Erik Cardiac Anatomy Test

What's the structure you use to go transeptal

Fossa Ovalis

How many leaflets does the tricuspid valve have?

3

How many leaflets does the mitral valve (bicuspid) have?

2

How many papillary muscles does the mitral valve (bicuspid) have?

2

How many papillary muscles does the tricuspid valve have?

3

What are the three coronary cusps?

Right coronary cusp, left coronary cusp, non coronary cusp

Where are the coronary cusps located?

Aortic valve

How many pulmonary veins are there

4

What are the four pulmonary veins

Left Superior and inferior pulmonary veins and right superior and inferior pulmonary veins

Superior

Above

Inferior

Below

Anterior

Front

Posterior

Back

Space in between the superior and inferior pulmonary veins

Carina

LVOT is posterior to the

RVOT

What coronary artery supplies blood to the posterior part of the heart

LCX (left circumflex)

What coronary artery supplies blood to the anterior part of the heart

LAD (left anterior descending)

What view of the heart shows ventricle and atrial portions?

RAO

What are the views of the heart

RAO, LAO, AP, PA, LL, RL

If you're in RAO View where is the spine and heart

Heart is on the right spine is on the left

If you're in LAO view where is the spine and heart

Heart is on the left and spine is on the right

Where is the crista terminalis?

Right atrium

What's the importance of the crista terminalis?

- Transitional tissue from smooth to rough (pectinate muscle)

- Focal tach comes from this area usually

- Right atrium location

Pectinate muscles

Rough muscular tissue

Falls along wall of right atrium

Right atrial appendage

Made up of pectinate muscles and crista terminalis

Potential area for atrial arrhythmias

What valve covers up in utero the inferior vena cava?

The eustachian valve covers it up

Once birth happens it usually goes away and then can leave behind a rough muscle which is called the eustachian ridge

The eustachian ridge is where and why

Left over after birth

Turns into rough muscle tissue

When catheter comes up through IVC this ridge can be curved and harder to get through and ablate

What's the space in between the inferior vena cava and the tricuspid valve?

Cavotricuspid isthmus CTI

Isthmus means in between

Tricuspid so think tricuspid valve

Cavo inferior vena CAVA

What's the three entry ways for deoxygenated blood

SVC, IVC (deox blood from body)

CS is (deox blood from actual heart)

What lies posterior to the posterior wall of the left atrium

Esophagus

What's the most anterior structure of the heart

Right ventricular outflow tract (RVOT)

What's the most posterior structure of the heart

The posterior wall of the left atrium

What's the most posterior chamber

Left atrium

What's the most anterior chamber

Right ventricle

The RVOT leads into the what

Pulmonic valve and pulmonary artery to the lungs

Arteries carry what kind of blood

Oxygenated blood

it's higher pressure because it's having a huge job of taking it to the body

Veins carry what blood

Deoxygenated

Pulmonary arteries carry what kind of blood

Deoxygenated blood (taking to the lungs to pick up some oxygenated blood to bring back)

What's after the tricuspid valve

Tricuspid valve 3 leaflets -> chordae tendonae -> 3 papillary muscles

Purpose of papillary muscles

To keep the tricuspid valve leaflets above closed during systole

Papillary muscles connects to what

Right ventricle valls

Trabeculae

Cushion at the bottom of the right ventricle, this is so that when red and white blood cells start spewing down from the right atrium they are able to be bounced off in a way so it doesn't hit the walls

chordae tendonae

Like a rope or strings connective tissue

Chordae tendonae connects what

The papillary muscles to the tricuspid valve leaflets

Moderator band

Not everyone has this, Muscle tissue that connects the lateral lateral wall of the ventricle to the septum (think of it as the M Man Moderator connects etc) and PVCs can come from this location

Fossa ovalis

Is the hole that usually closes up after birth, you puncture this which is the transeptal puncture from the right atrium to the left atrium

Triangle of Koch is made up of

Tendon of todaro, tricuspid valve, CS os

Triangle tip is what

AV node

Why is the triangle of Koch important

Used as a reference point for doctors during ablations and procedures to find AV node

Left atrium has how many entrances

Four which are the right and left superior and inferior veins

A fib comes around what area

Pulmonary veins ->posterior atrial wall of left atrium -> if there the carina of pulmonary veins gets ablated

