(More*) Letters Re: The Article “Trick Question!”

Marshall,

I have been using my hand as a heart model for years and have ultimately found that my right hand allows me to show the heart and the orientation of the left and right coronaries. By making a fist with the right hand, I can “overlay the hand” with the extended index and middle fingers, showing the LAD [left anterior descending coronary artery] and LCX [left circumflex] (Figure 1), really giving students (and patients) a feel for the lateral and posterior distribution of the LCX. The left thumb represents the proximal to mid portion of the RCA [right coronary artery] (Figure 2), but I have to then open my right fist to use the right index finger as the RPDA [right posterior descending artery] (Figure 3).

Mark A. Shima, MD, FACC, FACP, FSCAI
Director of STEMI Center
Northeast Regional Medical Center
Kirksville, Missouri

Dr. Shima, great idea! Thank you for writing.

Respectfully yours,
Marshall W. Ritchey 
Director, Cardiovascular Lab Services
Loma Linda University Medical Center 
Loma Linda, California

Marshall,
As an anecdote, I find the left hand easier to explain coronary anatomy, along with positioning. Left thumb is the RCA, pointer finger is the LAD, and the middle finger is the circumflex. As you spread them, it’s easy to explain cranial, caudal, etc. Just a quick tip.

Mark Morrison
Executive Sales Associate
Abbott Vascular

Dear Mr. Morrison,

Thank you for your input on the “Trick Question”. I’m glad to hear that there are many people out there using their hands as teaching models to train and teach others.
Tim Powell, RN, at Presbyterian UPMC [University of Pittsburgh Medical Center] taught me originally. I don’t know who taught him. I do know that we should pass on our knowledge and teaching techniques to the next generation.
Thank you for your input!

Respectfully yours,
Marshall W. Ritchey 
Director, Cardiovascular Lab Services
Loma Linda University Medical Center 
Loma Linda, California