Will and Erik: Cardiac Anatomy, EP Testing/Study, ICE, Mapping Images

from front to back

Anterior/Posterior (AP) View

from back to front

Posterior/Anterior (PA) View

looking down the barrel of the heart valves

Left Anterior Oblique (LAO) View

looking across the heart valves

Right Anterior Oblique (RAO) View

directly from left side

Left Lateral (LL) View

directly from right side

Right Lateral (RL) View

from the head looking down

Superior/Cranial View

from the feet looking up

Inferior/Caudal View

Right Ventricle

Most anterior chamber of the heart

Left Atrium

Most posterior chamber of the heart

Left Atrium

Esophagus is directly posterior to what heart chamber?

heat or cold damaging esophageal wall, causing an ulcer or a hole following catheter ablation procedure for atrial fibrillation

Atrioesophageal Fistula

deoxygenated blood

The blood in the right atrium is

brings deoxygenated blood to right atrium from upper parts of the body

Superior Vena Cava (SVC)

brings deoxygenated blood to right atrium from lower parts of the body

Inferior Vena Cava (IVC)

Inferior Vena Cava (IVC)

Most catheters enter the heart from what part of the right atrium?

the opening where the coronary sinus brings deoxygenated venous blood from the heart muscle into the right atrium

Coronary Sinus Os

a small, muscular, triangular pouch extending from the upper front part of the right atrium

Right Atrial Appendage

parallel muscular ridges on the inner walls of the atria of the heart

Pectinate Muscles

Three

Tricuspid Valve has how many leaflets?

"area between"

Isthmus means?

the area between the inferior vena cava and tricuspid valve

Cavotricuspid Isthmus (CTI)

Cavotricuspid Isthmus (CTI)

What is the site of typical atrial flutter ablation in the right atrium?

covers the inferior vena cava during fetal development

Eustachian Valve

a normal fibrous tissue fold in the right atrium of the heart, a more prominent ER can make catheter ablation procedures more difficult

Eustachian Ridge

thin tissue in wall of right atrium, used to cross to left atrium for LA ablations

Fossa Ovalis

when fossa ovalis does not close after birth

Patent Foramen Ovale (PFO)

transition between rough and smooth musculature in the right atrium, exclusive to the right atrium

Crista Terminalis

Crista Terminalis

What is the site for most focal atrial tachycardias in the right atrium?

projection of the eustachian ridge

Tendon of Todaro

deoxygenated

the blood in the right ventricle is

connect atrioventricular valve leaflets to papillary muscles

Chordae Tendonae

connect to ventricular wall, keep leaflets closed during heart contraction

Papillary Muscles

1 papillary muscle per leaflet

How many papillary muscles per atrioventricular valve leaflet?

helps to coordinate electrical impulses through the right ventricle

Moderator Band

lines the ventricles, cushions blood and optimizes blood flow in ventricles

Trabeculae

"exit ramp" of the right ventricle, general area right before the pulmonary valve, transitional tissue between trabeculae and pulmonary valve

Right Ventricular Outflow Tract (RVOT)

Right Ventricular Outflow Tract (RVOT)

What is the most anterior structure of the heart?

The Right Ventircular Outflow Tract (RVOT) and the Left Ventricular Outflow Tract (LVOT)

Where do PVCs most occur?

has 3 cusps, opens and closes to allow blood flow from right ventricle, to pulmonary artery, and then to lungs

Semilunar Pulmonary Valve

Left and Right Superior Pulmonary Veins and the Left and Right Inferior Pulmonary Veins

Name the four pulmonary veins

oxygenated blood

What kind of blood is in the left atrium?

the posterior wall of the left atrium

What is the most posterior structure in the heart?

around the pulmonary veins

Where would you typically ablate for atrial fibrillation?

the process of ablating around the pulmonary veins for atrial fibrillation

Pulmonary Vein Isolation (PVI)

when two superior and inferior pulmonary veins merge before emptying into the left atrium via a single opening

Conjoined or Common Pulmonary Vein

where two pulmonary veins meet in the atrium, form two separate entrances

Carina

an extra step used during catheter ablation for atrial fibrillation, between the upper and lower pulmonary veins on one side of the heart, doctors use it when standard vein isolation fails to block stubborn electrical signals

Carina Ablation

separates the left pulmonary veins and the left atrial appendage

Warfarin Ridge/Coumadin Ridge

pouch in muscular wall of the heart's upper left chamber

Left Atrial Appendage

True

T/F: Is pectinate muscle only exclusively in the left atrial apendage in the left atrium?

it helps treat persistent atrial fibrillation, hard to treat atrial flutters, and specific electrical triggers by destroying muscle bundles and nerves that sustain abnormal heart rhythms

Epicardial Ablation at the Ligament of Marshall

a small heart vessel that runs along the outer surface of the left atrium

Vein of Marshall

a small fold of tissue on the outside of the heart's left atrium

Ligament of Marshall

Windsock, chicken wing, cactus, cauliflower

Name the 4 main shapes of a Left Atrial Appendage

It determines the sizing needed of a Left Atrial Appendage Closure device

Why does the Left Atrial Appendage shape matter?

ultrasound inside the heart

Intracardiac Echo (ICE)

2 leaflets

Mitral Valve has how many leaflets?

