Untitled Quiz

Order of Flow & Details

• Pages 9-14 cover the order of blood flow through the heart, excluding cardiac veins (page 10)
• Diagrams illustrate blood flow through the heart, showing the different chambers and valves.

Venous Return

• Three vessels return deoxygenated blood to the right atrium (RA):
  • Superior Vena Cava (SVC)
  • Inferior Vena Cava (IVC)
  • Coronary Sinus (CS)
• The SVC receives blood from the upper body, the IVC from the lower body, and the CS from the heart itself.

Superior Vena Cava (SVC)

• Carries deoxygenated blood from the upper body (head, neck, upper chest, arms) to the RA.
• Considered a large vein (~2 cm wide, ~7 cm long).
• Drains into the superior portion of the right atrium.

Inferior Vena Cava (IVC)

• Carries deoxygenated blood from the lower body (abdominal organs, pelvis, legs, feet) to the RA.
• Drains into the lower, posterior portion of the right atrium.
• Passes along the right side of the aorta, ~1.2-2.1 cm in diameter.

Coronary Sinus (CS)

• Cardiac veins return blood to the RA from the coronary artery system.
• Located behind the left atrium (LA), along the posterior atrioventricular groove.
• Cardiac veins empty into the CS, which is a "coronary gutter".
• Separated from the RA by the Thebesian valve.
• Approximately 2.5 cm long.
• Lowest O2 saturation in the body (60%).

Right Side of the Heart

• Right atrium (RA) function:
  • Receiving chamber for systemic and coronary venous return
  • Receives deoxygenated blood from the SVC, IVC, and Coronary Sinus.
  • Normal RA O2 saturation: 75%.
  • Fills more during inspiration; flow from high to low pressure.
• Right atrium (RA) has some embryonic remnants:
  • Fossa Ovalis
  • Eustachian Valve
  • Chiari Network
  • RA Appendage (RAA)
  • Crista Terminalis

Normal Embryonic Remnants

• Fossa Ovalis is a remnant of the Foramen Ovale, a fetal shunt.
• Eustachian Valve directs blood flow from the inferior vena cava (IVC) into the right atrium during fetal development.
• Chiari Network - web-like structure in the RA.
• RA appendage (RAA): a pouch-like extension off of right atrium.
• Crista Terminalis acts as a border between the smooth and trabeculated parts of the right atrium.

Eustachian Valve

• Normal embryonic remnant, directing blood flow from the IVC across the RA to the foramen ovale during fetal development, helping bypass the lungs.
• Located at the junction of the IVC and the right atrium (RA).

Chiari Network

• Embryonic remnant that may appear as a mobile, thin membrane in an echocardiogram.
• Located at the entrance of the inferior vena cava (IVC) into the right atrium (RA).

Right Atrial Appendage (RAA)

• Extension off the right atrium.
• Shaped like a pouch.
• Shaped broadly and triangular.

Crista Terminalis

• Smooth, muscular ridge, dividing the smooth surface of the right atrium from the muscular surface.

Tricuspid Valve

• Located between the right atrium (RA) and the right ventricle (RV).
• Largest of the heart valves.
• Has three leaflets: medial/septal, anterior, and posterior.
• Similar attachment anatomy to the mitral valve, but in the right ventricle.

Right Ventricle

• Most anterior chamber of the heart, lies beneath the sternum.
• Receives deoxygenated blood from the RA.
• Normal RV O2 saturation: 75%.
• Thinner walls compared to the left ventricle (LV).
• Contains trabeculations, a distinctive criss-cross pattern of muscular bands, and a moderator band.
• The right ventricular outflow tract (RVOT) is the pathway out of the RV.

Right Ventricular Components

• Right Ventricular Inflow Tract (RVIT)
• Trabeculations
• Moderator Band
• Right Ventricular Outflow Tract (RVOT)
• Antero-superior RV Wall (not discussed)
• RV Muscular Fold (not discussed)

LV Inflow Tract (MV Inflow)

• Area between the mitral valve apparatus and papillary muscles of the RV.

Trabeculations

• Make up the inner surface of the right ventricle (RV).
• Distinctive criss-cross muscular bands.
• Coarser than trabeculations of the left ventricle (LV).

Moderator Band

• Fibrous, band crossing the right ventricle (RV) apex.
• Spans across the RV from septum to RV papillary muscle.
• Unique to the RV.

