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Modern diagnostic of cardiovascular disorders. Blood Pressure Exhibits a normal distribution within the population Increasing blood pressure is associated with a progressive increase in the risk of stroke and cardiovascular disease Risk however rises exponentially and not linearly with pressure At what blood pressure is a patient hypertensive? BHS 140/90 JNC-VI 140/90 Opt <120/<80 WHO-ISH 140/90 The current recommendation in the UK is 140/90 However risk is important and in diabetes 130/80 In 95% of cases no cause can be found In 5-10% a cause can be found – Chronic renal disease – Renal artery stenosis – Endocrine disease, Cushings, Conn’s Syndrome, Phaeochromocytoma, GRA Home Blood Pressure Monitoring – Mercury sphygmomanometer Standard for BP monitoring No calibration May be bulky Need a second person to use machine May be difficult for hearing impaired or patients with arthritis Home Blood Pressure Monitoring – Aneroid equipment Inexpensive, lightweight and portable Two person operation/need stethoscope Delicate mechanism, easily damaged Needs calibration with mercury sphygmomanometer Home Blood Pressure Monitoring – Automatic equipment Contained in one unit Portable with easy-to-read digital display Expensive, fragile Must be calibrated Requires careful cuff placement Electrocardiogram It is the method of registration of heart bioelectrical potential from the chest of patient Electro gram of cardiac muscle Waves of ECG 1. P wave – depolarization of atria, precedes atria systole 2. QRS wave is depolarization of ventricles, precedes ventricular systole 3. atria repolarization also occurs at QRS 4. T wave indicates ventricular repolarization ECG leads a) Bipolar limb leads. The bipolar limb leads record the voltage between electrodes placed on the wrists and legs. These leads were proposed by Einthoven in 1913. I lead: left arm (+) - right arm (-); II lead: left leg (+) - right arm (-); III lead: left arm (+) - left leg (-). For recording limb leads we put red electrode on right arm, yellow - on left arm, green - on left leg and black - on right leg. Black electrode has zero potential (ground). ECG leads The unipolar limb leads were proposed by Goldberger in 1942. They record voltage between single “exploratory electrode” fro one limb and zero joined electrode from two other limbs. So there are three leads AVR, AVL, AVF. In fact zero electrodes records middle voltage of two limbs. Bipolar limb leads and unipolar limb leads record electrical power in frontal projection. ECG leads V1 - in crossing right IV right intercostal space and parasternal line; V2 - in crossing left IV intercostal space and parasternal line; V3 - between V2 and V4; V4 - in crossing V left intercostal space and medioclavicular line; V5 - in crossing V left intercostal space and anterior axilar line; V6 - in crossing V left intercostal space and middle axilar line. Holter Monitor Echocardiography 1. 2. 3. 4. M-measure D-measure Doppler Contrasting II position АО Cardiac Biomarkers 1. MI is diagnosed when blood levels of sensitive and specific biomarkers, such as cardiac troponin (I or T) and CK-MB (mass assay) are increased to values greater than 99% of a normal reference population (with less than 10% coefficient of variation of the assay) 2. These biomarkers reflect myocardial damage, but do not indicate its mechanism 3. ASAT, LDH isoenzymes should not be used to diagnose myocardial damage c1183higgin05[1]video2.mpeg Roentgenogram NORMAL MITRAL STENOSIS ROENTGENOGRAM NORMAL AORTIC STENOSIS Thank you!