1

A patient is diagnosed with ischemia (i.e., lack of blood flow) in a

left lobar pulmonary vein. The attending physician determines that

the ischemia is due to a vasospastic episode. Constriction of this

left lobar pulmonary vein is controlled by ____________.

effe

rent f

iber

s from

t..

sym

pathet

ic fi

bers

fr..

par

asym

pathet

ic fi

ber...

affe

rent f

iber

s from

th...

sym

pathet

ic fi

bers

fr..

0% 0% 0%0%0%

0

of

5

A. Efferent fibers from the phrenic nerve.

B. Post-ganglionic fibers from T1-T4sympathetic trunks

C. Post-ganglionic fibers from the vagus n.

D. Afferent fibers from the phrenic nerve

E. Sympathetic fibers from the vagus n.

Heart

• Surface anatomy and heart sounds

-Dry lecture

-Gray’s 169, 203-205

• Heart

-Gray’s pp. 153-181

-Gray’s dissector pp. 84-101

2

Subdivisions of the Mediastinum

The Heart

3

The Heart

Pericardium

Pericardium1. Fibrous pericardium (external sac)

2. Serous pericardium (internal sac) (parietal layer– lines the inner surface of the fibrous) (visceral layer [epicardium] – adheres to the heart)

Syllabus p. 41

4

Vessels and Nerves of the Pericardium

A patient is diagnosed with cardiac tamponade. Pericardiocentesis

is needed to drain fluid from the pericardial cavity to relieve

pressure on the heart. To remove fluid a wide bore needle is

inserted through the ________ intercostal space near the

____________ and passed superoposteriorly.

5th

or 6

th, s

tern

um, i

n...

5th

or 6

th, m

id-a

xilla

ry...

C. 2

nd, ste

rnal

angle

, ...

D. 2

nd, ste

rnal

angle

, ...

E. 5

th o

r 6th

, mid

-ver

...

0% 0% 0%0%0%

0

of

5

A. 5th or 6th, infrasternal angle

B. 5th or 6th, mid-axillary line

C. 2nd, sternal angle

D. 2nd, jugular notch

E. 5th or 6th, mid-vertebral line

5

Cardiac Tamponade

Walls of the Heart

Syllabus p. 41

6

General Features of the Heart

Arterial Supply of the Heart

Syllabus p. 42

7

Coronary AngiographyArterial Supply of the Heart

Venous Drainage of the Heart

8

Chambers of the Heart

Right Atrium

Syllabus p. 44

9

Tricuspid Valve and Right Ventricle

Left Atrium and Ventricle

10

Syllabus p. 45

Ventricular Filling MV and TC valves close

Heart Valves (Diastole)

Syllabus p. 45

Ventricular Contraction Semilunar valves close

Heart Valves (Systole)

11

Sympathetic Innervationof the Heart

Syllabus p. 46

ParasympatheticInnervation of the Heart

12

Referred Pain

Innervation of the Heart

• Sympathetic Innervation

-Increases heart rate and force of contraction

-Dilates coronary arteries

• Parasympathetic Fibers

-Decreases heart rate and force of contraction

-Constricts coronary arteries

13

Conduction System ofthe Heart

Syllabus p. 48

Blood Flow to and from the Heart

14

An aneurysm in the aortic arch compresses the left

vagus nerve and alters its activity. Stimulation of

parasympathetic vagus nerves __________.

Incr

ease

s hea

rt ra

te

Dila

tes

coro

nary

arte

ries

C. C

onstric

ts c

oronar

...

D. I

ncrea

ses

the

forc

e ..

E. C

onstric

ts p

ulmon...

40%

20% 20%

0%

20%A. Increases heart rate

B. Dilates coronary arteries

C. Constricts coronary arteries

D. Increases the force of theheartbeat

E. Constricts pulmonary arteries

A thrombus develops in the right atrium of a patient and

eventually lodges itself in the sinuatrial nodal branch

artery. Identify the course of the thrombus from the

right atrium to the sinuatrial nodal branch artery.

Rig

ht atriu

m, t

ricusp

i...

Rig

ht atriu

m, m

itral

va.

..

C. R

ight a

triu

m, t

ricu...

D. R

ight a

triu

m, m

itral

...

E. R

ight a

triu

m, t

ricus.

..

0% 0% 0%0%0%

0

of

5

A. Right atrium, tricuspid valve, right ventricle, aorticvalve, right coronary artery, sinuatrial nodal branchartery

B. Right atrium, mitral valve, right ventricle, aortic valve,right coronary artery, sinuatrial nodal branch artery.

C. Right atrium, tricuspid valve, right ventricle, aorticvalve, left coronary artery, sinuatrial nodal branchartery.

D. Right atrium, mitral valve, right ventricle, aortic valve,left coronary artery, sinuatrial nodal branch artery

E. Right atrium, tricuspid valve, right ventricle, aorticvalve, right coronary artery, right marginal branch,sinuatrial nodal branch artery

15

SCREEN 2

Subdivisions of the Mediastinum

16

Pericardial Parts

17

Vessels and Nerves of the Pericardium

18

Cardiac Tamponade

Walls of the Heart

19

General Features of the Heart

Arterial Supply of the Heart

20

Venous Drainage of the Heart

21

Blood Flow to and from the Heart

Tricuspid Valve and Right Ventricle

22

Left Atrium and Ventricle

Heart Valves (Cardiac Cycle)

23

Sympathetic Innervation of the Heart

Sympathetic Innervation of the Heart

24

Parasympathetic Innervation of the Heart

Visceral Sensory Fibers from the Heart

Syllabus p. 47

25

Referred Pain

Conduction System ofthe Heart

26

Syllabus p. 49

Blood Flow to and from the Heart