Order of Flow & Details PDF

Order of Flow & Details p. 9-14 (exclude p. 10: Cardiac Veins) Flow through the heart | Circulatory system physiology | NCLEX-RN | Khan Academy Learn how blood flows through the heart, and understand the difference between systemic and pulmonary blood flow. Rishi is a pedia...

Order of Flow & Details p. 9-14 (exclude p. 10: Cardiac Veins) Flow through the heart | Circulatory system physiology | NCLEX-RN | Khan Academy Learn how blood flows through the heart, and understand the difference between systemic and pulmonary blood flow. Rishi is a pediatric infectious disease physician and works at Khan Academy. Created by Rishi Desai. Watch the next lesson: https://www.khanacademy.org/test-prep/nclex-rn/nclex-rn-circulatory-system/rn-circulatory-system/v/two-circulations-in-the-body?utm_source=YTutm_medium=Descutm_campaign=Nclex-rn Missed the previous lesson? https://www.khanacademy.org/test-prep/nclex-rn/nclex-rn-circulatory-system/rn-circulatory-system/v/meet-the-heart?utm_source=YTutm_medium=Descutm_campaign=Nclex-rn NCLEX-RN on Khan Academy: A collection of questions from content covered on the NCLEX-RN. These questions are available under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 United States License (available at http://creativecommons.org/licenses/by-nc-sa/3.0/us/). About Khan Academy: Khan Academy offers practice exercises, instructional videos, and a personalized learning dashboard that empower learners to study at their own pace in and outside of the classroom. We tackle math, science, computer programming, history, art history, economics, and more. Our math missions guide learners from kindergarten to calculus using state-of-the-art, adaptive technology that identifies strengths and learning gaps. We've also partnered with institutions like NASA, The Museum of Modern Art, The California Academy of Sciences, and MIT to offer specialized content. For free. For everyone. Forever. #YouCanLearnAnything Subscribe to Khan Academy’s NCLEX-RN channel: https://www.youtube.com/channel/UCDx5cTeADCvKWgF9x_Qjz3g?sub_confirmation=1 Subscribe to Khan Academy: https://www.youtube.com/subscription_center?add_user=khanacademy  Order of Flow p.9 1. Superior Vena Cava 2. Inferior Vena Cava 3. Right Atrium 4. Tricuspid Valve 5. Right Ventricle 6. Pulmonic Valve 7. Main Pulmonary Artery 8. Right Pulmonary Artery 9. Left Pulmonary Artery (Lungs) 1. Pulmonary Veins (4) 2. Left Atrium 3. Mitral Valve 4. Left Ventricle 5. Aortic Valve 6. Ascending Aorta 7. Aortic Arch / Transverse Ao 8. Brachiocephalic/Innominate Artery 9. Left Common Carotid Artery 10.Left Subclavian Artery 11.Descending Aorta  p.10 VENOUS RETURN 3 vessels empty deoxygenated blood into the RA: 1. SVC 2. IVC 3. Coronary Sinus  p.10 Superior Vena Cava (SVC) ⚫Receives deoxygenated / venous blood from the upper half of the body ⚫ head, neck, upper chest, arms ⚫Drains into the superior portion of the right atrium (RA) ⚫Considered a large vein: ⚫ Width: ~2 cm ⚫ Length: ~7 cm  p.10 Inferior Vena Cava (IVC) ⚫Receives deoxygenated / venous blood from the veins below the diaphragm ⚫ abdominal organs, pelvis, legs, feet ⚫Drains into the lower, posterior portion of the right atrium ⚫Passes along the right side of the aorta in front of the spine ⚫ Diameter: 1.2-2.1 cm  Coronary Sinus (CS) ⚫ Cardiac veins return blood to the RA from coronary artery system (more on these next week!) ⚫ The Coronary Sinus is part of the cardiac venous system ⚫ positioned behind the LA, along the posterior atrioventricular groove ⚫ Cardiac veins dump into the CS ⚫ like a “coronary gutter” ⚫ CS is the 3rd vein that empties into RA ⚫ separated by the Thebesian valve ⚫ approximately 2.5 cm / 1 inch in length ⚫ lowest O2 saturation of the body p.10 ⚫ 60%  p.10 RIGHT SIDE  p.10 Right Atrium (RA) ⚫Receiving chamber for systemic & coronary venous return ⚫ Receives deoxygenated blood from SVC, IVC & Coronary Sinus ⚫Normal RA O2 saturation: 