CVT 101 Cardiac Anatomy (tristyn notecards) Flashcards
Fossa Ovalis
Fetal circulation- Interaptal septum mode up of 3 different layers (very thin)
Patent Fossa Ovalis: Patients fossa ovalis never closed; causes blood flow between atriums (PFO)
Sulcus Terminalis
Groove located outside right atrium
located anterior to SCV
Responsible for Nodal Artery Protection
What are the 3 bands of muscle part of RVOT?
Moderator band: connects medial and posterior cusps
Parietal Band:
Septal Band: connects anterior cust of TV
RVIF
Right ventricular in flow
In flow from tricuspid valve to apex
Right Ventricle
pumps venus blood to lungs
Normal pressure: 25-30mmHg systolic
0-5mmHg diastolic
Normal SvO2: 74-76%
Preload
volume in ventricle after diastole
Papillary Muscle
connects the tricuspid valve
Anterior pap muscle: off moderator band
-connects posterior cusp of TV
Posterior Pap muscle: off moderator band
-connects medial cusp of TV
Medial Pap muscle: off septal band
-connects anterior cusp of TV
*pap muscles contract! Supports TV cordaeRVOF
Right ventricle outflow
outflow from apex to pulmonic valve
Infundibulum
AKA: RVOF
Infundibular stenosis: pulmonic stenosis
Trabeculation
striations in ventricular myocardium surface inside chamber.
most of RV is tribeculated
*Only anterior portion of RA where SVC and IVC meet is smooth
Crux of the heart
Located posteriorly
Where coronary sinus, posterior interventricular sulcus and right atrioventricular sulcus meets
Pulmonary Veins
4 pulmonary veins 1. Right superior 2. Left superior 3. Right inferior 4. Left inferior -Continuous flow, no valves -Transports oxygenated blood from the lungs to the LA Normal pressure: 9-15mmHg Normal SaO2: 97-99%
Pulmonary Artery
(2) Right and Left
-Pumps venous blood to the lungs thru PV
-Rises from the left ventricle
-more anterior than the aorta
-main pulmonary trunk branches into Right and Left pulmonary branches
Normal Pressure: 25-30mmHg systolic
5-10mmHg diastolic
Normal SaO2: 74-76%
Right Main Coromary artery
2 branches:
- Anterior Right artial branch
- lays underneath RAA
- Nodal Artery
- Supplies SA Node
Continues posteriorly and rises to posterior decending artery
Supplies: RA, RV, and LV (right dominate)
Thoracic Cavity
Occupies upper portion of thoracic cage above diaphragm
Contains: 2 pleural cavities, 2 plural sacs that encase the lungs, mediastinal and pericardial
Left Atrioventricular sulcus
Divides LA and LV contains: 1. Left Coronary (Main) 2. Circumflex Arteries 3. Great Cardiac Vein
Anterior Interventricular sulcus
Divides LV and RV on anterior side
Contains:
1. Anterior interventricular sulcus (LAD) (Decending) Artery
2. Great Cardiac Vein
Azygos System
Azygos Veins drain into SVC and IVC
Longitudinal vessels on each side of body that drain blood from body wall and move it superiorly to empty into SVC
*Pathway for venous return from lower extremities to heart if IVC gets blocked.
Carotid Sheath
Fibrous Connective tissue that surrounds the brachial plexus
Lower Esophogeal Veins
Venous return from esophagus to IVC
Pulmonary Artery Wedge pressure
- Indirect estimate of left arterial pressure
- Directly measures pulmonary artery pressure
- Swan-Ganz catheter thru RA, RV, PV, PA and wedged into pulmonary branch
- Normal Pressure: 9-15mmHg
Atrial-Septal Defect (ASD)
Hole between RA and LA
causes right side failure due to volume and pressure overload in RA which causes too high pressure going to lungs
Ductus Arterious/
Ligamentum Arteriosum
In fetal circulation, ductus arterius is located between the Ao and Pulmonary artery
Left and Right shunt
Once closed (72 hours after birth) then known in adulthood as ligamentum arteriosum
What is normal Ao Root size?
3.8 cm
Ao Dilation
Large Ao wall
At risk for Ao rupture or dissection
Aorta
Located posterior to the manubrium and arches left. Part of pericardial and mediastinal cavities.
Semi-lunar valve
Gives rise to the 3 head vessels:
- Brachiocephalic (innominate) Artery
- Left common carotid
- Left subclavian
Acending to Transverse to Decending to Abdominal
Artery Dissection
Tear in the intima/media wall of artery
What does Aorta do when heart contracts?
