Anatomy of Heart Variants

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Questions and Answers

What is the primary factor determining oxygen demand in individual cardiomyocytes?

  • Ventricular wall stress (correct)
  • Heart rate
  • Coronary artery blood flow
  • Blood oxygen carrying capacity

Increased wall stress leads to decreased tension required to pump blood out of the heart.

False (B)

What is the equation for calculating wall stress?

Wall stress = (LV systolic pressure * radius) / (2 * wall thickness)

A dilated left ventricle, often caused by leaky valves or cardiomyopathy, can lead to ______ oxygen demand.

<p>increased</p> Signup and view all the answers

What is the medical term for a sudden chest pain at rest, often associated with a blockage in a coronary artery?

<p>Unstable angina (A)</p> Signup and view all the answers

Variant angina is often triggered by physical activity and exertion.

<p>False (B)</p> Signup and view all the answers

Match the type of angina with its typical characteristics:

<p>Stable angina = Chest pain during physical exertion Unstable angina = Chest pain at rest, often a medical emergency Variant angina = Chest pain at rest, triggered by coronary artery spasms Atypical angina = Vague or less severe chest pain, more common in women</p> Signup and view all the answers

What are two potential consequences of a mismatch between oxygen supply and demand in the heart?

<p>Angina and heart attack</p> Signup and view all the answers

Which of these structures are found within the right atrium? (Select all that apply)

<p>Crista terminalis (A), Eustachian valve (D), Eustachian ridge (E)</p> Signup and view all the answers

Epicardial fat is found around the left ventricle.

<p>False (B)</p> Signup and view all the answers

What is the name of the muscular band that runs along the IVS and forms part of the medial papillary muscles in the right ventricle?

<p>Septomarginal band</p> Signup and view all the answers

The ______ is a prominent muscular band found near the RV apex.

<p>Moderator band</p> Signup and view all the answers

Match the following valve excrescences with their locations:

<p>Lambl's excrescences = Atrial side of semilunar valves Transverse sinus = Posterior to ascending aorta and pulmonary trunk, superior to LA Atrial side = Ventricular side of semilunar valves</p> Signup and view all the answers

Which of the following accurately describes the blood flow through arteries?

<p>Arteries carry deoxygenated blood away from the heart (D)</p> Signup and view all the answers

Increased blood volume leads to decreased blood flow.

<p>False (B)</p> Signup and view all the answers

What is the name of the force exerted by blood upon the walls of the blood vessels or chambers of the heart ?

<p>Blood pressure</p> Signup and view all the answers

The ______ pump helps veins in the thoracic and abdominal cavities fight gravity to return blood to the heart.

<p>Respiratory</p> Signup and view all the answers

Which of the following factors can affect blood viscosity?

<p>Plasma elements and proteins (B)</p> Signup and view all the answers

Increased vessel radius leads to decreased blood flow.

<p>False (B)</p> Signup and view all the answers

What is the formula for cardiac output?

<p>Cardiac Output (CO) = Heart Rate (HR) x Stroke Volume (SV)</p> Signup and view all the answers

The ______ is the difference between the rate at which the heart pumps blood and its maximum capacity.

<p>Cardiac reserve</p> Signup and view all the answers

Which of these statements accurately describes the isovolumetric contraction phase of the cardiac cycle?

<p>AV valves and semilunar valves are closed, and ventricular pressure rapidly rises. (C)</p> Signup and view all the answers

The rapid ejection phase occurs when ventricular pressure drops below aortic pressure.

<p>False (B)</p> Signup and view all the answers

What is the name of the conical pouch or space in the RVOT that is also known as the conus arteriosus?

<p>Infundibulum</p> Signup and view all the answers

What occurs during isovolumic relaxation?

<p>All four valves close (B)</p> Signup and view all the answers

Decreased compliance of the left ventricle causes an increase in left atrial pressure.

<p>True (A)</p> Signup and view all the answers

What does impaired relaxation of the left ventricle slow down?

<p>The rate of pressure decline in the left ventricle.</p> Signup and view all the answers

The __________ phase is characterized by the closure of semilunar valves to the closure of AV valves.

