Clinical Cardiac Anatomy

Question 1

Trace blood through body: RA -> superior vena cava

Answer 1

RA 
Tricuspid valve 
RV
Pulmonic valve 
R or L pulm artery 
Pulm arterioles 
Pulm capillaries 
Pulm venules 
1 of 4 pulm veins 
LA
Bicuspid valve 
LV 
Aortic valve
Aorta 
Peripheral arteries --> arterioles --> capillaries --> venules --> inf/sup VC

Question 2

If you pass a catheter from the inf vena cava into RA, where can the catheter go from there?

Answer 2

1. Tricuspid –> RV –> pulm art
2. SVC
3. Patent foramen ovale –> LV
4. Coronary sinus

Question 3

What route would you take to place pacemaker wire in the RV?

Answer 3

Sup VC
RA
RV - wedged into trabeculae of RV apex

Question 4

What route would you take to place pacemaker wire in the LV?

Answer 4

Sup VC
RA
Cornary sinus which lies behind LV

Question 5

How can you tell the RV from LV?

Answer 5

RV = more trabeculae + tricuspid valve  
LV = smoother + mitral valve

Question 6

How can a clot from the legs cause stroke?

Answer 6

It's going to cause a PE... duh
Stroke:
- Septal defect
- Increased R sided P 
= Paradoxical embolus

Question 7

If the pt is in AFib, where is a thrombus likely to form?

Answer 7

No atrial contraction –> clots in atria
Increased risk for PE
**LA appendage

Question 8

Name the associated L and R coronary arteries.

Answer 8

From sinus of valsalva = outpouching from aorta
L main coronary art from L coronary cusp sinus of Valsalva
- LAD
- L circumflex
R coronary art from R coronary cusp of sinus Valsalva

Question 9

Describe the path of the LAD - what pts of the heart does this supply

Answer 9

Ant interventricular groove
Supplies:
- Ant septum
- Ant wall LV (largest pt of LV)

Question 10

Describe the path of the L circumflex - what parts of the heart does this supply

Answer 10

Post AV groove = between LA & LV in back of heart

Supplies LV lat wall

Question 11

Describe path of RCA - what parts of the heart does this supply?

Answer 11

Ant AV groove = bet RA & RV anteriorly

Supplies inf wall of LV & RV

Question 12

Why is it difficult to bypass directly to the main circumflex art in surgery?

Answer 12

Coronary sinus is in post AV groove on top of main circumflex art
Branches of circumflex can easily be bypassed

Question 13

How do you est RA pressure?

Answer 13

Int jugular vein catheter

Question 14

If the P wave vector (direction of atrial depol) is abnormal, what are the possible sites of pacemaker?

Answer 14

Normal atrial depol = bet 0 –> +90 degrees
Abnormal means pacemaker cannot be the SA node
Other options:
- Somewhere else in atrium = ectopic atrial rhythm, atrial flutter
- AV node = junctional rhythm
- The ventricle