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Anatomy class > Unit 12: Heart > Flashcards

Unit 12: Heart Flashcards

1
Q

How is the identification of the pericardial sac and descending aorta useful in ultrasound images?

A

Descending aorta is not inside the pericardial sac, sac should pass anterior to it.
Locating these structures should allow identification if any fluid build up is inside or outside the pericardium.

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2
Q

How should you get a four-chamber image of the heart on an ultrasound machine?

A

Patient supine and lying on the let side
Place probe in midclavicular line at T4 is level.
Point probe indicators towards patient left
Tile probe so other end is towards the right shoulder.
Note patients left venricle tends to be on our right side of the screen

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3
Q

How to achieve a subxiphpod view of the heart and pericardium?

A

Probe in midline 2 to 4 cm below xiphoid process
Pot light pressure and flattened probel and direct upwards towards left shoulder
View will show the right ventricle, right atrium with the underlying left atrium and left ventricle.
First contact is with right ventricle

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4
Q

How do you achieve a parasternal long axis view of the heart?

A

Probe left to sternum in the 4 the intercostal space.
Point marker to patient left elbow and other towards right shoulder
Adjust until heart is imaged

This will show the right ventricle most superioaly
Then underneath the left ventricle. atria and sum of the aorta.

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5
Q

How to achieve a parastenrnal short axis view of the heart?

A

Place probe left to sternum on 4th intercostal space.
Point marker to left shoulder and opposite to right elbow.
Move problem up or down an intercostal space until the left ventricle appears,
May fan superiorly to see aortic valves.

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6
Q

What is the origin of the coronart arteries?

A

The aortic sinus (anterior to right) (left posterior for the left coronary)
In the acsending aorta.

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7
Q

What is the passage of the sinoatrial artery?

A

First branch of the right coronary artery
passes between the aorta and the right auricle to loop behind the SVC to supply the right atrium.

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8
Q

Where is the right coronary artery found?

A

Arises from the anterior aortic sinus
Travels in the right atrioventricular groove

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9
Q

What are the branches of the right coronary arteri from the right atrioventricular groove?

A

The conus branch (will anatasmose with left) supplies conus of heart.
Ventricular branches - to supply ventricles

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10
Q

What is the right marginal artery?

A

Branch of right coronary artery
Supplies the right inferior surface of the heart and may continue towards the the apex of the heart.

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11
Q

What is the right posterior descending artery?

A

Branch of right cornary artery
Found in the interventricular groove on the diaphragmatic surface
May continue to apex of the heart and anastamose with the left anterior descending artery

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12
Q

How does the right coronary artery terminate?

A

Gradullay reduces in size
May anastamose with the left circumflex artery

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13
Q

Which coronary artery is larger?

A

The left coronary artery (not is wider but is shorter)

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14
Q

What is the origin of the left coronary artery?

A

The left posterior aortic sinus
Emerges between left auricle and the left side of pulmonary trunk

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15
Q

What are the immediate branches of the left coronary artery?

A

Devices after emerging between the pulomonary trunk and the left auricle
Into the:
- circumflex branches (travel left)
- the left anterior descending artery.

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16
Q

What is the location of the left anterior descending artery?
(branches)

A

Travels in the interventricular groove on the anterior surface of the heart
Has a conus branch - (anastamose with right)
Diagonal branch - for anterior surface of the heart
Anastomoses with the posterior interventricular artery as continues towards the apex of the heart.

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17
Q

Describe the passage of the left circumflex artery of the heart?
(branches)

A

Travels to the diaphragmatic surface of the heart between the left atrium and ventricle edges
has a left marginal branch on the left margin of the heart.

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18
Q

What is meant by coronary artery dominance?

A

The dominant artery is the artery that gives rise to the posterior descending artery
In most individuals this is the right coronary artery (80%)
In 10% individuals this is the left coronary (is a branch from the circumflex)
When both vessels anastamose and give rise is a co-dominant (10%)

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19
Q

What is the consequence of an infraction in a coronary artery?

A

Myocardial death
Anastomosis between vessels is not enough to compromise this.

