Download Used to

CARDIOVASCULAR MEDICINE
INVESTICATIONS OF CARDIOVASCULAR
DISEASES
BY
Dr. Arwa Mahmood Fuzi Al Sarraf
LECTURE 1
INVESTICATIONS OF CARDIOVASCULAR DISEASE
OBJECTIVES
1- ECG
1. STANDARD 12 L. ECG (next 2 lectures)
2. EXERCISE STRESS ECG
3. AMBULATORY ECG – HOLTER MONITOUR
2- CARDIAC BIOMARKERS
3- CHEST X-RAY
4-ECHOCARDIOGRAPHY
1. 2 D. ECHO
2. DOPPLER ECHO
5- CT SCAN &MRI
6-CARDIAC CATHETARISATION
7-RADIONUCLIED IMAGING
1. BLOOD POOL IMAGING
2. MYOCARDIAL PERFUSION IMAGING
ELECTROCARDIOGRAPHY
ECG
It is a test that record the electrical activity of the heart
from electrodes on the body surface
USES OF ECG
It is used to diagnose the following conditions:
1- Cardiac arrhythmias & conduction defects
2- Myocardial hypertrophy
3- Ischemia &infarction
4- Pericardial diseases
5- Electrolytes imbalance
6- Certain drug toxicity.
EXERCISE (STRESS) ECG
A12 lead ECG is recorded during exercise on a
treadmill or bicycle ergo meter.
INDICATIONS:
1. Confirm diagnosis of angina.
2. Evaluate stable angina.
3. Asses prognosis following MI
4. Assess outcome of coronary revascularization
5.Diagnosis of exercise induced arrhythmia
CONTRAINDICATION:

Unstable angina

Severe HF

Hypertension

Aortic stenosis
TEST IS POSITIVE IF:

Anginal pain occurs

BP falls or fails to rise

ST segment shift >1mm
AMBULATORY ECG
(HOLTER MONITORING)
Continuous recording of one or more ECG leads
obtained by attaching them to small portable tape
recorder for 24 hrs or more.
It is useful for detecting transient episodes of
arrhythmias or ischemia.
CARDIAC BIOMARKERS
Measured to asses myocardial dysfunction and ischemia.
Brain natriuretic peptides:
Secreted by the LV , it is elevated in LV systolic dysfunction to aid
the diagnosis and asses prognosis and response to therapy in
patients with heart failure.
Cardiac troponins ( I & T):
Structural cardiac muscle protiens that are released during
myocyte damage and necrosis
It represent the corner stone of the diagnosis of acute MI
CHEST X - RAY
CXR is useful for :
*Determine size & shape of the heart (cardiothoracic ratio <0,5).
*States of pulmonary blood vessels.
*Fields of the lungs.
Dilatation of individual cardiac chambers:
*Left atrial dilatation :prominence of laap, double cardiac shadow,
widening of carina .
*Rt atrial enlargement projects from RT heart border to RT lower
lung
*Lv dilatation: prominence of LT lower heart border, inc heart size
*Rv dilatation: inc heart size, displace apex upward.
ECHOCARDIOGRAPHY
DEFINITION:
The application of US for imaging
the heart.
HOW DOES IT WORK?
An echo sends high frequency sound
waves into the chest to rebound from
the heart walls & valves, the recorded
waves form a moving image of the
heart on TV screen.
ECHO TEGHNEQUES (1)
STANDARED ECHO TECH.

2-D ECHO


M-MODE
DOPPLER
*Colour doppler (image flowing blood )
*Continuous wave doppler
*Pulsed wave doppler
(both measure velocity of flowing blood) .
ECHO TECH. (2)

1.
2.
3.

LATEST DEVELOPMENT IN ECHO TECH.
Real time 3-d imaging
Tissue doppler
Other specialized tech.
STRESS ECHO
2-D echo after infusion of dobutamine, for pt
unsuitable for stress ECG
METHODES OF PERFORMING ECHO

TRANSTHORASIC ECHO (TTE)
heart is imaged from outside through
the chest wall ,the echo probe is placed
on the chest wall of the subject &
images are obtained, it is simple highly
accurate test.

TRANSESOPHAGEAL ECHO (TEE)
insert specialized endoscope containing
echo transducer into pt. esoph.& record
pictures .it has advantage of giving
better images ,b. the transducer is
closer to the heart some of post.
Structures of the heart are better
imaged with TEE (aorta, pulm.art.
,valves & L.atrium).
WINDOWS &VIEWS OF TTE

L.PARASTERNAL WINDOW
1.
2.
Long axis view
Short axis view

APICAL WINDOW
1.
3.
4- chamber v.
5-chamber v.
Long axis &2- chamber v. of LV

SUBCOSTAL WINDOW

SUPRASTERNAL WINDOW

RT.PARASTERNAL WINDOW
2.
INFORMATION GET BY ECHO
1.
Heart chambers size
2.
Chamber function
3.
Valve motion &function
4.
Intracardiac &extracardiac masses
5.
Direction of blood flow, heamodynamic changes
&pressure gradient in valve lesion.
CLINICAL APPLICATION OF ECHO
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Assesment of valve function (native &prosthetic valves)
Asses LV function
Pericardial dis.(Pericarditis ,effusion&tamponade)
Endocarditis & myocarditis
IHD & complication of MI
Cardiac masses
Arrhythmias
Estimation of intracardiac& vascular pressures
Asses hypertensive cardiac changes (LVH)
Asses cardiac sources of embolism in CVA
Diagnoses of CHD
COMPUTED TOMOGRAPHIC IMAGING
)CT)
Useful for imaging the following:
 Chambers of the heart.
 The great vessels.
 Pericardium
 Surrounding structures.
Practical uses in:
 Diagnosing aortic dissection.
 The helical ct recently used for non invasive imaging of
coronary art &coronary bypass grafts, coronary art. Calcification
& calcified plagues.
MAGNATIC RESONANCE IMAGING
(MRI)
Useful for imaging:
 Aorta
 Relationship of the great vessels to the cardiac
chambers in cong. Hd
 Detect infiltrative condition affecting the heart.
 Quantify velocities across regugitant & stenotic
valves
 Regional wall motion
 Asses myocardial viability.
CARDIAC CATHETERISATION
A specially designed catheter is inserted
into a vein or artery & advanced into
the heart under x-ray guidance.
Uses :
 Measure intra cardiac pressures
 Take blood samples from cardiac
chambers.
 Obtains angiogram by injecting
contrast into chamber or blood vessel.
LEFT HEART CATH:
Cannulating the heart via the femoral,
brachial or radial art.
Used to :
 Asses coronary art disease and guide
revascularization procedure
 Asses mitral, aortic valve dis & aorta
 Asses size and function of LV
Rt HEART CATH:
Used to:
 Assess pulmonary art pressure
 Detect intracardiac shunts
 Measuring cardiac output
 Measuring left atrial pressure (swan-ganz )
balloon cath to measure pulmonary wedge
pressre
RADIONUCLIDE IMAGING
Study cardiac function non invasively by using Gamma
Rays.
Types:
1- Blood pool imaging to assess vent function.
to calculate RT & LT ventricle ejection fraction.
2-Myocardial perfusion imaging.