Module 2 : Cardaic Anatomy - Parasternal Views Flashcards
Great vessels - pulmonary trunk
Main pulmonary artery - bifurcation
- bifurcation lies above to the roof of the left atrium
- left pulmonary artery arches backward toward left lung
- right pulmonary artery travels behind the ascending aorta and superior vena cava to the right lung
Great vessels - coronary arteries
- 2 main branches originate at the aorta
- originate behind the right and left coronary cusp of the aortic valve
Coronary arteries - right coronary artery
- BLUE
- travels rightward along AV sulcus toward posterior heart
- gives rise to RIGHT MARGINAL ARTERY
+ 70-80% people the posterior descending artery PDA comes from the Right coronary artery and travels in the posterior IV sulcus
Coronary arteries - left coronary artery
- YELLOW
- from a few mm to 1.5 cm in length
- gives rise to
+ LAD - left anterior descending artery (RED)
+CXM - circumflex Artery (YELLOW)
PLAX - parasternal long axis view
- patient in left lateral decubitus, right shoulder back to open up intercostal spaces
- probe places in the left 3rd or 4th intercostal space close to sternum
- marker toward right shoulder of patient
PLAX - anterior structures
Anterior to posterior
- pericardium
- RV anterior wall
- RV cavity
- IV septum
- aortic valve
+ right coronary cusp RCC
+ non-coronary cusp NCC - aortic sinus
+ bulge at base of aorta
PLAX - posterior structures
Anterior to posterior
-LV cavity
- Mitral valve
+ Anterior leaflet AML
+ posterior leaflet PML
-LA
- posterior LV wall
- descending aorta
RVIT - right ventricular inflow tract
- from PLAX slide laterally slightly and angle under the sternum toward patient right hip
RVIT - structures
Anteriorly to posterior
- pericardium
- RV anterior wall
- RV chamber
- IV septum
- anterior tricuspid valve leaflet ANTL
- Posterior TV leaflet (angle dependant)
- right atrium
- coronary sinus
- IVC
Optional
- chiari network
- eustachian valve
- SVC
- septal TV leaflet
RVOT - right ventricular outflow tract
- from PLAX angle toward patient left shoulder
RVOT - structures
- RVOT
- pulmonary valve
+ right and left posterior cusp ALWAYS - main pulmonary artery
+ sometimes see branches
Parasternal Short Axis views PSAX
- imaged at 6 different levels
- beam swept from base to apex
- from PLAX rotate 90 degrees clockwise
PSAX Levels
- base of heart (AB level)
- pulmonary artery level
- MV level
- LV base level (chordae tendinae)
- LV mid (pap) level
- LV apex
PSAX - pulmonary valve level structures
- RVOT
- RPC
- LPC
- main pulmonary artery
- right pulmonary artery
- left pulmonary artery
PSAX - base (AV) level - structures
- MAIN FOCUS IS AV
- must see all leaflets
-SVC - RA
- TV
+ septal and anterior
-RV
-PV
-LPPC, RPPC - PA
-LA
PSAX - MV level - structures
- RV free wall
- RV chamber
- IVS
- AML
- PML
- MV annulus
PSAX - LV base
- this level is mm below MV at level of chordae tendinae
- most superior portion of LV
- if you see MV leaflets to high
- if see pap attached to wall too low
- chordae resemble eyelashes
PSAX - mid / pap level - structures
- RV free wall
- RV chamber
- IVS
- all walls of LV simultaneously
- pap muscle attached to wall
- pericardium
PSAX - apical level - structures
- slide inferior
- inferior to paps
- all walls of LV at apical level
- sliver of RV
- excellent for pericardial effusions
Perfusion territories
- each wall has particular artery which perfumes it
- knowing names of all the walls and noticing abnormal movement
- INDIRECTLY DIAGNOSE ISCHEMIA OR INFARCTION
