Major Vessels

Several major vessels enter and exit the heart. The arteries carry blood away from the heart while the veins bring blood to the heart. While memorizing the major vessels is unnecessary, having a basic picture of the major vessels is clinically important. The main vessel feeding the right heart is the vena cava. The right atrium also receives venous blood from the coronary sinus, the main venous return of the heart’s blood supply.

Approximately 65% of blood volume is normally contained in the venous system. With increased energy demands, blood flow must increase. Sympathetic nervous system stimulation is responsible for the majority of the fluctuations in blood flow during exercise, with vasodilation and vasoconstriction occurring simultaneously to increase blood flow to the vital organs (i.e. brain, muscle).

The right ventricle ejects blood through the main branches of the left and right pulmonary arteries to the lungs. The left atrium receives its oxygen-rich blood supply via four main pulmonary veins. The left ventricle ejects blood into the aortic arch to the body. Within the arch, the coronary arteries branch off first followed by three main arteries that branch to the brain (carotids) and the upper thorax (subclavian artery).

Note that the lion’s share of blood volume is delivered to the muscles during exercise. During periods of cardiac ischemia, resting the muscles provide significant reductions to cardiac output demands – and cardiac oxygen demand – thus helping to minimize the extent of the ischemic episode.

Atrial Fibrillation and the Major Vessels

About 1 in 5 people over the age of 50 develop atrial fibrillation, a chaotic quivering of the atria. Blood velocity typically slows along the walls of the atria from the friction between the endocardium and the blood. As long as the atria rhythmically contract, the blood is propelled quickly forward. Without atrial contraction (i.e. atrial fibrillation), blood along the walls can slow significantly. After 48 hours, about 3-5% of people in atrial fibrillation will form a blood clot in the atria.

If this clot is dislodged from the right atrium and floats to the lungs via the pulmonary arteries, a pulmonary emboli results. If a clot develops and moves from the left atrium, the aortic arch is next in line. Of the three main vessels of the arch, two of the three vessels target the brain. As expected, atrial fibrillation is a major risk factor for cerebral vascular accidents (stroke).

Having an understanding of the mechanical structures of the heart helps us make sense of both normal physiology and pathophysiology. Looking at the ramifications of atrial fibrillation is but one example.

Figure 1.6 Major Vessels

1. Six Second ECG Guidebook (2012), T Barill, p. 15-17

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Dynamic ECG rhythm interpretation
Static ECG rhythm interpretation
Clinical Impact Mapping
Acute Coronary Syndromes Overview
Acute Coronary Syndromes In-Depth
ST Segment & T Wave Differential
Identify Bundle Branch Blocks
15 | 18 Lead View Mapping
Electrical Axis
R Wave Progression
Left Bundle Branch Blocks with ACS
Atypical Findings
Acute Non-Ischemic Disease Conditions
Special Cases

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