Heart & Pericardium

1.A 55-year-old male brought to the emergency department with complaints of severe squeezing chest pain, breathing difficulty, sweating and pain along the inner aspect of left upper limb. After taking an electrocardiogram a provisional diagnosis of acute myocardial infarction was made. Apply your knowledge in anatomy and answer the following questions related to coronary artery.  Describe the origin, course, relations and branches of left coronary artery.  Describe the arterial supply of conducting system of heart.  Describe the venous drainage of heart.  Name two arteries supplying the heart most commonly involved in ischemic heart disease

2.A 40-year-old patient presents with a palpable pulsation on the left side of her chest. Upon examination, it is found that the pulsation is localized to the left fifth intercostal space 9cm lateral to the sternum.

• a) What is the term used to describe this pulsation.
• b) Name the chamber of heart which causes this palpable pulsation
• c) Explain the external features and internal features of this chamber of heart
• d) Describe the blood supply of this chamber of heart

3.A 60 year old man who is a smoker, alcoholic and known hypertensive suddenly developed pain in the left side of chest radiating along the medial border of left arm. ECG showed myocardial ischaemia. Coronary angiogram was advised for further evaluation. Based on your knowledge of anatomy answer the following:

• a) Describe the origin, course, branches and distribution of coronary arteries
• b) Add a note on coronary dominance
• c) Explain the nerve supply of heart

4.Describe the Heart under the following headings:-

• a) External features - Surfaces, borders and grooves and sulcus with their contents
• b) Describe the blood supply of the heart
• c) Add a note on the coronary dominance
• d) Applied anatomy

5.A 60 years old man while rushing to catch a train in the railway station felt severe chest pain with profuse sweating and tingling sensation along the medial aspect of his left arm. He was soon taken to the hospital where an ECG showed irregularities. His blood pressure dropped dramatically and he lapsed into deep coma and died several minutes later. Post mortem study revealed total obstruction of the left coronary artery and near complete obstruction of the right coronary artery. Based on your anatomical knowledge answer the following questions: • Explain how a coronary artery diseases produces retrosternal chest pain, tingling sensation along the medial side of his left arm and increased sweating. • Briefly describe the origin, course and areas of distribution of coronary arteries. • What is meant by left artery dominance. • Obstruction to which coronary artery is more likely to produce irregularities in hearts rhythm and why. • Mention the sites where the branches of left and right coronary arteries anastomose; what is the functional significance of these anastomosis (2+4½+1+1+1½=10)

1.Describe the features of the interior of the right atrium. Add a note on its development

2.Pericardium

3.Blood supply of heart

4.Describe the arterial supply of heart. Add a note on Coronary Artery Bypass Grafting

5.Right atrium – gross anatomy and development

1.Coronary sinus

2.Describe the anatomical basis of ischemic heart disease

3.Pericardial sinuses

4.Draw a neat labelled diagram of the anterior view of arteries supplying the heart

5.Pericardium

6.Sinuses of pericardium

1.Developmental sources of interatrial septum

2.Sterno-costal surface of heart

3.Tributaries of coronary sinus of heart

4.Assertion: The sinuses of pericardium are formed by the reflection of serous pericardium Reason: During cardiac surgery, the ligature is passed through the oblique sinus

5.The chamber of heart that forms the apex of heart

6.Boundaries of transverse sinus of pericardium

7.Interventricular septum

8.Relations of heart and great vessels to the anterior wall of thorax – surface marking - (borders, surfaces, valves of heart)

9.Transverse pericardial sinus

1.Which of the following statements are true about Fallot’s Tetralogy

• 1) Atrial Septal Defect
• 2) Pulmonary Stenosis
• 3) Left Ventricular Hypertrophy
• 4) Cyanotic Congenital Heart Disease
• a) 1, 2, 3
• b) 1, 3
• c) 2, 4
• d) 1, 3, 4

2.Which part of primitive heart is continuous cranially with the aortic sac

• a) Bulbus cordis
• b) Primitive ventricle
• c) Sinus venosus
• d) Primitive atrium

3.A: Anterior cardiac veins open into coronary sinus R: Coronary sinus is the largest vein of the heart

• a) Both A and R are true and R is the reason for A
• b) Both A and R are true and R is not the reason for A
• c) A is correct but B is incorrect
• d) A is incorrect but R is correct

4.A: Left ventricular hypertrophy is a feature of Fallot’s tetralogy of heart R: Pulmonary stenosis is also a feature of Fallot’s tetralogy of heart

• a) Both A and R are true, and R is the reason for A
• b) Both A and R are true, and R is not the reason for A
• c) A is correct but R is incorrect
• d) A is incorrect but R is correct

5.Feature of interior of right atrium is

• a) Trabeculae carneae
• b) Musculi pectinati
• c) Septomarginal trabeculae
• d) Moderator band

6.Which of the following statement/s is /are true about transverse sinus of pericardium?

• i) Anteriorly it is bounded by ascending aorta and pulmonary trunk
• ii) Posteriorly it is bounded by left atrium
• iii) During cardiac surgery it is used to ligate aorta and pulmonary trunk
• iv) Develops due to degeneration of dorsal mesocardium
• a) i, ii, iii
• b) i, iii, iv
• c) i, ii, iv
• d) ii, iii