1. Adult Echocardiography Lecture 10 Coronary Anatomy
holdorf

2. Anterior view

3. Anterior View

4. Posterior view

5. Coronary Perfusion Left anterior descending (LAD) Anterior wall
Anterior septum
LV Apex
From where do the coronaries originate?
In the left and right aortic sinus of Valsava

6. Coronary Perfusion Left Circumflex Lateral wall Posterior wall
What is meant by “Right Dominance?”
When the right coronary gives rise to the posterior descending artery (occurs 85% of the time)

7. Coronary Perfusion Right Inferior Wall Inferior Septum RV apex
RV free wall
Which coronary supplies the interatrial septum?
Right- which also usually supplies the SA and AV nodes.

8. Coronary Distribution

9. Which coronary artery feeds the infero-septal wall?
Right coronary artery

10. Other Imaging Modalities Nuclear Medicine -cardiolite

11. Ventricular wall anatomy Short Axis (SA)
Basal
Anterior
Anterolateral
Infero-lateral
Inferior
Infero-septal
Antero-septal

12. Mid-Cavity Short AXIS (SA)
Anterior
Antero-lateral
Infero-lateral
Inferior
Infero-septal
Antero-septal

13. Apical Short Axis (SA)
Anterior Lateral Inferior Septal

14. Exercise Echo (Stress)

15. Stress Echo - Premise
Transient exercise induced ischemia results in wall motion abnormalities which are detected with echocardiography.
Reliable
Easy to perform
Clinically established

16. Ischemic Cascade Ischemia vs. Stress

17. Utilization of Stress Echocardiography
Detection of CAD
Evaluation of ambiguous treadmill outcomes (digitalis, resting ECG abnormalities)
Functional significance of anatomic lesions
Quantitation of left ventricular performance
Post MI evaluation (prognosis/functional capacity)
Post PTCA evaluation : percutaneous transluminal coronary angioplasty 
Non cardiac surgery pre-operative assessment

18. Know the indications for stress echo
Know that in multi-vessel disease, stress echo is better than nuclear stress scans.
Which of the following drugs is used in Nuclear Stress tests?
Thallium
Inderal is a beta blocker
Single vessel disease is best with NM
Multi vessel disease is best with Echo

19. Indications To aid in the diagnosis of chest pain
To determine the severity and prognosis of CAD
To guide post MI rehab
To evaluate cardiac arrhythmias
To screen high risk or asymptomatic patients with multiple risk factors

20. Stress Echo analysis Regional wall motion Systolic wall thickening
Wall motion score
Ejection fraction response
Doppler velocities

21. ECG interpretation
Morphology, degree and duration of ST segment depression
ST segment elevation
Duration of exercise
Exercise induced hypotension or arrhythmias

22. Image interpretation
Captured systolic frame, ECG gated 6 to 8 frames, sec intervals
Continuous loop format, variable speed playback, minimized heart motion and respiratory interference
Side by side rest and exercise display. Quad screen.

23. Normal Stress Response
Normal response to stress includes all the following
Hyper-dynamic walls
Systolic thickening
Decreased systolic cavity
Normal diastolic dimensions

24. Normal Stress Response
What would be a contraindication to performing a stress test on an athlete with chest pain?
Chest pain at rest (unstable angina)