Heart

Extending from the crista terminalis are muscular, ridge like projections called ___ ___ (Pectinate Muscle).

Musculi Pectinati

The cardiac muscle itself is referred to as:

Myocardium

leads from the heart and courses superiorly

ascending aorta

The aorta is divided into 3 regions:

ascending aorta aortic arch descending aorta

The heart has 4 internal cavities called chambers, 2 ____ and 2 ____.

atria; ventricles

The impulse is carried to the atrioventricular (AV) node located within the membranous septum and is carried down the ____ ____. From here, the impulse is carried down the LEFT and RIGHT ___ ____ to the ___ ___which radiate throughout the ventricles.

atrioventricular (AV) bundle (of HIS); bundle branches; purkinje fibers

The heart is composed of 2 types of valves: ___ valves and ___ valves. (Semilunar valves will be discussed separately.)

atrioventricular and semilunar

The left atrium has its musculi pectinati located within the left ___ only. The majority of the surface area of the left atrium is taken up by the 4 separate openings of the pulmonary veins.

auricle

The Moderator Band or Septomarginal Trabecula contains important fibers of the ___ system of the heart (the right branch of the AV bundle).

conduction

All ___ pulmonary veins will enter the left atrium.

four

For each semilunar valve there are 3 flaps or cusps. The free edge of each cusp has a small central thickening of fibrous tissue termed the:

nodule

Blood flows through the pulmonary circuit as follows:

1. Right Ventricle 2. Pulmonary Semilunar Valve 3. Pulmonary Trunk 4. Pulmonary Arteries 5. Lungs 6. Pulmonary Veins 7. Left Atrium

Direction of Blood Flow Through the Heart:

1. Superior Vena Cava, Inferior Vena Cava and Coronary Sinus 2. Right atrium 3. Tricuspid valve 4. Right ventricle 5. Pulmonary semilunar valve 6. Pulmonary trunk 7. Pulmonary arteries 8. Lungs 9. Pulmonary veins 10. Left atrium 11. Bicuspid valve 12. Left Ventricle 13. Aortic semilunar valve 14. Aorta

The aortic semilunar valve possesses __ cusps located at the opening of the aorta. These cusps possess nodules, lunulae and sinuses as did the pulmonary semilunar valves.

3

Release of the neurotransmitter ___ at the ___ ___ will act to decrease the rate and intensity of ventricular contractions thus, slowing the heart rate.

Achetylcholine; SA Node

are 2 or 3 small vessels which drain the right ventricle and end directly in the right atrium.

Anterior Cardiac Veins

The only openings of the left ventricle are the: • Left Atrioventricular Opening • Opening of the ___ ___ ___ When the left ventricle contracts, blood will leave the heart and enter the aorta.

Aortic Semilunar Valve

The opening of the aorta is guarded by the ___ ___ ___.

Aortic Semilunar Valve

The ___ is located superiorly and posteriorly. It is the area where the great vessels attach to the heart. These vessels are the ___, ___ ___, and ___ ___ ___.

Base Aorta, Pulmonary Trunk, and Superior Vena Cava.

The only other opening of the left atrium is the Left Atrioventricular Opening guarded by the:

Bicuspid Valve, Mitral Valve or Left Atrioventricular Valve.

The left atrioventricular opening is guarded by the ___ ___, ___ ___, or ___ ___ ___. Being an atrioventricular valve, it has supporting papillary muscles connected to chordae tendineae which, in turn, attach to the cusps. It contains __ cusps. Blood will flow from the left atrium into the left ventricle through the bicuspid valve.

Bicuspid Valve, Mitral Valve or Left Atrioventricular Valve; 2

A congenital condition which occurs when the branches of the aortic arch take on alternate configurations resembling that of a cows anatomy.

Bovine heart syndrome

courses posteriorly and terminates by anastomosing with the Right Coronary Artery on the posterior surface of the heart.

Circumflex Branch

Arise from the ascending aorta and supply the myocardium of the heart itself with blood and oxygen.

Coronary Arteries

There are two coronary arteries aptly named the Left and Right ___ ___ which lead to the left and right sides of the heart respectively.

