Module 2 : Cardaic Anatomy - Parasternal Views

Question 1

Great vessels - pulmonary trunk

Answer 1

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

Question 2

Great vessels - coronary arteries

Answer 2

• 2 main branches originate at the aorta

- originate behind the right and left coronary cusp of the aortic valve

Question 3

Coronary arteries - right coronary artery

Answer 3

• 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

Question 4

Coronary arteries - left coronary artery

Answer 4

• YELLOW
• from a few mm to 1.5 cm in length
• gives rise to
  + LAD - left anterior descending artery (RED)
  +CXM - circumflex Artery (YELLOW)

Question 5

PLAX - parasternal long axis view

Answer 5

• 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

Question 6

PLAX - anterior structures

Answer 6

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

Question 7

PLAX - posterior structures

Answer 7

Anterior to posterior

-LV cavity
- Mitral valve
+ Anterior leaflet AML
+ posterior leaflet PML
-LA
- posterior LV wall
- descending aorta

Question 8

RVIT - right ventricular inflow tract

Answer 8

• from PLAX slide laterally slightly and angle under the sternum toward patient right hip

Question 9

RVIT - structures

Answer 9

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

Question 10

RVOT - right ventricular outflow tract

Answer 10

• from PLAX angle toward patient left shoulder

Question 11

RVOT - structures

Answer 11

• RVOT
• pulmonary valve
  + right and left posterior cusp ALWAYS
• main pulmonary artery
  + sometimes see branches

Question 12

Parasternal Short Axis views PSAX

Answer 12

• imaged at 6 different levels
• beam swept from base to apex
• from PLAX rotate 90 degrees clockwise

Question 13

PSAX Levels

Answer 13

• base of heart (AB level)
• pulmonary artery level
• MV level
• LV base level (chordae tendinae)
• LV mid (pap) level
• LV apex

Question 14

PSAX - pulmonary valve level structures

Answer 14

• RVOT
• RPC
• LPC
• main pulmonary artery
• right pulmonary artery
• left pulmonary artery

Question 15

PSAX - base (AV) level - structures

Answer 15

• MAIN FOCUS IS AV
• must see all leaflets
  -SVC
• RA
• TV
  + septal and anterior
  -RV
  -PV
  -LPPC, RPPC
• PA
  -LA

Question 16

PSAX - MV level - structures

Answer 16

• RV free wall
• RV chamber
• IVS
• AML
• PML
• MV annulus

Question 17

PSAX - LV base

Answer 17

• 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

Question 18

PSAX - mid / pap level - structures

Answer 18

• RV free wall
• RV chamber
• IVS
• all walls of LV simultaneously
• pap muscle attached to wall
• pericardium

Question 19

PSAX - apical level - structures

Answer 19

• slide inferior
• inferior to paps
• all walls of LV at apical level
• sliver of RV
• excellent for pericardial effusions

Question 20

Perfusion territories

Answer 20

• each wall has particular artery which perfumes it
• knowing names of all the walls and noticing abnormal movement
• INDIRECTLY DIAGNOSE ISCHEMIA OR INFARCTION