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Applied Anatomy of the Heart (syllabus and ICARS lecture notes) Understand the concepts & associated principles,

functional & clinical applications of: ! "isplacement of the ape# beat$ sternal thrust! Ape# %eat Is the heart enlar&ed Is the heart bein& pushed or pulled 'ush: (ension pneumothora# or a space occupyin& lesion )ill push the heart 'ull: 'neumothora# or fibrosis can pull the heart across Sternal (hrust Ri&ht *entricular Hypertrophy +! (he de&ree of anastomosis of the coronary arteries and the effects of sudden ,s &radual occlusion! Anastomoses of the coronary arteries are only potential anastomoses! -radual coronary artery disease can cause anastomoses bet)een the Ri&ht and .eft coronary arteries! Ho)e,er, Sudden e,ents such as thromo/emboli that bloc0 a substantial coronary artery )ill not allo) for the &radual anastomoses bet)een R 1 . coronary arteries and necrosis from local ischaemia )ill li0ely ensue! Anastomoses occur at the terminations of the coronary arteries, in the atrio,entricular &roo,e, and bet)een their inter,entricular branches, in the inter,entricular &roo,e! 2! (he area of distribution of each coronary artery includin& the conductin& tissue supplied (notin& that the patterns are ,ariable)! (he RI-H( coronary artery typically supplies: SA node 3 445 of people A* node 3 675 of people Ri&ht atrium 8ost of ri&ht ,entricle 'art of left ,entricle (diaphra&matic surface) Inter,entricular septum 3 posterior third (he .9:( coronary artery typically supplies: SA node 3 ;45 of people A* node 3 75 of people A* bundle .eft atrium 8ost of left ,entricle 'art of ri&ht ,entricle Inter,entricular septum 3 anterior + thirds Coronary Artery "ominance (here are 2 criteria to determine coronary artery dominance$ )hich artery supplies A* node + 'osterior "escendin& Artery 2 'osterior surface of the left ,entricle <75 of the population are Ri&ht coronary artery dominant$ +75 of the population are .eft coronary artery dominant or balanced

;! (he common areas of referral of cardiac pain! Relate these to the se&mental distribution of the sensory ner,e supply of the heart! Cardiac ner,e supply stems from ( /(4 (may e#tend do)n to (=/(>) and is bilaterally inner,ated! Cardiac pain is referred to skin supplied by spinal cord segments T1-T5$ in particular: Inner aspect of the arms (inner,ated by ( ) S0in of the Sternum (Ischaemic cardiac pain is typically referred to the s0in o,er the sternum in the midline: inner,ated by (+/(4) 4! 9#ternal cardiac compression (notin& the part of the sternum directly o,erlyin& the heart)! 9#ternal cardiac compression is performed simultaneously )ith ,entilatory support in Cardiopulmonary Resuscitation C'R! (he lo)er third of the patient?s sternum, )hich o,erlies the ,entricles, is depressed by direct pressure from the heel of the operator?s hand ()ith added pressure from the other hand on top)! (he operator uses a strai&ht arm techni@ue, roc0in& bac0 and forth usin& body )ei&ht rather than muscular effort to depress the sternum about 4 cms! At a rate of compressions per minute! =! (he probable paths of emboli from an atrial thrombus!

RI-H( A(RIA. (HRA8%US B embolus enters the ri&ht ,entricle B enters the pulmonary trun0 B enters the R or . pulmonary arteries B &ets stuc0 in the arterioles or capillary beds! .9:( A(RIA. (HRA8%US B embolus enters the left ,entricle B enters the aorta B can end up any)here in the systemic arterial system (places of se,ere complications include: cerebral arteries, femoral arteries and coronary arteries