound penetrates straight into the right side of the thorax in the mid-axillary line at the 4th intercostal space. What facial layers and spaces are penetrated? Consider that the wound penetrates into a ventrical of the heart.
2. The cardiac cycle may show disrupted timing of atrial and ventricle contractions. What regions may be damaged? What is the typical blood supply to each of these regions?
3. A fatal condition results when the cusps of the tricuspid valve evert into the atrium. Discuss the relevant anatomy.
4. Discuss stabilization of the heart within the middle mediastinum.
5. Discuss the conduction system of the heart.

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