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ICU TopicsAnatomy

ICU · Anatomy

Cardiovascular Anatomy

Also known as Cardiac anatomy · Coronary circulation · Left anterior descending · Conduction system · Heart valves · Aortic arch · Cardiac cycle · Frank-Starling law · Starling forces · Venous return curve · Guytonian physiology · Mean systemic filling pressure · Cardiac chambers · Pulmonary circulation · Great vessels · Peripheral venous anatomy · Central venous catheter anatomy

Cardiovascular anatomy and Guytonian physiology for the ICU First Part: the four chambers and valves, the cardiac wall and microscopic structure, the cardiac cycle, the coronary arteries and their perfusion territories (LAD, circumflex, right; coronary dominance; diastolic flow), the conduction system (SA node to AV node to His-Purkinje), the great vessels and aortic-arch branches, the systemic and pulmonary circulations, the Frank-Starling mechanism, the Starling forces governing transcapillary fluid exchange, the venous-return and cardiac-function curves of Guyton, and the peripheral venous system relevant to central venous catheter insertion.

high17 referencesUpdated 20 Aug 202631 min readVerification in progress

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Cardiovascular anatomy for the intensivist is three faces of one structure: the territory an artery feeds (coronary dominance decides which MI drops the BP), the timing of its flow (coronary flow is diastolic, so tachycardia ischaemia-s the subendocardium), and what sets the cardiac output (venous return, not the heart's pumping power). The right coronary artery supplies the right side of the heart plus part of the left atrium, a posterior region of the LV and the posterior third of the septum, and the AV nodal artery most commonly arises from it — which is why an inferior STEMI so often comes with bradycardia or heart block and may involve a preload-sensitive RV infarct. The LV coronary flow is diastolic because systole compresses the intramural vessels. And Guyton's equation — VR = (MSFP minus RAP) divided by Rv — is the credo of ICU haemodynamics.[1][10][16]

Meet the patient

A 62-year-old arrives with crushing central chest pain radiating to the jaw, diaphoretic and nauseated. The ECG shows ST elevation in II, III and aVF. The nurse gives sublingual glyceryl trinitrate, and within a minute the blood pressure collapses to 70 systolic, the heart rate drops to 38, and the lung fields are clear with a raised JVP.[1]

The question that this patient plants — and that every cardiovascular anatomy question turns on — is why did the nitrate drop the blood pressure? The answer is right ventricular infarction in the territory of a dominant right coronary artery, in a preload-dependent thin-walled RV that cannot tolerate venodilation. Hold that one chain — RCA dominance, nodal supply, diastolic flow, preload-dependence — and the coronary anatomy, the conduction system, and Guyton's haemodynamics all fall into place around it.[1]

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References17ShowHide
  1. [1]Guyton AC Determination of cardiac output by equating venous return curves with cardiac response curves Physiol Rev, 1955.PMID 14356924
  2. [2]Hoffman JIE, Buckberg GD The myocardial supply:demand ratio--a critical review Am J Cardiol, 1978.PMID 146425
  3. [3]Buckberg GD Variable effects of heart rate on phasic and regional left ventricular muscle blood flow in anaesthetized dogs Cardiovasc Res, 1975.PMID 123481
  4. [4]Pate JW Traumatic rupture of the aortic isthmus: program of selective management World J Surg, 1999.PMID 9841764
  5. [5]McGee DC, Gould MK Preventing complications of central venous catheterization N Engl J Med, 2003.PMID 12646670
  6. [6]Parienti JJ, Mongardon N, Mégarbane B, et al. Intravascular Complications of Central Venous Catheterization by Insertion Site N Engl J Med, 2015.PMID 26398070
  7. [7]Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU N Engl J Med, 2006.PMID 17192537
  8. [8]Kurapati R Atrial Kick StatPearls [Internet], 2026.PMID 29494028
  9. [9]Jindal H Anatomy, Thorax, Heart Left Anterior Descending (LAD) Artery StatPearls [Internet], 2026.PMID 29493997
  10. [10]Saxton A Anatomy, Thorax, Heart Right Coronary Arteries(Archived) StatPearls [Internet], 2026.PMID 30726042
  11. [11]Omole AE Anatomy, Thorax, Pericardium StatPearls [Internet], 2026.PMID 29489245
  12. [12]Gopal S Cardiac Tamponade StatPearls [Internet], 2026.PMID 28613742
  13. [13]Inohara T, et al. The challenges in the management of right ventricular infarction Eur Heart J Acute Cardiovasc Care, 2013.PMID 24222834
  14. [14]Wilkinson-Stokes M, et al. Adverse events from nitrate administration during right ventricular myocardial infarction: a systematic review and meta-analysis Emerg Med J, 2023.PMID 36180168
  15. [15]Namana V, et al. Right ventricular infarction Cardiovasc Revasc Med, 2018.PMID 28822687
  16. [16]Heaton J Atrioventricular Node StatPearls [Internet], 2026.PMID 32491596
  17. [17]Javed S, et al. Right ventricular involvement in patients with inferior myocardial infarction, correlation of electrocardiographic findings with echocardiography data J Pak Med Assoc, 2017.PMID 28303997

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