The Netter Collection of Medical Illustrations VOLUME 8

Plate 6-149  Cardiovascular System

Echinococcus Infection and
Hydatid Pericarditis

Cardiac Echinococcus Infection Multiple myocardial cysts More common form: multiple cysts
Even in endemic regions, the heart is rarely affected by intramurally located within unilocular sac in heart wall
Echinococcus disease; the incidence of primary myocar-
dial involvement is less than 2% in human echino­ Expulsion of cysts via carefully guarded small opening
cocciasis (echinococcosis). The parasitic six-hooked prior to removal of entire external wall of common sac
embryo reaches the myocardium through the coronary
circulation, having passed through the gastric or intes- CT. Transmitted cardiac pulsation in the opacity is ECG changes, supplemented by positive biologic tests
tinal mucosa into the portal circulation, and through demonstrated on fluoroscopy. The ECG may be useful and eosinophilia, in a person living in an endemic
both the hepatic and the pulmonary capillary bed. It can in diagnosis and more accurate localization of the cyst, region, should lead to the diagnosis of cardiac echino-
establish itself and develop into an echinococcus cyst in showing myocardial ischemia and conduction changes coccus disease.
almost any part of the myocardium, but cysts are mostly more often than with other imaging. Angiocardiogra-
located in the walls of the ventricles (see Plate 6-149). phy is a valuable adjunct to the radiologic investigation, Treatment of cardiac Echinococcus infection (echino-
There is a higher incidence of cysts in the myocardium whereas heart catheterization is of no diagnostic value. cocciasis, echinococcosis, hydatid disease, hydatid peri-
of the left ventricle because its vascular bed is more Casoni intradermal and Weinberg tests add greatly to carditis) should remove the cyst. In select patients,
abundant. The developing parasitic membranous cyst the establishment of the diagnosis. The correlation surgery should be performed under extracorporeal cir-
is surrounded by a fibrous sac or capsule, the adventitia. of radiographic and angiocardiographic findings with culation. If the cyst has not ruptured into a heart
When it grows larger, the cyst may protrude into a chamber, surgery probably will result in cure.
cardiac cavity, the pericardial sac, or both, its greater
and more prominent part usually projecting toward the
pericardium.

Primary echinococcus cyst of the heart is mostly
single and slow growing. Less often, more than one cyst
and rarely multiple cysts may develop. A single cyst
infrequently remains univesicular and intact. In addi-
tion to free hydatid fluid, the adventitial capsule usually
contains degenerated fragments of the ruptured origi-
nal membranous cyst—the mother cyst—and multiple,
even hundreds of, daughter cysts, both unruptured and
ruptured and varying in size. Rupture of the membra-
nous cyst is likely because of the repeated trauma of
continuous heart movement. On rupture, the membra-
nous cysts may die, the content of the adventitia
becomes caseous and inspissated, and the adventitial
capsule may calcify.

Hydatid Pericarditis
During the progressive enlargement of the echinococ-
cus cyst, disastrous complications can occur. The cyst
may rupture into a cardiac cavity or into the pericardial
sac. Such ruptures may cause sudden death from ana-
phylactic shock and hydatid embolism, which is usually
cerebral (less often, pulmonary). If the person survives,
hematogenous dissemination occurs (more often in the
CNS), with the eventual development of multiple meta-
static or secondary cysts in the brain, usually with a fatal
outcome. Rupture into the pericardial sac produces
acute hydatid pericarditis (hydatid disease). Implanta-
tion of brood capsules and scolices in the pericardium
leads to chronic hydatid pericarditis (hydatidopericar-
dium) with fibrous tissue reaction and secondary cyst
formation.

Clinically, the uncomplicated single cyst, when small
and particularly if dead, may be asymptomatic. As it
grows larger, atypical or even undetermined symptoms
may appear, although these do not lead to the diagnosis.
Radiographs show an eccentric deformity protruding
from the contour of the cardiac shadow, generally as a
circular or ovoid, homogeneous, well-defined opacity
continuous with the outline of the heart silhouette.
Calcification may also appear and is more distinct on

282 THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS

SELECTED REFERENCES

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J Anat 2004;205:159–77. raphy can obviate the need for noninvasive studies in many patients Section 6—Acquired Heart Disease
Anderson RH, Yanni J, Boyett MR, et al. The anatomy of the with ischemic heart disease. Clin Cardiol 1997;20:827–8. Khandaker MH, Espinosa RE, Nishimura RA, et al. Pericardial
Mieres JH, Makaryus AN, Redberg RF, Shaw LJ. Noninvasive
cardiac conduction system. Clin Anat 2009;22:99-113. cardiac imaging. Am Fam Physician 2007;75:1219–28. disease: diagnosis and management. Mayo Clin Proc 2010;85:
Fiss D. Normal coronary anatomy and anatomical variations. Appl Pennel DJ. Contemporary reviews in cardiovascular medicine. 572–93.
Cardiovascular magnetic resonance. Circulation 2010;121: Kirchhoff LV, Weiss LM, Wittner M, Tanowitz HB. Parasitic dis-
Radiol 2007;36:14–26. 692–705. eases of the heart. Front Biosci 2004;9:706–23. Review.
James TJ. Anatomy of the sinus node of the dog. Anat Rec Maron BJ, Towbin JA, Thiene G, et al. Contemporary definitions
Section 4—Embryology and classification of the cardiomyopathies: AHA scientific state-
1962;143:251. Abdulla R, Blew GA, Holterman MJ. Cardiovascular embryology. ment. Circulation 2006;113:1807–16.
Maseri A. Ischemic heart disease. Philadelphia: Churchill Living-
Section 2—Physiology Pediatr Cardiol 2004;25:191–200. stone; 1995.
Bayes de Luna A. Clinical electrocardiography: a textbook. 4th ed. Angelini P. Embryology and congenital heart disease. Tex Heart Remetz MS, Matthay RA. Cardiovascular manifestations
of connective tissue disorders. J Thorac Imaging 1992;7:
New York: Wiley-Blackwell; 2012. Inst J 1995;22:1–12. 49–63.
Kameswari M, Rigolin VH, Sarano ME, Bonow RO. Valvular Cochard LR. Netter’s atlas of human embryology. Philadelphia: Roberts K, Colquhoun S, Steer A, et al. Screening for rheumatic
heart disease: current approaches and controversies. Nat Rev
heart disease: diagnosis and management. Mayo Clin Proc Saunders; 2012. Cardiol 2013:10:49–58.
2010;85:483–500. Yeh ET, Bickford CL. Cardiovascular complications of cancer
Pepine C, Hill J, Lambert C, editors. Diagnostic and therapeutic Section 5—Congenital Heart Disease therapy: incidence, pathogenesis, diagnosis, and management.
cardiac catheterization. 3rd ed. Philadelphia: Lippincott Gersony WM, Rosenbaum MS. Congenital heart disease in the J Am Coll Cardiol 2009;53:2231–47.
Williams & Wilkins; 1997.
Stub D, Bernard S, Duffy S, Kaye D. Contemporary reviews adult. New York: McGraw-Hill; 2002.
in cardiovascular medicine. Post cardiac arrest syndrome: a Lewin MB, Stout K. Echocardiography in congenital heart disease.
review of therapeutic strategies. Circulation 2011;123:
1428–35. Philadelphia: Saunders; 2013.

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INDEX

A Advanced lesions of infective endocarditis, 215 Aorta (Continued)
A wave, jugular venous, 92f Adventitia, 134f coarctation of, 92f, 129–130, 241f
Abdominal aorta, aneurysm, 181f Afferent fibers, 17 cystic medial necrosis of, 180–181
Abdominal bruits, 20, 21f Albini nodules, 11, 12f descending
Aberrant right subclavian artery, 126f Alcohol, effects on heart, 204 at 55 days, 81f
Abnormal electrical impulses, 261f Alcohol septal ablation, 117 development of, 86f
Abscess Aldosterone secretion, in primary hyperaldosteronism, frontal projection, 50f
LAO projection, 52f
amebic, of liver, 281f 233f lateral projection, 53f, 57f
subepicardial, 194f Allantois, 77 normal pressure, 30
Absent pulmonary artery, 127 Amebiasis, 281 prenatal circulation, 89f
Accessory hemiazygos vein, 93f Amebic pericarditis, 281 RAO projection, 51f
Acquired heart disease. See also specific diseases Amnion, 74f–75f, 77f syphilis of, 182
angiogenesis, 140 Amniotic cavity, 73f thoracic, 4f
aortic valve aneurysm, 181f
primitive, 72 dilated and sclerotic, 182f
biologic grafts, 190 Amplatzer Duct Occluder, 126f transection, in repair of transposition of great vessels,
insertion of trileaflet valve, 189 Amplatzer Septal Occluder, 99f 120f
replacement, 179, 186–188 Amyloidosis, 193
arteriogenesis, 140 Aneurysm Aortic arch, 3f, 4–5, 5f–7f, 9f
biventricular pacing for heart failure, 271 at 14-somite stage, 76f
cardiopulmonary resuscitation, external, abdominal aortic, 181f at 20-somite stage, 77f
aortic, 138f at 27 to 29 days, 79f
221–222 of aortic sinus of Valsalva, 123 arteries, derivatives of, 85f
defibrillation, 222–223 medial fibroplasia with, 243–244 first appearance of, 74
of membranous septum, 108 heart tube primordia, 82f
intracardiac, 271–272 mycotic, 218 LAO view, 52–53
degree of flow-limiting stenoses, 144 postinfarction, 153f right, and left ductus arteriosus, 127f
disorders of potassium metabolism, 253 Aneurysmectomy, ventricular, 148
end-organ damage by vascular disease, 138 Angiitis, verrucous, 200 Aortic arch system, early, 90f
fractional flow reserve, 146 Angina Aortic arch system anomalies
heart transplantation, 274–276 caused by plaque rupture, 139f
heart wounds chronic, revascularization procedures, aberrant right subclavian artery, 126
cases of absent pulmonary artery, 127
nonpenetrating, 259–261 147–148 coarctation of aorta, 129–130
penetrating, 254–258 Angina pectoris, 142 double aortic arch, 126
in hypertension, 246–248 Angioblastic cords, paired, 73 left pulmonary artery arising from right pulmonary
hypothermia for cardiac arrest, 223 Angiocardiography, catheter-based
intra-aortic balloon counterpulsation, 157 artery, 128–129
mitral valve replacement, 185–186 frontal projection patent ductus arteriosus, 125–126
multiple-valve replacement, 188 of left side of heart, 55–56 pulmonary artery arising from
peripheral artery intervention, 263–264 of right side of heart, 54–55
prosthetic valve surgery, first and second generation, ascending aorta, 128
lateral projection ductus arteriosus, 128
183–184 of left side of heart, 56–57 right aortic arch with left-side contralateral ductus
pulmonary congestion, 267 of right side of heart, 55
arteriosus, 127
reduction of, 270 Angiogenesis, 140 Aortic area of cardiac auscultation, 21, 23f
pulmonary edema, 267–268 Angiography Aortic atresia, 115
reduction of cerebral emboli, percutaneous approaches Aortic insufficiency, 23f–24f, 177f, 225f
catheter-based coronary, 58–59 Aortic regurgitation, 21f, 186–187
to, 262 left-sided heart, 145
right ventricular failure, 269 left ventricular, 115f in ankylosing spondylitis, 225
substance abuse and heart, 204 of small pulmonary emboli, 209f pathology, 177–178
sudden death in young athletes, 277 Angiospastic retinitis, 242 Aortic sac, 75f–77f, 85f
syncope, management of, 278 Angiotensin, 237–238 Aortic sinuses (of Valsalva), 12f
unstable plaque formation, 139 Ankle-brachial index, 20 fistula into right atrium, 123f
Acquired immunodeficiency syndrome (AIDS), and heart, Ankylosing spondylitis, 225 posterior, mycotic aneurysm of, 218
Annuloplasty, in mitral valve repair, 173f Aortic stenosis, 23f–24f, 138f
203 Anomalies of cardiac veins, 93f abnormal findings in, 30f, 31
Acromegaly, 229 Anomalous pulmonary venous connection (APVC), rheumatic and nonrheumatic causes,
Action potentials, 32f–33f
Active pulmonary congestion, 267f 94–95 175–176
Acute anteroseptal infarct, 150f Ansa subclavia, 16f–17f valvular, 115
Acute cor pulmonale, 208–209 Anterior cardiac veins, 14f Aortic valve
Acute coronary syndromes, pathophysiology of, Anterior interventricular branch, of left coronary artery, bicuspid, 115, 175f, 213f
biologic grafts, 190
149 14f cusps, 56f–57f, 84f
Acute isolated (Fiedler) myocarditis, 197 Anterior interventricular sulcus, 6f
Acute margin of heart, 6f Anterior right ventricular branch, of right coronary fusion of right cusp, 162f
Acute pericarditis, 205–207 sequelae of infective endocarditis, 217f
Acute pulmonary congestion, reduction of, 270 artery, 58f with dilated annulus, 180f
Acute rheumatic carditis, residual changes in, 162 Anterior scalene muscle, 2f–3f in Eisenmenger complex, 113f
Acute rheumatic myocarditis, 160 Anteroposterior projection incompetent, in syphilitic aortic disease,
Acute rheumatic pericarditis, 160
Acute transmural myocardial infarct, 152f left-sided heart structures, 56f 182f
Acyanotic tetralogy of Fallot, 109 right-sided heart structures, 54f replacement
Addison’s disease, 253f Antishock therapy, 256
Adhesive pericarditis, 205 Aorta. See also Ascending aorta aortic valve regurgitation, 186–187
at 37 and 55 days, 81f surgical technique, 187–188
with focal calcification, 162f abdominal, aneurysm, 181f transcutaneous, 179
Adrenal pheochromocytoma, 234f aneurysm, 138f rupture, 260f
Adrenocorticotropic hormone (ACTH), hypersecretion semilunar cusps, 9f–13f
excision of, 187f in tetralogy of Fallot, 109f
in Cushing’s syndrome, 232 anteroposterior projection, 56f
arising from right ventricle, 124f