75% ⚫Fills more during inspiration ⚫ flow travels from high pressure to low pressure ⚫pressure in RA is less than pressure in veins  p.10 Normal Embryonic Remnants 1. Fossa Ovalis 2. Eustachian Valve 3. Chiari Network 4. RA Appendage (RAA) 5. Crista Terminalis (not in book)  Fossa Ovalis ⚫ Remnant of the Foramen Ovale (FO) ⚫ Remember: In utero, the FO is a normal, necessary shunt that should close at birth ⚫ location: Interatrial Septum p.10  Eustachian Valve ⚫ Normal embryonic remnant ⚫ What did it do? Directed flow from IVC across the RA through the foramen ovale & into the LA. ⚫ helped direct blood through the fetal shunt to bypass lungs ⚫ Location: junction of IVC & RA p.10 Chiari Network ⚫ Another embryonic remnant ⚫ Web-like structure that may appear on echo as a mobile, thin membrane with a whip-like motion ⚫ location: RA near entrance of IVC p.10  p.10 Right Atrial Appendage (RAA) ⚫ Another name for appendage = auricle ⚫ pouch-like extension off of the RA ⚫ broad & triangular  Crista Terminalis ⚫ aka Terminal Crest ⚫ smooth, muscular ridge that divides the smooth surface of the RA from the muscular & rigid surface of the RA & RAA not in book  Tricuspid Valve ⚫ located between RA & RV ⚫ Largest of the valves ⚫ Most inferior valve -- valve closest to apex ⚫ Same attachment anatomy as MV, just in the right ventricle ⚫ chordae tendinae, papillary muscles, annulus fibrosus ⚫ 3 leaflets: ⚫ Medial/Septal ⚫ Anterior ⚫ Posterior Alli-ism: I think of a weather MAP on the TV ⚫ Normal TV valve area: 7-9 cm2 p.11  p.11 Right Ventricle ⚫ most ANTERIOR chamber of the heart ⚫ FUN FACT: because of its position at the front of the chest, the RV is the chamber most likely to be affected by gunshot wounds, stabbings etc! ⚫ lies beneath the sternum ⚫ receives deoxygenated blood from RA ⚫ Normal RV O2 saturation: 75% ⚫ Compared to LV: thinner walls, smaller, triangular/ crescent shaped, contains moderator band, more coarse trabeculations Right Ventricular Components 1. Right Ventricular Inflow Tract (RVIT) 2. Trabeculations 3. Moderator Band 4. Right Ventricular Outflow Tract (RVOT) 5. Antero-superior RV Wall (not discussed) 6. RV Muscular Fold (not discussed)  p.11 Right Ventricular Inflow Tract (RVIT) ⚫ Path INTO the RV ⚫ area between TV apparatus & papillary muscles of RV  p.11 Trabeculations ⚫ make up the inner surface of RV ⚫ distinctive criss-cross muscular bands ⚫ coarser than trabeculations of LV  p.11 Moderator Band ⚫ aka septomarginal trabeculation ⚫ fibrous band crossing RV apex ⚫ spans across RV from septum to RV papillary muscle ⚫ unique only to the RV…a “landmark”  p.11 Right Ventricular Outflow Tract (RVOT) ⚫ aka INFUNDIBULUM ⚫ aka Conus Arteriosus ⚫ Pathway OUT of the RV ⚫ smooth-walled, funnel shaped ⚫ at the entrance of the pulmonary trunk  p.12 Pulmonic Valve ⚫ most superior of all valves ⚫ located between RV & MPA ⚫ thinner cusps than AoV ⚫ Normal Pulmonic Valve Area (PVA): >2 cm2 ⚫ comparable to AoV ⚫ 3 cusps: ⚫ Anterior ⚫ Right Posterior ⚫ Left Posterior Alli-ism: PULMONIC has the more POSTERIOR cusps  p.12 Main Pulmonary Artery (MPA) ⚫ aka Pulmonary Trunk ⚫ Normal MPA dimensions: ⚫ 3 cm wide x 5 cm long ⚫ typically smaller than the Aorta ⚫ if the same size as the Aorta or larger, the MPA is considered dilated ⚫ RV pumps deoxygenated blood through PV & into MPA ⚫ bifurcates into Right Pulmonary Artery & Left Pulmonary Artery  p.12 Pulmonary Arteries & Pulmonary Veins Pulmonary Arteries Pulmonary Veins (PV4) ⚫ 2: Left Pulmonary Artery (LPA) ⚫ 4: left upper (LUPV), left lower & Right Pulmonary Artery (RPA) (LLPV), right upper (RUPV), ⚫ carry deoxygenated blood to left right lower (RLPV) lung & right lung, respectively ⚫ only veins to carry oxygenated ⚫ only arteries to carry blood deoxygenated blood ⚫ picks up oxygenated blood in ⚫ divides into arteries, arterioles & capillary bed & then converges capillaries lung alveoli to from venules & capillaries exchange carbon dioxide for ⚫ returns