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Adult Echocardiography
Lecture 10
Coronary Anatomy
holdorf
Anterior view
Anterior View
Posterior view
Coronary Perfusion
• Left anterior descending (LAD)
• Anterior wall
• Anterior septum
• LV Apex
• From where do the coronaries originate?
• In the left and right aortic sinus of Valsava
Coronary Perfusion
• Left Circumflex
• Lateral wall
• Posterior wall
• What is meant by “Right Dominance?”
• When the right coronary gives rise to the posterior
descending artery (occurs 85% of the time)
Coronary Perfusion
• Right
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•
•
•
Inferior Wall
Inferior Septum
RV apex
RV free wall
• Which coronary supplies the interatrial septum?
• Right- which also usually supplies the SA and AV
nodes.
Coronary Distribution
• Which coronary artery feeds the inferoseptal wall?
• Right coronary artery
Other Imaging Modalities
Nuclear Medicine -cardiolite
Ventricular wall anatomy
Short Axis (SA)
• Basal
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•
•
•
•
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Anterior
Anterolateral
Infero-lateral
Inferior
Infero-septal
Antero-septal
Mid-Cavity
Short AXIS (SA)
•
•
•
•
•
•
Anterior
Antero-lateral
Infero-lateral
Inferior
Infero-septal
Antero-septal
Apical
Short Axis (SA)
Anterior
Lateral
Inferior
Septal
Exercise Echo (Stress)
Stress Echo - Premise
• Transient exercise induced ischemia results
in wall motion abnormalities which are
detected with echocardiography.
• Reliable
• Easy to perform
• Clinically established
Ischemic Cascade
Ischemia vs. Stress
Utilization of Stress
Echocardiography
• Detection of CAD
• Evaluation of ambiguous treadmill outcomes (digitalis, resting ECG
abnormalities)
• Functional significance of anatomic lesions
• Quantitation of left ventricular performance
• Post MI evaluation (prognosis/functional capacity)
• Post PTCA evaluation : percutaneous transluminal coronary
angioplasty
• Non cardiac surgery pre-operative assessment
• Know the indications for stress echo
• Know that in multi-vessel disease, stress
echo is better than nuclear stress scans.
• Which of the following drugs is used in
Nuclear Stress tests?
• Thallium
• Inderal is a beta blocker
• Single vessel disease is best with NM
• Multi vessel disease is best with Echo
Indications
• To aid in the diagnosis of chest pain
• To determine the severity and prognosis of
CAD
• To guide post MI rehab
• To evaluate cardiac arrhythmias
• To screen high risk or asymptomatic
patients with multiple risk factors
Stress Echo analysis
•
•
•
•
•
Regional wall motion
Systolic wall thickening
Wall motion score
Ejection fraction response
Doppler velocities
ECG interpretation
• Morphology, degree and duration of ST
segment depression
• ST segment elevation
• Duration of exercise
• Exercise induced hypotension or
arrhythmias
Image interpretation
• Captured systolic frame, ECG gated 6 to 8
frames, 40-80 sec intervals
• Continuous loop format, variable speed
playback, minimized heart motion and
respiratory interference
• Side by side rest and exercise display. Quad
screen.
Normal Stress Response
• Normal response to stress includes all the
following
•
•
•
•
Hyper-dynamic walls
Systolic thickening
Decreased systolic cavity
Normal diastolic dimensions
Normal Stress Response
• What would be a contraindication to
performing a stress test on an athlete with
chest pain?
• Chest pain at rest (unstable angina)