<p>isovolumetric relaxation</p> Signup and view all the answers

During which phase does the mitral valve open, allowing blood to rush into the left ventricle?

<p>Early rapid filling (B)</p> Signup and view all the answers

Match the following terms related to the heart with their definitions:

<p>Ventricular relaxation = Heart muscle fibers return to resting length LV compliance = Ability of the heart to expand Diastolic dysfunction = Condition affecting filling of the heart Atrial contraction = Contraction of the atria to push blood into ventricles</p> Signup and view all the answers

The atrial contraction phase is indicated by an increase in left ventricular volume.

<p>True (A)</p> Signup and view all the answers

The __________ is characterized by the movement of blood from the left atrium to the left ventricle after the mitral valve opens.

<p>E wave</p> Signup and view all the answers

What is the primary consequence of diastolic abnormalities?

<p>Pulmonary hypertension (A)</p> Signup and view all the answers

Atrial contraction contributes to approximately 50% of total left ventricular filling in a normal heart.

<p>False (B)</p> Signup and view all the answers

What condition is a leading cause of LV hypertrophy?

<p>Hypertension</p> Signup and view all the answers

During __________, the pressures of the left atrium and left ventricle are almost equal.

<p>diastasis</p> Signup and view all the answers

Match the following parameters with their corresponding definitions:

<p>E wave velocity = Reflects LA-LV pressure gradient in early diastole Deceleration time (DT) = Measures slope from peak of E wave to baseline A wave velocity = Reflects LA-LV pressure gradient in late diastole Isovolumetric relaxation time = Time during which the heart is relaxed before the ventricles fill</p> Signup and view all the answers

Which of the following symptoms is associated with diastolic dysfunction?

<p>Edema (B)</p> Signup and view all the answers

Patients with diastolic dysfunction typically have a lower risk of morbidity and mortality.

<p>False (B)</p> Signup and view all the answers

What happens to the heart muscle as one ages in relation to compliance?

<p>It becomes less compliant.</p> Signup and view all the answers

The __________ is calculated from the E wave to the baseline, reflecting the rate of decline of the LA/LV pressure gradient.

<p>deceleration time (DT)</p> Signup and view all the answers

Which characteristic is typical of a heart experiencing diastolic dysfunction?

<p>Normal ejection fraction (D)</p> Signup and view all the answers

The E/A ratio is used to determine the filling pattern of the heart.

<p>True (A)</p> Signup and view all the answers

What is the consequence of elevated left atrial pressure on the left ventricle?

<p>It forces blood into a non-compliant left ventricle.</p> Signup and view all the answers

The __________ measures myocardial velocities at the medial and lateral mitral annulus.

<p>tissue doppler</p> Signup and view all the answers

Match the following terms with their descriptions:

<p>E velocity = Reflects the rate of LV relaxation A wave = Occurs late in diastole LV compliance = Influences the filling pattern of the heart Pulmonary vein flow = Mirrors left ventricular inflow pattern</p> Signup and view all the answers

What is the most common symptom of ischemic heart disease?

<p>Chest pain (D)</p> Signup and view all the answers

Cardiac arrest refers to a lack of electrical activity in the heart.

<p>True (A)</p> Signup and view all the answers

What are the two types of myocardial infarction identified by ECG?

<p>STEMI and NSTEMI</p> Signup and view all the answers

Elevated levels of ________ indicate cardiac muscle cell death.

<p>troponin</p> Signup and view all the answers

Match the following conditions with their definitions:

<p>Angina = Chest pain due to reduced blood supply Unstable angina = Chest pain at rest NSTEMI = Partial blockage of a coronary artery Cardiac arrest = Complete cessation of heart function</p> Signup and view all the answers

Which condition is characterized by cardiac electrical activity without a palpable pulse?

<p>Pulseless electrical activity (D)</p> Signup and view all the answers

Cardiac pumps continue to beat adequately during a myocardial infarction.

<p>False (B)</p> Signup and view all the answers

What causes a ruptured papillary muscle?

<p>Damage to the left ventricle walls</p> Signup and view all the answers

The most common etiology of cardiogenic shock is ________ infarction.