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS 285

Index

Aortic valve ring Atrioventricular bundle (of His), 13f Blalock-Hanlon operation, for transposition of great
frontal projection, 50f diffuse cellular infiltration of, 195f vessels, 119f
LAO projection, 52f
lateral projection, 53f Atrioventricular canal, 77f Blalock-Taussig operation, for tetralogy of Fallot, 110f,
RAO projection, 51f formation of, 78, 79f 111–112

Aorticopulmonary septum, 81f Atrioventricular junction, in Ebstein’s anomaly, 105f Blastocyst, 72
defect of, 122 Atrioventricular nodal branch, 11f, 58f Blood flow
Atrioventricular node, 13f, 33f
Aortogram, lateral view, 125f normal, during inspiration and expiration, 31f
Apex of heart, 6f–7f, 51 in delayed ventricular activation, 271f turbulent, at bifurcation, 212f
depolarization at, 36 Blood island, 73f
right, recession of, 198f Atrioventricular part of membranous septum, 8f, 10f–11f, Blood loss, voluminous, 256f
Apical area of cardiac auscultation, 20 Blood pressure
Apical depolarization, 37, 40f 84f controlling mechanisms
Apical position of transducer, 61f Atrioventricular septum, in chronic cor pulmonale, 211f
Arrhythmias, sinus and atrial, 43 Atrioventricular sulcus endocrine factors, 239
Arterial disease of lower extremity, 263–264 neural factors, 239–240
Arterial repair of transposition of great arteries, 120f frontal projection, 50f renal factors, 237–238
Arterial wall LAO projection, 52f proximal and distal to stenosis, 146
lateral projection, 53f Blood supply
cutaway view, 134f RAO projection, 51f chest wall, 3–4
susceptibility of, 136f Atrioventricular valve heart, 14–15
Arteriogenesis, 140 apparatus, 11 Blood vessels
Arteriosclerotic kidney, 245f embryologic origin of, 78f development of
Arteriovenous variations, 15f formation of, 84 aortic arch system, 85–86
Arthritis insufficiency, 23 major systemic veins, 86–88
migratory, 159f Augmented limb leads, ECG, 35 formation of, 73f
rheumatoid, 224 Auscultation, cardiac Blood volume, during pregnancy, 26
Ascending aorta, 5f, 8f, 10f, 12f–13f, 81f aortic area, 21 Body of Arantius, 12f
calcification of, 182f clues to CHD, 92f Brachial artery, 27f
development of, 86f left ventricular area, 20 catheter introduced into, 28f
dilated, 180f positions for, 20 Brachial plexus, 2f–3f
hypoplastic, 115f pulmonary area, 21 Brachiocephalic trunk, 3f, 6f–7f, 86f, 111f
poststenotic dilatation of, 176f right ventricular area, 21 Brachiocephalic vein, 88f
pulmonary artery arising from, 128 significant findings left, TAPVC to, 94f
Aschoff bodies, 160f right, 95f
Asplenia syndrome, 96 friction rubs, 24 Bradycardia, sinus, 43
Asystole, in cardiopulmonary arrest, 221 heart sounds, 21–23 Brain
Atherectomy, rotational, 148f murmurs, 23–24 damage caused by vascular disease, 138f
Atheroma, 137 for third heart sounds, 265f infarct of, 168f, 219f–220f
Atherophils, 134f Avascular zone, of coronary artery, 134f Branchial arches, 85
genetically susceptible and resistant, 135 Axillary artery, 2f Brock operation, for tetralogy of Fallot,
Atherosclerosis Axillary vein, 2f 111–112
causing renal artery stenosis, 243 Axis deviation in normal ECG, 38 Bronchus
coronary, 58 Azygos drainage of inferior vena cava, 93 compression, in mitral stenosis, 165f
pathogenesis of, 135 Azygos vein, 4f, 88f left and right main, branches of, 4f
pulmonary, in mitral stenosis, 164f orifice of, 50f Bruits, carotid, 92f
risk factors in etiology of, 136 RAO projection, 51f Bulbar swellings, 79f–80f, 84f
Athletes, young, sudden death in, 277 B Bulboventricular flange, 79f
Atresia Babinski sign, 252f persistent, 113f
aortic, 115 Bacterial arteritis, vegetations in pulmonary trunk, Bulboventricular sulcus, 76f
pulmonary valve, 114f 216f Bulbus cordis, 75f, 77f, 79f, 81–82
Atria. See also Left atrium; Right atrium Bacterial endocarditis Bundle branch block, 41
anomalies of, 96 advanced, 215f Bundle of His
auricles/pectinate muscle walls, 82f cardiac sequelae, 217f atrioventricular, 13f
enlargement of, 39 early vegetations, 214f diffuse cellular infiltration of, 195f
formation of, 78–80 portals of entry and predisposing lesions, 213f C
premature contractions of, 44 Ball-valve thrombus, 167f Calcification
septation of, 83f Balloon angioplasty, of common iliac artery, 264f of ascending aorta, 182
Atrial appendages Balloon atrial septostomy, 120f of cardiac valves, 51
juxtaposition of, 96 Balloon catheter, in stent deployment for PCI, 147f focal, adhesive pericarditis with, 162f
left, 50–51, 50f Balloon valvuloplasty Calcium contrast studies, CTA, 67
mitral, 169f Calcium levels, effects on ECG, 47
anteroposterior projection, 56f in pulmonary stenosis, 114 Carbomedics bileaflet valve, 184f
occlusion, 262 Bamboo spine, 225f Carcinoma
thrombus in, 167f, 247f Baroreceptor reflexes, 25 bronchial, metastasis to heart wall, 236f
right, anteroposterior projection, 54f Base of heart, 7f infiltration of pericardium, 206f
Atrial depolarization, 36 Basement membrane, 134f of tail of pancreas, 220f
Atrial fibrillation, 46, 230f Basilic vein, in right-heart catheterization, 27f Cardiac apical impulse, 21f
in mitral stenosis, 164f Beall valve, 183f Cardiac auscultation
Atrial flutter, 46 Beam, in IVUS, 60f aortic area, 21
Atrial muscle electrical activity, 33f Becker’s disease, 200 clues to CHD, 92f
Atrial pressure, normal, 29–30 Beer drinker’s cardiomyopathy, 202 left ventricular area, 20
Atrial septal defects, 94f–95f, 97–99 Beriberi, 201 positions for, 20
bubble study, 64f Bicaval cardiac transplantation, 275f pulmonary area, 21
common atrium, 99 Bicuspid aortic valve, 115, 175f, 213f right ventricular area, 21
ostium primum defect, 99 Bileaflet prosthetic valves, 184f significant findings
ostium secundum defect, 97–99 Biologic valves, 184 friction rubs, 24
sinus venosus defect, 99 aortic grafts, 190 heart sounds, 21–23
Atrial septum Bisferiens pulse, 21f murmurs, 23–24
formation, 78–80 Biventricular pacing, 48 for third heart sounds, 265f
in multiple-valve replacement surgery, 188f for heart failure, 271
Atrioventricular (AV) block, 45 Björk-Shiley valve, 184f
Atrioventricular branch of circumflex branch, 59f
THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS
286

