(Return to Courseware Index) Middle Mediastinum LAB MANUAL |Topic and Text Reference | Learning Objectives | Special Instructions | Clinical Exercises | Key Structures TOPIC AND TEXT REFERENCE: MIDDLE MEDIASTINUM PP. 52-59 LEARNING OBJECTIVES: Learn the borders of the four regions of the mediastinum. Examine the four chambers of the heart and their relationship to each other and surrounding organs and structures. Study the sternocostal, base and diaphragmatic surfaces of the heart and learn which chambers contribute to each. Examine the serous membranes associated with the heart and pericardial cavity. Find the tranverse and oblique pericardial sinuses. Trace the coronary blood vessels (arteries and veins) of the heart, their anastomoses, and understand right/left dominant variations. Understand the pathway of the blood through the heart and how it differs from the prenatal blood flow. Learn the identifying features within each chamber. (conus arteriosus, crista terminale, etc.) Understand and identify the innervation to the parietal pericardium vs the innervation to the heart itself. Understand the conducting system of the heart. Understand referred pain from the heart. SPECIAL INSTRUCTIONS FOR LAB TODAY: Begin the dissection as written in the dissector. Pg. 54: After consultation with the instructors, tables will either be advised to remove the heart completely or merely mobilize it. If your table is asked to only mobilize the heart you should cut the IVC as inferiorly in the pericardial cavity as possible. In this way it will be possible to study the heart in situ as well as outside the cadaver. Pg. 56: To open the right atrium do not use the cut suggested in the dissector. Instead, open the right atrium by making an incision that begins in the lateral aspect of the inferior vena cava and ends in the wall of the superior vena cava.   CLINICAL CORRELATIONS AND EXERCISES: With skin flaps closed on your cadaver mark with a pen where you would ascultate the four cardiac valves? When a transesophageal echocardiogram is performed, which chamber is most easily observed? In other words which chamber lies directly anterior to the esophagus? If a cardiac vessel ruptures, where does the blood collect? How does this affect the functioning of the heart? Locate the fossa ovalis and the ligamentum arteriosum, which are embryological remnants of the foramen ovale and the ductus arteriosus respectively. What are the ramifications of defects in these two structures? Where is the bare area of the pericardium (as opposed to the bare area of the heart), and why is it clinically important? KEY STRUCTURES: You should be able to identify in a cadaver all the structures listed under key words unless they have an asterisk. structure Netter's Gold Standard structure Netter's Gold Standard Arteries     Other structures - heart     anterior interventricular artery (LAD) N1   aortic cusps N1   circumflex artery N1   bicuspid valve (mitral valve) N1   anterior right atrial artery     chordae tendineae N1   ascending aorta N1   conus arteriosus N1   coronary artery, left N1   coronary sinus N1   nodal artery N1   coronary sulcus N1   posterior interventricular artery N1   crista terminalis N1   pulmonary trunk N1   epicardium     Ligaments     fossa ovalis N1   ligamentum arteriosum N1   interventricular grooves     Nerves     left atrium N1   vagus nerve, left N1   left ventricle N1   recurrent laryngeal nerve N1   limbus N1         location of AV node N1   Veins     location of SA node N1   great cardiac vein N1   moderator (septomarginal) band N1   inferior vena cava N1   oblique pericardial sinus N1   middle cardiac vein N1   papillary muscle N1         pectinate muscles N1         pericardial sac N1         right atrium N1                                   |Topic and Text Reference | Learning Objectives | Special Instructions | Clinical Exercises | Key Structures

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