Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Adult Echocardiography. Lecture 10 Coronary Anatomy
Document related concepts
Transcript
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 • • • • 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 • • • • • • 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)