Catheterization (Continued) Index
normal oxygen saturations and pressure, 29
Cardiac cycle right-sided heart, 212 Conduction system of heart, 13
CTA studies, 67 vascular access and, 27 electrical activity of heart, 33
left ventricle, 20f physiology of specialized system, 32–33
Caudal artery, 87f sequence of excitation and ECG, 33
Cardiac depolarization, and repolarization and mean Caudal veins, 87f
instantaneous vectors, 36–37 Celiac trunk, 87f, 89f Congenital heart disease (CHD)
Cerebral emboli, percutaneous approaches to reducing, adults with coronary artery anomalies, 124
Cardiac function, neural and humoral regulation, 25 aneurysm of aortic sinus of Valsalva, 123
Cardiac jelly, 74f, 75, 76f 262 anomalies of great systemic veins, 93
Cardiac markers, and diagnosis of acute myocardial Cerebrovascular emboli protection device, 263f anomalous left coronary artery, 123
Cervicothoracic (stellate) ganglion, 16f–17f anomalous pulmonary venous connection, 94–95
infarction, 155 Chagas disease, 280 aortic arch system anomalies, 125–130
Cardiac notch of left lung, 2f Chest wall atrial anomalies, 96
Cardiac origin defects of atrial septum, 97–99
blood supply, 3–4 endocardial cushion defects, 100–101
of peripheral or systemic congestion or edema, 269 muscles originating from, 3 endocardial fibroelastosis, 131
of pulmonary congestion, 267f penetrating wounds to, 255f glycogen storage disease, 131
of pulmonary edema, 267–268 Chest x-ray left ventricular outflow anomalies, 115–117
Cardiac output clues to CHD, 92f right ventricular outflow tract anomalies,
changes in pregnancy, 26f frontal view, 50–51 109–114
thermodilution technique in catheterization, 29 lateral view, 53 simple diagnostic clues to, 92f
Cardiac pacing, 48 Chordae tendineae, 8f–9f, 11, 12f, 84 transposition of great arteries, 118–121
Cardiac plexus, 16–17 fusion, 162f tricuspid valve anomalies, 102–105
Cardiac resynchronization therapy (CRT), 48 in mitral valve prolapse, 174f truncus septum anomalies, 122
Cardiac septa formation rupture, 152f ventricular septum anomalies, 106–108
atria, atrial septum, and pulmonary veins, 78–80 in tricuspid stenosis, 191f
AV and semilunar valves, 84 Chordal transfer, in mitral valve repair, 173f Congestive heart failure, hypertension and, 248f
AV canal, 78 Chorion, 72 Connecting stalk, 72, 73f
development of ventricles, 80–81 Chorionic villi of placenta, 90f Conn’s syndrome, 233
sinus venosus, 82–83 Chronic angina Constrictive pericarditis, 207f
truncus arteriosus and bulbus cordis, 81–82 coronary artery bypass grafts, 148 Continuous-flow LVAS, 276f
Cardiac tamponade, 254–255 percutaneous coronary intervention, 147 Continuous positive airway pressure (CPAP), 249f
Cardiac veins, 14–15 surgery for, 147–148 Contractions, premature, 44
anomalies of, 93f ventricular aneurysmectomy, 148 Contrast echocardiography, 64
Cardinal veins, 76f–77f, 87f–88f, 90f Chronic cor pulmonale, 210–212 Contusion, cardiac, 259f
Cardiogenic mesoderm, 72–73 Chronic ischemia, effect on brain, 138f Conus arteriosus, 6f, 8f–9f, 11f
Cardiomyopathy Chvostek sign, 233 Conus arteriosus branch, 58f
alcoholic, 204f Circulation Conus swellings, 100f
in Cushing’s syndrome, 232 fetal, and changes at birth, 89–90 Cor pulmonale
hypertrophic, 21f, 116–117, 277f in mitral stenosis, 166f
nonischemic, 202 Circumflex branch of left coronary artery, 11f, 14f, 59f acute, 208–209
right-sided heart failure and, 265–266 Clavicle, 2f chronic, 210–212
Cardiopulmonary resuscitation Claw toes, in Friedreich’s ataxia, 252f Cor triatriatum, 96
defibrillation, 222–223 Clinical features CoreValve, 179f
external, 221–222 of Cushing’s syndrome, 232f Coronary arteries, 14–15. See also Left coronary artery;
hypothermia for cardiac arrest, 223 of pheochromocytoma, 234f
Cardiorrhaphy, 257f–258f of primary hyperaldosteronism, 233f Right coronary artery
Cardiovascular abnormalities, in systemic sclerosis, of transposition of great vessels, 118–119 anomalous, in adult patients, 124
Clip-on catheter, MitraClip detachable, 172f calcium study, 67f
227 Cloacal membrane, 77f cannulated, 186f
Cardiovascular examination Clubbing of fingers LDL and plaque, 144f
resulting from infective endocarditis, 219f occluded, recanalization in acute myocardial infarction,
cardiac auscultation in tetralogy of Fallot, 109f
areas of, 20–21 Coarctation of aorta, 92f, 129–130 156
positions for, 20 hypertension caused by, 241f openings of, 10f
significant findings, 21–24 Cocaine, effect on heart, 204 serial sections in ultrasound study, 60f
Coelom structure of, 134
events in cardiac cycle: left ventricle, 20 extraembryonic, 72 Coronary artery bypass grafts (CABG), 148
Cardiovascular factors, in blood pressure control, intraembryonic, 73, 74f Coronary artery disease, pathologic changes in,
Cogwheel respiration, in tricuspid insufficiency, 192f
240 Collagen, 134f 137
Carotid artery stenosis, 263 dense layer lining left ventricle, 198f Coronary sinus, 4f–5f, 7f, 9f, 14f, 88f
Carotid ducts, 86f Collateralization, potential sources of, 140
Carotid pulses, 21f Colloidal osmotic pressure of blood, decreased, 268f leads, 48f
Carotid sinus sensitivity, 278 Common atrium, 97f, 99 opening of, 8f, 12f
Cataracts, in myotonic dystrophy, 251f Common carotid artery, 2f–3f, 6f–7f, 89f TAPVC to, 94f, 95
Catecholamine cardiomyopathy, 234 development of, 86f Coronary sinus ostium, 93
Catecholamines, control of cardiac function, 25f Common ventricle, 107f, 108 Coronary sulcus, 6f
Catheter-based angiocardiography Commotio cordis, 261 Corrected transposition of great vessels, 120–121
Compensation (hypertrophy and remodeling), 248f Corrigan’s pulse, 21f
left side of heart Compression-ventilation cycles, 221f Costal cartilage
frontal projection, 55–56 Computed tomographic angiography (CTA) 7th, 2f
lateral projection, 56–57 advances and interpretation, 67 5th left, 4f
cardiac cycle and calcium contrast studies, 67 Costodiaphragmatic recess, 2f
right side of heart image interpretation, 68f Costomediastinal space, 2f
frontal projection, 54–55 Computer reconstruction, of acquired image data, Creatine kinase (CK), isoenzymes, 155
lateral projection, 55 Crista terminalis, 8f, 13f, 83, 104f
65f Cuboidal endodermal cells, 72
Catheter-based coronary angiography Concentric hypertrophy, 273f Current transvenous pacemakers, 48
clinical applications, 59 Conduction block, 271f Cushing’s syndrome, 232
Judkins technique, 59 Conduction system disease, in ankylosing spondylitis, hypertension caused by, 241f
radial artery technique, 59 Cyanosis
Sones technique, 58–59 225 of lips and nail beds, 265f
in right-sided heart failure, 266f
Catheterization in tetralogy of Fallot, 109f
abnormal oxygen and pressure findings, 30–31 in transposition of great vessels, 118–119
cardiac output: thermodilution technique, 29 in tricuspid stenosis and/or insufficiency, 192f
femoral artery, 28f
intracardiac pressures and flow, effects of inspiration 287
and expiration, 31
left-sided heart, 28, 145
normal intracardiac pressures, 29–30

