LAB 7: LABORATORY CHECKLIST: THE HEART

READING ASSIGNMENT:
GRANT’S DISSECTOR, 14 EDITION, PAGES 64-73
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Pericardium:
- Fibrous Pericardium
- Serous Pericardium
- Parietal layer
- Visceral layer (epicardium)
Nerves:
- Phrenic
- Left Vagus nerve:
- Left recurrent laryngeal nerve
Sinuses:
- Transverse pericardial sinus
- Oblique pericardial sinus
Grooves:
- Atrioventricular groove (coronary sulcus)
- Anterior interventricular groove / sulcus
- Posterior interventricular groove/sulcus
Arteries:
- Pulmonary trunk/ arteries
- Pulmonary valve/ cusps
- Ascending aorta:
- Aortic sinuses
- Ostia for left and right coronary arteries
- Left coronary artery: (Arises from the left posterior aortic sinus)
- Anterior interventricular artery (LAD -Left anterior descending).
- Circumflex branch
- Right coronary artery: (Arises from the anterior or ventral aortic sinus)
- Artery to SA node
- Right marginal branch
- Posterior interventricular artery (PDA)
Veins:
- Great cardiac vein
- Small cardiac vein
- Middle cardiac vein
- Coronary sinus
- Pulmonary veins
- Superior vena cava (SVC)
- Inferior venae cava (IVC)
Right Atrium:
- Musculi pectinati
- Sinus venarum
- Crista terminalis
- Sulcus terminalis
- Fossa ovalis

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 - Limbus of the Fossa ovalis
- Tricuspid valve
- Right auricle
- Opening for IVC
- Opening for SVC
- Opening for coronary sinus
Right Ventricle:
- Trabeculae carneae
- Papillary muscles:
- Anterior
- Posterior
- Septal
- Chordae tendineae
- Moderator band (septomarginal trabecula)
- Conus arteriosus (infundibulum)
- Opening for Pulmonary trunk and the valves
Left Ventricle:
-Trabeculae carneae
- Papillary muscle:
- Anterior
- Posterior
- Chorda tendineae
- Aortic vestibule
- Aortic opening/valve
- Mitral valve
Left Atrium:
- Pulmonary veins
- Left auricle:
- musculi pectinati
- Mitral valve

CLINICAL CASE: THORACIC WALL AND PLEURA

During one of your third-year rotations you observe a resident on your service
perform a thoracocentesis to obtain a sample of pleural fluid. The resident inserts
the needle near the lower border of the eighth rib at the right anterior axillary line
and withdraws a few milliliters of fluid. The next day, during your rounds, the
patient complains of tingling and numbness of the skin of his chest from the level
of the eighth rib down toward the umbilicus on the right side.

Questions to consider:

1. Why is the needle inserted in the eighth interspace?

The needle needs to be inserted below the level of the lungs, in the
costodiaphragmatic recess, which would be the eighth or lower interspace.
Recall that at the midclavicular line, the recess is between rib spaces 6

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 and 8, at the midaxillary line between 8 and 10 and at the paravertebral
line between 10 and 12.

2. How would you explain the presence of the parasthesia?

Parasthesia is normally caused by some sort of nervous insult, i.e.

impingement, cutting, or rough handling of a cutaneous nerve during a
medical procedure, for instance.

3. What specific structure was likely damaged by the needle, and how does
this explain the distribution of the parasthesia?

8th intercostal nerve. The dermatome of the 8th intercostal nerve includes
the region of the chest from about the eighth rib medially and inferiorly,
towards the region just above the umbilicus.

4. What other structures are associated with the damaged structure and how
are they arranged? Between what two muscle layers are these structures
found?

The 8th intercostal artery and vein are associated with the 8th intercostal
nerve, and run along the subcostal groove of the eighth rib. The most
superior structure is the vein, and the nerve is the most inferior structure.
This neurovascular bundle is found between the internal and innermost
intercostal muscles.

5. Where should the resident have inserted the needle to avoid damaging
these structures?

Needles used for thoracocentesis, or any other purpose in the region of

the thorax should always be inserted near the upper border of a rib in
order to avoid damage to the neurovascular bundles found below the ribs.
However, in an intercostal nerve block, the needle would be inserted along
the inferior margin in order to deliver the anesthetic agent to the nerve
lying there.

6. For what other reasons (besides sampling pleural fluid) might

a thoracocentesis be performed?

Thoracocentesis may be used to drain a pleural effusion, empyema,

or hemothorax, as well as to remove air from the pleural space in the case
of pneumothorax.