Coronary Arteries

There are three major veins that all drain into the:

Coronary Sinus

a short, wide vessel that receives all 3 cardiac veins and empties directly into the right atrium.

Coronary Sinus

Involves harvesting the internal thoracic (internal mammillary) arteries or greater saphenous vein which are literally utilized to "bypass" the obstructed coronary arteries and reestablish blood flow to the myocardium. Single, double, triple or quadruple bypass surgeries are possible depending on the extent of the obstruction.

Coronary bypass surgery

A vertical muscular ridge is seen on the posterior wall of the right atrium called the:

Crista Terminalis

The inner epithelium lining the chambers of the heart is referred to as:

Endocardium

The fossa ovalis is a remnant of a foramen that, in the fetal stage of development, existed between the right atrium and left atrium. This opening is called the ___ ___. Normally, it closes at birth and becomes the fossa ovalis in adults.

Foramen Ovale

On this septum in the right atrium lies an oval depression called the:

Fossa Ovalis.

courses with the anterior interventricular artery and circumflex branch. It continues on the posterior surface of the heart as the coronary sinus.

Great Cardiac Vein

Due to atherosclerotic plaque build up in the arteries of the body, blood pressure will increase leading to ___. The heart responds to the increased oxygen demands by increasing the force of its contractions.

Hypertension

Prolonged hypertension can lead to ____ of the myocardium which increases the risk for myocardial infarction.

Hypertrophy

The opening for the inferior vena cava, the main vein returning blood from the lower half of the body.

Inferior Vena Caval Opening

the partition between the right and left atria.

Interatrial Septum

the Left Coronary Artery bifurcates into the:

Left Anterior Descending Artery (Anterior Interventricular Branch) and the Circumflex Branch.

Originates from the left side of the aorta and courses a short distance before giving off 2 branches.

Left Coronary Artery

The fossa ovalis is surrounded at its periphery by a ridge called the:

Limbus Fossa Ovalis

courses with the posterior interventricular artery and drains directly into the coronary sinus.

Middle Cardiac Vein

Another special type of trabeculae carneae is a band of muscle that attaches to the interventricular septum and to the papillary muscle called the:

Moderator Band or Septomarginal Trabecula

The release of the neurotransmitter ___ directly to the myocardium of the ___ will result in increased heart rate and force of contraction.

Norepinephrine; ventricles

Blood will leave the right ventricle and enter the pulmonary trunk by passing through the ___ ___ Opening guarded by the ___ ___ ___.

Pulmonary Trunk and Pulmonary Semilunar Valve.

Oxygenated blood will return to the heart via the four ___ ___, 2 from the right lung and 2 from the left lung.

Pulmonary Veins

Oxygenated blood will return to the heart via the four ___ ___, 2 from the right lung and 2 from the left lung. All ___ pulmonary veins will enter the left atrium.

Pulmonary Veins; four

lies adjacent to the medial surface of the left and right lungs

Pulmonary surface

The only openings of the right ventricle are the ___ ____ Opening (guarded by the Tricuspid Valve) and the ___ ___ Opening.

Right Atrioventricular and Pulmonary Trunk

The ___ ___ ___ originates from the right side of the aorta, courses underneath the right auricle and continues to the posterior surface of the heart.

Right Coronary Artery

The right coronary artery gives off the __ ___ branch and ___ ___ branch. The right coronary artery terminates posteriorly by anastomosing with the circumflex branch of the left coronary artery.

Right Marginal and Posterior Interventricular

courses with the marginal branch and drains into the coronary sinus.

Small Cardiac Vein

Lies adjacent to the sternum and costal cartilages.

Sternocostal surface

The heart is described as having an apex, base and three surfaces:

Sternocostal surface Diaphragmatic surface Pulmonary surface

The opening for the superior vena cava, the main vein returning blood from the upper half of the body.

Superior Vena Caval Opening

Sympathetic innervation of the heart is derived from the ___ ___ ___ located on either side of the spinal column.

Sympathetic Chain Ganglion

involves the • stenosis of the pulmonary trunk • an interventricular septal defect • displacement of the aorta • and hypertrophy of the right ventricle. Children born with this will exhibit bluish skin upon episodes of crying or feeding.

