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39 Cards in this Set

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definition
Coronary Artery Disease
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)
Coronary Artery Disease
Etiology
Artherosclerosis-hardening of the arteries, begins in the intima
Coronary Artery Disease
Etiology
Artherosclerosis usually develops at the bifurcations
Coronary Artery Disease
Risk factors
Advanced age
family history
Male gender (6 x higher in males
Coronary Artery Disease
Risk factors
Post menopause
cigarette smoking
Hypercholesterolemia
Coronary Artery Disease
Risk Factors:
Diabetes Mellitus
Obesity
Stress
Oral Contraceptive use
Alchohol consumption
Coronary Artery Disease
Symptoms:
Chest Pain
Dyspnea
CHF
MI
Sudden Cardiac Death (30-35%)
Coronary Artery Disease
Electrocardiogram
May be normal at rest, even if significant CAD
T wave inversion, suggesting cardiac ischemia
Coronary Artery Disease
Electrocardiogram
ST segment changes (depresed ST segments suggest cardiac ischemia, while elevated ST segments may suggest acute MI
Coronary Artery Disease
Electrocardiogram
Ventricular arrhythmias
Conduction defects(1st AV block, LBBB)
Coronary Artery Disease
Cardiac Catherization
Artieriogram is the gold standard for determining the presence and severity of CAD
Coronary Artery Disease
Cardiac Catherization
SWMA
Segmental wall motion abnormalties
Coronary Artery Disease
Cardiac Catherization
Identification of the complications of MI
Coronary Artery Disease
2D Findings/Evaluation
Evaluate sytolic wall thickening, systolic wall motion and diastolic wall thickness
Coronary Artery Disease
2D Findings/Evaluation
Opposing wall of involved region may be hyperkinetic
Thin, bright akinetic muscle section suggests old MI
Coronary Artery Disease
2D Findings/Evaluation
Spontaneous echo contrast may be visualized in the infarcted area
Coronary Artery Disease
2D Findings/Evaluation
Serial echos may be useful to evaluate infact extension (progressive necrosis, stunned myocardium)
Describe SWMA
hypokinesis
akinesis
dyskinesis
hypokinesis-not moving well
akinesis-not moving at all
dyskinesis-moving in the opposit direction
Coronary Artery Disease
2D Findings/Evaluation
Determine systolic function/ejection fraction
Coronary Artery Disease
2D Findings/Evaluation
Determine severity of coexisting valvular regurgitation using CFD
Coronary Artery Disease
Treatment
Reduce modifiable risk factors
Excercise
sublingual nitroglycerin, beta blockers, calcium channel blockers, ACE inhibitors
Pacemakers
Coronary stent
CABG
Coronary Artery Disease
Echo in determination of CAD
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
Coronary Artery Disease
Echo in determination of CAD
Best Method?
A stress echo should be performed
Left Ventricular Dysfunction
Why is it important to determine LV function?
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
Left Ventricular Dysfunction
2D Evaluation
Determine LV size by m-mode. Internal dimesions are obtained at end diastole and end sytole
Left Ventricular Dysfunction
2D Evaluation
A visual EF can be approximated by assessing LV funtion in the PSA
Left Ventricular Dysfunction
2D Evaluation
Always performa complete exam, including CFD, CW, and PWD, unless you are doing a limited F/U exam
Methods to determine LV dimension
Cardiac Output
Fractional shortening
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
Fractional Shortening
Definition
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
Fractional Shortening
Definition
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
What is the formula for CO?
CO=SVxHR
How is EF similiar to ES?
It uses the percent change of LV instead of change i the LV diameter
What is the main function of Cardiac Output?
To pump oxygenated blood to the peripheral tissues.
What is stroke Volume?
The volume of blood ejected by the LV during systole is referred to as the stroke volume
Cycle time of CO
Volume of blood ejected by ventricle during a 1 minute cycle
Thrombi
Diagnosis is based on?
Detection of echoic mass with defined margins clearly id'd throughout cardiac cycle visable in at least 2 echo views
Thrombi
2D Findings and Evaluations
Segmental WMA, usually akinesis or dyskinesis
Thrombi Types
Mural-Well adhered to wall
Pedunculated -stalk