Cardiac Sonographers Training Course

Cardiac Anatomy

The Cardiovascular System

consists of the heart plus all the blood vessels

transports blood to all parts of the body in two 'circulations': pulmonary (lungs) & systemic
(the rest of the body)

External Anatomy of the Heart and Great Vessels

Four chambered hollow muscular organ

Function
Propel blood forward to the tissues in an amount that meets the metabolic needs of
the body
4 chambers: 2 atria (right & left) & 2 ventricles (right & left)

Thoracic Landmarks

Heart Valves
Atrioventricular (AV) valves - prevent backflow of blood from ventricles to atria during
ventricular systole (contraction)
Tricuspid valve - located between right atrium & right ventricle
Mitral valve - located between left atrium & left ventricle
Semilunar valves - prevent backflow of blood from arteries (pulmonary artery & the aorta) to
ventricles during ventricular diastole (relaxation)
Aortic valve - located between left ventricle & the aorta
Pulmonary valve - located between right ventricle & the pulmonary artery (trunk)

Heart Valves

All valves consist of connective tissue (not cardiac muscle tissue) and, therefore, open &
close passively. Valves open & close in response to changes in pressure

AV valves - open when pressure in the atria is greater than pressure in the ventricles
(i.e., during ventricular diastole) & closed when pressure in the ventricles is greater
than pressure in the atria (i.e., during ventricular systole)
Semilunar valves - open when pressure in the ventricles is greater than pressure in
the arteries (i.e., during ventricular systole) and closed when pressure in the
pulmonary trunk & aorta is greater than pressure in the ventricles (i.e., during
ventricular diastole)

Heart Walls
3 distinct layers:
1 - endocardium - innermost
layer; epithelial tissue that lines
the entire circulatory system
2 - myocardium - thickest layer;
consists of cardiac muscle
3 - epicardium - thin, external
membrane around the heart
Cardiac Muscle Tissue
striated (consists of sarcomeres just
like skeletal muscle)
cells contain numerous
mitochondria (up to 40% of cell
volume)
adjacent cells join end-to-end at
structures called intercalated discs

In cardiac muscle, there are two types of cells:

contractile cells

autorhythmic (or automatic) cells.

Contractile cells, of course, contract when stimulated.

Autorhythmic cells, on the other hand, are self-stimulating & contract without any external
stimulation.

Coronary Arteries
Left Main Coronary Artery (LMCA)
Left anterior descending artery (LAD)
Left circumflex (LCx)
Right Coronary Artery (RCA)
LV Segments
The left ventricle is composed of an actual 17
segments but the segments seen in the
echocardiogram is 16 segments. These
segments are being supplied by coronary
arteries.
This is used for segmental wall motion
evaluation in screening for coronary artery
disease.
It is useful for a sonographers to remember all the 17 segments and their blood supply.
Left Ventricular Segments

Coronary Territories

The Circulation
Blood returning from the systemic (body)
circulation enters the right atrium (via the
inferior & superior vena cavas). From there,
blood flows into the right ventricle, which then
pumps blood to the lungs (via the pulmonary
artery). Blood returning from the lungs enters
the left atrium (via pulmonary veins), then the
left ventricle. The left ventricle then pumps
blood to the rest of the body (systemic
circulation) via the aorta.

Arteries
serve as passageways for blood from heart to
tissues
act as pressure reservoirs because the elastic walls collapse inward during ventricular
diastole (when there is less blood in the arteries):
blood pressure averages 120 mm Hg during systole (systolic pressure) & 80 mm Hg
during diastole (diastolic pressure) (& the difference between systolic & diastolic
pressures is called the pulse pressure)
Arterioles
distribute cardiac output among
systemic organs (whose needs vary
over time)
Resistance (&, therefore, blood flow)
varies as a result of VASODILATION &
VASOCONSTRICTION
Factors that influence radius of
arterioles:

intrinsic (or local) control

extrinsic control

Capillaries
site of exchange of materials between
blood & tissues
exchange may occur by simple diffusion
diffusion enhanced by:

thin capillary walls (just one cell

thick)
narrow capillaries (so the red blood cells & plasma are close to the walls)
large numbers (the human body has 10 - 40 billion capillaries!) which translates into a
tremendous amount of surface area through which exchange can occur
relatively slow flow of blood (providing more time for exchange to occur)

exchange also occurs through pores (located between the cells the form the capillary walls),
by vesicular transport (e.g., pinocytosis), & by bulk flow

Veins
serve as low-resistance passageways to return blood from the tissues to the heart

serve as a BLOOD RESERVOIR (under resting conditions nearly two-thirds of all your blood
in located in the veins) &, therefore, the veins are important in permitting changes in stroke
volume

Conductions System of the Heart

Various automatic cells have different 'rhythms':
SA node - 60 - 100 per minute (usually 70 - 80
per minute)
AV node & AV bundle - 40 - 60 per minute
Bundle branches & Purkinje fibers - 20 - 40 per
minute
SA node = has the highest or fastest rhythm &, therefore,
sets the pace or rate of contraction for the entire heart.
As a result, the SA node is commonly referred to as the
PACEMAKER.