VASC CHP 1- ANATOMY

A set of flashcards defining key terms and concepts related to the functions of the vascular lab and the cardiovascular system.

Testing in 3 major areas

1. Arterial Disease- (PVD) peripheral Vascular Disease

2. Cerebrovascular Disease- results in (CVA) cerebrovascular accident “stroke”

3. Venous Disease- Deep Vein Thrombosis (DVT) and Pulmonary Embolisms (PE)

Peripheral Vascular Disease (PVD)

A vascular disease that affects the vascular system in any part of the body except the heart and head.

How early can. PVD begin?

-young age due to diet, onset 50 yrs

Risk Factors of PVD

-age, gender diabetes, smoking, high BP, High Cholesterol and potential limb loss resulting in pain affecting quality of life

Another arterial Disease other the PVD that we look for is?

(AAA) Abdominal Aortic Aneurysms

Abdominal Aortic Aneurysm (AAA)

Mostly men over 65, Could lead to rupture, ultrasound is very helpful to detect and monitor, high mortality rate. Krations are thought to be a leading cause of AAA.

Krations consist of

Food, beverages, cigarettes & toilet paper. Cigarettes are thought to be the common cause so many people in this age group have AAA

Cerebrovascular Disease

Affects the carotid arteries and brain resulting in CVA, 3rd most common cause of death

Cerebrovascular Accident (CVA)

Also called a stroke, when the embolism dies-having a stroke don’t recover

CVA Recovery %

-30% no longer can care for themselves

-10% deaths annually

High burden on the health care system

One cause of CVA

Carotid Stenosis

Role of a sonographer when it comes to Cerebrovascular disease

Our role to evaluate and identify the disease before a major event like CVA

Common Carotid Artery FLOW

-Anterior/ posterior flow

-internal feeds the brain

-external feeds the face

Vertebral Artery supplies blood to

The brain and spine

Circle of Willis

A ring shaped network of arteries located at the base of the brain that connects the brain to the main blood vessels

Venous Disease

Including deep vein thrombosis- can result in PE

(DVT) Deep Vein Thrombosis

Thrombosis or clot in the deep veins can result in a pulmonary Embolus (PE)

-2.5 million cases a year: 600,00 PE & 50,000 deaths

What are 3 main branches off the aortic arch?

1. Innominate (brachiocephalic) right side only, splits into right common carotid +right subclavian.

2. Left Common Carotid

3. Left subclavian

(First= innominate, second = left carotid, third= left subclavian)

What does the brachiocephalic (innominate) artery divide into?

Right Common Carotid Artery (to head and neck) and right subclavian artery (to right arm)

Where does the subclavian artery turn into the axillary artery?

At the outer boarder of the first rib

(Axillary runs through armpit/ shoulder area, then becomes brachial in upper arm)

What artery runs down the upper arm and splits at the elbow?

Brachial Artery- ends ~1 cm below the elbow bend (anticubital fossa), divides into radial (thumb side) and ulnar (pinky side)

Which Artery is the main blood supply to the hand? What arches does it form?

Ulnar Artery (medial/inner forearm)

It gives deep palmar branch + ends in superficial palmar arch

Radial helps complete deep palmar arch

Superficial vs deep palmar arch- what’s in each?

Superficial: mainly distal ulnar +branch from radial

Deep: deep branch of ulnar + distal radial

What comes off Ascending Aorta?

Left and right coronary arteries- feed the heart muscle itself

Main Branches of the Abdominal Aorta (visceral/ organs)?

-Celiac trunk (stomach, liver, spleen, pancreas, and duodenum)

• Superior Mesenteric (SMA)-small intestines, cecum, ascending/ transverse colon.

• Renal Arteries- Kidneys (can have multiples)

• Inferior Mesenteric (IMA)-Left colon, sigmoid, rectum

Where do common iliac arteries and into what?

At lumbosacral junction (~5cm origin)

Into: Internal illiac (hypogastric-pelvis, gluteals, perineum) and external iliac (continues to leg)

What happens to the external iliac artery?