oxygenated blood to the oxygen heart (left atrium)  p.12 LEFT SIDE  Left Atrium (LA) p.12 ⚫ Most posterior chamber ⚫ Receiving chamber for pulmonary venous return ⚫ Receives oxygenated blood from PV4 & lungs ⚫ Normal LA O2 saturation: 98% ⚫ respirations affect venous return & chamber filling ⚫ LA filling decreases with inspiration ⚫ LA filling increases with expiration due to change in pulmonary pressures ⚫ ⚫ delivers blood to the LV through MV ⚫ Compared to RA: ⚫ thicker walls ⚫ higher pressure  p.12 Normal Embryonic Remnants of LA 1. LA Appendage (LAA) 2. Coumadin Ridge (not in book)  p.12 Left Atrial Appendage ⚫ normal remnant of embryonic LA ⚫ long, tubular, hooked structure that is attached to the LA ⚫ lies within the pericardium, alongside LV ⚫ filling & emptying is directly derived from LV function ⚫ better the LV contracts & relaxes, the better the LAA empties & fills ⚫ acts as a decompression chamber ⚫ some say it also increases LA surface area & aids in contraction ⚫ PRONE TO THROMBUS ⚫ due to irregular rhythm (Afib) & MV disease ⚫ especially dangerous because this thrombus can embolize to the brain & cause a stroke!  Coumadin Ridge ⚫ aka Left Lateral Ridge ⚫ aka Warfarin Ridge ⚫ not associated with administration of Coumadin or Warfarin ⚫ lies between the LAA and the LUPV ⚫ easily mistaken for a tumor ⚫ “Q-Tip Sign” due to its appearance ⚫ non-pathological not in book  p.13 Mitral Valve ⚫ resembles a smiley face in SAX ⚫ between LA & LV ⚫ anchored via chordae tendineae & papillary muscles ⚫ 2 papillary muscles: Postero-Medial & Antero-Lateral ⚫ Alli-ism: From left to right on your screen “Please Move A Little” ⚫ Normal MV Area (MVA): 4-6 cm2  Echo View p.13 Surgeons View Mitral Valve Anatomy ⚫ Only valve with only 2 leaflets: ⚫ Anterior Mitral Valve Leaflet (AMVL) ⚫ Commissure = where 2 leaflets join ⚫ Posterior Mitral Valve Leaflet (PMVL) ⚫ Names are the same as Pap Muscles Alli-ism: “Mitral MAP--Mitral: Anterior & Posterior” ⚫ Postero-Medial & Antero-Lateral ⚫ same as Pap Muscles! ANTERIOR MVL: ⚫ divided into 3 sections (termed “scallops”) ⚫ A1, A2, A3 ⚫ LONGEST leaflet POSTERIOR MVL: ⚫ divided into 3 sections (termed “scallops”) ⚫ P1, P2, P3 ⚫ WIDEST leaflet  p.13 Left Ventricle (LV) ⚫most essential chamber! ⚫ receives oxygenated blood from LA ⚫ must pump to ENTIRE BODY! ⚫LARGEST / STRONGEST of the 4 chambers with the THICKEST WALLS ⚫ Shape: conical…forms the apex ⚫ Compared to the RV: ⚫ thicker walls ⚫ larger chamber ⚫ more conical ⚫ less trabeculated ⚫ higher pressure ⚫ Normal LV 02 saturation: 98%  p.13 Left Ventricle Components 1. LV Inflow Tract (MV Inflow) 2. LV Outflow Tract (LVOT) 3. LV Free Wall (not discussed)  p.13 LV Inflow (MV Inflow) ⚫ Road INTO the LV ⚫ includes MV annulus, leaflets & chordae tendineae ⚫ entire LV from base to apex  p.13 Left Ventricular Outflow Tract (LVOT) ⚫ consists of: ⚫ AMVL ⚫ IVS ⚫ Pathway OUT of the LV  p.14 Aortic Valve ⚫ located between LV & Aorta ⚫ Housed by AORTIC ROOT (Alli-ism: “dog bone”) ⚫ Same area as SINUS OF VALSALVA ⚫ anatomic dilation between AoV & AAo ⚫ Normal AoV Area: >2 cm2 ⚫ 3 pocket-like AoV Cusps: ⚫ Right Coronary Cusp ⚫ Left Coronary Cusp ⚫ Non-Coronary Cusp Aortic Valve Cusps ⚫ Each cusp is associated with a Sinus of Valsalva ⚫ pocket-like structure in the area of the AoR ⚫ 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 NOTHING! Nodule of Arantius ⚫ On the edge of each cusp, in the center is a small “nugget” ⚫ Ensures complete closure of the valve ⚫ If TOO THICK, can prevent valve from closing all the way ⚫ allows blood to leak backwards! ⚫ known as regurgitation Lambl’s Excrescences ⚫ very fine, hair-like projections visualized on AoV cusps ⚫ typical on edge of closure sites ⚫ Surgical removal may be suggested References DeWitt, S. K. (2022). ECHOCARDIOGRAPHY...From a Sonographer's Perspective: THE NOTEBOOK 8 (pp. 9-14). Launch Printing & Promotions. All visuals (images & gifs) obtained from Google Images