Tetralogy of Fallot

The left anterior descending branch of the left coronary artery has also acquired the morbid nickname "___ ___ ___" due to it's susceptibility to developing atherosclerotic plaque build up.

The Widow Maker

Anteriorly, the right atrium opens to the right ventricle via the right atrioventricular opening. The right atrioventricular opening is guarded by the ___ Valve or ___ ___ Valve.

Tricuspid; Right Atrioventricular

Parasympathetic innervation of the heart is supplied by the:

Vagus Nerve (CN X)

are numerous small veins that drain the myocardium itself and empty separately into all 4 chambers of the heart.

Venae Cordis Minimae

Within the lungs, blood will give off CO2 and ___ O2.

acquire

The ____ supplies the entire body with blood and originates at the aortic semilunar valve within the left ventricle of the heart.

aorta

courses posteriorly and to the left giving off it's major branches

aortic arch

The spaces between the cusps and the wall of the aorta are termed ____ ___ and differ from the pulmonary sinuses in that the right and left aortic sinuses are the sites of origin for the right and left ___ ___ respectively.

aortic sinuses; coronary arteries

A rounded projection of the heart that points inferiorly and to the left. It lies at the level of the left 6th costal cartilage.

apex

Superiorly, and posteriorly, the fibrous layer of the pericardium blends with the major ___ ___ of the heart (the superior vena cava, ___, and pulmonary trunk).

blood vessels; aorta

Following the coronary arteries, the first main branch off the aortic arch is the:

brachiocephalic trunk

the superior vena cava is formed as the left and right ___ ___ join together and empty into the right atrium.

brachiocephalic veins

The muscle of the heart is drained by the:

cardiac veins

The atrioventricular valve is characteristically composed of three parts: CUSPS are flaps of connective tissue named according to their anatomical position ___ ___ are connective tissue ___ that attach to the lower surface of the cusps.

chordae tendineae ; cords

The next branch off the aortic arch is the left ___ ___ ___ which supplies the left side of the head and neck.

common carotid artery

a venous chamber located on the posterior surface of the heart. It receives the cardiac veins that drain the myocardium of the heart itself. It opens into the right atrium just anterior and superior to the inferior vena cava.

coronary sinus

The atrioventricular valve is characteristically composed of three parts: ___ are flaps of connective tissue named according to their anatomical position.

cusps

The right and left pulmonary arteries carry deoxygenated blood to the right and left lungs respectively. It's important to note that the pulmonary arteries are the only arteries in the body which carry:

deoxygenated blood

courses posterior to the heart as it descends through the thorax.

descending aorta

The pericardium's outer layer blends with the central tendon of the ___ inferiorly.

diaphragm

It's important to note that the inferior vena cava does not attach to the base of the heart but, to it's ____ ____.

diaphragmatic surface

adjacent to the diaphragm

diaphragmatic surface

Both the Left and Right Atria have ___-___ appendages called ___ attached to their lateral surfaces. They increase the internal surface area of the left and right atria. Clinically, the term auricle is also referred to as the ___.

ear-like; Auricles; appendage

The tricuspid valve functions in closing during contraction of the right ventricle. When closed, it will prevent backflow of blood from the right ventricle to the right atrium. The valve is held in a closed position via the chordae tendineae that are attached to the lower surface of the cusps, and are thus not ___ into the atrium.

everted

Receives blood from the lower limbs, pelvis and abdomen and enters the right atrium of the heart inferiorly.

inferior vena cava

This plaque reduces blood flow to the antero-inferior surfaces of the heart which leads to a localized area of myocardial ischemia (___ ___ ___ to the myocardium). Typical treatments include ___ ___ ___ or if the blockage is more advanced, coronary bypass surgery.

lack of oxygen; coronary stint placement

Extending from each side of the nodule is a narrow thin crescent area termed the:

lunula

A Valve is a ___ device that will allow for flow of blood in 1 direction only, thus preventing retrograde flow (flow in the wrong direction).

mechanical

A semilunar valve, unlike atrioventricular valves, does ___ possess papillary muscles and chordae tendineae. Rather, it merely exists as pocket like flaps surrounding an opening.