Moves anteriorally to promote stroke volume
Aortic Wall Layers
Intima: Innermost layer composed of active endothelial cells; susceptible to clot formations
Media: middle myscular layer
*takes the most “grunt” from pressure
Adventitia: Outside layer
Vaso Vasorum
The arterial and venous supply to larger arteries
Example: Aorta and Coronary arteries
Aorta Pressure and sats
Normal Pressure:
120-129 systolic
60-80 diastolic
Normal SaO2: 95-97%
Bracial Plexus
Anatomical Region for vascular access
- contains jugulars, carotids, nerves, veins, and arteries
- protected by the scalene muscles, the carotid sheath and the sternocleidomastoid muscle
- located behind the first rib
Sternoceidomastoid muscle
Neck muscle connects top of manubrium to mastoid process of temporal bone
Phrenic Nerve
Supplies motor and sensory innervation to the diaphragm
- Arises off 3rd and 4th spinal nerves
- sympathetic NS
Vagus Nerve
Para sympathetic NS
Innervates the SA node and HR
What are 2 atrioventricular valves?
Tricuspid (right) and Mitral (left)
How many leaflets does the mitral valve have?
- Anterior cusp
2. Posterior Cusp
How many leaflets does the tricuspid valve have?
- Anterior cusp
- medial cusp
- posterior cusp
Layers of the TV and Mitral Valves
Atrial side: fibrosa layer
Middle layer: spongiosa
Distal (Ventricular) side: ventricularis
Right and Left Fibrous Trigones
Areas next to TV and Mirtal Valves that consists of stronger Fibrous tissue
- Thickest part of the heart, very thick
- OR surgeons use to anchor
- Located below atria, above ventricles
- LEFT: Ao and MV
- RIGHT: TV and MV
Commissures
Point where leaflets meet when closed (each valve)
Interventricular Septum
Divides RV and LV
2 components:
Muscular Septum (thick muscle)
Membranous Septum
Interventricular Septum can be divided into:
Base section, Mid segment, and Apical segment
Atrioventricular Valves
Mitral and Tricuspid Valves Components: 1. Leaflets: composed of elastin, collagen, fibrogin (thin yet strong) 2. Cordae (3 groups) 3. Pap muscles 4. Annulus
TV and MV annulus Fibrosus
Fibrous skeleton
The structual “skeleton” support around each valve
Serous Fluid
Clear, protein based fluid inside sacs or cavities for lubrication
Parts of the Aorta
- Ascending Ao (root)
- After AoV to first head vessel
- Transverse Ao (arch)
- Top of arch - all 3 head vessels
- Descending/Thoracic Ao
- After last head vessel to diaphragm
- Abdominal Ao
- Once it passes diaphragm
Thebesiian Veins
Very tiny veins that drain venous blood into each chamber
*Responsible for O2 drops in chambers!
Rib Cage/Thoracic Cage
Made up of:
Contains 12 thoracic vertebrae, sternum, 24 rib, intercostal and muscles
Superficial
Protection and structure for cavities
Pressure -1 to -5 atmospheres
Contains 5 cavities: thoracic, 2 pleural, mediastinal, and pericardial
Peritoneal Cavity
Separates abdominal and thoracic cavities
Borders inferiorly to thoracic cavity (to lower tip of sternum)
Normal Fluid amount in pericardial sac:
5-15 mls
Pericardial Effusion
too much in pericardial cavity
- Serous
- Hemorrhagic
- Air
- Sanguinous: blood tinged
Pericarditis
Inflammation of pericardium
*can be due to open heart surgery, flu, lung problems, bronchitis
Pericardial Friction Rub
Pericardium irritated by rubbing on pericardial sac
sounds like rubbing sand paper
Valve of Thebesii
Valve over coronary sinus
Coronary Sinus
Venous return from coronary arteries
Normal SvO2: 8-20%: very low due to high metabolic rate in myocardium
Valve of Thebesii: prevents backflow
Located next to valve of Eustachii (IVC) to move blood towards tricuspid valve.
Superior Vena Cava
Venous return from upper extremities, brain, and thorax
Located next to ascending aorta
superior and anterior to right atrium
No Valve, continuous flow
Normal pressure: 3-5mmHg
Normal SvO2: 72-74% (brain uses a lot of O2)
5 main cardiac circulation Veins:
- SVC
- IVC
- Jugulars - internal and external
- subclavian - arms
- Brachiocephallic
Inferior Vena Cava
Venous return from lower extremities and abdominal
Sits on the floor of the RA
Valve of Eustachii - prevents backflow
Located behind heart, to the right of the descending aorta
Normal Pressure: 3-5mmHg
Normal SvO2: 76-78%
IVC Filters
Stops blood clots
Types of patients: sedentary, diabetic, obese, renal failure, smokes, chemotherapy, clotting disorder
Left Circumflex
Located in left atrioventricular sulcus
Provides circulation to left atrium and LV
Ends at obtuse marginal
LAD
comes off of left main coronary artery
Lies in anterior interventricular sulcus
Septal Perfurators
Supplies:
- Interventricular Septum
- HIS Bundle
- R & L Bundle Branches
Posterior Interventricular Sulcus
Divides LV and RV posteriorly
Contains posterior interventricular artery and middle cardiac Vein
Has Septal perforators that supply HIS bundle,
R & L bundle branches and interventricular septum
Left Main Coronary Artery
Very short-stemmed: 4mm then biforcates into:
- LAD
- L Circumflex
- Typically stops @ L. Margin in right dominant
Right Atrioventricular Sulcus
Lies between RA & RV
Contains right coronary artery
Pulmonic Valve Sinuses
Not as prominent as AoV
Sinuses help support PV
Sinus of Valsalva
Cusps on Aortic Valve (ascending Ao)
Used for coronary reserve
When does coronary profusion occur?