<p>acute myocardial</p> Signup and view all the answers

Match the following biomarkers with their characteristics:

<p>Troponin = Elevates within 3-4 hours Creatine kinase (CK) = Rises in 3-8 hours Infarcted myocardium = Appears thin and echogenic Biomarkers = Reveal blood changes in response to myocardial damage</p> Signup and view all the answers

Which of the following is a cause of cardiac arrest?

<p>Coronary artery disease (D)</p> Signup and view all the answers

Inflammation of the pericardial sac post-MI is referred to as Dressler's syndrome.

<p>False (B)</p> Signup and view all the answers

What is paradoxical septal motion?

<p>IVS motion away from the LV free wall during systole</p> Signup and view all the answers

Flashcards

Arrhythmias

An irregular heartbeat that can disrupt normal blood flow.

LV Relaxation

Ability of heart muscle fibers to return to resting length after contraction.

Isovolumetric Relaxation

Period after aortic valve closure where all valves are closed, and LV pressure drops.

Early Rapid Filling

The phase where mitral valve opens and blood rushes from LA to LV.

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Diastasis

A brief phase where blood flow is slow and the AV valves flutter.

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Atrial Contraction

Final phase where the atria contract to fill the ventricles.

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LV Compliance

Ability of the left ventricle to expand and fill with blood.

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Oxygen supply

The amount of oxygen delivered to heart muscle via coronary arteries.

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Diastolic Dysfunction Causes

Conditions like LVH lead to decreased compliance and heart stiffness.

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Oxygen demand

The oxygen needed by cardiomyocytes, determined by wall stress.

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Wall stress

Tension required to pump blood, influenced by heart structure.

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LV systolic pressure

The pressure in the left ventricle during contraction, affects wall stress.

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Systolic dysfunction

A condition where the heart's ability to contract is impaired, leading to inadequate blood ejection.

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Dilated LV

A condition where the left ventricle expands, impacting oxygen demand.

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Myocardial infarction (MI)

A heart attack caused by complete blockage of a coronary artery, damaging heart muscle.

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Concentric hypertrophy

Thickening of the left ventricle walls, changing muscle load distribution.

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LaPlace law

Describes the relationship between wall tension, radius, and pressure in the heart.

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Angina pectoris

Chest pain resulting from reduced blood supply to the myocardium, often a symptom of ischemic heart disease.

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Stable angina

A predictable form of angina that occurs with increased oxygen demand but does not occur at rest.

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Angina

Chest pain due to reduced blood flow to the heart, indicative of oxygen imbalance.

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Unstable angina

Chest pain that may occur at rest and is a sign of worsening heart condition, often with a flat ST segment on ECG.

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Variant angina

Chest pain at rest, often due to coronary artery spasms.

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NSTEMI

Non-ST segment elevation myocardial infarction, indicating partial blockage of a coronary artery.

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Atypical angina

Vague chest pain, typically less severe and more common in women.

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STEMI

ST segment elevation myocardial infarction, indicating complete blockage of a coronary artery.

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Cardiac arrest

A complete cessation of electrical activity in the heart, leading to no contractions and potential death without treatment.

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Pulseless electrical activity (PEA)

A condition where there is heart electrical activity but no palpable pulse due to ineffective contractions.

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Biomarkers

Substances in the blood that indicate myocardial damage; common ones are troponin and CK.

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Troponin

A protein that becomes elevated in the blood after myocardial cell death; sensitive indicator of heart damage.

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Cardiogenic shock

A state where the heart cannot pump enough blood to meet the body's needs, often after a heart attack.

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Mitral regurgitation

Condition where the mitral valve can't close fully, often due to ruptured papillary muscle, leading to backward blood flow.

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Aneurysm

A localized enlargement of a weakened area in the wall of an artery or heart chamber, potentially leading to complications.

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Pseudoaneurysm

A contained rupture of the heart's wall, usually with a neck, causing risk of further rupture.

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PICC lines

Peripherally inserted central catheters used for medication administration.

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Eustachian ridge

Fibromuscular ridge between inferior vena cava and coronary sinus in the right atrium.

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Lipomatous hypertrophy

Fatty infiltration of the interatrial septum with fossa ovalis sparing.

