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Anatomy
O The position of the heart in the mediastinum is such that 2/3 of it
extends to the left of the mediastinum
O The most anterior chamber is the right ventricle and most posterior
chamber is the left Atrium.
O The normal heart in chest x ray occupies < 50 % of transthoracic
diameter.
O The left border formed by Aortic arch, pulm trunk, left atrium and
left ventricle, on the right the right atrium joined by SVC.
Coronary circulation
+ The left main and right coronary arteries arise from the left and right
coronary sinuses just distal to the aortic valve.
+ The left coronary gives Left anterior descending artery
supplies anterior left ventricle, Apex
and the anterior septum
Circumflex artery supplies the left
atriumand left ventricle (marginal
branches)
+ The right coronary gives branches to supply the right Atrium , right
ventricle and inferior and posterior aspect of left ventricle.
Nerve supply of the heart
Sympathetic supplies Atria & Ventricles
Parasympathetic supplies Atria only (vegal escape)
Cardiac symptoms see the practical part
Cardiac examination see the practical part
ECG and X ray see the practical part
1
CARDIOLOGY
Other investigations
1. Echo Ultrasonic to study blood flow, heart structures and the
movement of valve and muscle
Value
Chamber pressure and size.
Valve diseases (stenosis - Regurge).
Calcification.
Pulmonary and Aortic pressure.
Pericardial effusion.
Cardiomyopathy.
measure COP and ejection fraction = Stroke Volume = 55-75%
End diastolic volume
The function of artificial valves
Echo Doppler detects abnormal direction of blood and pressure
Gradient across valves and blood velocity.
2. ECG with effort and ambulatory ECG (Holter) see later
3. Cardiac Catheter
O Catheter from the femoral or brachial V can be advanced into the
RT. Atr RTV pulm Ar ..........
Value 1- Measure Pr Chambers pressure
Gradient across the valves
2- Measure O
2
left side O
2
right side O
2