During diastole
*Cannot profuse when myocardium contracts
What are 2 Semilunar Valves?
Aortic Valve and Pulmonic Valve
Semilunar: 3 cusps
Valve of Eustachii
Valve located in RA to prevent backflow into IVC
Right Atrial Appendage
Small appendage on right atrium
Located anterior to SVC and Aorta
Used for Vascular Access during open heart surgery
Prone to clot formation is patient has A-fib or arrhythmias
Right Atrium
Systemic Venous Return
Normal Pressure: 3-5mmHg
Normal SvO2: 74-76%
Pericardium
Fibrous sac that contains the heart
supports the heart during systole and diastole whhen heart rotates
Extends 2cm up great vessels and pulmonary veins
protects heart from infection and isolates it from mediastinum
congestive heart failure (CHF)
Hearts inability to maintain CO
depressed ejection fraction
leads to multi-system failure
Pulmonary Infiltrates
Venous Congestion:
Left or right heart failure can cause pulmonary congestion - respiratory problems
Forces fluid into alveoli which decreases gas exchange
Hypertrophy
Enlarged Muscle
Dilated
Enlarged chamber or vessel
Cardiac Mass (Weight)
Males: 280-340 grams
Females: 230-280 grams
Point of maximal Impact (PMI)
Point where apex of heart hits chest wall thru 4th or 5th intercostal space
By palpating- should be size of quarter
Cardiac Apex
Primary consists of LV and some RV
Points inferior, anterior and sits 60 degrees to the left
Pericardial Attachments
Inferior: anchored to diaphragm by tendon
Superior: anchors/supported by head vessels
Lateral: borders R and L pleural sacs
Anterior: sternal ligaments
Layers of pericardium
Endocardium (inside chambers)
Myocardium (inside muscles)
Epicardium (outside muscle)
Pericardial space
Make up of the pericardium:
Parietal Layer
Fibrous Layer (pericardial sac)
Epicardial fat
Mediastinal Cavity
Contains: Great Vessels Trachea Esophagus Thymus Pericardial cavity Vagus nerve Phrenic Nerve
Pericardial Cavity
Contains:
Heart
Pericardial sac
Great vessels that enter and leave the heart
Pericardial sac
Serous membrane sac that heart sits in-
surrounds up to 2cm around the heart
Helps anchor the great vessels to the heart when heart twists during systole
What helps to maintain breathing?
scalene muscles
diaphragm
intercostal muscles (contract)
negative pressure (-1) to (-5) inside the thoracic cage
Diaphragm
Separates thoracic and peritoneal cavitites
Sheet of muscle that flattens and contracts
2 layers:
Muscles and Tendons help close Thoracic cavity Inferiorly
Helps maintain breathing
Scalene Muscles
2 sets:
Elevate first and second ribs
Anterior scalene: 1st rib
Posterior scalene: 2nd rib
Intercostal Muscles
Located in between ribs
External: towards medial, downward
Internal: towards lateral (outward)
Sternum
Lies anteriorly in Thoracic cage. Articulates with the clavicles and first 7 ribs
3 parts:
- manubrium (top)
- body
- xyphoid process (bottom)
Sternal angle of louie
Sternal Angle of Louie
Where the manubrium meets the body of the sternum
*Anatomical landmark for second intercostal space
Sulcus Costae
Costal groove in each rib that protects the intercostal arteries, veins, and nerves
The innermost intercostal muscle keeps the arteries, veins, and nerves against the groove
Transverse and oblique pericardial sinuses
Anatomical landmark seen by TEE that are folds in the pericardium filled with serous fluid
Transverse: located inferior to pulmonary trunk
Oblique: located medial to pulmonary veins
2 LV Papillary muscles
Anterior Lateral
Posterior Medial
Attached at myocardium that contracts and connects cordaes of mitral valve
Left Ventricle
Systemic output
Normal pressure: 120-130mmHg systolic
0-10 mmHg diastolic
Normal SaO2: 95-97%
Larger than RV, cone shaped, wider @ base, narrow @ apex, not trabeculated as much as RV
Bronchiole Veins
Venous return from bronchiole branches to azygos vein
Normal LV myocardium thickness
1cm
Left Atrium
Receives oxygenated blood from lungs
Normal Pressure: 9-15mmHg
Normal SaO2: 97-99%
Has left atrium appendage (not useful)
Contains only smooth walls
Vq
More Ventilating, less blood profusion
Example: standing
vQ
Less Ventilation, more blood profusion in lower lobes
Example: sitting
Crista Terminalis
Groove located inside right atrium
separates smooth wall and trabeculated wall
Valve of Eustachii
Valve over IVC
Afterload
What the ventricle has to pump against
Nodulus Arantii
Notches that help close the valve
Located in center of each cusp