Arterial and venous tissue

This is when high pressure blood that is going to the body away from the heart (arteries ox blood) and venous tissue has thinner walls and accommodates lower pressure blood returning to the heart (veins deox blood)

transition of venous and arterial tissue

This is when A Fib can come around the pulmonary veins because it's transitioning the tissue

When you ablate what are you doing

You are creating scars and getting rid of conduction tissue

What's the channel leading out into the pulmonic valve

Right ventricular outflow tract (RVOT)

What's the thinnest part of the right atrium

Fossa Ovalis

SPV

Superior pulmonary vein

IPV

Inferior pulmonary vein

If someone has a carina what does that mean

The two pulmonary veins just won't meet before entering into the left atrium

So what veins bring blood to the left atrium

Pulmonary veins

What separates the left atrium from the left atrial appendage

Coumadin ridge

Coumadin ridge is where and separates what

It's endocardium and separates the left atrium and left atrial appendage inside

What separates the left atrium and left atrial appendage on the outside

Ligament of Marshall

The ligament of Marshall is where and seperates what

It's epicardium and seperates the left atrium and left atrial appendage

Left atrial appendage is the primary location for what

Blood clots

What appendage doesn't contract a lot

The left atrial appendage

What's the purpose of the left atrial appendage

It doesn't contract a lot, so blood doesn't move, when blood doesn't move it clots, and if the blood clots get out, that leads to a stroke

Left atrial appendage closure device (Watchman or Abbott Amulet) importance

Helps so that blood clots don't move outside LAA

What is an left atrial appendage closure device

This is a closure device that sits in the atrial appendage and keeps blood clots from moving hopefully preventing stroke

Left atrial appendage anatomy

Chicken wing, cactus, cauliflower, windsock

What view gives the most atrial and ventricular views

RAO

What view is looking up from apex

LAO

This is the blood flow on left

Left atrium -> mitral (bicuspid valve) -> left ventricle -> LVOT -> Aortic valve -> aorta -> to body

What shape is the pulmonic and aortic valves

Semilunar

Coronary cusps

Left coronary cusps, right coronary cusp, non coronary cusp

Right coronary cusp connects to what

Right coronary artery

Left coronary cusp connects to what

Left main coronary artery

When the mitral valves close in left what happens to blood

Blood gets pumped into coronary cusps through contraction

Most anterior cusp

Right cusp because supplying blood to right side

Right coronary artery supplies blood to

Right atrium right ventricle and left ventricle inferior (bottom of left ventricle) & SA node & AV node

The left coronary artery has two branches called what

LAD and LCX (left anterior descending and left circumflex)

Lack of blood supply to heart is caused by what

Blood clots

Blood clots restricts blood flow and what to the tissue

Oxygen

What is ischemia

reduced blood flow

If the ischemia is prolonged then what

That can lead to a heart attack aka myocardial infarction

So a lack of oxygen from ischemia results in what

Heart attack

After a heart attack the body replaces the damaged or dead heart muscle cells with what tissue

Scar tissue (which is non conductive)

Scar tissue isn't flexible and doesn't contract normally so then it doesn't pump blood effectively and that leads to

Heart failure

If you're coronary artery is blocked that can lead to

Scarring which can lead to ischemic VT

Right coronary artery supplies blood to where

Right atrium and ventricles and inferior portion of left ventricle

Coronary arteries delivery what

Deliver oxygenated blood to the heart itself

When the blood from the heart is deoxygenated where does that go

Goes into the coronary veins

The coronary veins dumps deoxygenated blood into what

The coronary sinus and into the right atrium

What veins bring deoxygenated blood from the heart back to right atrium

Coronary veins

Great cardiac vein

Most amount of blood (because it is on left side which left ventricle is biggest because pumps blood to body)

The great cardiac vein is where

Runs along the left anterior descending coronary artery Originates at the apex of the heart and curves to the left to join into the CS to dump deox blood back into right atrium

Middle cardiac vein

runs alongside the posterior portion (back) of left ventricle

Cardiac veins are important why

Because they return the deoxygenated blood from the heart itself bark to the right atrium

The heart is in your body in the position

Oblong

Thesbian valve

Covers the CS os but usually dissolves after birth, if it doesn't dissolve after birth it's called guarded CS os