Rewording 3 Papers

The Heart Location size and position:

● Cone shape

● Fibromuscular organ

● Located in the mediastinum between the 2 lungs laterally.

● The sternum anteriorly and the thoracic spine posteriorly.

● Two thirds of the heart is to the left side and one third is to the right.

● Size is roughly the size of a closed fist of its owner.

External Features of the Heart:

● 6 sides or 6 borders

● Base is the superior border of the heart where the great arteries originate.

● The apex the tip of the left ventricle

● Lies directly above the diaphragm at the fifth intercostal space.

● It points anteriorly, inferiorly and to the left.

● The anterior surface is mainly made by the Rv( behind the sternum) with a small portion

of the LV and RA.

● The right border is formed by the left ventricle.

● The posterior surface is formed by the atria and large veins.

● Inferior surface lies on the diaphragm and formed primarily by the left ventricle and

small portion of the RV.

The Apex and the Base Of the Heart:

● The apex and blunt point of the lower edge is directed inferiorly, anteriorly and to the left.

● Lies on the diaphragm at the diaphragm at the intersection of the left 5Th intercostal

space with the mid -clavicular line.

● Heart beets are best heard at this point( called apical beat or point of maximal impulse).

● The base of the heart is the superior part positioned at the level of the 2nd intercostal

space.

External Features of the Heart:

● A depression called the atrioventricular groove separates the atria from the ventricles.

● Posterior AV groove contains the coronary sinus that drains the blood from the

myocardium to the right atrium.

● The interventricular groove separates the RT and Lt ventricles.

● The posterior interventricular groove contains the posterior descending coronary artery.

● Each atrium has a blind pouch called appendage that lies superior to RA and overlies the

root of the aorta.

The Walls of the heart:

● The pericardium is the outer sac-like layer.

● The myocardium is the muscular middle layer.

● The endocardium the inner lining of the heart chambers.

Basic Imaging Principles

Tomographic Imaging:

● Nomenclature of standard views is determined by the acoustic window.

● Parasternal ( long axis and short axis)

● Apical (4-chamber, 2-chamber, 3 chamber)

● Subcostal window (long axis and short axis)

● Suprasternal window

● Nomenclature also includes the axis of the LV rather than by skeletal plans and the

number of cardiac chambers.

● Long axis plane vs. short axis plane

● Apical 4-chamber, 2- chamber, 5-chamber , 3-chamber

Standard Images:

● Parasternal long-axis view

● Parasternal short- axis view

● Apical four-chamber view

● Apical two-chamber view

● Apical three-chamber view

● Apical five-chamber view

● Subcostal view (Long-axis and short-axis)

● Suprasternal view

Image Orientation in Long Axis View

Parasternal Long Axis:

● The transducer is positioned at the top of the screen so that structure is closer to the

transducer.

● From the parasternal long axis, RVOT with the pulmonic valve and the pulmonary artery

can be seen .

● By angling the probe toward the right hip, the RVIT view can be seen , which shows the

right ventricle.

● The right atrium, the tricuspid valve and the IVC .

Parasternal Short Axis:

● View is obtained from rotating the transducer 90 degrees clockwise from the long axis

parasternal position.

● The transducer will point to the patient’s left shoulder.

● Paratsernal short-axis plane shows a series of image planes perpendicular to the long axis

of the LV.

● PSAX displays bisects the heart in several levels

1. Aortic valve level

2. Mitral valve level

3. Papillary muscle level

4. Apical level

Display Modes

There are three basic modes of display:

● Amplitude mode

● Brightness mode

● Motion mode

M-mode of Aortic Valve and Left Atrium

● Displays the aortic root; aortic cusp opening in systole and closure in diastole and left

atrium posterior to the aortic root.

● Aortic root should be measured at the end of the diastole.

● Aortic cusp separation measured early systole

● Aortic ejection time from the beginning of the valvae opening to the end of the valve

opening.

● Left atrium dimension measurement is taken at the end of the ventricular systole.