Right Ventricular Outflow Tract (RVOT)

• Pathway out of the right ventricle (RV).
• Smooth-walled, funnel-shaped.
• At the entrance of the pulmonary trunk.

Pulmonic Valve

• Superior valve, located between the right ventricle (RV) and the pulmonary artery.
• Thinner cusps than the aortic valve.
• Normal pulmonic valve area (PVA) is typically greater than 1.
• Has three cusps: anterior, right posterior, and left posterior.

Main Pulmonary Artery (MPA)

• Carries deoxygenated blood from the right ventricle (RV) to the lungs.
• Typically smaller than the aorta.
• Approximately 3 cm wide and 5 cm long.
• Bifurcates into the right and left pulmonary arteries.

Pulmonary Arteries & Veins

• Pulmonary arteries carry deoxygenated blood to the lungs.
• Pulmonary veins carry oxygenated blood from the lungs to the left atrium (LA).

Left Side of the Heart

• Left atrium (LA) is a posterior chamber of the heart, receives oxygenated blood from the pulmonary veins.
• Normal LA O2 saturation: 98%.
• Respirations affect venous return and chamber filling.
• Empties during inspiration; fills during expiration.
• Delivers blood to the left ventricle (LV) through the mitral valve (MV).

Normal Embryonic Remnants of LA

• Left atrial appendage (LAA)
• Coumadin Ridge

Left Atrial Appendage (LAA)

• Normal remnant of embryonic LA.
• Tubular, hooked structure attached to LA.
• Lies in the pericardium beside LV.

Coumadin Ridge

• Aka Left Lateral Ridge/Warfarin Ridge.
• Not associated with Coumadin or Warfarin.
• Located between LAA and LUPV.
• Possibly mistaken for a tumor.

Mitral Valve

• Smiley-face in SAX view.
• Located between the left atrium (LA) and the left ventricle (LV).
• Anchored by chordae tendineae and papillary muscles.
• Two papillary muscles: posteromedial and anterolateral.
• Normal mitral valve area (MVA): 4-6 cm2.

Mitral Valve Anatomy

• Only valve with two leaflets: anterior and posterior.
• Anterior leaflet is the longest.
• Posterior leaflet is divided into three sections (commonly called "scallops").
• Commissure is where the leaflets join.

Left Ventricle (LV)

• Most essential chamber of the heart.
• Receives oxygenated blood from the left atrium (LA).
• Largest/strongest of the four heart chambers.
• Thickest walls.
• Conical shape, forming the apex.
• Compared to the right ventricle (RV): thicker walls, larger chamber, more conical, less trabeculated, higher pressure.
• Normal LV O2 saturation: 98%.

Left Ventricle Components

• Left Ventricular Inflow Tract (MV Inflow)
• Left Ventricular Outflow Tract (LVOT)
• Left Ventricular Free Wall (not discussed)

LV Inflow Tract (MV Inflow)

• Pathway into the left ventricle (LV).
• Includes mitral valve annulus, leaflets, and chordae tendineae.

Left Ventricular Outflow Tract (LVOT)

• Pathway out of the left ventricle (LV).
• Consists of AMVL and IVS.

Aortic Valve

• Located between left ventricle (LV) and the aorta.
• Housed by the aortic root.
• Same area as the sinuses of Valsalva (anatomic dilation between aortic valve [AoV] & aorta).
• Normal aortic valve area (AoV Area): greater than 2 cm2.

Aortic Valve Leaflets

• Three pocket-like AoV Cusps: Right Coronary Cusp (RCC), Left Coronary Cusp (LCC), Non-Coronary Cusp (NCC).

Aortic Valve Cusps

• Each cusp is associated with a sinus of Valsalva, a pocket-like structure in the area of the aorta.
• Right Coronary Cusp (RCC) gives rise to the right coronary artery.
• Left Coronary Cusp (LCC) gives rise to the left coronary artery.
• Non-Coronary Cusp (NCC) gives rise to the non-coronary artery.

Nodule of Arantius

• Small "nugget" on each aortic valve cusp edge, ensuring complete closure.

Lambl's Excrescences

• Very fine, hair-like projections, on the aortic valve cusps.
• Usually found at edge of closure sites.
• Surgical removal may be suggested.