Anatomy Second Semester Oral Quiz Review1/12/2013 4:47:00 PM
1) Demonstrate the organization of the three layers of the
pericardial sac and explain their role in the occurrence of pericardial
tamponade.
The pericardial sac begins externally with a tough fibrous layer of dense
connective tissue. Internal to that is the serous parietal pericardium, and,
like the lung, there is a visceral pericardium attached directly to the organ
parenchyme, that here, is the myocardium.
Pericardial tamponade is an acute type of pericardial effusion. Due to the
tough outer layer of the pericardial sac, there is a finite space that fluid may
accumulate in, and while it does so, puts a great deal of pressure on the
ventricles, reducing stroke volume. The cause of the effusion can be
myocardial rupture, pericarditis, trauma, neoplasm, and cardiac surgery.
Pressure is relieved by pericardiocentesis (needle inserted from the skin by
ultrasound guidance)
2) Demonstrate the transverse and oblique sinuses of the
pericardium, describing their borders (arterial and venous) and
explain their use in cardiac surgery.
After the pericardial sac has been opened anteriorly, a finger can be passed
through the transverse pericardial sinus posterior to the aorta and
pulmonary trunk. The transverse pericardial sinus is between the venous
and arterial mesocardia, namely, the ascending aorta and pulmonary artery
cranio-ventrally and the superior vena cava dorsally.
The transverse pericardial sinus is especially important to cardiac surgeons.
By passing a surgical clamp or placing a ligature around these vessels,
inserting the tubes of a coronary bypass machine, and then tightening the
ligature, surgeons can stop or divert the circulation of blood in these large
arteries while performing cardiac surgery.
The oblique pericardial sinus lies posterior to the heart (dorsal) and is
bounded
 Anteriorly by serous pericardium of the left atrium
 Posteriorly by the parietal pericardium of the pericardial sac
 Superiorly and laterally by the reflection of serous pericardium
around the four pulmonary veins, SVC & IVC
Lift the apex of the heart and place fingers posterior to the heart to identify
the oblique pericardial sinus. This space is utilized during cardiac surgery to
manually massage and manipulate the heart.
3) Demonstrate the four borders of the heart seen in the anterior
view (inferior, superior, left or right pulmonary) and describe the
structures composing each border.
Right border (from superior to inferior)
 SVC
 Right atrium
 IVC
Left border (from superior to inferior)
 Arch of the aorta (aortic knob on film)
 Pulmonary trunk (knob)
 Left auricle
 Left ventricle
4) Demonstrate the four surfaces of the heart (anterior, posterior,
left & right lateral, inferior & superior) ….[that’s six for those
counting] and describe the structures composing each surface.
Superior: where the great vessels are located
Inferior (floor): directed downward and dorsally, is formed by both ventricles
and rests on the central tendon
Right Lateral: Right atrium, ventricle and vena cavae
Left Lateral: Left auricle, atrium and ventricle
Posterior: Left atrium, vena cavae, pulmonary veins, coronary sinus
Anterior: The apex of the heart, formed by both ventricles, and the left
auricle and right atrium compose the anterior aspect of the heart.
5) Demonstrate the components present in the right atrium and
right ventricle and explain the clinical aspects of right sided failure.
The right atrium receives venous, oxygen-poor blood, from the systemic
circulation via the superior vena cava (SVC), inferior vena cava (IVC), and
(posteriorly) the coronary sinus. The pectinate muscles extend from the
crista terminalis (vertical muscular ridge on the internal surface of the
anterior right atrial wall.) The fossa ovale is also visible, a region of the
interatrial septum, which, in the patient’s embryonic life, served as a rightto-left shunt, known as the foramen ovale. The smooth interior portion of
the anterior right atrial wall is what remains of the sinus venarum.
The right ventricle receives from blood from the right atrium via the
tricuspid valve. The chordae tendineae are ligaments that connect each
cusp to the papillary muscles, allowing them to open when the papillary
muscles are contracting. The valve has a septal, anterior and posterior
valve. Tracking the anterior papillary muscle inferiorly, one can locate the
muscular moderator band (aka septomarginal trabeculae) and follow it to
the ventricular septum. The moderator band carries the right bundle
branch from the AV node. The trabeculae carnea is the term for the
musculature of the right ventricular wall. The conus arteriosus is the
narrowing, smooth walled portion of the ventricle located left and superiorly,
leading to the pulmonary valve, which also has three cusps; anterior, right
and left cusps.
When the right ventricle begins to lose efficiency (losing ejection fraction)
Common clinical symptoms of right-sided heart failure:
 Dyspnea
 Peripheral edema
 Jugular vein distension (JVD)
 Nocturia
 Hepatomegaly
Common causes of right-sided heart failure:
 Coronary artery disease (CAD)
 Left-sided heart failure
 COPD or chronic bronchitis / emphysema alone
 Congestive Heart Failure (CHF)
 Pulmonary embolism (PE)
 Valvular disease / damage / defect
 Anemia (associated)

Hyperthyroidism
6) Demonstrate the components present in the left atrium and left
ventricle and explain the clinical findings in left sided failure.
The left atrium receives oxygen-rich blood from the pulmonary venous
system (2 veins per lung). These pulmonary veins dump into the posterior
region of the left atrium. The left atrium lack pectinate muscles. Blood
passes from the left atrium to the left ventricle via the mitral valve (aka
bicuspid valve).
The left ventricle receives oxygen-rich blood and is responsible for pumping
that into the systemic circulation. With a much thicker myocardium than the
right ventricle, the left also has two papillary muscles, (one per mitral cusp).
Blood is ejected through the aortic (semilunar) valve into the ascending
aorta. From the ascending aorta, you can see the 3 sac-like depressions
called aortic sinuses. From these sinuses you can find the coronary artery
and vein branch points.
Left-sided heart failure is associated with these symptoms & findings:
 Increased work to breath
 Rales or crackles upon auscultation (lung bases)
 Cyanosis
 Cough, frothy
 Hemoptysis
 Needs to elevate head
 Decreased urine production
 Fatigue, weakness
 Paraoxysmal nocturnal dyspnea
 Weight gain
 Laterally displaced heart apex beat
 Gallop rhythm
Common causes of left-sided heart failure:
 MI
 Myocarditis
 High blood pressure


Valvular damage, defect, disease
Hypothryroidism
7) Demonstrate the course of the great vessels in and out of the
heart and explain the two ‘crosses’ present in the heart.
Identify them on your own heart:
 Pulmonary veins



Pulmonary arteries
Ascending aorta
Inferior & Superior Vena Cavae
The two crosses of the great vessels are (1) between the pulmonary veins
and the vena cavae and (2) aorta and the pulmonary trunk (45° from floor)
(Thanks reader)
8) Describe and identify the sites of auscultation of the cardiac
sounds on your partner.
A(ortic) region: Between 2nd & 3rd intercostal spaces, immediately lateral to
sternum (RUSB)
P(ulmonary) region: Left 2nd intercostal space, immediately lateral to
sternum (LUSB)
T(ricuspid) region: 4th to 6th intercostal spaces, at lower left sternal border
(LLSB)
M(itral) region: between 5th and 6th intercostal spaces on the left
mid-clavicular line