Passes under inguinal ligament→ becomes common femoral artery runs down

Gives off inferior epigastric and deep circumflex iliac (abdominal wall)

Common femoral artery splits into what?

Superficial femoral (main down thigh → becomes popliteal at Hunter’s Canal/ adductor hiatus).

Deep femoral (profunda -big thigh branc, collateral helper.)

What is the Popliteal Artery? Where does it branch?

Continuation of superficial femoral behind the knee

Branches into anterior tibial + tibioperoneal trunk (which splits to posterior tibial + peroneal).

What does anterior tibial become in the foot?

Dorsalis pedis artery (top of foot)

It’s deep plantar branch helps complete plantar arch with lateral plantar (from posterior tibial).

Posterior Tibial Artery Path and End?

Back/ medial leg → behind medial malleolus (inner ankle bone), divides into medial & lateral plantar arteries (sole of foot)

Peroneal (fibular) artery?

From tibioperoneal trunk, runs along fibula, supplies lateral leg and heel area.

Plantar Arch in. Foot is made of what?

Deep plantar (from dorsalis pedis) + lateral plantar (from posterior tibial)

Sends dorsalis metatarsal/ digital arteries to toes.

What happens when heart contracts (systole)??

At the beginning- at the cardiac contraction the pressure in the left ventricle rises rapidly. Quickly exceeds the pressure in the ascending aorta so that the aortic valve opens -blood is ejected and blood pressure rises. The amount of of blood ejected is called the stroke volume

Faster heart rate effect on blood?

Increased blood volume pumped (more nutrients/ oxygen delivered)

Slower rate= less volume

Normal Blood Flow shape inside an artery?

Laminar/Parabolic flow- like a bullet:fast in center, slower at the walls (friction)

Disrupted by Plaque → turbulent

Arterial waveforms

Early systolic upstroke → peak systolic → systolic decline →dicrotic notch →diastolic run off→ end diastolic.

Blood is like water vs Chocolate pudding-why?

Thin like water =easy flow

Thick (high cholesterol/viscosity)= harder/ slower flow, more resistance

What increases resistance in vessels?

Bifurcations (branching), longer vessels, small diameter , high viscosity (thicker blood)

Role of a Sonographer

1. Provide the highest quality exams

-duplex exam: in PVD, Cerebrovascular, Venous

-Pulse Volume Recording (PVR) with the blood pressure cuff

2. Sonographer dependent

-Exam is only as good as the Sonographer, know your material

-recognize, demonstrate, communicate anatomy and pathology to physicians

Functions of the Cardio Vascular System

Transport-using the heart to pump to circulate blood through vessels to deliver oxygen, hormones, immune cells to tissue

Regulation- maintain homeostasis: takes blood from peripheral system and puts it in the axial system

Immunity-proteins are carried by the Cardiovascular system, necesssary for resistance and elimination of disease

Primary Function in the arterial system

Deliver nutrients in the blood- blood carries to each cell in the body- carries oxygen, glucose, amino acids, electrolytes and hormones

Primary Function of the Venous System

Removes waste products to be carried away from the system. Removes carbon dioxide, urea, uremic acid (bi products takes out of urine)

Absorbtion into the small intestines

When Arterial and Venous system takes up nutrients

Loop of Henle

Concentrates urine-nutrients are taken out at this point as well

Cardiac Heart -Shape size and Location

Cone shaped, hollow muscular organ about the size of a closed fist. Lies between the lungs 2/3 of heart shifts to the left of the midline.

-Apex(pointed end): points to the right

-the Broader portion of the base: base points to the left-little tilt posteriorly -projects superior and posteriorly

Pericardial sac

Serous membrane, it encloses (holds) the heart. Outside layer of heart holds the heart up. Consists of Fibrous Layer and Serous Layer

Fibrous Layer

Outer layer of Pericardial Sac attached to blood vessels, diaphragm and sternum. Keeps the heart in place.

