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 )

Module 1 : Intro Echo and Cardiac Anatomy Flashcards by Adyson Strong

Echo indication

Ischemic heart disease
Valvular disease
Congestive heart failure
Pericardial disease 
Functional capacity

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Heart orientation

Heart axis is different then body axis

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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

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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

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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 : endothelium

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Right heart

Contains 
 Right atrium
 Right ventricle
 Pulmonary valve
 Tricuspid valve

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Left heart

Contains 
 Left atrium
 Left ventricle
 Aortic valve
 Mitral valve

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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

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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

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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

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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

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Mediastinum

Anterior mediastinum - in front of pericardium

Middle mediastinum - contains pericardium and heart

Posterior mediastinum - behind the pericardium

Superior mediastinum - surrounding great vessels

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Coronary arteries

Main arteries
 - Left Main Coronary Artery 
    \+ left anterior descending artery LDA
    \+ circumflex Artery 
 - Right Coronary Artery

ONLY FILL DURING DIASTOLE

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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

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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 )

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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
    \+ epicardium

Pericardial 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