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Grad Cert Ultrasound University of Melbourne > Anatomy of the Heart and Coronary Arteries > Flashcards

Anatomy of the Heart and Coronary Arteries Flashcards

1
Q

Which parts of the heart lie directly under the sternum?

A
  • Right Atrium
  • Right half of the Right Ventricle
  • Left Ventricular Outflow Tract
  • SVC and IVC
  • Ascending Aorta
  • Aortic Valve
  • Tricuspid Valve
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2
Q

What are the sinuses of valsalva and where are they located?

A

The Sinuses of Valsalva (also known as aortic sinuses) are the anatomic spaces in the aortic root just above the aortic valve cusps, between the dilations in the aortic wall and the aortic valve cusps.

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3
Q

What are the the anatomical structures in the following image?

A
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4
Q

What are the names of the highlighted areas?

A
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5
Q

What major vascular structures are positioned behind the sternal manubrium?

A
  • Aortic arch
  • brachiocephalic trunk
  • Origin of left common carotid artery
  • Origin of left subclavian artery
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6
Q

What anatomical structure makes the distal portion of the ascending aorta and proximal portion of the aortic arch invisible during TOE?

A

The location of the trachea and left main bronchus between the oesophagus and the aortic arch.

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7
Q

Where does the ascending aorta travel in relation to the pulmonary arteries?

A

It crosses beneath the main pulmonary artery and then travels in an anterior, cranial and rightward direction over the origin of the right pulmonary artery in a superior direction

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8
Q

What is the highlighted part of the aorta called?

A

The aortic isthmus

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9
Q

Where does the oeseophagus sit in relation to the aortic arch?

A

it is located posteriorly to the aortic arch.

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10
Q

Where is the descending thoracic aorta positioned in relation to the vertebrae?

A

The descending thoracic aorta is positioned anteriorly to the spine.

It runs downward from the anterior left side of T4 to the anterior midline of T11.

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11
Q

Where does the oesophagus sit in relation to the aorta from the arch to the diaphragm?

A

The oesophagus is posterior to the aortic arch. It lies to the right of the top of the descending thoracic aorta in the same coronal plane at the level of T4.
It then begins to move anteriorly to the left and by the time it reaches T11 where it passes through the diaphragm it is anterior to the thoracic aorta crossing from right to left.

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12
Q

What is the cardiac skeleton?

A

The supporting fibrous framework within the heart composed of dense collagen with membranous, tendinous and fibrous extensions.

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13
Q

What roles does the cardiac skeleton have?

A
  • Provide stable attachment for the atrial and ventricular myocardium.
  • Anchor cardiac valves.
  • Provide electrical insulation between the atrial and ventricular myocardium.
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14
Q

What are the main components of the cardiac skeleton?

A
  • 4 fibrous rings (anuli fibrosi) that encircle the heart valve orifices.
  • Right and left trigones
  • Membranous aspects of the interatrial, interventricular and atrioventricular septa.
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15
Q

Name the following parts of the cardiac skeleton.

A
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16
Q

Name the following structures and valves.

A
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17
Q

What are the fila coronaria?

A

the two fibrous prongs with curve around the mitral and tricuspid orifices that make up the left and right fibrous rings, respectively.

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18
Q

What parts of the cardiac skeleton are connected by the right fibrous trigone?

A

The right fibrous trigone is the thick fibrous tissue at the intersection of the mitral and tricuspid annuli, the membranous septum and the aortic fibrous ring.

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19
Q

Where does the bundle of his pass through the cardiac skeleton?

A

Through the middle of the right fibrous trigone where it superiorly borders the intraventricular septum.

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20
Q

Where is the left fibrous trigone located?

A

The left fibrous trigone connects the aortic valve annulus (on the side of the left coronary cusp), and the anterior part of the left side of the mitral valve annulus.

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21
Q

At what level of the sternum does the pleural attachment divert, and in what direction?

A

At the 4th costal cartilage the pleural attachment diverts laterally in an oblique line to the level of the 6th costal cartilage.

22
Q

What causes lungs to meet or cross the sternal midline?

A

hyper-inlfation from PEEP or chronic airway disease.

23
Q

What effect does positioning the patient supine as opposed to left lateral have on cardiac windows?

A

Supine positioning moves the windows one to two rib spaces inferiorly.

24
Q

label the following parts of the lungs and identify the cardiac notch and the lingula.