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS

Index

Cyst Echocardiography Endocrine factors, in blood pressure control, 239
echinococcus, 282f contrast, 64 Endoderm, 73f–74f
exocelomic, 72f Doppler, 62 Endomyocardial fibrosis, 198
exercise, 64 Endothelium, 134f
Cystic medial necrosis of aorta, 180–181, 187f transducer positions in examination by, 61f Enlargement
Cytotrophoblast, 72 transesophageal, 63
D of heart, in cardiomyopathy, 202f
Dacron skirt, 187f Ectoderm, 72–73 left atrial, 39
Decompensation (myocardial failure), 248f Edema
Deep vein thrombosis, 212 in mitral stenosis, 165
Defibrillation, 222–223 of face, in trichinosis, 279f left ventricular, in aortic regurgitation, 178f
interstitial, in beriberi, 201f of liver, in mitral stenosis, 164f
intracardiac, in heart failure, 271–272 in Löffler’s endocarditis, 199f right atrial
Deflection, of QRS complex, 34 in mitral stenosis, 164f
Delayed ventricular activation, 271f of optic discs, 242 in tricuspid stenosis, 191f
Depolarization peripheral or systemic, cardiac origins, 269 in tricuspid stenosis and/or insufficiency, 192f
pulmonary, 267–268 right ventricular, in mitral stenosis, 163f
chaotic ventricular, 46f of T and P waves, 39
end of, followed by repolarization, 37 therapy for, 270 Eosinophilic endomyocardial disease, 199
progression of, 36–37 in right-sided heart failure, 265, 266f Epiblast, 72
Dermatomyositis, 226 Edwards-Carpentier valve, 184f Epinephrine, intracardiac injection, 222f
Descending aorta Efferent fibers, 17 Episcleritis, nodular, 224f
at 55 days, 81f Ehlers-Danlos syndrome, 92f Erb’s point, 22
development of, 86f Eighth rib, 4f Erythema, in dermatomyositis, 226f
Desmosome, 134f Einthoven triangle, 36 Erythema marginatum, 159f
Diagonal branch, of anterior interventricular artery, Eisenmenger complex, 112, 113f Erythrocyte sedimentation rate (ESR), 159
Electrical activity of heart, 33 Esophageal plexus, 4f
14f abnormal impulses, 261f Esophageal prominence, 5f
Diaphragm, 2f–3f Electrocardiogram (ECG) Esophagus, 4f
characteristic findings in pulmonary embolism, 208f displaced, in mitral stenosis, 165f
frontal projection, 50f clues to CHD, 92f Ethical implications of heart transplantation, 275–276
LAO projection, 52f in diagnosis of pericarditis, 206 Eustachian valve of inferior vena cava, 8f
lateral projection, 53f effects of Exercise and diet, in etiology of atherosclerosis, 136f
RAO projection, 51f Exercise echocardiography, 64
Diaphragmatic aspect of heart, 7 calcium and potassium levels, 47 Expiration, effect on intracardiac pressures and flow, 31
Diaphragmatic part of pericardium, 5f digitalis, 47 External carotid arteries, 86f
Diaphragmatic surface of heart, 14f myocardial ischemia, injury, and infarction, 155f External (closed-chest) defibrillation, 222, 223f
Diastole, ventriculographic projections, 66f evidence of left ventricular hypertrophy, 171f External iliac artery, 88f
Diastolic heart failure, 273 leads and reference lines, 35 External iliac vein, 88f
Diastolic hypertension, 238f localization of ischemic injury and infarction, 154–155 External jugular vein, 2f–3f
Diastolic obstruction, in tricuspid stenosis, 192f in myxedema, 231f External resuscitation
Diastolic opening snap, 23 normal, 34 cardiopulmonary, 221
Diet and exercise, in etiology of atherosclerosis, axis deviation in, 38 internal cardiac massage, 221–222
patterns, in cardiopulmonary arrest, 221 Extracellular matrix, restored, 140f
136f pressure tracings in relation to, 29f Extraembryonic coelom, 72
Digitalis in primary amyloidosis of heart, 193f Extraembryonic mesoderm, 72
sequence of excitation and, 33 Extrarenal stenosis, 138f
causing PAT with block, 46 signs of ischemic myocardium, 149f Eye
effects on ECG, 47 studies of coronary artery flow, 144f heliotrope discoloration around, 226f
Diphtheritic myocarditis, 195 for syncope, 278f iridocyclitis with irregular pupil, 225f
Distal protection device, coronary filter, 148f of tetralogy of Fallot, 109f nodular episcleritis with scleromalacia, 224f
Diuretics, 270 Electromyogram, in myotonic dystrophy, 251f F
Door-to-balloon (D2B) time, 156 Embolism Fatty streaks, 135, 139f, 149f
Doppler color study, of mitral regurgitation, 170f cardiac, 218 Femoral artery, 27f
Doppler echocardiography, 62 cerebral, percutaneous approaches to reducing, 262 catheterization, 28f
Dorsal aortae, 73, 74f–75f, 85f, 90f from left atrial thrombosis, sites of, 168f Fetal circulation, and changes at birth, 89–90
Dorsal intersegmental arteries, 90f pulmonary, 208–209 Fibrillation
Double aortic arch, 126 sequela of thrombosis, 152–153 atrial, 46, 230f
Double inferior vena cava, 93 Embolus, in middle cerebral artery, 220f in mitral stenosis, 164f
Double-outlet right ventricle, 112–113 Embryoblast, 72 ventricular, 46
Down syndrome, 92f Embryologic origin in cardiopulmonary arrest, 221
Dual-chamber pacemaker, 48f of anomalies of aortic arch system, 127f Fibrinoid necrosis, in rheumatoid nodule, 224f
Duchenne muscular dystrophy, 250 of AV valve, 78f Fibrinous pericarditis, mild, 205f
Ductus arteriosus, 81f. See also Patent ductus Embryonic development, early, 72 Fibroblast, 134f
Emphysema, 210f–211f Fibroelastosis, endocardial, 131
arteriosus End of depolarization followed by repolarization, 37 Fibromuscular hyperplasia, 244
in bacterial arteritis, 216f Endocardial cushions, 79f–80f Fibrophils, 134, 135f
left, right aortic arch and, 127 defects of, 100–101 Fibroplasia
ligated, 112f, 117f Endocardial fibroelastosis, 131 intimal, 243
prenatal circulation, 89f Endocardial tubes, 74f–75f subadventitial, 244
Ductus venosus, 87f Endocarditis Fibrosis
Dyspnea infective around cardiac muscle fibers, 196f
in mitral stenosis, 164f advanced lesions, 215 endocardial, 199f
paroxysmal, therapy for, 270 cardiac sequelae, 217 endomyocardial, 198
E early lesions, 214 pulmonary, 210f, 227f
Early intraembryonic vasculogenesis, 73 and mycotic aneurysms and emboli in heart, 218 in mitral stenosis, 164f
Early lesions, of infective endocarditis, 214 portals of entry, 213 Fibrotic renal arterial lesions
Ebstein’s anomaly, 104–105 remote embolic effects, 219 fibromuscular hyperplasia, 244
Echinococcus infection, cardiac, 282 right-sided heart involvement, 216 intimal fibroplasia, 243
Echocardiogram Löffler’s, 199 medial fibroplasia with aneurysms, 243–244
concentric hypertrophy, 273f nonbacterial thrombotic (marantic), 220 subadventitial fibroplasia, 244
demonstrating mitral stenosis, 163f Endocardium
findings in mitral valve prolapse, 174f hemorrhagic lesions of, 200f
scoring of mitral valve stenosis severity, 169f herniation of, 280f

288 THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS

Index

Fibrous pericardium, 2f–3f, 5f Healed anterolateral infarct, 151f High AV nodal rhythm, 44
Fibrous ring, valvular, 11f, 13f Heart High-density lipoproteins (HDL), 136
Fibrous skeleton of heart, 12f
Fibrous subaortic stenosis, 116 AIDS and, 203 alcohol effect, 204
Fibrous trigone, left and right, 11f blood supply, 14–15 Highly active antiretroviral therapy (HAART), 203
First-generation synthetic valves, 183–184 changes related to myocardial infarction, 150–153 Hilum of lungs, 6f
First heart sound, 21–22 chronic or intermittent ischemia, 138f Hindgut, 74f, 77f
First rib, 3f electrical activity of, 33 His–Purkinje system, 33
Fissures of lungs, 2f fibrous skeleton, 12f Historical perspective, surgery for acquired heart disease,
Fistula infarct of, 168f
innervation, 16–17 183
of aortic sinus into right atrium, 123f iodinated contrast CT studies, 67f Holter monitor, for syncope, 278f
communicating right coronary artery with right left-side structures Homografts

ventricle, 124f anteroposterior projection, 56f aortic, in valve replacement surgery, 184f
Fixation leads, ICD, 272f lateral projection, 57f patch, of neoaorta, 117f
Flutter, atrial, 46 MRI, 69f sterilization of, 190f
Follow-up position in chest, ECG and, 38 Horizontal fissure, 2f
posterior and diaphragmatic aspects, 7 Hufnagel valve, 183f
after CABG, 148 right-side structures Human immunodeficiency virus (HIV), 203
of heart transplant patient, 275 anteroposterior projection, 54f Humoral regulation of cardiac function, 25
Fontan atriopulmonary connections, 102f lateral projection, 55f Hydatid pericarditis, 282
Fontan procedure (modified), 117f rupture of, 153, 260–261 Hyperaldosteronism, primary, 233
Foramen ovale, 89f, 104f in situ, 3f Hypercalcemia, 47f
Foramen secundum, 79, 83f specialized conduction system of, 13 Hyperkalemia, 47f, 253f
Forebrain, 75f–76f sternocostal aspect, 6–7 Hyperplasia, fibromuscular, 244
Foregut, 73f–74f subepicardial abscess, 194f Hypertension
Fossa ovalis, 8f, 83f–84f, 89f, 97f substance abuse and, 204 associated with glucocorticoid excess, 232f
Four-somite stage, 75 transplantation, 274–276 etiology of, 238f
Fourteen-somite stage, 76–77 Heart disease heart disease in, 246–248
Fourth heart sound, 22–23 in hypertension, 246–248 kidneys and, 245
Fractional flow reserve, 146 parasitic mechanisms of blood pressure control
Free-floating disc valve, 183–184 Chagas disease, 280
Freestyle valve, Medtronic, 184f trichinosis, 279 cardiovascular factors, 240
Friction rub, 24 Heart failure chemical, 237–239
in acute pericarditis, 206 biventricular pacing for, 271 neural factors, 239–240
Friedreich’s ataxia, 252 diastolic, 273 mineralocorticoid, 233
Frontal projection left-sided, and pulmonary congestion, 266 obstructive sleep apnea and, 249
angiocardiographic right-sided, and cardiomyopathy, 265–266 portal, in tricuspid stenosis and/or insufficiency, 192f
Heart loop formation pulmonary
of left side of heart, 55–56 10- and 14-somite stages, 76–77 secondary to mitral stenosis, 21f
of right side of heart, 54–55 20-somite stage, 77 in ventricular septal defect, 107
radiologic, 50–51 Heart sounds, 21–23 renal artery disease inducing, 243f
G in aortic regurgitation, 178f retinal changes in, 242
Gallop, atrial, 22–23 in aortic stenosis, 176f secondary, 241
Ganglion of Wrisberg, 16–17 in mitral stenosis, 23f–24f Hyperthyroidism, 230
Gangrene, visceral or peripheral, 138f third, cardiac auscultation for, 265f Hypertrophic cardiomyopathy, 21f, 116–117, 277f
Genetic susceptibility to atherosclerosis, 135f Heart tube Hypertrophy
Giant cell myocarditis, 197 derivatives, 82f concentric, in aortic regurgitation, 177f
Glenn surgical technique, for tricuspid atresia, 103f formation of, 74–75 heart, in Becker’s disease, 200f
Glucocorticoid excess, hypertension associated with, 232f partitioning of, 83f left ventricular
Glycogen storage disease, 131 Heart tumors in aortic regurgitation, 178
Gore-Tex conduit, 117f metastatic, 236 in aortic stenosis, 175f
Gowers maneuver, 250f myxomas, 235–236 in hypertension, 246f
Grading system, for retinal changes, 242 rhabdomyomas, 235–236 papillary muscles, 169f
Grafts Heart wounds right ventricular, 110f, 211f
biologic, aortic valve, 190 nonpenetrating ventricular, 40, 112f
CABG, 148 cardiac rupture, 260–261 Hypoblast, 72
homograft patch of neoaorta, 117f commotio cordis and sudden cardiac death, 261 Hypocalcemia, 47f
prosthetic, in aortic aneurysms, 181f contusion, 259 Hypokalemia, 47f, 253f
in repair of tetralogy of Fallot, 112f penetrating Hypoplastic left heart syndrome, Norwood correction
Granular arteriosclerotic kidney, 245f antishock therapy, 256 for, 117f
Granuloma, with giant cell, in heart wall, 196f cardiac tamponade, 254–255 Hypopnea, 249f
Granulomatous myocarditis, 279 diagnosis of cardiac injury, 255–256 Hypotension, orthostatic, 278
Gray ramus communicans, 17f pericardiocentesis, 256 Hypothermia, for cardiac arrest victims, 223
Great cardiac vein, 14f Hypothyroidism, 231
Great systemic veins vs. open operation, 257–258 I
anomalies of, 93 thoracotomy, 256–257 Idiopathic hypertrophic subaortic stenosis, 116f
development of, 86–88 Idiopathic myocarditis, 197
Greater thoracic splanchnic nerve, 4f reasons for favoring, 258 Iliac lesion, 264f
Growth hormone excess, in acromegaly, 229 HeartMate II left ventricular assist system, 276f Image interpretation, CT coronary angiogram, 68f
Guidewire Hematologic changes in pregnancy, 26f Implantable cardiac defibrillator (ICD), 272f
in double-balloon mitral valvuloplasty, 169f Hemiazygos vein, 4f, 93f Infarction
in IVUS, 60f Hemolytic streptococci, 158f myocardial
in left coronary artery, 27f Hemoptysis, in mitral stenosis, 164f changes in heart, 150–153
passed through needle, 28f Hemorrhage, into atheroma, 137 manifestations of, 154–155
Gynecomastia, in myotonic dystrophy, 251f Hemorrhagic lesions, of endocardium, 200f recanalization of occluded coronary artery in, 156
H Hepatic diverticulum, 76f–77f retinal, 219f
Hancock porcine valve, 184f Hepatic vein, 89f Infarcts
Head-up tilt-table test, 278f Hepatocardiac channel, 87f acute anteroseptal, 150f
Herniation, endocardial, 280f acute transmural myocardial, 152f
Heuser’s membrane, 72f brain, 168f, 219f–220f
HF-PEF (heart failure-preserved LV ejection fraction),
289
273

