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MIDS 197 > Ch 8 Wall Segs + Coronary Arteries > Flashcards

Ch 8 Wall Segs + Coronary Arteries Flashcards

1
Q

Which coronary artery is known as the widow maker?

A

LAD

(b/c is worst vessel to become blocked, many men die of blockage in this artery )

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2
Q

Where does the LMCA/LCA arise from?

A

Superior aspect of left coronary sinus of valsalva

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3
Q

The LCA divides into what?

A

-LAD
-LCx

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4
Q

The LAD extends where?

A

Into the interventricular groove down the anterior wall to the LV apex

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5
Q

The LCx extends where?

A

Continues laterally in the atrioventricular groove

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6
Q

The RCA arises from what?

A

Superior aspect of the right coronary sinus of valsalva

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7
Q

The RCA divides into what?

A

-Right posterior descending artery (RPDA)
-Large marginal branch

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8
Q

The RPDA lies where?

A

In the inferior interventricular groove

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9
Q

What is coronary artery disease?

A

The narrowing or blockage of the coronary arteries, typically due to plaque build up which then causes ischemia (lack of blood perfusion)

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10
Q

What is one of the m/c indications for an echo exam?

A

Suspected or documented CAD

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11
Q

List 3 main symptoms of CAD?

A

-Angina (chest pain)
-Fatigue/weakness
-Dyspnea with or w/o exertion (DOE)

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12
Q

Is echo able to assess systolic wall thickening + endocardial motion?

A

Yes! Able to assess specific segments experiencing wall motion abnormalities

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13
Q

What is abnormal wall motion caused by?

A

Lack of blood perfusion to myocardium - we can visualize this

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14
Q

Does echo provide detailed visualization of distal vessel anatomy or location/severity of CAD narrowing?

A

Nope!

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15
Q

What is the procedure of choice for direct assessment of CAD (the gold standard)?

A

Coronary angiogram

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16
Q

What is a coronary angiogram procedure?

A

-M/c as an outpatient procedure
-A catheter is snaked up through the femoral or radial artery into the heart where contrast is released into the coronaries to map them
-Fluroscopy (form of x-ray) is used to capture images in quick succession for a clip

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17
Q

What do coronary angiograms allow rapid assessment of?

A

Of blocked coronaries + coronary stents can be launched in area of stenosis as well

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18
Q

80% of pt’s have a right or left sided dominant coronary circulation?

A

Right! Meaning the RCA gives rise to the PDA

(20% left - meaning the LCx gives rise to the PDA)

19
Q

What variability is why in coronary artery charts we see cross overs b/w certain wall segment perfusions?

A

Variability b/w right + left sided dominant coronary circulation (right is m/c)

20
Q

LAD can supply up to how much blood in the LV?

A

55% (a key vessel for blood supply to the heart)

21
Q

If the LAD is blocked proximally, will the rest of the vessel supplying blood to the anterior heart become blocked too?

A

Yes

22
Q

What does blockage in the LAD lead to?

A

Massive heart attack/myocardial infarction + potentially sudden death

23
Q

Where is the basal segment?

A

Area extending from the MV annulus to MV tips of the pap muscles

24
Q

Where is the mid cavity segment?

A

Area includes entire length of pap muscles

25
Q

Where is the apical segment?

A

Area beyond pap muscles

26
Q

An entire wall is broken up into what?

A

Individual segments

27
Q

Wall segments follow a naming scheme based on what?

A

Their position (basal, mid, apical) + the individual wall they belong to

28
Q

Which segment model is the m/c + the one we follow?

A

Model 17 - is recommended by ASE

(there are also 16 + 18 models)

29
Q

LAD delivers oxygenated blood where?

A

To anterior part of IVS, anterior wall + apex of heart

30
Q

The areas of possible overlap b/w RCA + LCx are based on what?

A

Coronary dominance

31
Q

The RCA delivers oxygenated blood where?

A

To inferior aspect of IVS, inferior wall + RV free wall

32
Q

The inferolateral (posterior) LV wall may be supplied by what?

A

Supplied by extension branches from the RCA

33
Q

The LCx delivers oxygenated blood where?

A

To lateral wall:
-Anterolateral wall segs
-Inferolateral wall segs

34
Q

What is considered normal wall motion?

A

Normal endocardial inward motion + wall thickening in systole

35
Q

What is hypokinesis wall motion?

A

-Reduced amplitude (<5mm) + velocity of endocardial motion + wall thickening in systole
-Delay in the onset of contraction + relaxation

36
Q

What is akinesis wall motion?

A

Absence of inward endocardial motion (<2mm) or wall thickening in systole

37
Q

What is dyskinesis wall motion?

A

Outward motion or bulging of the segment in systole, m/c associated with thin + scarred myocardium

38
Q

What is aneurysmal wall motion?

A

Diastolic contour abnormality with dyskinesis

39
Q

Ischemia results in what in regards to wall motion?

A

A decrease in total amplitude, velocity of endocardial motion, wall thickening + in a delay in the onset of contraction/relaxation

(this decrease is what we are qualifying with the following terms: hypokinesis, akinesis, dyskinesis, aneurysmal)

40
Q

What is global depression?

A

Refers to the entire wall being abnormal + sucking together

41
Q

What is the overall wall motion score formula?

A

Sum of individual segment scores / # of segments visualized

42
Q

List the numeric scoring system for wall motion?

A

1 = normal
2 = hypokinetic
3 = akinetic
4 = dyskinetic
5 = aneurysmal

43
Q

Which coronary artery primarily supplies the RV?

A

RCA - via acute marginal branches

44
Q

The more proximal an occlusion, the more or less myocardium will be affected?

A

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MIDS 197 (15 decks)

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