Module 1: Advanced Cardiac Anatomy And Echo Windows Flashcards
The heart is divided into two different Sulci what are they?
- Interventricular sulcus (groove)
- Atrioventricular sulcus (groove)
What is the interventricular sulcus?
Between the two ventricles (vertical)
What is the atrioventricular sulcus?
Between the atria + ventricles
How do we follow the IV sulcus ?
Follows the path of the interventricular septum
How do we follow the AV sulcus seen in ultrasound?
Follow the path between both ventricles and atria (Horizontal)
What is the crux?
Where the IV and AV sulcus meet. Crux = cross
What does the sulcus composed of?
Vessels and pericardial fat
What is found on the anterior of the IV sulcus?
- LAD (left anterior descending artery)
- Great cardiac vein
What arteries found on the posterior of the IV sulci? 2
- PDA (posterior descending artery)
- Middle cardiac vein
What does the AV sulcus contain? 2
Contains vessels and epicardial fat
What arteries are found on the anterior AV sulcus?
- Circumflex artery (CX wraps around left side)
- Right coronary artery (RCA wraps around right side)
What is found on the posterior of the AV sulcus? 2
- Coronary sinus
- PDA from RCA
What are the two main arteries of the coronary arteries?
- Left main coronary branches
- Right coronary artery
What is in the left main coronary artery branches?
- Left anterior descending artery (LAD)
- Circumflex artery (CX)
Where does the Right coronary artery (blue) travel?
Travels rightward along the AV sulcus towards the posterior heart
In 70-80% of people the PDA (posterior descending artery) comes from where? Where does it travel?
The RCA and travels in the posterior IV sulcus
How long is the Left main coronary artery?
From a few mm to about 1.5 cm in length
What Colour is the Left main coronary artery?
Yellow
What does the Left main coronary artery give rise to? 2
- Left descending artery
- Circumflex artery
What is the oxygen saturation in the coronary sinus?
About 50%
Deoxygenated blood in the venous system has how much O2 saturation?
Still around 75%
All cardiac veins drain into what?
The coronary sinus
What are the different types of cardiac veins? 3
- Great
- Middle
- Small cardiac veins
What are the 5 main right atrial structures?
- IVC
- SVC
- Coronary sinus
- Tricuspid valve
- Right atrial appendage (auricle)
What is the Right atrial appendage shaped like?
Snoopy ear
How is the right ventricle shaped?
- Crescent shaped
- Curves all the way around the LT heart
How thick is the Right ventricle wall?
<5mm
RV inflow is at what angle compared to RV outflow?
45 degree
What is the main right ventricle points? 4
- Tricuspid valve
- Pulmonary valve
- Moderator band
- Infundibulum
Where is the moderator band found?
Only in the RV
What is the infundibulum?
Smooth muscle ridge between RVOT and LVOT
What is the bifurcation in the main pulmonary muscle found?
Superiorly to the roof of the Left atrium
The left pulmonary artery arches towards what?
backward (laterally/ posteriorly) towards the left lung
The RPA travels behind what?
The ascending aorta and SVC to the right lung
What are the 4 pulmonary veins?
- Right upper pulmonary vein
- Left upper Pulmonary vein
- Right lower pulmonary vein
- Left lower pulmonary vein
What is the LA appendage shaped like?
Piglet ear
What is the most muscular chamber in the heart?
The left ventricle
How thick is the LV walls?
6-10 mm thick
What is the chamber volume during end- diastolic volume?
100mls
What is the chamber volume during end systolic volume?
30 mls
What are the segments of the Aorta arch? 3
- Ascending
- arch
- Descending
Where is the descending aorta located?
Above and below the diaphragm
Where does the right coronary cusp (RCC) face? Where is the origin?
- Faces towards the RV
- Origin of the right coronary artery
What does the left coronary cusp (LCC) face? What is its origin?
- Faces the pulmonary artery
- Origin of the left main coronary artery
What the non coronary cusp (NCC) face? Is it associated with the coronary artery?
- Faces the inter atrial septum
- Not associated with coronary artery
The AV has how many cusps?
Three
What does the mitral valve apparatus include? 5
- Annulus
- Mitral leaflets
- Commissaries
- Chordae tendons
- Papillary muscles
What are the two mitral leaflets?
- Anterior mitral leaflet
- Posterior Mitral leaflet
What are the two different points of the papillary muscles?
- Posteromedial
- Anterolateral
What is the AML consist of? How is it numbered?
- A1, A2, A3
- Numbered lateral to medial
How is the PML labeled?
- P1/P2/ P3
- Numbered lateral to medial
What is the three leaflets of the tricuspid valve?
- Anterior
- Posterior
- Septal
What does the anterior leaflet of the tricuspid face?
Towards the probe in the parasternal window
What does the posterior leaflet of the tricuspid valve face?
The RV free wall
What does the septal leaflet of the tricuspid valve face?
IV septum
The leaflets in the Tricuspid valve are connected to what?
Papillary muscles with chordae tendonae
What does the moderator band connect?
two of the papillary muscles
How is the pulmonary valve structured like?
Similar to the Atrial valve
Abnormality in the pulmonary valve tend to be what?
Congenital
What are the three cusps of the pulmonary artery named?
- Anterior
- Left
- Right
What are the four basic echo window?
- Parasternal
- Apical
- Subcostal
- Substernal notch
Where does the parasternal window sit?
In the 3rd or 4th intercostal space at the Left parasternal boarder
Where do we point the indicator in Parasternal long axis (PLAX)?
Indicator points to the patients RT shoulder (10-11)
What is the short axis (PSAX)?
Indicator points to the patients LT shoulder, 90 degrees clockwise from the long axis
How is the heart sliced with parasternal long axis? What does the Parasternal long axis do? What valves are shown?
- Slices the length of the heart
- Shows left inflow and outflow
- MV and AV
How do we get RV inflow in plax?
Angle beam Inferiorly towards patients RT hip
How do we get RV outflow?
Angle beam superiorly towards patients LT shoulder in plax
How do we slice the heart with parasternal short axis? Where should the indicator point towards? What does the Parasternal short axis do? What valves does it show?
- Slices 90 degrees to the length of the heart
- Indicator towards LT shoulder
- Shows right inflow and outflow
- Shows the Tricuspid valve, Atrial Valve and Pulmonary valve (usually)
The apical window sits where?
4th and 5th intercostal space at the mid clavicular line (below nipple)
During apical 4 chamber and apical 5 chamber where is the indicator pointed?
Towards the bend 2-3 o’clock
During 2 chamber view where is the indicator pointed?
Indicator points to the patient LT Axillia (1:00)
During apical 3 chamber or long axis where is the indicator pointed towards?
To the patients RT shoulder around 11:00
What can be seen during A4C?
- RA/RV, TV
- LA/LV, MV
How do we get from A5C from A4C?
- Angle the probe more anteriorly/ superiorly to see AV
- May lose some of the other chambers
What is seen in A2C?
LA/LV, MV
What is seen in A3C?
- LA/LV
- MV/AV
What is the subcostal window? How is the indicator pointed?
- The window that sits within the subxiphoid region of the abdomen
- Indicator maker at 3-4:00
What is seen in the sub coastal window? 4
- RA/RV
- TV
- LA/LV
- MV
How is the probe placed during the subcostal window? 2
- Fairly flat
- Tail tucked close to the patients abdomen
What is the suprasternal notch window?
Window that sits within the suprasternal notch of the neck
What does the suprasternal notch show?
Aortic notch
Where does the indicator angled during the suprasternal notch?
1:00