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS

Index

Infarcts (Continued) Intracardiac pressures Left atrium (Continued)
healed anterolateral, 151f effects of inspiration and expiration, 31 enlargement, 39
heart, 168f normal, 29–30 in mitral stenosis, 165
posterior subendocardial, 150f LAO projection, 52f
pulmonary, in bacterial arteritis, 216f Intraembryonic coelom, 73f–74f lateral projection, 53f, 57f
spleen, 168f, 219f Intraembryonic mesoderm, 72 pulmonary venous pool anastomosed to, 95f
subacute apical, 150f Intraembryonic vascular system, 90f thrombus, 167f
superior pole of kidney, 168f Intrapleural pressure, 31f
Intrarenal atherosclerosis, 138f Left auricle (atrial appendage), 5f–7f, 9f–10f, 13f–14f, 57f
Infection Intravascular ultrasound (IVUS), 60 Left brachiocephalic vein, 3f, 6f
cardiac Echinococcus, 281f Intravenous drug use, effect on heart, 204f
foci of origin of septic myocarditis, 194f Inversion of ventricles, transposition of great vessels with, anteroposterior projection, 54f
HIV, 203 frontal projection, 50f
streptococcal, rheumatic fever following, 158 120–121 LAO projection, 52f
Iridocyclitis, with irregular pupil, 225f lateral projection, 53f, 55f
Infective endocarditis Ischemia RAO projection, 51f
advanced lesions, 215 Left bundle branch block, 41
cardiac sequelae, 217 chronic, effect on brain, 138f Left coronary artery, 6f, 14f
early lesions, 214 intermittent, 138f anomalous, 123–124
and mycotic aneurysms and emboli in heart, 218 myocardial arteriographic views, 59f
portals of entry and predisposing lesions, 213 guidewire in, 27f
remote embolic effects, 219 detection of, 143 orifice of, 218f
right-sided heart involvement, 216 effect on ECG, 155f Left decubitus position, for cardiac auscultation, 22f
overview of, 141 Left gastric vein, distended, 94f
Inferior cervical sympathetic cardiac nerves, 16, 17f Isolated systolic hypertension, wave reflection and, 240f Left inferior pulmonary vein, 4f, 7f
Inferior thyroid artery, 16f J anteroposterior projection, 56f
Inferior thyroid veins, 2f–3f Jet lesion lateral projection, 57f
Inferior vena cava, 5f, 7f–9f, 13f, 27f, 84f in advanced bacterial endocarditis, 216f Left innominate vein, TAPVC to, 94f
caused by incompetent aortic valve, 116f Left lateral decubitus position, effect on pregnant
azygos drainage of, 93 on left ventricular wall, 163f, 177–178
bypass cannula in, 117f Judkins technique, 59 woman, 26f
cannulated, 108f, 186f Jugular pulse, 21f Left lung, 3f–4f
contributions, 89 Jugular venous A-wave, 92f Left main bronchus, branches of, 4f
double, 93 Jugular venous pressure, elevated, 255–256 Left (obtuse) marginal artery, 14f
frontal projection, 50f Juxtaposition of atrial appendages, 96 Left (obtuse) marginal branch, 59f
lateral projection, 53f, 55f K Left pulmonary artery, 6f–7f, 9f
in mitral valve replacement surgery, 185f Kidneys
opening of, 12f damage caused by vascular disease, 138f anteroposterior projection, 54f, 56f
partitioning of heart tube and, 83f granular arteriosclerotic, 245f development of, 86f
RAO projection, 51f and hypertension, 245 frontal projection, 50f
Inflammation infarcts LAO projection, 52f
chronic, in SLE, 228f resulting from infective endocarditis, 219 lateral projection, 53f, 55f, 57f
rheumatic, causing aortic stenosis, 175–176 of superior pole of, 168f primitive, 85f
Infradiaphragmatic TAPVC, 94f, 95 L Left pulmonary veins, 5f, 9f–10f
Innervation of heart, 16–17 Lamina propria, 134 LAO projection, 52f
Inoue balloon technique, 169f Laplace’s law, 273f lateral projection, 53f
Inspiration, effect on intracardiac pressures and flow, Late left ventricular depolarization, 37 surgery for anomalous pulmonary venous return, 95f
Lateral projection Left recurrent laryngeal nerve, 3f, 6f, 16f
31 angiocardiographic Left-sided heart catheterization, 28, 145
Insufficiency of left side of heart, 56–57 Left-sided heart failure, and pulmonary congestion, 266
of right side of heart, 55 Left subclavian artery, 7f
aortic, 23f–24f, 177f, 225f radiologic, 53 Left superior pulmonary vein, 6f–7f, 9f
mitral, 23f–24f Leads anteroposterior projection, 56f
semilunar valve, regurgitant murmur of, 24 axis deviation and, 38f lateral projection, 57f
tricuspid, 192f, 265 in biventricular pacing, 272f Left superior vena cava
Interatrial groove, 119f in cardiac pacing, 48f anomalies of, 93
Interatrial septum, 8f ECG, 35 TAPVC to, 94–95
Intercostal arteries, 129f end of depolarization followed by repolarization and, Left sympathetic trunk, 4f
Intercostal muscles, 2f Left ventricle, 4f–7f, 10
Intercostal nerve, first, 17f 37f with amyloid deposits, 193f
Internal cardiac massage, 221–222 progression of depolarization and, 36f anteroposterior projection, 56f
Internal carotid arteries, 86f Leaflets area of cardiac auscultation, 20, 23f
Internal iliac artery, 88f held together by mitral valve clip, 172f dense collagen layer lining, 198f
Internal iliac vein, 88f mitral valve, prolapsed, 180f elongation of, 175f
Internal jugular vein, 2f–3f, 6f, 88f Leaning forward position, for cardiac auscultation, 22f events in cardiac cycle, 20f
Internal thoracic artery, 2f–4f, 6f Left anterior descending branch, coronary artery, 59f frontal projection, 50f
Internal thoracic vein, 2f, 4f, 6f Left anterior oblique (LAO) projection, 52–53 hypertrophy, 40
Internodal tracts, 13 left coronary artery, 59f
Interventricular part of membranous septum, 10f, 84f, left ventricle, 66f in aortic regurgitation, 178
right coronary artery, 58f in aortic stenosis, 175f
115f Left atrial appendage, 50–51, 50f in hypertension, 246f
Interventricular septal branches, 14f, 59f anteroposterior projection, 56f LAO projection, 52f
Interventricular septum occlusion, 262 lateral projection, 53f, 57f
thrombus, 167f, 247f primitive, 79f
at 20-somite stage, 77 Left atrial pressure, elevated in mitral stenosis, 164f RAO projection, 51f
at 27 to 29 days, 79f Left atrium, 4f–5f, 7f–8f, 9, 10f Left ventricular depolarization, 37
membranous part, 8f at 20-somite stage, 77f Left ventricular end-diastolic pressure (LVEDP), 27, 141,
muscular part, 4f, 8f–10f, 12f–13f, 78f, 107f with amyloid deposits, 193f 266
rupture of, 152f, 260–261 anteroposterior projection, 56f Left ventricular impulse, 44
Interventricular sulcus Left ventricular outflow anomalies
frontal projection, 50f aortic atresia, 115
LAO projection, 52f aortic valvular stenosis, 115
lateral projection, 53f bicuspid aortic valve, 115
RAO projection, 51f fibrous subaortic stenosis, 116
Intimacytes, 134, 135f hypertrophic cardiomyopathy, 116–117
Intimal fibroplasia, 243
Intra-aortic balloon counterpulsation, 157 THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS
Intracardiac defibrillator, in heart failure, 271–272