25
What is the average weight of the adult human heart in men and women?
* Men: 325g * Women: 275g
26
Describe the flow of blood through the heart.
* Deoxygenated blood enters the RA through IVC/SVC. * Bloodis pumped by RA to RV via tricuspid valve. * RV pumps blood to pulmonary artery via pulmonary artery. * Blood returns from lungs via pulmonary veins to LA. * Blood is pumped by LA to LV via mitral valve. * Blood is pumped by LV to body for circulation via Aortic valve into the Aorta.
27
Which chamber of the heart is the most posterior, and what structure passes directly behind it?
The left atrium is the most posterior chamber. The oesophagus passes directly behind it.
28
Where is the Left Atrial Appendage (LAA) located?
The LAA is part of the LA. It is a small pouch connected to the left wall of the LA, lying anterior to the LA and adjacent to the LV. It may be multi-lobular but this cannot often be seen on TTE.
29
What is the function of the Left Atrial Appendage?
The LAA relieves high atrial pressures in times of stress by acting as an overflow vessel. When this occurs it acts as a modulator of intravascular volume by releasing Atrial Natriuretic Peptide (ANP) and Brain Natriuretic Peptide (BNP) into the coronary sinus as a response to increased myocyte stretch to regulate blood pressure and volume.
30
What veins enter the Left Atrium?
The four pulmonary veins carrying oxygenated blood from the lungs enter the LA. * Left superior pulmonary vein * Left inferior pulmonary vein * Right superior pulmonary vein * Right inferior pulmonary vein
31
Where is the right atrium located?
Anteriorly and to the right of the LA in the same transverse plane, and posteriorly to the Right wall of the RV.
32
What is the anatomy of the Right Atrium (RA)?
The RA has a principle cavity and an anteriorly/superiorly located chamber called the Right Atrial Appendage (RAA). The IVC, SVC and CS drain into the posterior region of the RA. There is a piece of tissue at the IVC/RA junction called the Eustachian Valve. The medial wall of the RA acts as the interatrial septum. In the middle of this septum is an especially thin part known as the Fossa Ovalis.
33
Label the following parts of the heart.
34
Label the following parts of the heart.
35
* What is the general anatomy of the Right Ventricle (RV) and the 3 portions of it? * What part of the RV wall is thickest/thinnest?
* The LV is in the shape of a cone, mostly posterior to the RV. The right wall forms part of the interventricular septum. It is made up of an inlet portion containing the MV, an outlet portion leading to the AV, and an apical portion. * The RV wall is thickest at the base, gradually tapering to the apex where it is thinnest.
36
What is contained within the apical portion of the left ventricle?
Fine trabeculations extend from the endocardium.
37
Describe the Left Ventricular Papillary Muscles.
There are 2 LV Papillary muscles. The Anterolateral and posteromedial papillary muscle. They originate near the junction between the apical and middle third of the LV. They connect to the Mitral Valve leaflets with cordae tendinae.
38
Which part of the heart is the most anterior? How much of the anterior surface of the heart does it form?
The right ventricle is the most anterior part of the heart, and forms two thirds of the anterior surface of the heart.
39
* What is the general anatomy of the Right Ventricle (RV)? * What are the 3 portions of the RV?
* The RV is shaped like a cone, positioned anteriorly to the LV. The TV and PV are at it's base facing posteriorly/superiorly. * The Inflow tract containing the TV, the outflow tract containing the PV, and the body/apex.
40
What lines the body and apex of the right ventricle?
Coarse trabeculated myocardium.
41
What is the moderator band?
A thin band of tissue containing conducting tissue that runs from the interventricular septum to the free wall of the RV. This is located near the RV apex.
42
What is the pericardium?
A sac that encases the heart containing serous lubricating fluid.
43
What are the layers of the cardiac tissue and the pericardium?
* Endocardium * Myocardium * Epicardium (Visceral Pericardium) * Pericardial cavity * Parietal pericardium * Fibrous pericardium
44
What are the functions of the pericardium?
The pericardium fixes the position of the heart in the middle mediastinum and limits unnecessary motion. It also protects the heart from infection and physical damage.
45
At what points does the pericardium attach to the body?
The pericardium attaches inferorly with the central tendon of the diaphragm. It attaches to the sternum and the vertebral column by ligaments.
46
* What is the name of the following coronary artery * What part of the heart does it perfuse? * What percentage of the heart does it supply?
* The Left Anterior Descending Artery (LAD). * It perfuses the anterior portion of the interventricular septum, the anterior wall and apex of the LV including the bundle branches. * The LAD supplies approx. 50% of the cardiac blood flow.
47
* What is the name of the highlighted coronary artery? * Where does it originate from? * What part of the heart does it supply?
* Left Main Coronary Artery (LMCA) * It originates in the Coronary Sinus of Valsalva within the ascending aorta, behind the left coronary cusp of the aortic valve. * It bifurcates into the Left Anterior Descending (LAD) and the Circumflex (Cx) arteries that supply the Ventricular Septum, LV and LA.
48
* What is the name of the highlighted coronary artery? * What part of the heart does it perfuse?
* The Circumflex (Cx) Artery * It perfuses the lateral wall of the LV, as well as the LA. It often also supplies the SA and AV node.
49
* What is the name of the following coronary artery? * Where does it originate from? * What parts of the heart does it supply?
* The Right Coronary Artery (RCA). * It originates in the Sinus of Valsalva within the ascending aorta behind the right coronary cusp. * It supplies the RV, RA, posterior interventricular septum. In most people it also supplies the SA and AV nodes.
50
* What is the name of the highlighted structure? * What does it connect to?
* The Coronary Sinus (CS) vein. * It drains into the Inferior Vena Cava.
51
What is the name of the following structure?
The Great Cardiac Vein.
52
Where is the Vein of Marshall located?
It runs in an inferior direction from the top of the Left Atrium, between the LA and the Left Atrial Appendage. It connects to the Coronary Sinus.

Grad Cert Ultrasound University of Melbourne (7 decks)

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