not

The pulmonary veins are the only veins in the body which carry ____ blood.

oxygenated

The atrioventricular valve is characteristically composed of three parts: CUSPS are flaps of connective tissue named according to their anatomical position CHORDAE TENDINEAE are connective tissue cords that attach to the lower surface of the cusps. ___ ___ are internal folds of ventricular muscle that give attachment to the chordae tendineae.

papillary muscles

In addition to the previous structures, the heart is encased in a tough connective tissue sac called the ____.

pericardium

a fibrous sac that encloses the heart.

pericardium

The Left Anterior Descending (Anterior Interventricular Branch) continues inferiorly across the anterior surface of the heart and terminates by anastomosing with the ___ ___ ___ from the right coronary artery.

posterior interventricular branch

The heart is positioned in such a way that the atria lie ___ (not superior) to the ventricles; thus, blood passing from the atria to the ventricles moves ___ rather that vertically. The heart is located in the thorax between the lungs, resting on the diaphragm.

posterior; horizontally

Leads from the right ventricle and carries deoxygenated blood from the heart to the lungs for oxygenation.

pulmonary trunk

Blood will flow through the __ __ which bifurcates into the left and right ___ ___.

pulmonary trunk; Pulmonary Arteries

Blood will flow through the ___ ___ which bifurcates into the left and right ___ ___. The right and left pulmonary arteries carry deoxygenated blood to the right and left lungs respectively.

pulmonary trunk; Pulmonary Arteries

Following the pulmonary semilunar valve, blood will flow through the ___ ___ into the right and left ___ ___, to the right and left lungs.

pulmonary trunk; pulmonary arteries

When the flow of blood is from the right ventricle into the pulmonary trunk, the valve opens. If the flow is ___, the valve closes.

retrograde

Laterally, the heart is protected by the ___, ___ ___ and ___.

ribs, intercostal muscles and lungs.

The Musculi Pectinati are found in the:

right atrium and in the right and left auricles.

Like any other muscle tissue in the body, the heart relies on nervous innervation to initiate contraction. The nerve impulse initiates at the ___ ___ located at the base of the superior vena cava, just superior to the right atrium.

sinuatrial (SA) node

The spaces between the cusps and the wall of the vessel are called:

sinuses

Anteriorly, the heart is protected by the ___.

sternum

The heart is a muscle that functions in pumping blood through vessels of the cardiovascular system. The heart is composed of ___ muscle, ____ in type.

striated; cardiac

The final branch off the aortic arch is the left ___ ___ which supplies the left upper limb.

subclavian artery

The brachiocephalic trunk quickly branches into the right ___ ___ and the right ___ ___ ___ which supply the right upper limb and the right side of the face and head respectively.

subclavian artery; common carotid artery

drains the head, neck and upper limbs.

superior vena cava

Blood leaves the left ventricle and enters the aorta and then passes to all parts of the ___ ___.

systemic circulation

One major difference between the right and left ventricles is the ___ of the wall itself. The wall of the left ventricle is usually more than twice as thick as that of the right. The right ventricle must pump blood only to 1 organ, the ___. The left ventricle must pump blood to every organ of the body with exception of the lungs. Thus, the left ventricle performs more work and is therefor larger.

thickness; lungs

Posteriorly, the heart is protected by the ____ ____.

thoracic vertebrae

The internal surface of the ventricle consists of irregular ridge like projections of muscle called ___ ___. Papillary muscles are a specialized type of this.

trabeculae carneae

The left ventricle contains the internal muscular ridge like folds called ___ ___. Papillary muscles of the bicuspid valve are a type of trabeculae carneae.

trabeculae carneae

The atria and ventricles are further differentiated by the side of the body; thus we can speak of the 4 chambers as the right atrium, left atrium, right ____ and left ventricle.

ventricle

The great vessels from right to left across the base of the heart can be remembered as "S.A.P." Which stands for:

• Superior vena cava • Aorta • Pulmonary trunk

There are three major venous openings into the right atrium. These are the:

• Superior vena caval opening • Inferior vena caval opening • Opening of the coronary sinus.