Cardiac Imaging

Question 1

Cardiac X Ray Findings in Heart Failure (4)

Answer 1

Cardiomegaly (more than ½ the transverse diameter)
Prominent vascular markings
“Fluffy” infiltrates in butterfly or batwing distribution
Pleural effusion (blunted costophrenic angle)

Question 2

What is wrong with this image?

Answer 2

Cardiomegaly - heart diameter is larger than diameter of hemi thorax

Question 3

What is wrong with this image?

Answer 3

Prominent Vascular Markings - Increased fluid

Question 4

What is wrong with this image

Answer 4

“Fluffy” Butterfly distribution

Question 5

What is wrong with this image

Answer 5

Pleural effusion - blunted costophrenic angle

Question 6

Echocardiogram Measurement and Assessments

Answer 6

Chamber dimensions, wall thickness, chamber pressures, EF %
Assesses wall motion and valve function

Question 7

Echo Advantages

Answer 7

Readily available
Noninvasive
No contrast
No radiation
Gives info about both structure and function
Does not require participation from patient

Question 8

Echo Disadvantages

Answer 8

Operator-dependent
Requires patient to remain still in positions
Can be low quality in some patients (Very obese and COPD)

Question 9

Where does a clot go after it leaves the left ventricle?

Answer 9

The brain!

Question 10

Transesophageal Echo (TEE) Uses

Answer 10

Gain better view of valves and chambers
Used when view is critical or echo is not adequate

Question 11

Left Heart Catheterization Uses

Answer 11

Coronary arteries—coronary angiography (ability to see severity of lesions and measures flow across the lesion; stents can be applied during catheterization)

Left ventricle—ventriculography (Measures LV function; Volumes/flows/pressures; requires additional dye and is not as accurate)

Question 12

Left Heart Catheterization Complications

Answer 12

Common: Bleeding, hematoma, contrast-induced kidney injury, vascular complications

Retroperitoneal bleed: Rarely, femoral nerve compression causes acute quadriceps weakness

Rare: Death, myocardial infarction, stroke, contrast reactions

Question 13

Groin entrance considerations

Answer 13

Times vary on closure but longer bedrest is required

Question 14

Wrist entrance considerations

Answer 14

Two days of limited wrist extension and weight bearing (pushing off, etc)

Question 15

Right Heart Catheterization Uses

Answer 15

VENOUS access
Measures pressures within the heart and pulmonary artery
Provides information about heart and lung pressures, central venous O2 saturation, and indirect measurement of cardiac output and cardiac index
Can guide volume management in HF, determine cardiac vs. pulmonary cause of pulmonary HTN, and estimate LV function (diagnostic)

Question 16

Cardiac MRI/A Advantages

Answer 16

Gives most clear view of heart structure, function, and heart muscle
Used to diagnose: Congenital anomalies, Diseases effecting heart muscle and Cardiac viability
Gives better image quality in situations where echo quality is low
Contrast is gentle
No x-ray exposure

Question 17

Cardiac MRI/A Disadvantages

Answer 17

Expensive, so use is targeted
Patient must stay still, follow instructions for breath-holding
Slow: 1–2 hours to complete
Not always available
Contrast usually needed
Claustrophobia

Question 18

Cardiac CT Uses

Answer 18

Best view of coronary arteries
Diagnosis of CAD

Question 19

Cardiac CT Advantages

Answer 19

Best view of coronary arteries and other vessels
Noninvasive
Calcium score CT does not require contrast

Question 20

Cardiac CT Disadvantages

Answer 20

Heavy radiation
Harsh contrast
Needs low heart rate
Not useful emergently
No intervention