Ch 8 Wall Segs + Coronary Arteries Flashcards
Which coronary artery is known as the widow maker?
LAD
(b/c is worst vessel to become blocked, many men die of blockage in this artery )
Where does the LMCA/LCA arise from?
Superior aspect of left coronary sinus of valsalva
The LCA divides into what?
-LAD
-LCx
The LAD extends where?
Into the interventricular groove down the anterior wall to the LV apex
The LCx extends where?
Continues laterally in the atrioventricular groove
The RCA arises from what?
Superior aspect of the right coronary sinus of valsalva
The RCA divides into what?
-Right posterior descending artery (RPDA)
-Large marginal branch
The RPDA lies where?
In the inferior interventricular groove
What is coronary artery disease?
The narrowing or blockage of the coronary arteries, typically due to plaque build up which then causes ischemia (lack of blood perfusion)
What is one of the m/c indications for an echo exam?
Suspected or documented CAD
List 3 main symptoms of CAD?
-Angina (chest pain)
-Fatigue/weakness
-Dyspnea with or w/o exertion (DOE)
Is echo able to assess systolic wall thickening + endocardial motion?
Yes! Able to assess specific segments experiencing wall motion abnormalities
What is abnormal wall motion caused by?
Lack of blood perfusion to myocardium - we can visualize this
Does echo provide detailed visualization of distal vessel anatomy or location/severity of CAD narrowing?
Nope!
What is the procedure of choice for direct assessment of CAD (the gold standard)?
Coronary angiogram
What is a coronary angiogram procedure?
-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
What do coronary angiograms allow rapid assessment of?
Of blocked coronaries + coronary stents can be launched in area of stenosis as well
80% of pt’s have a right or left sided dominant coronary circulation?
Right! Meaning the RCA gives rise to the PDA
(20% left - meaning the LCx gives rise to the PDA)
What variability is why in coronary artery charts we see cross overs b/w certain wall segment perfusions?
Variability b/w right + left sided dominant coronary circulation (right is m/c)
LAD can supply up to how much blood in the LV?
55% (a key vessel for blood supply to the heart)
If the LAD is blocked proximally, will the rest of the vessel supplying blood to the anterior heart become blocked too?
Yes
What does blockage in the LAD lead to?
Massive heart attack/myocardial infarction + potentially sudden death
Where is the basal segment?
Area extending from the MV annulus to MV tips of the pap muscles
Where is the mid cavity segment?
Area includes entire length of pap muscles
Where is the apical segment?
Area beyond pap muscles
An entire wall is broken up into what?
Individual segments
Wall segments follow a naming scheme based on what?
Their position (basal, mid, apical) + the individual wall they belong to
Which segment model is the m/c + the one we follow?
Model 17 - is recommended by ASE
(there are also 16 + 18 models)
LAD delivers oxygenated blood where?
To anterior part of IVS, anterior wall + apex of heart
The areas of possible overlap b/w RCA + LCx are based on what?
Coronary dominance
The RCA delivers oxygenated blood where?
To inferior aspect of IVS, inferior wall + RV free wall
The inferolateral (posterior) LV wall may be supplied by what?
Supplied by extension branches from the RCA
The LCx delivers oxygenated blood where?
To lateral wall:
-Anterolateral wall segs
-Inferolateral wall segs
What is considered normal wall motion?
Normal endocardial inward motion + wall thickening in systole
What is hypokinesis wall motion?
-Reduced amplitude (<5mm) + velocity of endocardial motion + wall thickening in systole
-Delay in the onset of contraction + relaxation
What is akinesis wall motion?
Absence of inward endocardial motion (<2mm) or wall thickening in systole
What is dyskinesis wall motion?
Outward motion or bulging of the segment in systole, m/c associated with thin + scarred myocardium
What is aneurysmal wall motion?
Diastolic contour abnormality with dyskinesis
Ischemia results in what in regards to wall motion?
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)
What is global depression?
Refers to the entire wall being abnormal + sucking together
What is the overall wall motion score formula?
Sum of individual segment scores / # of segments visualized
List the numeric scoring system for wall motion?
1 = normal
2 = hypokinetic
3 = akinetic
4 = dyskinetic
5 = aneurysmal
Which coronary artery primarily supplies the RV?
RCA - via acute marginal branches
The more proximal an occlusion, the more or less myocardium will be affected?
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