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Cardiac output (CO)

The volume of blood the heart pumps per minute, calculated by heart rate multiplied by stroke volume.

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Vasoconstriction

Narrowing of blood vessels, which increases blood pressure and reduces blood flow.

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Viscosity of blood

A measure of the thickness of blood, affecting blood flow.

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Isovolumetric contraction

Phase where ventricles contract but no blood is ejected, pressure rises rapidly.

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Tricuspid valve

Valve located between the right atrium and right ventricle, consisting of three leaflets.

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Atrial special aneurysm

An out-pouching of the interatrial septum often associated with a patent foramen ovale.

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Ejection fraction (EF)

Measure of the percentage of blood pumped out of the heart with each contraction.

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E-point septal separation (EPSS)

Distance measured between the anterior mitral valve leaflet and the interventricular septum during early diastole.

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Coronary artery disease (CAD)

A condition characterized by the narrowing or blockage of coronary arteries due to plaque buildup.

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Diastolic filling

Phase where the left ventricle fills with blood before contraction, volume increases.

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Stroke volume (SV)

The amount of blood pumped by the heart in one contraction.

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Collateral circulation

Alternative blood flow that develops slowly due to obstruction within a vessel.

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Hypertension

A condition of elevated blood pressure, often leading to other heart issues.

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Aortic stenosis

Narrowing of the aortic valve, causing resistance to blood flow.

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Ejection fraction

The percentage of blood that is pumped out of the LV with each heartbeat.

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E wave velocity

The speed of blood flow from LA to LV during early diastole.

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A wave velocity

The speed of blood flow from LA to LV during late diastole caused by atrial contraction.

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Deceleration time (DT)

The time it takes for the E wave to peak and return to baseline.

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Pulmonary hypertension

Increased blood pressure in the pulmonary arteries, often due to high LA pressure.

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Left ventricular hypertrophy

Thickening of the LV muscle, often caused by hypertension.

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Tissue Doppler imaging

A method to measure the speed of the heart's walls during the cardiac cycle.

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LA pressure

The pressure in the left atrium, which affects blood return to the LV.

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Diastolic dysfunction

Impaired filling of the heart due to stiffness or abnormalities.

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Study Notes

Normal Variants

  • Right Atrium:
    • Crista terminalis: A C-shaped, fibrous ridge directing blood from superior vena cava (SVC) to inferior vena cava (IVC).
    • Eustachian ridge: Located between IVC and coronary sinus, remnant of fetal circulation.
    • Eustachian valve: Remnant of fetal circulation.
    • Chari network: Fenestrated variant of Eustachian valve.
  • Left Atrium:
    • Pectinate muscles: Prominent parallel ridges within the left atrial appendage (LAA).
    • Coumadin or warfarin ridge: Partition between LAA and left upper pulmonary vein (LUPV).
  • Interatrial Septum:
    • Lipomatous hypertrophy: Fatty infiltration of interatrial septum, sparing fossa ovalis; typically asymptomatic.
  • Ventricular Muscle Bands and False Tendons:
    • Moderator band: Muscular band near right ventricular (RV) apex.
    • False tendons: Fibrous bands traversing left ventricle (LV) cavity; may be single or multiple.
  • Valve Excrescences:
    • Tiny filaments, frequently multiple: formed on valve leaflets, located on ventricular side of semilunar valves (Lambl's excrescences) or atrial side.

Hemodynamics

  • Blood Flow: Measured in liters per minute, blood moves from high to low pressure, initiated by the heart.
  • Arteries: Thick-walled vessels carry oxygenated blood from heart to body, high pressure flow with pulse.
  • Arterioles: Small arteries regulating blood flow distribution to capillaries; regulate blood flow and pressure.
  • Capillaries: Smallest vessels facilitating gas exchange, maintaining low pressure.

Additional Notes

  • Epicardial Fat: Surrounding right ventricle (RV), similar echogenicity to myocardium.
  • Atrial Special Aneurysm: Outpouching of interatrial septum (IAS) at fossa ovalis level. Often associated with patent foramen ovale (PFO).
  • Excursion:
    • Septal tissue excursion >10mm is considered significant.

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