290

Index

Ligamentum arteriosum, 6f, 9f Middle nodal rhythm, 44 Myocardium, 74f–75f
Ligamentum teres, 89f Midesophagus position of transducer, 63f of acromegalic patient, 229
Ligamentum venosum, 89f Midgut, 74f inflammation, in SLE, 228
Limb leads, ECG, 35 Migratory arthritis, in Sydenham’s chorea, 159f ischemic, 140f, 149f
Limbus marginalis, 10 Mineralocorticoid hypertension, 233 perivascular amyloid deposits in, 193f
Limbus of fossa ovalis, 8f Mitral insufficiency, 23f–24f, 170f rupture of, 260f
Lingula of left lung lobe, 2f
Lipoproteins following bacterial endocarditis, 217 Myotonia congenita, 251f
Mitral orifice, 81f Myotonic dystrophy, 251
concentration of, 136f Mitral regurgitation, 170–171 Myxedema, 231
high-density (HDL), 136 Myxomas, 235–236
secondary, 177–178 N
alcohol effect, 204 Mitral stenosis Neck muscles, originating from thoracic cage, 3
low-density (LDL), 136 Neck veins, in tricuspid stenosis and/or insufficiency,
abnormal findings in, 30f, 31
in acute coronary syndromes, 149f clinical aspects of, 164f 192f
alcohol effect, 204 pathologic anatomy, 163–164 Neoaorta, 117f
prolonged elevation of, 135f pulmonary hypertension secondary to, 21f Network of Chiari, 8
Liver secondary anatomic effects, 165 Neural factors, in blood pressure control, 239–240
amebic abscess, 281f secondary pulmonary effects, 166 Neural plate, 73f
enlarged sounds of, 23f–24f Neural regulation of cardiac function, 25
in mitral stenosis, 164f thromboembolic complications, 167–169 Nodal premature contractions, 44
in tricuspid stenosis, 192f Mitral valve, 4f, 9f, 13f Nodal tachycardia, paroxysmal, 46
Lobes of lung, 2f advanced lesion of, 215f Nodular episcleritis, 224f
Löffler’s endocarditis, 199 annulus, 56f–57f Nodule of semilunar valve, 12f
Low-density lipoproteins (LDL), 136 cusps, 9f–12f Nodules
in acute coronary syndromes, 149f
alcohol effect, 204 blood vessel growing into, 162f Albini, 11, 12f
Low nodal impulse, 44 shortened and thickened, 170f subcutaneous
Lower extremity arterial disease, 263–264 embryologic origin of, 78f
Lungs in RAO projection, 52 in rheumatoid arthritis, 224f
parietal pleura, 4 repair, 173 in Sydenham’s chorea, 159f
reticular opacification, 227f replacement, 185–186 Nonbacterial thrombotic (marantic) endocarditis, 220
rheumatoid nodule in, 224f rheumatic vegetations on, 161f Nonischemic cardiomyopathy, 202
in situ, anterior view, 2f suture of cleft in, 101f Nonpenetrating heart wounds
Lunula, 12f thickening and erosion of, 217f cardiac rupture, 260–261
Lymphatics, pulmonary, dilatation of, 166 vegetations on, 220f commotio cordis and sudden cardiac death, 261
Lymphocytes, infiltration of cardiac muscle, 202f Mitral valve clip, 172 contusion, 259
M Mitral valve prolapse, 174 Nonspecific pericarditis, 207
Magnetic resonance imaging (MRI), cardiac, 69 Mitral valve ring Norwood correction, for hypoplastic left heart syndrome,
Major blood vessels: development frontal projection, 50f 117f
aortic arch system, 85–86 LAO projection, 52f Nucleus of solitary tract, 17f
major systemic veins, 86–88 lateral projection, 53f O
Malignant hypertension, 245f RAO projection, 51f Oblique fissure, 2f
Malignant melanoma, metastases to heart, 236f Moderator band, 8f, 10f, 13 Oblique vein of left atrium (of Marshall), 5f, 7f, 9f, 14f
Management of syncope, 278 Monocytes, infiltration of cardiac muscle, 202f Obstructive sleep apnea, and hypertension, 249
Manubrium of sternum, 2f Moral implications of heart transplantation, 275–276 Obtuse margin of heart, 6f
Marantic endocarditis, 220 Morula, 72 Occlusive disease of main renal artery
Marfan syndrome, 92f, 180f, 277 Mucous membranes, petechiae of, 219f atherosclerosis, 243
Marginal branch of right coronary artery, 14f Multiple-transducer array, 60f fibrotic lesions, 243–244
Massage, internal cardiac, 221–222 Multiple-valve replacement, 188 Occlusive vascular disease, 238f
Massive embolization, 208–209 Multivalvular disease, 191–192 Omohyoid muscle, 2f
Matrix of artery, 134f Murmurs, 23–24 One-somite stage, 74f
Mean vectors, atrial depolarization and, 36 in aortic stenosis, 176 Open-chest defibrillation, 222–223
Medial fibroplasia, with aneurysms, 243–244 clues to CHD, 92f Organ involvement
Medial necrosis, cystic, of aorta, 180–181 Muscle weakness in sarcoidosis, 196f
Medial umbilical ligaments, 89f in disorders of potassium metabolism, 253 in scleroderma, 227f
Mediastinal pleura, 6f in myotonic dystrophy, 251f in systemic lupus erythematosus, 228f
Mediastinum, cross section, 4f in polymyositis, 226f Organizing fibrinous pericarditis, 228
Medtronic-Hall pivoting-disc valve, 184f Muscular interventricular septum, 4f, 8f–10f, 12f–13f, Oropharyngeal membrane, 72, 73f, 75f–77f
Medulla oblongata, 17f 78f Orthostatic hypotension, 278
Melanoma, malignant, metastases to heart, 236f defects of, 107f, 108 Orthotopic biatrial cardiac transplantation, 274f
Membranous septum Musculophrenic artery, 2f–3f Ostium primum
aneurysm of, 108 Mustard operation, for transposition of great vessels, 119f defect of, 99
anteroposterior projection, 56f Mycotic aneurysms, 218 patch applied to, 101f
AV part, 8f, 11f Myocardial infarction type of endocardial cushion defect, 100
lateral projection, 57f changes in heart, 150–153 Ostium secundum defect, 97–99
parts of, 4f, 9f–10f, 10, 12f–13f, 84f manifestations of, 154–155 Outflow to pulmonary trunk, 10f
Membranous ventricular septal defects MRI, 70f Ovary, developing follicles, 72f
large defects, 106–107 recanalization of occluded coronary artery in, 156 Oxygen demand, myocardial, 144f
moderate-sized defects, 107 Myocardial ischemia Oxygen saturation (SO2), normal, 29
pulmonary hypertension, 107 detection of, 143 P
small defects and shunts, 106 overview of, 141 P-R interval, 34f, 42f
Mesenchyme cells, 73f Myocardial perfusion imaging, 65 P waves, enlargement of, 39
Mesocardium, dorsal, 75f–76f Myocarditis Pacemaker
Mesoderm, parietal and visceral layers, 73 acute isolated (Fiedler), 197 AV nodal, 46f
Metanephros, right, 87f diphtheritic, 195 current transvenous, 48
Metastatic heart tumors, 236 giant cell, 197 wandering, 43
Middle cardiac vein, 14f granulomatous, 279
Middle cerebral artery, embolus in, 220f parasitic, 280
Middle cervical sympathetic cardiac nerve, 16, 17f in sarcoidosis, 196
THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS in scleroderma, 196
septic, 194
viral, 195

291

Index

Pain Pericardial sac, 5f Posterolateral branches of left coronary artery,
of acute pericarditis, 205–206 Pericardial sinus, oblique, 4f–5f 59f
distribution in angina pectoris, 142f Pericardial tap, at Larrey’s point, 254f
of myocardial ischemia, 141f Pericardiocentesis, 256 Postexercise echocardiograms, 64f
Postural changes, effect on pregnant woman, 26f
Pancreas, tail of, carcinoma of, 220f vs. open operation, 257–258 Potassium levels, effects on ECG, 47
Papillary muscles, 4f, 8f, 9, 10f, 12f–13f Pericardiotomy, 256, 258f Potassium metabolism disorders, 253
Pericarditis Precipitating factors in angina pectoris, 142f
at 55 days, 81f Precordial leads, ECG, 35
development of, 84 acute forms of, 205–207 Predisposing lesions of infective endocarditis, 213
embryologic origin of, 78f acute rheumatic, 160 Preductal type of coarctation of aorta, 129f
in idiopathic subaortic stenosis, 116f adhesive, with focal calcification, 162f Preganglionic parasympathetic fibers, 17
ischemic, in mitral valve prolapse, 174f amebic, 281 Pregnancy, physiologic changes during, 26
in mitral valve replacement surgery, 185f hydatid, 282 Premature contraction
rupture of, 153 nonspecific, 207
Papilledema, retinal, 242f purulent, 207 atrial, 44
Parallelogram law, 36 in systemic lupus erythematosus, 228f left ventricular impulse, 44
Parasitic heart disease tuberculous, 207 nodal, 44
Chagas disease, 280 Pericardium, 6f, 74f right ventricular impulse, 44
trichinosis, 279 carcinomatous infiltration, 206f Presomite stage, 73f
Parasternal position of transducer, 61f fibrous, 2f–3f, 5f Pressure ranges in heart chambers, 29f
Parasympathetic fibers Pericytes, 140f Primary hyperaldosteronism, 233
negative chronotropic effect, 25 Peripartum cardiomyopathy, 202 hypertension caused by, 241
preganglionic and postganglionic, 17 Peripheral artery intervention Primitive streak, 72
Parenchymal renal disease, 238f carotid stenoses, 263 Principles of Doppler echocardiography, 62f
Parietal band, 111f, 113f lower extremity arterial disease, 263–264 Progression of depolarization
Parietal pleura, 4 Peripheral congestion, cardiac origins, 269 apical depolarization, 37
costal part, 2f–3f Perivascular amyloid deposits, in myocardium, 193f atrial depolarization and mean vectors, 36
diaphragmatic part, 2f–3f Perivascular infiltration, in sarcoidosis, 196f left ventricular depolarization, 37
mediastinal part, 2f–6f Permanent pacing, 48 septal depolarization, 36–37
Paroxysmal atrial tachycardia (PAT), 46 Persistence Progressive systemic sclerosis, 227
Paroxysmal dyspnea, therapy for, 270 of bulboventricular flange, 113f Propagation of impulse, 33
Paroxysmal nodal tachycardia, 46 of left superior vena cava, 93 Prosthetic valve surgery
Paroxysmal tachycardia, 42f, 46 of truncus arteriosus, 122f first-generation valves, 183–184
Partitioning of heart tube, 83f Pes cavus, in Friedreich’s ataxia, 252f second-generation valves, 184
Passive pulmonary congestion, 267f Petechiae, resulting from infective endocarditis, 219f Protection device, cerebrovascular emboli, 263f
Patch Phalanges, in acromegaly, 229f Proximal superior vena cava, oversewn, 117f
applied to ostium primum defect, 101f Pharyngeal arches, 85 Ptosis, in myotonic dystrophy, 251f
closure of Pharyngeal pouches, 76f–77f Pulmonary area of cardiac auscultation, 21, 23f
Phased-array transducer, 60f Pulmonary artery. See also Left pulmonary artery; Right
sinus venosus defect, 98f Phenotypes, CHD, 92f
ventricular septal defect, 111f Pheochromocytoma, 234 pulmonary artery
homograft, of neoaorta, 117f hypertension caused by, 241 anomalous origin of left coronary artery from,
pericardial Phonocardiogram, 152f
in Mustard operation, 119f Phrenic nerve, 2f–6f, 16f 124f
over closure of right ventriculotomy, 122f Physiologic changes during pregnancy, 26 arising from
to reduce subpulmonic stenosis, 112f PLAATO (percutaneous left atrial appendage
Patent ductus arteriosus, 23f, 112f, 125–126 ascending aorta, 128
murmur caused by, 24 transcatheter occlusion), 262f ductus arteriosus, 128
Patent foramen ovale, occlusion, 262 Placental vascular system, 90f constriction, in mitral stenosis, 164f
Pathogenesis Plaque formation effects of mitral stenosis, 166f
of atherosclerosis, 135 normal pressure, 30
of pulmonary edema, 268f in acute coronary syndromes, 149f transection, in repair of transposition of great vessels,
Pathophysiology unstable, 139
of acute coronary syndromes, 149 Platelet aggregation, 212f 120f
of mitral regurgitation, 171f Pleura Pulmonary capillaries, high pressure in, 268
of tetralogy of Fallot, 110f lung, 4 Pulmonary capillary wedge pressure (PCWP), 27
Pectinate muscles, 8f mediastinal, 6f Pulmonary congestion
Pectoralis major muscle, 2f, 3, 4f parts of, 3f
Pectoralis minor muscle, 2f, 3 Pleural cavity, 4f acute, reduction of, 270
Penetrating heart wounds Pleural reflections, 2f of cardiac origin, 267f
antishock therapy, 256 Pleuritis, 216f effect of tricuspid disease, 192f
cardiac tamponade, 254–255 Polarization, of resting fiber, 32 left-sided heart failure and, 266
diagnosis of cardiac injury, 255–256 Polycystic kidney disease, associated with hypertension, in mitral stenosis, 164f
pericardiocentesis, 256 Pulmonary edema, 267–268
vs. open operation, 257–258 241 therapy for, 270
thoracotomy, 256–257 Polymorphonuclear leukocytes (PMNs), 150 Pulmonary embolism, 208–209
reasons for favoring, 258 Polymyositis, 226 Pulmonary fibrosis, 210
Percussion myotonic reaction, 251f Portal hypertension, in tricuspid stenosis and/or Pulmonary hypertension
Percutaneous approaches to reduce cerebral emboli, 262 secondary to mitral stenosis, 21f
Percutaneous coronary intervention (PCI), 147 insufficiency, 192f in ventricular septal defect, 107
Percutaneous transluminal angioplasty with stent (PTAS), Portals of entry, in bacterial endocarditis, 213f Pulmonary infarcts, in bacterial arteritis, 216f
263–264 Position(s) Pulmonary stenosis, 113–114
Pericardiacophrenic artery, 3f–6f Pulmonary trunk, 5f–6f, 8f, 10f, 27f
Pericardiacophrenic vein, 3f–6f for cardiac auscultation, 20, 22f at 37 and 55 days, 81f
Pericardial cavity, 4f, 5, 75f–76f of hand, for direct cardiac compression massage, 222f anteroposterior projection, 54f, 56f
Pericardial effusion, 205f of heart in chest, ECG and, 38 atrophic, 102f
in myxedema, 231f of transducer, in echocardiographic examination, 61f in chronic cor pulmonale, 211f
Pericardial patch for transesophageal echocardiography, 63f frontal projection, 50f
in Mustard operation, 119f Postductal type of coarctation of aorta, 129f LAO projection, 52f
over closure of right ventriculotomy, 122f Posterior aspect of heart, 7 lateral projection, 53f, 55f, 57f
to reduce subpulmonic stenosis, 112f Posterior basal aneurysm, 153f left coronary artery arising from, 123f
Pericardial reflection, 7f–9f Posterior descending artery, 58f prenatal circulation, 89f
Posterior interventricular branch, 11f RAO projection, 51f
Posterior interventricular sulcus, 5f, 7f stenotic, 112f
Posterior left ventricular branch, 14f in transposition of great vessels, 121f
Posterior subendocardial infarct, 150f vegetations of bacterial arteritis in, 216f
THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS
292