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20
Q

What are atrial septal defects?

A

Abnormal communications between the upper cardiac chambers
Most common type of congential cardiac abnormalities.

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21
Q

What are the two types of atrial septal defects?

A

Patent foramen oval (tunnel)
Patent ostium secundum (direct hole between the two)

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22
Q

What is the pathology behinda trial septal defects?

A

Intrauterine adaptation allows blood flow between RA and LA to bypass lungs through foramen
ovale
This passage normally closes by 3 month extrauterine
If not initially blood will move from left atrium to right (low consequence as mixed blood moves to lungs)
However, right atrium becomes hypertrophied due to dealing with excess blood volume
Now pressure higher in right atrium then left atrium, deoxygenated blood travels into left atrium as shunt is reversed.
Deoxygenated blood enters systemic circulation patient experiences hypoxemia

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23
Q

What are some of the gentic backgrounds to atrial septal defects?

A

DiGeorge
Down Syndrome
Ellis-van Creveld

Commonly present in childhood but can also be diagnosed in adults

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24
Q

What is though to be the original of most atrial septal defects?

A

Abnormal absoprtion of the septum prium - incorrect part of too much is reabsorbed leading to a patient or large foramen ovale
Failure of septum secondum to form and occlude ostium secundum
Endocardial cushions fail to fuse, ostium primum remains patent and septum premium has nothing to fuse with

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25
Q

What is pericardial effusion?

A

Build up of fluid in the pericardium around the heart
Above physiological range or 15-50ml

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26
Q

What are the common causes of pericardial effusion?

A

Is fluid is sterile - congestive heart failure or hypoalbuminemia
Contains blood - heart malignant, aortic dissection or myocardium rupture
Lymph - mediastinal lymphatic obstruction

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27
Q

How does cardiac tamponade relate to pericardial effusion?

A

When fluid accumulates quickly such as in an aortic dissection imposes large pressure on the heart and causes heart failure due to acute effusion

28
Q

What is cardiocentesis?

A

When pericardial effusion fluid accumulation is slow, meaning volume growth is some what accommodated for.
Cardiocentesis is a life saving procedure to spiral the perical content and drain fluid using a thin needle

29
Q

What are the five types of atrial septal defects?

A

Ostium secundum - deficiency in septum primum
Ostium primum - defect in the canal septum
Sinus venosus defect - communication between strai via a straddling venous structure (SVC or IVC)
Coronary sinus - partially of completely unroofed coronary sinus
Juxtaposition of the atrial appendages - absence of misplacement of the septum secundum.

30
Q

Describe the passage of the right coronary artery and its branches.

A

Courses in the right atrioventricular groove to the inferior surface/ diaphragmatic surface of the heart, then turns anteriorly at the crux of the heart to give the posterior descending artery.

31
Q

Describe the passage of the left coronary artery and its branches

A

Has a short common stem then bifurcates just after the pulmonary trunk.
THe left circumflex artery travels in the left atrioventricular groove.
The left anterior descending atery passes towards the apex in the anterior interventricular groove

32
Q

What anatomical abnormality results in a trifurcation of the left coronary artery?

A

Left coronary artery splits into left circumflex, left anterior descending and a ramus intermedius
In left dominanat hearts this supplies the the posterior descending artery

33
Q

Describe what region of the heart the right coronary artery supplies.

A

The entire RV via the right marginal branch
I/3 of the IV septum and branch to the posterior wall
In right dominated - supplies the inferior wall of the left ventricle
AV node
SA node

34
Q

What region of the heart is supplied by the left anterior descending artery?

A

THe anterior part of the septaum with septal branches,
Supplies the anterior and left of the left ventricle with diagonal branches
May contribute to the AV bundle

35
Q

What does the left circumflex artery supply?

A

In left dominant will supply the AV node and the inferior wall of the ventricles
In right dominant supplies the basal and mid parts of the posterolateral wall.

36
Q

What are coronary artery anomalies?

A

Variations in the coronary anatomy present in less than 1% of the population
Normals varients
: Left coronary dominance
Posterolateral branches from the left circumflex
Co-dominance
- ramus intermedius
- separate ostium of conus branch

37
Q

What are some common congenital coronary artery anomalies?

