Module 1 : Intro Echo and Cardiac Anatomy Flashcards
Echo indication
Ischemic heart disease Valvular disease Congestive heart failure Pericardial disease Functional capacity
Heart orientation
Heart axis is different then body axis
Gross anatomy
Dual pump as well as sucks
Pumps through 2 systems in a series like a figure 8
Left heart - systemic system
Right heart - pulmonary system
the cardiovascular system
The Left ventricle pumps between 6-8 metric tones of blood in 24 hours (1cm pure muscle)
Left heart - artery- arterioles-capillary bed- venule - Vein- Right heart
Vascular system
Three layers to every vessel
- tunica adventitia
- tunica media
\+ the layer is thicker in arteries than veins because it has to withstand greater pressure
- tunica intima : endotheliumRight heart
Contains Right atrium Right ventricle Pulmonary valve Tricuspid valve
Left heart
Contains Left atrium Left ventricle Aortic valve Mitral valve
Cardiac location
2/3 of the hearts mass to the left of midline 1/3 to the right or under the sternum
Sits in 4th intercostal spaces
Rests on diaphragm
Lies within the pericardial sac
Surrounded by lungs and pleura
Cardiac shape
Cone or pyramid shape
Base - broader upper portion formed by the atria
Apex - blunt formed by LV and RV, points downward anterior and left
Heart divisions / sulci
Interventricular sulcus
-runs down the front and around to the back of the heart
- the coronary vessels run through it
- follows path of the interventricular septum
- anteriorly contains
+ left anterior descending artery LAD
+ great cardiac vein
Atrioventricular suculus
- follows path between both ventricles and atria
- anteriorly between atria and Vern tickles
- contains
+ circumflex Artery CXM (left)
+ right coronary artery RCA (right)
+ coronary sinus posteriorly
* where both sulci meet = crux
Great vessels and flow direction
Left heart IN - 2 upper (superior) and 2 lower (inferior) pulmonary veins Left heart OUT - aorta Right heart IN - SVC and IVC Right heart OUT - pulmonary artery
Mediastinum
Anterior mediastinum - in front of pericardium
Middle mediastinum - contains pericardium and heart
Posterior mediastinum - behind the pericardium
Superior mediastinum - surrounding great vessels
Coronary arteries
Main arteries
- Left Main Coronary Artery
\+ left anterior descending artery LDA
\+ circumflex Artery
- Right Coronary Artery
ONLY FILL DURING DIASTOLE
Cardiac veins
All veins drain into the coronary sinus Great - follows LDA middle Small cardiac veins * Coronary sinus on the back of the heart and drains into the right atrium
Left ventricle
The most muscular chamber in the heart
The walls measure 6-10 mm thick
Chamber volume
- end diastolic = 100ml
- end systolic = 30ml
Appears as a circle in short axis (cone shape)
Interventricular septum bulges to right due to high LV pressure
LV muscle trabeculated ( bumpy )
Heart muscle layers
Endocardium
- innermost layer needs good definition on image
- same echogenicity of myocardium
- thin layer between blood and myocardium
Myocardium
- thickest layer of striated muscle fibers
- LV 6 to 10 mm
- RV 3 to 5mm
- muscle has water in it so doesn’t reflect as well
Epicardium
- also called visceral pericardium and very bright
The pericardium
Fibrous pericardium
- outermost layer
- prevents over distention of the heart
- stiff
Serous pericardium
- 2 layers between 20-50 ml of fluid resides
- parietal layer
- visceral layer
\+ epicardiumPericardial fluid
Normal 20 - 50ml
Too. UCB fluid compresses the heart
- may be acute or chronic
+ depends on rate of accumulation
The right heart
Crescent shaped
Curves all the way around the left heart
Wall thickness <5mm
RV inflow at 45’ angle compared to RV outflow
Right atrial structures
IVC SVC Coronary sinus Tricuspid valve Right atrial appendage (auricle)
SVC and IVC
SVC - drains all vessels above the heart - drains into the superior portion of the RA IVC - drains vessels below the diaphragm - drains into inferior RA
Aorta
Segments
- ascending
\+ going toward head
- arch
\+ 1st branch to 3rd branch
- descending
\+ above diaphragm
\+ after 3rd branch
\+ below diaphragm
- can’t see all three segments on same image
The right ventricle
Tricuspid valve
Pulmonary valve
Anterior papillary muscle (moderator band)
Infundibulum (smooth muscle ridge between RVOT and LVOT)
Left atrium
4 pulmonary veins
- Right Upper Pulmonary Vein (RUPV)
- Left Upper Pulmonary Vein (LUPV)
- Right Lower Pulmonary Vein (RLPV)
- Left Lower Pulmonary Vein (LLPV)
LA appendage also on LA
- common site of thrombus formation
LA mostly made up of Pulmonary connections
The aortic valve
Right coronary cusp (RCC) - faces toward the RV - origin of the right coronary artery - straight up Left Coronary Cusp (LCC) -Faces the pulmonary artery - origin of the left main coronary artery Non-coronary Cusp (NCC) - faces the interatrial septum - no coronary artery associated with it
AV parts
Crown snapped annulus ( edge of cusps)
Coaptation zone - cusps overlap slightly
Aortic Sinus - (bulge)
Aortic root continuous with the IV septum
Mitral valve apparatus
AML - anterior mitral leaflet
PML - posterior mitral leaflet
Chordae tendinae
Papillary muscles
- posteromedial
- anterolateral
Annulus
Scallops of the mitral valve
- Anterior Mitral Leaflet
+A1, A2, A3
+ numbered lateral to medial (septum side) - Posterior Mitral Leaflet
+ P1, P2, P3
+ numbered lateral to medial
+ posterior scallops named first then correspond to anterior scallops
The tricuspid valve leaflets
- Anterior \+ faces toward the transducer in the parasternal window - Posterior \+ facing RV free wall - Septal \+ faces IV septum
Tricuspid valve attachments
- leaflets are connected to 2 papillary muscles with chordae tendinae
- the MODERATOR BAND connects the pap muscles
The pulmonary valve
- structurally similar to AV ( different rotation)
- abnormalities tend to be congenital rather than acquired
- 3 cusps
+ anterior
+left
+ right
The interventricular septum
- divides right and left ventricles
- part of cardiac crux
- high pressure in LV pushes septum toward the RV
2 parts of IV septum
Membranous septum
- most common site of ventricular septal defect (VSD)
- thin
Muscular septum
-less common site of VSD
-most of the thickness of IVS belongs to LV
Interatrial septum
3 segments
- septum primum
\+ very bottom
- septum secoundum
\+ very top
- foramen ovale
\+ covering flap
- structures this way so in fetus blood could get to left side of the heart
