Situs and Position/hemodynamics Flashcards by Brooklyn Shartzer

Atrial situs refers to the

location /position of the atria and abdominal organs

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“Atrial situs solitus” the arrangement is

right sided atrium
right sided trilobed lung
right side liver and gallbladder
left side stomach bubble, spleen, AO
Levocardia apex point to the left

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“Atrial situs inverses” the arrangement is

Atria are transposed “mirror image”
left side systemic atrium
left sided trilobed lung and liver
right-sided stomach and Aorta
cardiac apex pointed rightward

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“Situs ambiguous” describes

everything in-between

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Heterotaxy

Means different arrangement,
maybe right or left isomerism

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Situs ambiguous with right isomerism

referred to asplenia or double right-sidedness
bilateral trilobed lungs
bilateral right atria
no spleen
bilateral SVC
absent coronary sinus
TAPVR
intact IVC
midline liver

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Situs totalis

refers to situs inversus totallis which means complete mirror image of all major organs in the chest and abdomen

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How are the left and right atria best distinguished apart from one another?

by their appendage.

-Right atria appendage is broad base triangle shape
-left atria appendage is narrow and finger like

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Situs ambiguous with left isomerism

Bilateral left sidedness
* Bilateral left atrial appendages
* Bilateral bilobed lungs
* polyspleens
* Interruption of the IVC with azygos continuation
* Ipsilateral pulmonary veins
* Persistent LSVC

Absent Sinus node
atrioventricular septal defect
pulmonary outflow obstruction
congenital complete heart block

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situs ambiguous with left isomerism is referred as

Polysplenia

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situs ambiguous with right isomerism is referred as

asplenia

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Azygos Vein

present during interrupted IVC.
-runs parallel to the AO
-takes flow back to the SVC

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Right atria with right isomerism

Bilateral right sidedness
* Bilateral RA appendage
* Persistent LSVC
* Hepatic veins drain directly into atria
* Absent (unroofed) coronary sinus
* TAPVR
* Bilateral trilobed lungs
* Usually absent spleen

-Unbalanced AVSD- right dominate (think DORV)
-pulmonary outflow obstruction/ atresia
-ventricle - arterial connection abnormalities (DTGA)

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Vertical Vein

connection between pulmonary veins to the innominate vein to SVC

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What does septophobi and septophilic mean?

TV is septophilic, likes the septum
MV is septophobic needs to attach to the papillary muscle “phobia of septum”

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Scimitar Vein

connects one or both of the right pulmonary veins to the IVC in the presence of PAPVR

Infracardiac PAPVR

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What are the 3 types of viscero-atrial situs?

solitus-normal
inversus- mirror image
Ambiguous- often associated with splenic syndromes and cardiac isomerism

look at stomach bubble and liver, visceral(abdominal) situs and atrial situs are nearly always the same

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Great vessel relations
name 5 types

solitus- normal relation
inverted- mirror image but normally related
D-malposed- aortic valve lies to the right of PV (D-TGA)
L-malposed- aortic valve lies to the left of the PV (L-TGA)
A-malposed- aortic valve is directly anterior to the PV

The four potential relationships between the great arteries (i.e. aorta [AO] and pulmonary artery [PA]). A) Solitus relationship (usual or normal relationship) is present when the aortic valve is posterior and to the right of the pulmonary artery. B) Inversus relationship is where the aortic valve is posterior and to the left of the pulmonary valve (mirror-image of the usual or normal arrangement). C) Complete transposition (d-transposition) is present when the aortic valve is anterior and to the right of the pulmonary valve. D) Congenitally-corrected transposition (l-transposition) is present when the aortic valve is anterior and to the left of the pulmonary valve.

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Normal relation heart would be as follows
Abbreviations

S,D,S

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Inverted normal heart segment abbreviation is

I,L,I

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Cardiac position needs to clarify two points

Where is the heart located in the chest cavity?
Which direction does the apex of the heart point?

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Levocardia

heart is in the left chest with apex pointed leftward and anteriorly and inferiorly

normal postion

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Dextrocardia

the heart is in the right chest with the apex pointing to the right

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dextroposition

Heart is in the right chest with the apex pointing leftward

Can cause hypoplastic right lung

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mesocardia

midline position of the heart (apex still slightly pointed to the left but is shifted more midline)

Label the photo below

## Footnote normal visceral(abdominal) situs

How much of the heart mass lies to the right of the midline of the chest?

1/3

What are the four sections of the mediastinum?