A

Left circumflex artery arising from the right coronary artery
Left coronaru artery arising from the right aortic sinus and traveling prepulmonic or retroaortic in order to go the left

38
Q

How do most patients with coronary artery abnormalities present?

A

Mainly asymtpomtic and indeitided by coronary angiography or autopsy following a sudden cardiac death
May cause angina, syncope, heart failure and myocardial infarction

39
Q

How might congential coronary artery abnormalities be dangerous?

A

Most common cause of sudden cardiac death in young competitive athlelets (25%)
Particulary, when artery originates from the wrong aortic sinus then travels between the pulsatile pulmonary trunk and the aorta - this can compress the artery and diminish blood flow
Cause reentry phenomenon in the myocardium
Ventricular fibrillation or sustained ventricular tachycardia leads to sudden death

40
Q

What is intramural course of a cornary artery (myocardial bridging)?
How does this present?

A

When coronary artery passes in the myocardium rather than on its surface
Is hemodynamically unstable - often presents with exertional angina
Most common location is LAD
Can cause myocardial damage particular if systolic impression increases or distaloci filling decreases.
Predispose to acute coronary syndromes, arryhtmias, coronary vasospasm, MI and left ventricular dysfunction.

41
Q

What is the timeline by which the embryological development of the heart occurs/

A

Day 20: primitive heart rube
Day 21: differentiation of the heart tube
Day 20-30: folding of the heart tube
Day 28: Atrioventricular septum
Day 35+ : atrial, ventricular and aorticopulomonary spetum

42
Q

Give an example of an aorticopulomonary septal defect.

A

Asymmetrical AP septum through truncus arteriosus
Occurs when the aortopulmonary septum and the muscular ventricular septum do not align.
Results in a narrowed pulmonary trunk and a over-riding aorta
Is a component of tetraology of fallot.

43
Q

What are the features of the tetralogy of fallot?

A

Over-riding Aorta
Pulmonary stenosis
Right ventricular hypertrophy
Ventricular septal defect

Small percentage may also have an atrial septal defect.

44
Q

What are the different fetal cardiac shunts?

A

The foramen ovale - from RA to LA
The ductus arteriosum - from the pulmonary trunk to the aortic arch

Both allow oxygenated blood from maternal circulation to bypass the pulmonary circulation and pass straight into systemic circulation.

45
Q

What are the associated congential conditions from foetal cardiac shunts?

A

Patent foramen ovale (does not close to form fossa ovalis)
Patent ductus ateriosus - (does not close to become the ligamentum arteriosum)

46
Q

What are some common congenital defects of the heart?

A

The atrial septal defects
The ventricular septal defects
Tetralogy of fallot
Patent ductus arteriosus

47
Q

What are the key events in the embryological development of the cardiovascular system?

A

Differentiation - from progenitor cells to primitive heart tube
Looping: from endocardial tube to primitive heart (grows and folds)
Septation.

48
Q

What are the different septas that must form during the embryological development of the cardiovascular system?

A

The atrio-ventricular septum
The atrial septum
The ventricular septum
The aorta/pulmonary trunk

49
Q

Where do the cardiac progenitor cells arise from?

A

The splanchnic mesorderm gives rise to cardiac progenitor cells for both the primary and secondary heart fields
The ectoderm - gives rise to neural crest cells that migrate to the splanchnic mesoderm to help form the heart

50
Q

What is the consequence of a genetic defect in the cardiac progenitor cells?

A

Leads to congenital heart defects,

51
Q

Describe how the heart tube forms?

A

The growth of the mesoderm results in two endocardial tubes growing from each splanchnic mesoderm
The folding of the embryo in a craniocaudal and external to internal fashion results in the fashion of the endocardial tubes as day 21 forming a heart tube.
This tube will be surrounded by pericardial cavity which also merged together on folding.

52
Q

What are the different section of the heart tube as it bulges?

A

The truncus arteriosis
The bulbus cordis
The primitive ventricle
The primitive atrium

53
Q

How can the heart tube be divided by its blood supply?

