Cardiac Anatomy: Valves and Coronary Arteries

• Cardiac Anatomy covers the vessels and other structures of the heart.
• Circulation of the normal heart shows the flow of oxygenated vs deoxygenated blood.

Valves

• Valves include the Tricuspid, Mitral, Aortic and Pulmonary valves
• Chordae tendinae attach the valve leaflets to the papillary muscles in the ventricles.
• The tricuspid valve sits between the right atrium and right ventricle
• The mitral valve sits between the left atrium and left ventricle
• The aortic valve sits between the left ventricle and the aorta.
• The pulmonary valve sits between the right ventricle and the pulmonary artery.

Clinical Application - Valve Disease & Stenosis

• Valvular heart disease can be congenital or acquired.
• Mitral valve stenosis can cause A-fib and atrial hypertrophy.
• Medical management of complications and valve repair depend on the case.
• Timing of valve repair or replacement is crucial because valves don't last forever.

Coronary Arteries

• The coronary arteries supply blood to the heart.
• They originate from the base of the ascending aorta, immediately above leaflets or cusps of AV
• Two branches include the right main coronary artery (RCA) & left main coronary artery (LCA).
• Aorta, part of aorta removed, aortic valve cusps, circumflex, LAD, right coronary artery, and opening of left coronary artery comprise of the structure of the Aorta
• Coronary arteries can be viewed from sternocostal diaphragmatic aspects

Sternocostal Aspect:

• Great Cardiac Vein
• Anterior Interventricular (Anterior Descending) Branch of L. Coronary Artery

Clinical Application - Ischemia

• Right coronary artery can lead to inferior wall issues.
• Inferior wall issues can be diagnosed in leads 2, 3, and AvF indicated by ST depression or T wave inversion (ST depin VS. W)
• Left anterior descending artery can lead to anterior wall and septal wall issues
• Anterior wall issues involve leads V1, V2, V3, and V4
• Circumflex can lead to lateral wall issues
• Lateral wall issues involve leads 1, Avl, V5, and V6

Coronary artery dominance

• Defined as the coronary artery that reaches the crux of the heart and then gives off the Posterior Descending Artery
• Most people are right-dominant

Mitral valve & heart block

• Development of collateral circulation impacts survival in the presence of heart disease.
• SA and AV nodes are supplied by the nodal artery.
• MI to the nodal artery may cause a 3rd degree heart block, potentially causing the patient to become bradycardic
• Antero-lateral papillary muscle blood supply comes from the left anterior descending and the diagonal or a marginal branch of the circumflex artery.
• Postero-medial papillary muscle blood supply comes from the right coronary artery or left circumflex (depending on dominance).

Endocardium Myocardium and pericardium

• Endocardium is the inner most layer, followed by the myocardium, then the epicardium and finally the pericardium

Clinical Appications

• Subacute Bacterial Endocarditis is infectious etiology
• Destructive against the valve
• Myocarditis means the pt is not pumping effectively
• This is inflammation of the muscle

Pericardium

• Pericardium is a sac around the heart

Clinical Applications - Pericardium

• Pericardial Effusion means fluid in pericardial spore
• Cardiac Tamponade means effusion is significant or occurs rapidly which calls for emergent situation pericardigecentesis
• Acute Pericarditis means inflammation of pericardium
• Constrictive Pericarditis causes constriction from scarring of the pericardium caused by TB