1. Anterior mediastinum 1. Posterior mediastinum 1. middle mediastinum 2. Superior mediastinum

What is the anterior mediastinum

* Borders sternum and ribs * Includes fascia, lymph nodes, and vessels

What is the Posterior mediastinum

* Border vertebral column * Contains the thoracic DAO, trachea, and esophagus

What is the middle mediastinum

contains the heart, pericardium, and proximal origins of great vessels

What is the superior mediastinum

Bordered by the 1st ribs contains aortic arch

Atrial contractions contributes to __ % of ventricle filling?

20%

atrial contraction correlates with ___ wave on the EKG

P wave | atrial depolarization

IVRT time begins with the ___ of the semilunar valves?

closure | proceeds ventricle "relaxation"

IVRT time is affected by?

preload (left atrial pressure) Age (increases with age)

IVCT time begins with the ___ of the atrioventricular valves?

closure of mitral and tricuspid valve | proceeds Ventricle "contraction"

IVCT time is affected by?

afterload dependent

Afterload

refers to the **pressure that the heart must work against to eject blood during ventricular contraction,** essentially the resistance the heart faces when trying to pump blood out

Preload

refers to the amount of stretch placed on the cardiac muscle fibers just **before contraction**, essentially representing the volume of **blood filling the ventricle at the end of diastole**

Heart defects that significantly affect preload include

MS MR AI

Heart defects that significantly affect afterload include

Starlings law

what enters the heart must leave the heart

Ohm's law

flow is dependent upon pressure and resistance

What is normal pulmonary venous pressure?

mean of 2mmHg

Only veins in the body to carry O2 blood are

Pulmonary veins

Of the branch pulmonary arteries which is longer and what is it course

**RIGHT** travels below the aortic arch, posterior to SVC, across the roof of the LA to the lungs

Normal pulmonary artery pressure is

25/10mmHg | mean of 15

The only arteries to carry deoxygenated blood in the body are

pulmonary arteries

Systemic blood can be divided into

low-pressure venous return and high-pressure arterial output

Systemic venous return refers to

IVC and SVC coronary sinus

How is the SVC formed

right and left innominate veins ## Footnote innominate veins are formed by same side subclavian vein and jugular vein left side longer

azygous vein receives blood from the___ What does it drain into and what appearance does it give?

thoracic and abdominal walls and drains into the SVC give the appearance of a "shepherds crook"

Systemic venous pressure is normally | SVC/IVC, think what RA chamber pressures are

6mmHg | mean of 6mmHg

Systemic arterial pressures are | think of normal BP and AO pressures

120/80mmHg

LA pressure is

10mmHg

LV pressure and Ao pressures are?

LV- 120/70mmHg AO- 120/80mmHg

RA pressures

5mmHg

RV pressures and PA pressures are

RV 25/5mmHg PA 25/10mmHg

Oxygen saturation in the left heart is? Oxygen saturation in the right heart is?

Left- 95% right- 75%

MS and TS can result in ___ preload due to ___

decrease preload and cardiac output due to reduced ventricle filling during diastole | MS- not as much flow getting to the LV

semilunar valve stenosis will result in ___ afterload

increased afterload ## Footnote Flow can't get out so therefore at the end of contraction there is more vol remaining in the LV

TR and MR causes the afterload to ___

decrease ## Footnote at the end of contraction there is less vol in the LV/RV because TR/MR happens during systole and will reduce the afterload at the end of contraction

AI and PI cause the preload to ___

increase

Moderate VSD will affect what chamber

Left sided volume overload (LVE)

Large VSD blood flow direction will be ___ during early systole and ___ during end systole.

Left to right right to left

Large PDA's will have an affect on the ___ side of the heart

left side ## Footnote there will be an increase in pulmonary venous return to the left side

The ability of the heart to alter force of the ventricular contraction in response to increased ventricle volume is?

Frank-Starling relationship

Fractional area

change in LV area during systole obtained in PSAX ## Footnote naormal value 64% +or- 16%

Definition of fractional shortening Normal values?

% of change in LV cavity dimensions from systole to diastole ## Footnote nml= 25-46%

stroke volume

amount of blood pumped in a single cycle ## Footnote 30-60mL

Cardiac output

amount of blood pumped per minute ## Footnote 4-8 L/min

Normal values for delta pressure/delta time | dP/dt

1000mmHg

Normal values for IVRT

60-80msec ## Footnote diastolic measurement

end systolic measurements occur at the end diastolic measurements occur at the

Systolic: T-wave Diastolic: onset of the QRS

Continuity equation

AVA=(0.785xLVOT^2)(VTI LVOT) ________ (VTI AV) | CSA= 0.785 x d^2 ## Footnote stroke volume

Normal QP/QS

ratio of 1 abnormal >1.5

Bernoulli equation

4V^2 ## Footnote determine preassure gradient across valves and shunts