Cardiac Anatomy Flashcards
Dextro and levocardia
Dextro - heart points to right
Can also be dextroposition, mesoposition or levoposition (most common)
Persistent L SVC
Drains the left brachiocephalic vein into a dilated coronary sinus
Not azygous/hemiazyous veins
IVC
Returns blood from below diaphragm
Eustachian valve directs blood toward the interatrial septum
Clinical significace of IVC vs SVC
IVC blood generally higher in oxygenation due to renal venous return (filtered but not extracted)
WHen calculating mixed vneous…need to account for IVC blood
Presence of persistent L SVC can agfect central venous catheter poisoning
RA
Furthest to the right and near the diaphragm
Accepts venous return from systemic circulation (SVC, IVC (eustachian) and coronary sinus (Thesbesian))
Crista terminalis
Thick ridge of muscle protruding into the RA
Separates smooth from trabeculated areas of atrium…can be mistaken as a mass
Chiari network
Located near eustachian valve
Normal
Van look like vegetation…mobile mass on echo
Clinical relevance - RA
Crista terminalis and chiari can be mixtaken as mass
Pacemaker lead into RA appendgage
Biventricular pacemaker or ICDs go into coronary sinus via right atrium
LA
Most posterior
Anterior to esophagus but caudal to left bronchus/pulmonary artery
Accepts pulm venous return
Variable size and may impact potential procedures
CLinical relevance of LA
TEE able ot be performed bc LA is next to esophagus (not lung)
LAA is common thrombus fomration location in pts with afib
Pulm veins are commonly origin of Afib
Interatrial spetum
Formed by septum primum and spetum secundum
Fossa ovale
Can contain fat and appears thickened (lipomatous hypertrophy)
Clinical relevance of interatrial septum
Patent foramen ovale (stroke and migraines)
Cather based therapy can reach left atrium via the interatrial septum
Next to aorta anterioroy so must avoid in interatrial septal puncture
RV
Most anteriro (behind sternum)
Rests on top of diaphragm
THin walled
Handles lower rpessure and ejects to pulm artery
Pyramidal in cross section
RVOT
INside the RV
Trabeculated
Associated with tricuspid valve
Septal marginal band
Moderator band
CLinical relevance of RV
Ventricular pacemaker lead placement
DIlation indicates left o right shunts
Pulm HTN
Arrythmogenic RV dysplasia
Chest trauma may be first to be injured in trauam
IV septum
Membranous and muscular septa
Gerbodes defect - where left ventricle and enter the right atrium (atrioventricular septum)
LV
anterio and infrerior to LA
Posterolateral to RV
Higher pressure
Circular in cross section
Volumetrically cone shaped
Thick walled
Less trabeculation
Mitral valve
No septal papillary muscle or moderator band
Relevance of LV
Systolic defect - contracile dysfunction
Diastolic - filling
Chamber can dilate and walls thicken
Mitral valve
Two large leaflets (A and P)
Connect ot two papillary muscles via chordae tendinae
Tricuspid valve
3 leaflets (septal, anterior, posterior)
Valve is slightly apically displaced compared to mitral
Aortic valve
3 cusps (right coronary most anterior, left coronary and noncoronary cusp)
Aorto-mitral continuity
Pulmonic valvle
Opens during systole and closes during distole
No tricuspid pulmonic continuity
Aortic root
Sinus of valsava
SInotubuluar jxn
Ostia or coronary arteries (left and right)
Pulm artery
Exits RV anterior anterior to aorta
Bifurcates into L and R pulm artery
Right runs under aortic arch
Left runs under descneding aorta
Coronary arteries
Most commonly originate above the sinus of valsalva of the right and left coronary cusps
Coronary ostia clinical sig
Need to know for coronary angiography
Determine whether root replacement requires re-implantation of coronaries
Avoid during TAVR
Left and right coronary arteries
Left - LADA, left circumflex
Right coronary - conal , sinoatrial, RV marginal, posterior descending, posterolateral
DOminance
Determined by main vessel giving off post descending artery
85% right (RCA to PDA)
8% left (LCx- PDA)
7% co (both supply PDA)
Coronary sinus
Great cardiac veins
Courses inferior to left AV groove into RA via IA septum
From anterior lwall of left AV groove to coronary sinus
Middle cardiac vein
POst/left marg vein
Thebesian veins
From post IV septum
Lateral LV wall
Directly from myocardium into ventricular chamber
Nervous system
PS - vagal nerve dec HR
Symp - cervical ganglion, inc HR< inc contractility
Cardiac pain can correlate to anything
Pericardium
2 layers - parietal (fibrous) and visceral
