Podcast
Questions and Answers
Which structure is the first to receive deoxygenated blood returning from the upper half of the body?
Which structure is the first to receive deoxygenated blood returning from the upper half of the body?
Which of the following has the lowest oxygen saturation in the body?
Which of the following has the lowest oxygen saturation in the body?
The Inferior Vena Cava drains blood from which of the following areas?
The Inferior Vena Cava drains blood from which of the following areas?
Which structure separates the Coronary Sinus from the Right Atrium?
Which structure separates the Coronary Sinus from the Right Atrium?
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What embryonic remnant is located in the interatrial septum?
What embryonic remnant is located in the interatrial septum?
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During inspiration, the pressure in which chamber of the heart is lower than in the veins, leading to increased filling?
During inspiration, the pressure in which chamber of the heart is lower than in the veins, leading to increased filling?
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Which of the following statements about the Tricuspid Valve is accurate?
Which of the following statements about the Tricuspid Valve is accurate?
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Which artery is the first major branch off the Aortic Arch?
Which artery is the first major branch off the Aortic Arch?
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What is the primary function of the foramen ovale during fetal development?
What is the primary function of the foramen ovale during fetal development?
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Which description accurately characterizes the Chiari Network?
Which description accurately characterizes the Chiari Network?
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What is the anatomical significance of the crista terminalis?
What is the anatomical significance of the crista terminalis?
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Which of the following statements about the tricuspid valve is true?
Which of the following statements about the tricuspid valve is true?
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Why is the right ventricle considered the most vulnerable chamber of the heart?
Why is the right ventricle considered the most vulnerable chamber of the heart?
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What is the primary function of the left ventricle?
What is the primary function of the left ventricle?
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Which statement accurately describes the left ventricle's structure compared to the right ventricle?
Which statement accurately describes the left ventricle's structure compared to the right ventricle?
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What does the normal oxygen saturation of the left ventricle indicate?
What does the normal oxygen saturation of the left ventricle indicate?
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Which structure is NOT part of the left ventricle inflow tract?
Which structure is NOT part of the left ventricle inflow tract?
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What does the term 'Nodule of Arantius' refer to?
What does the term 'Nodule of Arantius' refer to?
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What is the function of Lambl's excrescences on aortic valve cusps?
What is the function of Lambl's excrescences on aortic valve cusps?
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Which of the following correctly identifies the components of the left ventricular outflow tract (LVOT)?
Which of the following correctly identifies the components of the left ventricular outflow tract (LVOT)?
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Which aortic valve cusp is associated with the left coronary artery?
Which aortic valve cusp is associated with the left coronary artery?
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Which structure serves as a pathway into the right ventricle?
Which structure serves as a pathway into the right ventricle?
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What is the primary difference between the right ventricle (RV) and the left ventricle (LV)?
What is the primary difference between the right ventricle (RV) and the left ventricle (LV)?
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What is the function of the moderator band in the right ventricle?
What is the function of the moderator band in the right ventricle?
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Which descriptor most accurately characterizes the normal pulmonic valve area?
Which descriptor most accurately characterizes the normal pulmonic valve area?
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Which of the following describes the pulmonary arteries?
Which of the following describes the pulmonary arteries?
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What is the primary role of the left atrial appendage (LAA)?
What is the primary role of the left atrial appendage (LAA)?
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Which of the following statements regarding the left atrium is correct?
Which of the following statements regarding the left atrium is correct?
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What is a unique feature of the mitral valve compared to other heart valves?
What is a unique feature of the mitral valve compared to other heart valves?
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How does respiration affect the filling of the left atrium?
How does respiration affect the filling of the left atrium?
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Which of the following accurately describes the characteristics of the main pulmonary artery (MPA)?
Which of the following accurately describes the characteristics of the main pulmonary artery (MPA)?
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What is the significance of the Coumadin Ridge in the left atrium?
What is the significance of the Coumadin Ridge in the left atrium?
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What type of blood does the right ventricle primarily pump?
What type of blood does the right ventricle primarily pump?
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Which of the following components is NOT typically part of the right ventricle structure?
Which of the following components is NOT typically part of the right ventricle structure?
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Which specific part of the right ventricle is known for its criss-cross muscular bands?
Which specific part of the right ventricle is known for its criss-cross muscular bands?
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Study Notes
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.
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