Rheumatic heart disease Index
acute changes of acute rheumatic carditis, 162
Pulmonary valve, 13f acute rheumatic myocarditis, 160 Right ventricle (Continued)
atresia of, 114f acute rheumatic pericarditis, 160 diminutive, 102f
bicuspid, 109f acute valvular involvement, 161 double-outlet, 112–113
cusps, 8f, 11f, 54f–57f, 84f enlargement, in mitral stenosis, 163f
stenotic, 111f, 114f Rheumatic inflammation, causing aortic stenosis, frontal projection, 50f
175–176 hypertrophy, 40, 109f–110f, 211f
Pulmonary valve ring LAO projection, 52f
frontal projection, 50f Rheumatoid arthritis, 224 lateral projection, 53f, 55f, 57f
LAO projection, 52f Ribs outflow obstruction with intact ventricular septum,
lateral projection, 53f 113–114
RAO projection, 51f and intercostal muscles, 2–3 outflow tract vegetations, 216f
sizes and shapes of, 2 outlet, 51f
Pulmonary veins. See also Left pulmonary veins; Right Right anterior oblique (RAO) projection, 51–52 RAO projection, 51f
pulmonary veins left coronary artery, 59f rupture of, 260f
left ventricle, 66f
APVC, 94–95 right coronary artery, 58f Right ventricular failure, 269
effects of mitral stenosis, 166f Right atrial appendage, anteroposterior projection, 54f Right ventricular impulse, 44
formation of, 78–80 Right atrium, 4f–7f, 8, 10f, 12f, 27f Right ventricular outflow tract anomalies
partitioning of heart tube and, 83f anteroposterior projection, 54f
Pulmonary venous pressure, elevated in mitral stenosis, enlargement, 39, 191f–192f double-outlet right ventricle, 112–113
fistula of aortic sinus into, 123f Eisenmenger complex, 112
164f frontal projection, 50f pulmonary stenosis, 113–114
Pulsatile LVAS, 276f incomplete rupture of, 260f tetralogy of Fallot, 109–112
Pulse generator, in cardiac pacing, 48f LAO projection, 52f Rindfleisch folds, 6–7
Pulse-pressure tracing, in tricuspid insufficiency, lateral projection, 53f, 55f Ring annuloplasty, in mitral valve repair, 173
RAO projection, 51f Risk factors, in etiology of atherosclerosis, 136
192f ventricularization of, 102f Roentgenogram, chest, 180f
Pulseless electrical activity (PEA), 221 Right auricle, in idiopathic subaortic stenosis, 116f Rotating beam transducer, in IVUS, 60f
Purkinje fibers, 13f Right auricle (atrial appendage), 6f–8f, 10f, 55f Rotational atherectomy and distal protection device, 148f
Right Blalock shunt, 111f Rupture
action potentials, 33f Right brachiocephalic vein, 3f, 6f abscessed liver, into pericardium, 281f
Purulent pericarditis, 206f, 207 anteroposterior projection, 54f aortic, 138f
Pyelonephritis, hypertension caused by, 241 frontal projection, 50f heart, 152f
Q LAO projection, 52f myocardial, 260f
Q-T interval, 34f lateral projection, 53f, 55f plaque, 139f
Q waves, in myocardial infarction, 154f RAO projection, 51f S
QRS complex, 33–34 Right bundle branch block, 41 Sacrocardino-subcardinal anastomosis, 87f
QRS deflection, in bundle branch block, 41f Right coronary artery, 6f–7f, 11f Sacroiliac joints, bony ankylosis of, 225f
Quinidine, 42f arteriographic views, 58f Saddle embolus, 208f
R atrial branch, 14f at aortic bifurcation, 168f
R waves communication with right ventricle via fistula, 124f Sapien valve (Edwards Laboratories), 179f
narrowing of, 145f Sarcoidosis, myocarditis in, 196
in chronic cor pulmonale, 211f opening of, 12f Scleroderma
in myocardial infarction, 154f Right-heart catheterization, 27f myocarditis in, 196
Radial artery, 27f Right inferior pulmonary vein, 4f, 7f–8f visceral involvement, 227
Radial artery technique, 59 anteroposterior projection, 56f Scleromalacia, nodular episcleritis with, 224f
Radiology Right lung, 3f–4f Sclerosis, retinal, 242f
frontal projection, 50–51 Right main bronchus, branches of, 4f Second-generation prosthetic valves, 184
lateral projection, 53 Right marginal branch, 58f Second heart sound, 22
left anterior oblique projection, 52–53 Right pulmonary artery, 6f–9f Segmental veins, 87f
right anterior oblique projection, 51–52 anteroposterior projection, 54f, 56f Seldinger technique, 28
Rate-responsive pacemaker, 48 development of, 86f Semilunar valve
Recanalization of occluded coronary artery, frontal projection, 50f cusps, commissure of, 12f
LAO projection, 52f formation of, 84
156 lateral projection, 55f, 57f insufficiency, regurgitant murmur of, 24
Recurrent laryngeal nerve, 165f ligated in Glenn technique for tricuspid atresia, 103f stenotic murmur, 24
Red thrombus, 212f orifice of, 53f Septal band, 81f, 84f
Reference lines, ECG, 35 primitive, 85f in tetralogy of Fallot, 109f
Regurgitant murmur, 24 RAO projection, 51f Septal depolarization, 36–37, 40f
Regurgitation Right pulmonary veins, 5f, 9f, 13f Septal leaflet, retracted, 108f
frontal projection, 50f Septal occluder device, 99f
aortic, 21f, 177–178, 186–187, 225 RAO projection, 51f Septal papillary muscle, 8f, 12f
mitral, 170–171 Right recurrent laryngeal nerve, 6f, 16f Septic myocarditis, 194
Right-sided heart Septomarginal trabecula, 8f, 10f, 13f
secondary, 177–178 catheterization, 212 Septostomy, balloon atrial, 120f
systolic, in tricuspid insufficiency, 192f involvement in infective endocarditis, 216 Septum primum, 79f, 83f
tricuspid, 21f, 191 Right-sided heart failure, and cardiomyopathy, 265–266 Septum transversum, 76f
Renal artery disease, 243f Right subclavian artery Serous pericarditis, 205
Renal factors, in blood pressure control, aberrant, 126, 126f Seven-somite stage, 75
anomalous, 93f Shortness of breath, in myocardial ischemia, 141f
237–238 in right Blalock shunt, 111f Signal processing, Doppler, 62f
Renal vein, 93f Right superior intercostal vein, 88f Single-chamber pacemaker, 48
Renin, 237 Right superior pulmonary vein, 6f–8f, 10f Single-photon emission tomography (SPECT), 65f
Renin–angiotensin system, 239f anteroposterior projection, 56f Sinoatrial block, 45
Repolarization Right ventricle, 4f–7f, 8–9, 10f, 27f Sinoatrial nodal artery, 13f
anteroposterior projection, 54f, 56f Sinoatrial nodal branch, 14f, 58f
end of depolarization followed by, 37 area of cardiac auscultation, 21, 23f Sinoatrial node, 13f
of normal resting potential, 32–33 atrialized portion of, 104f action potential, 33
Rescuer, performing CPR, 221f communication with right coronary artery via fistula, Sinoatrial orifice, 83
Resection of valve leaflet, 173 Sinus arrest, 45
Resting potential, transmembrane, 32 124f
Retinal changes in hypertension, 242 dilated and hypertrophied, 166f 293
Retrograde passage of catheter, 28
Revascularization procedures, for chronic angina,

147–148
Rhabdomyomas, 235–236
Rhabdomyosarcoma, 235f
Rheumatic fever, 158–159
THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS

