Iscemic Heart Disease

Front 1

definition
Coronary Artery Disease

Back 1

Defined as the narrowing of the coronary arteries sufficiency to prevent adequate blood blood flow to the myocardium of the heart. This narrowing may progress to the point that the heart muscle is damaged. (infacted)

Front 2

Coronary Artery Disease
Etiology

Back 2

Artherosclerosis-hardening of the arteries, begins in the intima

Front 3

Coronary Artery Disease
Etiology

Back 3

Artherosclerosis usually develops at the bifurcations

Front 4

Coronary Artery Disease
Risk factors

Back 4

Advanced age
family history
Male gender (6 x higher in males

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Coronary Artery Disease
Risk factors

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Post menopause
cigarette smoking
Hypercholesterolemia

Front 6

Coronary Artery Disease
Risk Factors:

Back 6

Diabetes Mellitus
Obesity
Stress
Oral Contraceptive use
Alchohol consumption

Front 7

Coronary Artery Disease
Symptoms:

Back 7

Chest Pain
Dyspnea
CHF
MI
Sudden Cardiac Death (30-35%)

Front 8

Coronary Artery Disease
Electrocardiogram

Back 8

May be normal at rest, even if significant CAD
T wave inversion, suggesting cardiac ischemia

Front 9

Coronary Artery Disease
Electrocardiogram

Back 9

ST segment changes (depresed ST segments suggest cardiac ischemia, while elevated ST segments may suggest acute MI

Front 10

Coronary Artery Disease
Electrocardiogram

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Ventricular arrhythmias
Conduction defects(1st AV block, LBBB)

Front 11

Coronary Artery Disease
Cardiac Catherization

Back 11

Artieriogram is the gold standard for determining the presence and severity of CAD

Front 12

Coronary Artery Disease
Cardiac Catherization

Back 12

SWMA
Segmental wall motion abnormalties

Front 13

Coronary Artery Disease
Cardiac Catherization

Back 13

Identification of the complications of MI

Front 14

Coronary Artery Disease
2D Findings/Evaluation

Back 14

Evaluate sytolic wall thickening, systolic wall motion and diastolic wall thickness

Front 15

Coronary Artery Disease
2D Findings/Evaluation

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Opposing wall of involved region may be hyperkinetic
Thin, bright akinetic muscle section suggests old MI

Front 16

Coronary Artery Disease
2D Findings/Evaluation

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Spontaneous echo contrast may be visualized in the infarcted area

Front 17

Coronary Artery Disease
2D Findings/Evaluation

Back 17

Serial echos may be useful to evaluate infact extension (progressive necrosis, stunned myocardium)

Front 18

Describe SWMA
hypokinesis
akinesis
dyskinesis

Back 18

hypokinesis-not moving well
akinesis-not moving at all
dyskinesis-moving in the opposit direction

Front 19

Coronary Artery Disease
2D Findings/Evaluation

Back 19

Determine systolic function/ejection fraction

Front 20

Coronary Artery Disease
2D Findings/Evaluation

Back 20

Determine severity of coexisting valvular regurgitation using CFD

Front 21

Coronary Artery Disease
Treatment

Back 21

Reduce modifiable risk factors
Excercise
sublingual nitroglycerin, beta blockers, calcium channel blockers, ACE inhibitors
Pacemakers
Coronary stent
CABG

Front 22

Coronary Artery Disease
Echo in determination of CAD

Back 22

Routine echos tend to overlook CAD because the exam if done at rest, when the arteris may still be able to provide adequate blood flow to the heart

Front 23

Coronary Artery Disease
Echo in determination of CAD
Best Method?

Back 23

A stress echo should be performed

Front 24

Left Ventricular Dysfunction
Why is it important to determine LV function?

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It is important to determine the contractility of the LV since clinical desisions for medical therapy or surgical intervention depend on the status of Left ventricular function

Front 25

Left Ventricular Dysfunction
2D Evaluation

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Determine LV size by m-mode. Internal dimesions are obtained at end diastole and end sytole

Front 26

Left Ventricular Dysfunction
2D Evaluation

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A visual EF can be approximated by assessing LV funtion in the PSA

Front 27

Left Ventricular Dysfunction
2D Evaluation

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Always performa complete exam, including CFD, CW, and PWD, unless you are doing a limited F/U exam

Front 28

Methods to determine LV dimension

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Cardiac Output

Front 29

Fractional shortening

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FS reflects the change of LV internal dimension throughout the cardiac cycle. Increased FS is observed in pts with hypercontractile ventricles decresed FS is observed in a poorly contracting muscle

Front 30

Fractional Shortening
Definition

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Fractional Shortening is measured as the ratio of the difference betweeb EDd and ESd to the EDd. This ratio is multified by 100 to obtain the percentage FS

Front 31

Fractional Shortening
Definition

Back 31

Fractional Shortening is measured as the ratio of the difference betweeb EDd and ESd to the EDd. This ratio is multified by 100 to obtain the percentage FS

Front 32

What is the formula for CO?

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CO=SVxHR

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How is EF similiar to ES?

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It uses the percent change of LV instead of change i the LV diameter

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What is the main function of Cardiac Output?

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To pump oxygenated blood to the peripheral tissues.

Front 35

What is stroke Volume?

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The volume of blood ejected by the LV during systole is referred to as the stroke volume

Front 36

Cycle time of CO

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Volume of blood ejected by ventricle during a 1 minute cycle

Front 37

Thrombi
Diagnosis is based on?

Back 37

Detection of echoic mass with defined margins clearly id'd throughout cardiac cycle visable in at least 2 echo views

Front 38

Thrombi
2D Findings and Evaluations

Back 38

Segmental WMA, usually akinesis or dyskinesis

Front 39

Thrombi Types

Back 39

Mural-Well adhered to wall
Pedunculated -stalk