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  <head>
    <title>077-02 Mediastinum, pericardium, heart, coronary circulation, and great vessels</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Mediastinum, heart, and great vessels">
      <outline text="Mediastinal compartments">
        <outline text="Central corridor between pleural cavities">
          <outline text="One lesion can compress several systems"/>
        </outline>
        <outline text="Sternal angle plane to T4-T5 disc">
          <outline text="Divides superior from inferior"/>
        </outline>
        <outline text="Inferior split by pericardium"/>
        <outline text="Superior order: vein, artery, airway, oesophagus"/>
        <outline text="Anterior: loose tissue, nodes, thymic tissue"/>
        <outline text="Middle: pericardium, heart, phrenic nerves"/>
        <outline text="Posterior: aorta, oesophagus, duct, azygos"/>
        <outline text="Mass sites are tendencies, not rules"/>
      </outline>
      <outline text="Pericardium">
        <outline text="Fibrous sac on tendon, vessels, sternum"/>
        <outline text="Serous parietal and visceral layers"/>
        <outline text="Transverse sinus behind arterial outflow">
          <outline text="Surgical passage around aorta, trunk"/>
        </outline>
        <outline text="Oblique sinus behind left atrium"/>
        <outline text="Phrenic anterior, vagus posterior to roots"/>
        <outline text="Tamponade physiology">
          <outline text="Rapid fluid raises pressure, impairs filling"/>
          <outline text="Slow fluid stretches sac first"/>
          <outline text="Right chambers vulnerable in diastole"/>
        </outline>
      </outline>
      <outline text="External cardiac surfaces">
        <outline text="Apex mainly left ventricle"/>
        <outline text="Base mainly left atrium, faces back"/>
        <outline text="Borders">
          <outline text="Right border right atrium"/>
          <outline text="Left border left ventricle and auricle"/>
        </outline>
        <outline text="Sternocostal surface mainly right ventricle"/>
        <outline text="Diaphragmatic surface mainly left ventricle"/>
      </outline>
      <outline text="Chambers and valves">
        <outline text="Right atrium receives cavae, coronary sinus">
          <outline text="Crista terminalis divides wall"/>
          <outline text="Fossa ovalis marks foramen ovale"/>
        </outline>
        <outline text="Right ventricle with moderator band">
          <outline text="Conus arteriosus to pulmonary valve"/>
        </outline>
        <outline text="Left atrium receives pulmonary veins"/>
        <outline text="Mitral valve with two papillary groups"/>
        <outline text="Thick left ventricle for systemic ejection"/>
        <outline text="Coronaries from right and left aortic sinuses"/>
        <outline text="Closure by pressure reversal, coaptation">
          <outline text="Papillary muscles prevent prolapse only"/>
        </outline>
        <outline text="Fibrous skeleton insulates atria"/>
      </outline>
      <outline text="Coronary territories">
        <outline text="Right coronary in right groove">
          <outline text="Nodal and posterior interventricular branches"/>
        </outline>
        <outline text="Left coronary splits in two">
          <outline text="Anterior interventricular: anterior septum"/>
          <outline text="Circumflex in left groove"/>
        </outline>
        <outline text="Dominance by posterior interventricular origin">
          <outline text="Affects inferior wall and nodal supply"/>
        </outline>
        <outline text="Functional end arteries">
          <outline text="Acute occlusion infarcts"/>
          <outline text="Gradual narrowing enlarges collaterals"/>
        </outline>
        <outline text="Subendocardium perfused mainly in diastole"/>
        <outline text="Veins drain to coronary sinus"/>
      </outline>
      <outline text="Conduction and autonomic supply">
        <outline text="Sinoatrial node near caval entry"/>
        <outline text="Atrioventricular node near coronary sinus"/>
        <outline text="Bundle crosses skeleton, splits in two">
          <outline text="Right bundle through moderator band"/>
          <outline text="Left bundle fans along septum"/>
        </outline>
        <outline text="Nodal supply varies with dominance"/>
        <outline text="Septal or valve injury impairs conduction"/>
        <outline text="Sympathetic raises rate and force"/>
        <outline text="Vagus slows nodal function"/>
        <outline text="Pain afferents with sympathetics">
          <outline text="Referred chest and medial arm pain"/>
        </outline>
      </outline>
      <outline text="Great-vessel relations">
        <outline text="Ascending aorta gives coronaries"/>
        <outline text="Arch over left main bronchus to T4"/>
        <outline text="Pulmonary trunk anterior to aorta">
          <outline text="Right artery behind aorta and cava"/>
        </outline>
        <outline text="Ligamentum arteriosum near left recurrent nerve"/>
        <outline text="Left brachiocephalic vein crosses anteriorly"/>
        <outline text="Azygos arches over right root"/>
        <outline text="Thoracic duct empties at left venous angle">
          <outline text="Injury causes chylothorax"/>
        </outline>
      </outline>
      <outline text="Mediastinal pathology">
        <outline text="Dissection extends to branches, valve">
          <outline text="Pericardial rupture causes tamponade"/>
          <outline text="Pleural rupture causes haemothorax"/>
        </outline>
        <outline text="Aneurysm compresses nerve, airway, veins"/>
        <outline text="Left atrial enlargement affects oesophagus"/>
        <outline text="Caval obstruction: collaterals, oedema"/>
        <outline text="Pneumomediastinum tracks fascial planes"/>
        <outline text="Auscultation sites are transmission points">
          <outline text="Echocardiography shows real valves"/>
        </outline>
      </outline>
    </outline>
  </body>
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