Cardiac imaging Flashcards
What are the main tests cardiologists request? [4]
Main tests:
- Chest X-ray
- Echocardiography (Thoracic/Oesophageal)
- Further Imaging (MRI, Nuclear medicine, Ultrasound, CT) (non-invasive)
- Coronary angiography (invasive)
What is the pathology indicated by this CXR? [1]
Pulmonary oedema
What pathology is indicated by this CXR? [1]
Mediastinum is wider: thoracic aortic aneurysm
Echocardiography uses what type of imaging to produce images? [1]
Ultrasound waves
Which of the following uses ultrasound waves?
Echocardiography
Cardiac MRI
Nuclear MPS
Chest x-ray
CT-coronary angiography
Which of the following uses ultrasound waves?
Echocardiography
Cardiac MRI
Nuclear MPS
Chest x-ray
CT-coronary angiography
Which of the following allows for calculating velocities and hence pressure gradients of blood flow
Echocardiography
Cardiac MRI
Nuclear MPS
Chest x-ray
CT-coronary angiography
Which of the following allows for calculating velocities and hence pressure gradients of blood flow
Echocardiography: Doppler
Cardiac MRI
Nuclear MPS
Chest x-ray
CT-coronary angiography
What pathologies are Echos good for investigating? [4]
Valves: if narrower, then the flow / velocity will increase; endocarditis
Myocardial diseases: MI ; LV thrombus
Great vessels: dilation
Thrombus/infection/tumor
Arrhythmias
Cryptogenic (unknown cause) stroke: Looking for thrombus at apex
What axis is this echo taken from?
long-axis
short-axis
four chamber-plane
What axis is this echo taken from?
long-axis
short-axis
four chamber-plane
Label A-C
A: long-axis
B: four chamber-plane
C: short-axis
What axis is this echo taken from?
long-axis
short-axis
four chamber-plane
What axis is this echo taken from?
long-axis
short-axis
four chamber-plane
What colours do the doppler echo show?
Red: towards
Blue: away
Green: areas of turbulence
Which valves are more commonly pathological? [2]
Aortic and pulmonary
** ECHO and cardiomyopathy **
Which pathologies can preclude useful ECHO assesment? [2]
High BMI & COPD can preclude useful assessment
Why are transesophageal cardiograms (TEE) more useful than transthoracic echocardiograms (TTE)?
TEE is better because don’t have chest wall to look through: can therefore use higher frequency wavelength: see structures more clearly
What is TEE useful for IDing if TTE is normal or unclear? [4]
Post-operative (if particularly invasive: TTE can be disrupted by wound repairs)
Accurate valve assessment (mitral)
Endocarditis
Pre-ablation assessment of left atrial appendage(bc often have a thrombus in LA, if interefere will cause a stroke)
What would you be highly suspicious of identifying with a TEE if you had a TTE but no findings? [1]
Endocarditis [1] (life-threatening inflammation of the inner lining of the heart’s chambers and valves)
Name 3 AEs of TEE
- Oesophageal stricture (tightening) diverticula (outpouching) / tumour
- Varices
What are CT-Coronary angiographys useful for diagnosing?
New onset chest pain
If no previous documented CAD
Useful in CABG patients to assess grafts
What specifically can CTCAs ID? [2]
Zero coronary artery calcification (CAC) score in patients with stable angina has a high negative predictive value for the exclusion of obstructive CAD and is associated with a good medium-term prognosis
Narrowing / stenosis of arteries
How do you perform a CTCA? [3]
Give BB prior to: clearer image
ECG gating: pick an area after T wave, when heart is at stillest (during diastole) to take image
Breath hold (any movement will cause blurring)
Which modality if the gold standard for assessing LV function?
Contrast enhanced echo
Nuclear myocardial perfusion scintigraphy
CT coronary angiography
Cardiac MRI
SPECT imaging
Which modality if the gold standard for assessing LV function?
Contrast enhanced echo
Nuclear myocardial perfusion scintigraphy
CT coronary angiography
Cardiac MRI
SPECT imaging
What is MRI good for assesing?
- Crystal clear images
- Useful for distinguishing cardiomyopathy types
- ## Gold standard for assessing LV function
Which modality is useful for assessing cardiomyopathy types?
Contrast enhanced echo
Nuclear myocardial perfusion scintigraphy
CT coronary angiography
Cardiac MRI
SPECT imaging
Which modality is useful for assessing cardiomyopathy types?
Contrast enhanced echo
Nuclear myocardial perfusion scintigraphy
CT coronary angiography
Cardiac MRI
SPECT imaging
What do you need to check prior to MRI? [2]
Patient’s renal function: risk for Retroperitoneal fibrosis. Need to have eGFR < 30
Pacemakers
What are MRIs useful for IDing? [4]
Discriminating between MI and myocarditis. MI with non-obstructive coronary arteries: MINOCA. (e.g. if present with STEMI / NSTEMI but no diagnosis from CTCA or ECHO imaging. So use MRI)
Cardiomyopathies (Fe / Lipid storage disorders)
Storage disorders
Thrombus/mass discrimination
Explain how myocardial perfusion scanning (MPS) works
Give someone a tracer, look at differential flow and can infer if narrowing is causing a flow limiting problem in a non-invasive way
Uses nuclear tracers (to determine tissue activity)
Which modality is very good for assessing MI?
Contrast enhanced echo
Nuclear myocardial perfusion scintigraphy
CT coronary angiography
Cardiac MRI
SPECT imaging
Which modality is very good for assessing MI?
Contrast enhanced echo
Nuclear myocardial perfusion scintigraphy (MPS)
CT coronary angiography
Cardiac MRI
SPECT imaging
How do you conduct MPS imaging? [2]
Performed during pharmacological stress (give adenosine) and rest
Areas of reduced uptake (and lighting up) suggest ischemia
Negatives for MPS? [3]
Radiation
Requires stressing agents (some Ptx with asthma can’t have)
Time consuming
