Cardiac Anatomy Quiz

The cardiac borders on a chest x-ray consist of the sternocostal (anterior) surface, diaphragmatic (inferior) surface, right ventricle, left ventricle, right atrium, left ventricle, and the base (posterior) surface.

The two separate sides of the heart are the right heart and the left heart. The right heart pumps deoxygenated blood to the lungs in the pulmonary circulation, while the left heart pumps oxygenated blood throughout the body in the systemic circulation.

The septa of the heart include the interatrial septum, interventricular septum, and atrioventricular septum. The chambers of the heart include the right atrium, left atrium, right ventricle, and left ventricle.

After studying the internal and surface anatomy of the heart, one should be able to describe the margins and surfaces of the heart, the morphological features of the cardiac valves, the surface anatomy of the heart and its valves in relation to patient examination and the interpretation of radiographs, explain the difference between points of auscultation of heart sounds and the surface projection of the heart valves, describe the functional anatomy of the chambers of the heart, explain the functional importance and position of the fibrous skeleton of the heart, and explain the clinical significance of papillary muscles and chorda tendineae.

The points of auscultation of heart sounds are different from the surface projection of the heart valves because the sounds produced by the valves are transmitted through the surrounding tissues and structures of the heart, resulting in the sounds being heard in different locations on the surface of the chest.

The fibrous skeleton of the heart provides structural support and acts as an electrical insulator between the atria and ventricles. It also serves as an attachment point for the heart valves and cardiac muscle fibers. The fibrous skeleton is located within the walls of the heart, separating the atria from the ventricles.

The two types of valves in the heart are atrioventricular (AV) valves and semilunar valves. AV valves, such as the tricuspid and mitral valves, have cusps attached to the anulus fibrosus and prevent blood regurgitation into the atria during ventricular systole. Semilunar valves, such as the pulmonary and aortic valves, have cusps with nodules and sinuses that fill during diastole to close the valve.

The fibrous skeleton of the heart is a structural support frame formed by fibrous rings and connecting areas. It provides structural and functional support, maintains the patency and integrity of AV and semilunar orifices, serves as origin/insertion for atrial and ventricular muscles, insulates the atria from the ventricles, and allows independent atrial and ventricular contraction.

The surface anatomy of the heart can be identified using specific landmarks. The tricuspid valve (S1) is best heard just to the left of the lower part of the sternum near the 4th/5th intercostal space. The mitral valve (S1) is best heard over the apex of the heart in the left 5th intercostal space at the midclavicular line. The aortic valve (S2) is best heard over the medial end of the right 2nd intercostal space, and the pulmonary valve (S2) is best heard over the medial end of the left 2nd intercostal space.

There are two types of muscles found on the ventricle walls. Trabeculae carneae are numerous irregular muscular ridges, while papillary muscles are named relative to their position and contract before ventricular contraction. Additionally, the right ventricle has a septomarginal trabecula (moderator band) that bridges between the interventricular septum and anterior papillary muscle and carries the right bundle branch of the AV bundle of the cardiac conduction system.

Causes include atherosclerosis, obesity, diabetes, hypertension, hypercholesterolemia, blood clot, and coronary artery spasm.

Microscopic features of an atheroma include fatty deposits, fibrous tissue, cholesterol crystals, and inflammatory cells.

Clinical features of an acute MI include chest pain, shortness of breath, nausea, and sweating. Investigatory features include ECG changes and elevated cardiac biomarkers.

STEMI occurs when a major artery of the heart becomes completely blocked, while NSTEMI occurs when a major artery becomes severely narrowed or transiently blocked.

Arrhythmias can be categorized based on the origin site (atrial, ventricular), rate (bradycardia, tachycardia), and rhythm (regular, irregular).

Tachy-arrhythmia refers to a fast heart rate, while brady-arrhythmia refers to a slow heart rate.

Atrial fibrillation can originate from the atria or the AV node.

Atrial flutter has a sawtooth pattern on ECG.

The treatment for atrial fibrillation can either focus on converting the rhythm to normal or controlling the ventricular rate.

Supraventricular tachycardia is a type of arrhythmia that originates above the bundle of His and usually has narrow complexes.

Echocardiography is the use of ultrasound to examine the heart.

The impact of echocardiography has been as profound as the revolution that occurred when Einthoven introduced the electrocardiogram.

Echocardiography may be done quickly, with the least trouble and distress to the patient, and provides speedy clinically relevant data at comparatively low cost.

The m-mode is designed to document and analyze tissue motion.

Basic echo in the resuscitation setting aims to answer focused clinical yes/no questions.

Cardiovascular complications of Marfan's Syndrome include dilatation of the ascending and sometimes descending aorta, incompetence of aortic and mitral valves, and aneurysm and dissection of the aorta.

Echocardiography is an important tool in the diagnosis and management of cardiovascular disease, providing detailed cardiac structural and functional information without the use of ionizing radiation.

Advantages of echocardiography include providing meticulous facts on cardiac structure, including the size and shape of cardiac chambers, as well as the function and morphology of cardiac valves. It also provides information on systolic and diastolic function and intra-cardiac hemodynamics. Disadvantages include the need for skilled technicians to perform and interpret the scans, the limited ability to visualize certain structures, and the potential for false-positive or false-negative results.

There are three main types of transducers/probes used in echocardiography: linear-array transducers, curved-array transducers, and phased-array transducers. Linear-array transducers produce images with a flat superficial surface and are designated with the letter L followed by the transmit frequency. Curved-array transducers have a curved superficial surface and are designated with the letter C followed by the transmit frequency. Phased-array transducers produce sector images and are smaller in size, allowing for scanning in areas with limited acoustic access.

There are three standard imaging windows used in transthoracic echocardiography: Parasternal, Apical, and Subcostal.