Serous Layer

Second layer of the pericardial sac, inner layer continuous (attached to) with the epicardium heart (outside layer)

Pericardial Cavity

The space between the serous layer and the epicardium, it contains fluid and prevents friction between the membrane as the heart moves- fluids keep it cool/ not overheating. Where fluid in the heart collects.

Cardiac diseases/ problems can be

Genetic

Heart Wall layers

1. Epicardium: thin outer layer of Pericardial of the heart

2. Myocardium:thick middle layer-made of cardiac tissue-responsible for contraction

3. Endocardium: extremely thin- lines chambers of heart.

4. Image shows layers in order from Fibrous Pericardium, Parietal layer of serous Pericardium, Pericardial cavity, Epicardium (visceral layer of serous pericardium), Myocardium, and Endocardium

Heart Chambers

1. Right & Left (2)Atria- receiving chambers

2. Right & Left (2) Ventricles-exiting chambers

3. 4 hear valves: (atrioventicular valves:tricuspid & bicuspid/mitral) (semi lunar valves: pulmonary & Aortic valve)

Right Atria

Receives blood from all parts of the body except the lungs. It’s slightly larger than the left atrium. Receives blood from the Superior & inferior vena cava (SVC&IVC) and the coronary sinus

Left Atria

Receives blood from the lungs to the four pulmonary veins

The left and right atria are separated by

The intraarterial septum which posteriorly corresponds to to the site of the Foreman Ovale

Foreman Ovale

Septum has a “valley” that develops in utero “escape valve” because we’re not “breathing”-closes when we’re born for most) if this isn’t fully closed. Defect that has caused athletes to die.

Right Ventricle

Pulmonary trunk also called pulmonary artery which divides into the right and left pulmonary arteries and carries blood to the lungs

Left Ventricle

Pumps blood into the Aorta - has the thickest wall

Coronary Sulcus

Separates the Atria from the Ventricles

The Anteriorly and posteriorly interventricular sulcus (Septum) separates

Left and right ventricles externally

Anterior Interventricular Sulcus is on the anterior surface of the heart and contains

1. The anteriorly interventricular artery

2. Great cardiac vein

The posterior interventricular sulcus is on the Diaphragmatic surface of the heart and contains

1. The posterior interventricular artery

2. The middle cardiac vein

The anteriorly and posterior interventricular sulci location

Just to the right of the apex of the heart

Heart Valves

Allows blood to flow only in one direction through the heart chambers preventing back flow

Atrioventricular Valves

1. Tricuspid valve

2. Bicuspid valve

Tricuspid valve

Between R Atrium & R Ventricle

Bicuspid/ Mitral Valve

Between L Atrium and L Ventricle

Semi lunar Valves

Guard the base of the two large vessels leaving the ventricular chambers allowing blood flow in only one direction (pulmonary valve & Aortic valve)

Pulmonary Valve

In through the pulmonary artery, receiving from R atrium-closes so there is no retrograde flow- distributes deoxygenated blood to each lung

Aortic Valve

WHEN HEART CONTRACTS- pushes to ascending aorta, aortic arch, and descending aorta

Pulmonary Artery

Only artery that carries deoxygenated blood

Valves close to prevent regurgitation

Keep blood flow in one direction

Cardiac Conduction System(also caused from dehydration)

It’s made of specialized muscle tissues that distributes electrical impulses which stimulate cardiac muscle fibers to contract. The nervous system only increases or decreases the time it takes to complete each cardiac cycle

Sinoatrial Node (SA node)

Located in the Right Atrium wall and initiates each cardiac cycle. It causes both Atria to contract. Impulses travel from SA node to AV node

After going from SA node to AV node

A tract of conducting fibers the atrioventricular septum as the right and left bundles. The atrioventricular bundle distributes charges over the medial services of the ventricles to the Purkinje fibers

Contractions of the ventricles is stimulated by

The P