Cardiac Anatomy, Physiology, and Pathology for the Invasive Lab
A candidate must hold a three-dimensional mental model of the heart: chamber relationships, the course of the coronary arteries and their territories, the conduction system, and the great-vessel anatomy that guides catheter placement. Know that the right coronary artery supplies the inferior wall and often the AV node, the left anterior descending supplies the anterior wall and septum, and the circumflex supplies the lateral wall. Coronary dominance is defined by which artery gives rise to the posterior descending artery. Understand the venous drainage into the coronary sinus and the anatomy relevant to the fossa ovalis and transseptal puncture.
Physiology questions test pressure-volume relationships, preload/afterload/contractility, the Frank-Starling curve, and the determinants of myocardial oxygen supply and demand. Pathology spans aortic stenosis, mitral regurgitation, hypertrophic cardiomyopathy, pericardial tamponade, and shunt lesions. Traps include confusing eccentric hypertrophy with dilation, misattributing a murmur to the wrong valve, and forgetting that tamponade physiology shows equalization of diastolic pressures with pulsus paradoxus.
Rule of thumb for coronary territory: inferior = RCA, anterior/septal = LAD, lateral = circumflex. Worked example: an inferior STEMI with bradycardia and heart block points to RCA occlusion proximal to the AV nodal branch - link the ECG territory to the artery and the conduction complication in one step. Always connect anatomy to the physiologic consequence the question is testing.