•  Ascending aorta: major branches (arising from the aortic arch)

  •  innominate

    • divides into right subclavian and right carotid arteries

  •  left carotid

  •  left subclavian

• Rationale for anesthesia providers in learning arterial circulation anatomy:

  1. target sites for direct arterial cannulations

  2. targets that must be avoided for venous cannulations

  3. helping to prevent surgical complications

return to main anatomy menu

return to main menu

Coronary Vasculature

• Origination: sinuses of Valsalva in the aortic valve (right & left coronary arteries)
  • Left coronary artery: short common or left main component, then dividing into:
    1. left anterior descending
    2. left circumflex
  • Left anterior descending path:
    • downward over the anterior left ventricular wall
    • supplying the interventricular groove by:
      1. diagonal branch
      2. septal perforator branch
  • Consequence of the occlusive disease in the anterior descending blood distribution system -- electrocardiographic manifestations
    •  Ischemic changes in ECG leads  V3-V5

information courtesy of  Frank G.Yanowitz, M.D. &  The Alan E. Lindsey  ECG Learning Center, used with permission, http://medstat.med.utah.edu/kw/ecg/index.html

above image courtesy of Marquette Electronics

"The "P wave presents atrial activation; the P-R interval is the time from onset of atrial activation to onset of ventricular activation.  The QRS complex represents ventricular activation; the QRS duration is the duration of ventricular activation.  The ST-T wave represents ventricular repolarization.  The QT interval is the duration of ventricular activation and recovery.  The U wave probably represents 'afterdepolarizations' of the ventricles"-courtesy of  Frank G.Yanowitz, M.D. &  The Alan E. Lindsey  ECG Learning Center, used with permission; http://medstat.med.utah.edu/kw/ecg/index.html

return to main anatomy menu

return to main menu

• Ischemic Heart Disease: ECG manifestations: ST segmental changes

ST Segment Depression

• courtesy of  Frank G.Yanowitz, M.D. &  The Alan E. Lindsey  ECG Learning Center, used with permission, http://medstat.med.utah.edu/kw/ecg/index.html
• note that "upsloping" ST depression is not considered an ischemic abnormality

• Subendocardial ischemia (above) -- exercise induced or during anginal episode (courtesy of  Frank G.Yanowitz, M.D. &  The Alan E. Lindsey  ECG Learning Center,used with permission, http://medstat.med.utah.edu/kw/ecg/index.html)

return to main anatomy menu

return to main menu

• Differential diagnostic issues in evaluating ST segmental depression
  • Normal variant/artifacts include:
    1. ST-depression secondary to poor skin-electrode contact [pseudo-ST-depression]
    2. Hyperventilation-induced ST segmental depression
    3. Physiological J-junctional depression associated with sinus tachycardia
  •  Ischemic Heart disease
    • "Subendocardial ischemia" (shown above)
    • "Nnon-Q-wave a cardinal infarction"
    • "Reciprocal reciprocal changes in acute Q-wave myocardial infarction (e.g., ST depression in leads I & aVL
  •  ST-segmental changes not due to ischemic heart disease
    •  Digoxin (Lanoxin, Lanoxicaps)/digitoxin (Crystodigin) ECG effects
    •  Hypokalemia
    •  Some cases of mitral valve prolapse
    •  CNS disorders
    •  Secondary ST-changes with certain conduction abnormalities (e.g. right bundle branch blocks, left bundle branch blocks, Wolff-Parkinson-White disorder)
    •  Right ventricular hypertrophy (right precordial leads)
    •  Left ventricular hypertrophy (left precordial leads, I, aVL)
    • courtesy of  Frank G.Yanowitz, M.D.&  The Alan E. Lindsey  ECG Learning Center, used with permission, http://medstat.med.utah.edu/kw/ecg/index.html

return to main anatomy menu

return to main menu