A

Veins flow into the sinus venosus, this is connected to the primitve atria
Then flows throuhfh the primitve ventricle, the bulbus cordis and the trunuc arteriosus
The aortic sac is a dilated part of the truncus arteriosus just before its bifurcation and is considered the arterial outflow area.

54
Q

Why does the heart tube fold during embryogenesis?

A

The heart tube grows faster than the surrounding pericardial cavity
As the tube is anchored at its ends to the pericardial cavity it must fold in order to fit.

55
Q

Describe the pattern of looping of the heart tube.

A

The trunucs arteriosus and the primitve ventricles can be generalised as moving in an cuadal and left direction
The primitive atria tends to move in a cranial and right direction
Results in a folded U ish shape, with the primitve atria being separated into two parts (a left and right) by the trunucs arteriosus/bulbos cordis

This now forms a primitive adult form of the heart, but only has one continuous chamber

56
Q

Describe how the atrioventricular septum develops?

A
  1. The folding of the heart tube creates an atrioventricular groove.
  2. Internally this groove causes a narrowing of the lumen.
  3. On its longitudinal axis there is some growth of tissue inwards in the primitive atria and ventricles towards the auricularventricular junction.
  4. At this section dorsal and ventral endocardial cushion grow towards each other and fuse separating the atria and ventricles.
  5. Note this separation is not across the full lumen, there are atrioventricular canals (one to the left and one to the right) which allows for communication between the R/L atria/ventricles respectively.
  6. Subendocardial tissue at these sites produces the mitral and bicuspide valves over this canals.
57
Q

How does the atrial septum develop?

A
  1. The interatrial septum proliferates downwards towards the endocardial cushions forming a division between the left and right atria.
  2. First the septa primum forms with the ostium primum just above the endocardial cushions
  3. Part of the septum primum closer to its origin undergoes apoptosis, fenestrations fuse to form the ostium secundum.
  4. At the same time the ostium primum closes
  5. The septa secundum then grows from a tissue ridge to the right a sp, forms a curtain like structure over the ostium secondum.
    Does not fuse with the endocardial cushion leaving a hole.
  6. The combination of the hole in septum secundum and the ostium secundum in septum primum forms the foramen ovale and with the septum primum act as a flutter vale for undirectional flow between the right and left atria.
58
Q

What happens to the atrial septum at birth (normally)?

A

The primary and secondary septa fuse due to pressure changes from feotal to adult circulation
This closes the foramen ovalis becomes the fossa ovalis.

59
Q

How does the ventricular septum develop during heart embryogenesis?
How does this relate to congenital defects?

A

Flooe of the ventricle develops upwards to form a muscular division
Also some contribution from the endocardial cushion growing downwards to form a membranous portion.
The membranous portion is more likely to have ventricular septal defects.

60
Q

Describe how the aorticopulmonary septum forms?

A

Pair of ridges develop at the bifurcation of the truncus arteriosus
Grow downwards in a spiral fashion fusing with the some of the walls of the truncus arteriosum, each other and eventually the ventricular septum.
The endocardial cushion will contribute to the growth required to join the AP septum and the V septum.
This closes the interventricular foramen

61
Q

What is the role of aorticopulomonary septum? (link to embryology)

A

Grows downwards from the bifurcation of the trunus arteriosus.
Spilts the outflow tract into the aortic arch and the pulmonary trunk
Links up with the ventricular septum to ensure the left and right ventricles have different outflow tracts
And explain why the aorta (from the left ventricle) is on the right of the pulmonary trunk (from the right ventricle) due to the spiral pattern of growth.

62
Q

Through which primordial structure does blood enter and leave the heart via embryonic development?

A

Enters via the sinus venosus (veins into atria) and leaves via the trunuc arteriosus (which becomes the aortic and pulmonary outflow tract)

63
Q

Draw what can be seen in the apical long axis ultrasound view of the heart

A
64
Q

Draw what can be seen in the parasternal long axis of the heart

A
65
Q

Describe what can be seen in the parasternal short axis of the heart

A

Anatomy class (42 decks)

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