2 papillary muscles

How many papillary muscles are in the left ventricle?

Because it has to send blood to the body which is a harder job and needs more force

Why does the left ventricle have a thicker muscular wall than the right ventricle?

lesion from inside the heart all the way through to the outside of myocardium

Transmural Lesion

lesion from inside the heart only getting below the surface not all the way through the myocardium

Subendocardial Lesion

the last point before the aortic valve opening

Left Ventricular Outflow Tract (LVOT)

Directly posterior to the Right Ventricular Outflow Tract (RVOT)

Where is the Left Ventircular Outflow Tract (LVOT) positioned?

semilunar

What shape is the aortic valve?

three

How many cusps does the aoritc valve have?

Left coronary cusp, Right coronary cusp, and the Noncoronary cusp

Name the aortic valve coronary cusps

the Left Main Coronary Artery ostium (LMCA)

What coronary artery ostium is within the left coronary cusp?

the Right Coronary Artery ostium (RCA)

What coronary artery ostium is within the right coronary cusp?

supplies oxygenated blood to the right atrium, right ventricle, the inferior part of the left ventricle, and electrical conduction system

Right Coronary Artery (RCA)

Left Anterior Descending (LAD), Left Circumflex Artery (LCx)

Left Coronary Artery (LCA) branches

at the front of the heart, branches off the left main coronary artery to supply oxygenated blood to the anterior and inferior left side of the heart muscle

Left Anterior Descending Artery (LAD)

a major branch of the left main coronary artery, wraps around the left side of the heart in the atrioventricular groove, supplying oxygenated blood to the left atrium and the lateral and posterior walls of the left ventricle

Left Circumflex Artery (LCx)

because it has a thick muscular wall and must pump oxygenated blood under high pressure to the entire body, requiring more energy and oxygen

Why does the left ventricle need more blood?

AV Node

Where in the conduction system does the Right Coronary Artery also supply blood?

Great Cardiac Vein, Anterior Interventricular Vein, Middle Cardiac Vein

Name the three main coronary veins

Anterior Interventricular Vein

What coronary vein does the Great Cardiac Vein turn into?

Coronary Sinus

Where do all coronary veins flow to?

Posterior

What side of the heart does the Coronary Sinus wrap around?

In the Atrioventricular Groove

Where does the Coronary Sinus sit?

Anterior Interventricular Vein

In the Coronary Sinus Clock analogy, what vein is at 12:00?

Lateral Veins

In the Coronary Sinus Clock analogy, what vein is at 4-5:00?

Middle Cardiac Vein

In the Coronary Sinus Clock analogy, what vein is at 7:00?

a thebesian valve that has not fully dissolved after birth, makes CS catheter insertion more difficult

Guarded CS Os

A fully dissolved thebesian valve after birth, leaving CS Os unblocked

Unguarded CS Os

covers the CS Os during fetal development and dissolves after birth

Thebesian Valve

the area in which the thebesian valve is dissolved at

Subthebesian Recess

Posterior Septal Wall

What wall of the right atrium is both the fossa ovalis and the CS Os on?

SA Node

Heart's primary pacemaker

Anterior, Middle, and Posterior Internodal Tracts

Name the three internodal tracts

Carries impulse from SA Node to the left atrium

Bachmann's Bundle

Heart's secondary pacemaker

AV Node

the higher the rate of AV Node receiving signals, the slower the AV Node passes impulses through to the ventricles, leads to longer PR interval

Decremental Conduction Property

Section of conduction pathway right after the AV Node

His Bundle

The posterior and anterior fascicles

Left Bundle Branch splits to which two main fascicles?

specialized muscle cells in the inner walls of the ventricles, for contraction

Purkinje Fibers

Tendon of Todaro, the CS Os, and the septal leaflet of the Tricuspid Valve

Name the three sides of the Triangle of Koch

AV Node location (at the tip of the triangle)

What is the Triangle of Koch used to identify?

inside layer of the heart

Endocardium

a layer of endothelial cells

What is the endocardium made up of?