Index

Sinus arrhythmia, 43 Superior mesenteric vein, 94f Thromboembolic complications of mitral stenosis,
Sinus bradycardia, 43f Superior vena cava, 3f, 5f, 7f, 10f, 13f, 27f, 84f 167–169
Sinus node, 271f
Sinus tachycardia, 43f anteroposterior projection, 54f Thrombosis
Sinus venosus, 75f–77f, 82–83, 87f, 90f cannulated, 108f, 186f deep vein, 212
Sinus venosus defect, 97f, 99 frontal projection, 50f embolism sequela of, 152–153
Sites of embolism from left atrial thrombosis, 168f LAO projection, 52f left atrial, sites of embolism from, 168f
Sites of pheochromocytoma, 234f lateral projection, 53f, 55f in mitral stenosis, 164f
Skin hyperelasticity, 92f left mural, in diphtheritic myocarditis, 195f
Skull, in acromegaly, 229f
Sleep apnea, obstructive, and hypertension, 249 anomalies of, 93 Thrombus
Sliding annuloplasty, in mitral valve repair, 173f TAPVC to, 94–95 blockade of coronary arteries, 137
Small cardiac vein, 14f ligated in Glenn technique for tricuspid atresia, left atrial appendage, 167f, 247f
Small pulmonary emboli, 209 mural
Smeloff-Cutter valve, 183f 103f in Becker’s disease, 200f
Smooth muscle cell, 134f in mitral valve replacement surgery, 185f in cardiomyopathy, 202f
Social implications of heart transplantation, 275–276 partitioning of heart tube and, 83f in endomyocardial fibrosis, 198f
Sones technique, 63f RAO projection, 51f in Löffler’s endocarditis, 199f
Specialized conduction system Supine position plaque related, 139, 144f, 149f
for cardiac auscultation, 22f in pulmonary vessels, 210f
electrical activity of heart, 33 effect on pregnant woman, 26f
physiology, 32–33 Supracardinal veins, 88 Thymus gland, 3f
sequence of excitation and ECG, 33 Suprarenal veins, 87f–88f Thyroid gland, 2f
Spinal cord degeneration, in Friedreich’s ataxia, 252f Suprasternal position of transducer, 61f Thyrotoxicosis, 230
Spiral arteries, 89f Supraventricular crest, 8f, 10f, 84f, 109f, 113f Timing of vessel occlusion, 156
Spleen, infarcts of, 168f, 219f lateral projection, 55f, 57f Tobacco smoking, effects on heart, 204
Splitting, in second heart sound, 22 Suturing Total anomalous pulmonary venous connection
Sprouting capillary, 140f of aortic valve biologic grafts, 190f
St. Jude bileaflet valve, 184f of trileaflet aortic valve, 189f (TAPVC)
ST segment, 34f Swan-neck deformity of middle finger, 224f to coronary sinus, 95
ST-segment elevation myocardial infarction (STEMI), Sydenham’s chorea, 159 infradiaphragmatic type, 95
Sympathetic fibers, positive chronotropic effect, 25 to left superior vena cava, 94–95
151–152, 154–155 Sympathetic nerve, 134f surgical treatment, 95
Starr-Edwards valve, 183f Syncope, management of, 278 Tourniquets, 270
Stenosis Syncytiotrophoblast, 72 Trabeculae carneae, 8f
Syphilitic aortic disease, 182 Trachea, 2f–3f, 5
aortic. See Aortic stenosis Systemic congestion, cardiac origins, 269 Tracheal bifurcation, 165
carotid, 263 Systemic lupus erythematosus (SLE), 228 Transatrial repair of ventricular septal defect, 108f
coronary, 146f Systole Transcutaneous aortic valve replacement, 179
extrarenal, 138f heart in, 11f Transducer
fibrous subaortic, 116 ventriculographic projections, 66f in IVUS, 60f
flow-limiting, degree of, 144 Systolic ejection click, 23 positions
mitral. See Mitral stenosis Systolic hypertension, isolated, wave reflection and, 240f
pulmonary, 113–114 Systolic regurgitation, in tricuspid insufficiency, 192f in echocardiographic examination, 61f
subpulmonic, 111f T in transesophageal echocardiography, 63f
tricuspid valve, 191, 192f T waves Transesophageal echocardiography, 63
Stents enlargement of, 39 Transgastric position of transducer, 63f
in cerebrovascular emboli protection device, 263f in myocardial infarction, 154f Transmembrane potentials, basis for, 32–33
deployment for PCI, 147 vulnerable section of, 261f Transmural infarction, 154f
in transcutaneous aortic valve replacement, 179f Tachycardia Transplantation, heart, 274–276
Sternocleidomastoid muscle, 2f, 3 in beriberi, 201f Transposition of great vessels
Sternocostal aspect of heart, 6–7 paroxysmal, 42f, 46 arterial repair, 120f
Sternocostal part of pericardium, 5f sinus, 43f balloon atrial septostomy, 120f
Sternocostal surface of heart, 14f ventricular, 46, 261f clinical features, 118–119
Sternohyoid muscle, 2f, 3 Tamponade, early and delayed, 256f with inversion of ventricles, 120–121
Sternothyroid muscle, 2f, 3 Ten-somite stage, 76–77 surgical treatment, 119–120
Sternum, manubrium of, 2f Terminal depolarization, 40f Transseptal catheter, 262f
Streptococci, hemolytic, 158f Tetralogy of Fallot, 30–31 Transthoracic ultrasound, 61
Stress test, 143f Blalock-Taussig operation, 110f, 111–112 Transvenous pacemakers, current, 48
Subacute apical infarct, 150f Brock operation for, 111–112 Transverse pericardial sinus, 5f–6f, 8f–9f
Subadventitial fibroplasia, 244 corrective operation for, 111f Transverse sinus, 218f
Subaortic fibrous ring, 115f developmental perspective on, 109 Transversus thoracis muscle, 4f
Subcardinal veins, 87f with left anterior descending coronary arising from Trichinosis, 279
Subclavian artery, 2f–3f, 6f Tricuspid atresia, 102–103
anastomosis to pulmonary artery, 110f right coronary artery, 124f Tricuspid insufficiency, 192f, 265
development of, 86f pathophysiology, 110f Tricuspid orifice, 81f
right Thebesian valve of coronary sinus, 8f Tricuspid valve, 4f
Thebesian veins, 15 annulus, 54f–57f
aberrant, 126, 126f Thermodilution technique, 29 anomalies
anomalous, 93f Thiamine deficiency, in beriberi, 201 Ebstein’s anomaly, 104–105
in right Blalock shunt, 111f Third heart sound, 22 tricuspid atresia, 102–103
Subclavian vein, 2f–3f, 6f, 88f Thomsen’s disease, 251f cusps, 8f, 10f–12f
Subcostal position of transducer, 61f Thoracic aorta, 4f embryologic origin of, 78f
Subendocardial branches, 13f aneurysm, 181f regurgitation, 21f, 191
Subepicardial abscess, 194f dilated and sclerotic, 182f retracted, 112f
Subpulmonic defect, 107f Thoracic duct, 2f–4f stenosis, 191, 192f
Substance abuse, effects on heart, 204 Thoracic sympathetic ganglia, 16f–17f Tricuspid valve ring
Sudden cardiac death, 261 Thoracic vagal cardiac nerves, 16 frontal projection, 50f
in young athletes, 277 Thoracic vertebrae, in acromegaly, 229f LAO projection, 52f
Sulcus terminalis, 7f Thoracotomy, 256–257 lateral projection, 53f
Summation gallop, 22–23 reasons for favoring, 258 RAO projection, 51f
Superior cervical sympathetic cardiac nerve, 16, 17f Thorax, anatomic features, 2–5 Trileaflet aortic valve, 189
Superior cervical sympathetic ganglion, 17f Trophoblast, 72
Superior epigastric artery, 3f Troponin T, 155
Trousseau sign, 233
294
THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS

Index

Truncus arteriosus, 77f, 79f, 81–82 Valves, 11–12 Ventricular septal defects (Continued)
inverted, 121 biologic, 184 pulmonary hypertension, 107
repair to, 122f synthetic prosthetic small defects and shunts, 106
first-generation, 183–184 in tetralogy of Fallot, 109f
Truncus septum anomalies second-generation, 184
aorticopulmonary septal defect, 122 Ventricular septum, 10
truncus arteriosus repair, 122 Valvular injuries, 260f, 261 anomalies of, 106–108
Valvular involvement in rheumatic heart disease, 161 regurgitant lesion on, 182f
Truncus swellings, 79f–80f, 84f, 118 Valvuloplasty, balloon
Trypanosomiasis, 280 Ventricular tachycardia, 46, 261f
Tuberculous pericarditis, 206f, 207 mitral, 169f Ventriculography, 66, 145
Tumors in pulmonary stenosis, 114 Verrucous lesions, 200f
Variations, arteriovenous, 15f Vertebrae
heart Vasa vasorum, 134f
metastatic, 236 Vascular access, right-sided heart catheterization and, 27 T8, 4f
myxomas, 235–236 Vascular disease, end-organ damage by, 138 thoracic, in acromegaly, 229f
rhabdomyomas, 235–236 Vascular sling, 128–129, 128f Vertebral artery, 16f
Vascular zone, 134f development of, 86f
MRI, 70f Vasculogenesis, early intraembryonic, 73 Vertebral ganglion, 16f–17f
Tunica media, 134 Vasospasm, pulmonary arteriolar, 166 Viral myocarditis, 195
Twenty-somite stage, 77 Vegetations Vitelline artery, 90f
Two-dimensional echocardiogram, 61 of bacterial endocarditis, 214f–216f Vitelline veins, 75f–76f, 86–87
Two-somite stage, 74f marantic, 220 W
U rheumatic, on mitral valve, 161f Wandering pacemaker, 43
Ultrasound Venous pulses, 21f Wave reflection, and isolated systolic hypertension, 240f
Ventricles Wedge pressure
intravascular, 60 development of, 78f, 80–81 elevated
transthoracic cardiac, 61 inversion of, transposition of great vessels with,
Umbilical arteries, 89f in mitral regurgitation, 171f
Umbilical cord, 90f 120–121 in mitral stenosis, 164f
Umbilical veins, 75f–76f, 86–87, 90f left. See Left ventricle normal, 29–30
Unstable plaque formation, 139 right. See Right ventricle White ramus communicans, 17f
Upper esophageal position of transducer, 63f trabecular walls, 82f Wolff–Parkinson–White syndrome, 42
Urine sample, in pheochromocytoma, 234f Ventricular aneurysmectomy, 148 Wrist sign, Walker-Murdoch, 92f
Uterine arcuate arteries, 89f Ventricular assist devices (VADs), 276 X
Uterine radial arteries, 89f Ventricular depolarization, 40f Xiphoid process, 2f
V Ventricular fibrillation, 46 Y
Vagal (parasympathetic) cardiac branches, 16 in cardiopulmonary arrest, 221 Yolk sac, 72, 73f–75f, 77f, 90f
Vagus nerve (X), 3f, 5, 6f, 16f Ventricular hypertrophy, 40, 112f Z
Valve of foramen ovale, 9f Ventricular pressures, normal, 30 Zygote, 72
Valve replacement Ventricular repolarization, 37
aortic, 186–188 Ventricular resynchronization, 271f
Ventricular septal defects, 23f, 102f
transcutaneous, 179 abnormal findings in, 30
mitral, 185–186 large defects, 106–107
multiple-valve, 188 moderate-sized defects, 107
murmur caused by, 24

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS 295

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