11 04 2014 Cardiac Imagine

Question 1

Findings of chest X-ray associated with Heart failure

Answer 1

Vascular redistribution from bases to apices of the lungs
- widening of vascular markings at the apex of the lung

Interstitial and alveolar edema
- Kerley B lines: parallel lines close to pleura at base of lung that depict fluid in interlobular spaces = interstitial edema

Air bronchograms

Pleural effusions

Question 2

2D echocardiography

Answer 2

multiple ultrasonic beams are transmitted from transducer through a wide arc.

Depicts anatomical relationships and defines the movement of cardiac structures relative to one another.

Wall and Valve abnormalities can be depicted.

Limitation: delineates only part of a given cardiac structure

Question 3

Doppler Echocardiography

Answer 3

depicts blood flow direction, velocity and turbulence.

2D image that can show blood flow abnormalities!

• location of stenotic and regurgitant valvular lesions and of abnormal communications within the heart and great vessels

Question 4

Transesophageal echocardiography (TEE)

Answer 4

miniatureized transducer mounted to end of endoscope – ULTRASOUND WAVES within esophagus = producing clear images of neighboring cardiac structures and thoracic aorta

• • Assesment of AORTIC and ATRIAL ABNORMALITIES
• better than transthoracic echo imaging
• better at detecting a thrombus
• Great for looking at patients with a prosthetic heart valves (because in transthoracic, mechanical valves reflect a large portion of ultrasound waves – interfere with visualization of more posterior structures

Question 5

Echocardiography role in ventricular assessment

Answer 5

Calculates Ejection fraction – measure of contractile function (Doppler)

-Measurement of ventricular wall thickness and mass

Question 6

Echocardiography and role in valvular lesion assessment

Answer 6

determine underlying cause of valvular abnormality and doppler can quantify the degree of valvular stenosis or regurgitation

Pressure gradient across valve can also be calculated

Question 7

Echocardiography and role in coronary artery disease

Answer 7

Ventricular wall motion abnormalities due to infarcted or ischemic myocardium

Stress echocardiogrpahy : aids in diagnosis of CAD

Question 8

Echocardiography and role in cardiomyopathy

Answer 8

heart muscle disorders:

1. dilated
2. hypertrophic
3. restrictive

Distinguished by echocardiography and severity of systolic and diastolic dysfunction is accessed

Question 9

Technetium -99m Nuclear Imagine (Tc)

Answer 9

provide better image quality and superior for detailed single photon emission computer tomography.

Sensitive to detection of ischemic or scarred myocardium

Question 10

Thallium -201 (Tl)

Answer 10

Injected IV while patient is exercising on treadmill - enters normal myocytes based on perfusion

After excerise thallium spreads to all viable myocytes! = equal concentration of thallium

Sensitive to detection of ischemic or scarred myocardium

Abnormalities = ischemia or infarcted area (cold spots)

PROBLEM: myocytes can be Falsely characterized as nonviable – ischemic areas but metabolically active myocytes with potential to regain function if blood is restored

– hibernating myocardium

Question 11

Electron Beam computed tomography (EBCT) and Coronary artery calcification

Answer 11

Calcified coronary artery plaques have a radio density similar to that of bone. Appear attenuated on CT.

Agatson score – a measure of total coronary artery calcium – correlates with atherosclerotic plaque burden and predicts the risk of coronary events independent of cardiac risk factors

Question 12

contrast enhanced MRI

Answer 12

Gadolinium - based agent
IV

Gadolinium is excluded from viable cells with intact membranes.

Identify infarcted (irreversibly damaged cells) = hyperenchacement on image.