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RAD415 PT2 > cardiac pathology and trauma > Flashcards

cardiac pathology and trauma Flashcards

1
Q

what are 6 imaging modalities used in cardiac imaging/

A
  • plain radiography
  • echocardiography
  • percutaneous angiography
  • CT
  • MRI
  • Nuclear medicine
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2
Q

what are some cardiac disease processes that can be seen on imaging

A
  • coronary artery disease
  • myocardial infarction
  • functional abnormalities (pump and valves)
  • heart muscle disease
  • congenital abnormalities
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3
Q

what is angina

A

Angina is chest pain caused by reduced blood flow to the heart muscles

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4
Q

what areas can the pain from angina radiate to, what can make this pain worse/better

A
  • retrosternal chest pain can radiate to arm or jaw
  • pain worsened on exercise or stress
  • alleviated by rest or using vasodilator medication
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5
Q

what term is used to classify predictable and unpredictable angina

A
  • predictable = stable angina
  • unpredictable = unstable angina
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6
Q

what can cause angina and what can happen if it becomes severe

A
  • coronary artery disease
  • when severe can be myocardial infarct
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7
Q

what is coronary heart disease

A
  • narrowing of one or more of the coronary arteries due to atheroma
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8
Q

what is atheroma

A

a fatty material that builds up inside your arteries.

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9
Q

what are the 4 ways to diagnose/ identify angina

A
  • clinical symptoms
  • ECG characteristics
  • precipitating factors e.g anaemia
  • diagnostic testing e.g cardiac CT, functional imaging, percutaneous angiography
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10
Q

compare the difference of the 4 different causes of cardiac chest pain, stable angina, unstable angina, nonSTEMI, STEMI

A
  • stable angina = atherosclerotic plaque in artery, reducing adequate blood flow to myocardial demand. (pain at stress)
  • unstable angina = ruptures plaque forming thrombus, causing partial occlusion. (pain at rest)
  • NONSTEMI = ruptured plaque forming thrombus and partial occlusion leading to infarct of subendocardial myocardium
  • STEMI = complete occlusion of blood vessel by plaque, leading to transmural injury and infarct myocardium (heart attack)
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11
Q

unstable angina, non stemi and stemi are classified as acute coronary syndromes

A

a term that describes a range of conditions related to sudden, reduced blood flow to the heart.

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12
Q

what is the pathway post discoing a stable angina, unstable angina, nonstemi and stemi

A
  • stable angina = outpatient imaging
  • unstable angina = inpatient imaging
  • nonstemi = inpatient imaging
  • stemi = primary PCI (time critical)
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13
Q

what does a primary PCI stand for and mean

A

Primary Percutaneous Coronary Intervention (PPCI), also known as angioplasty or coronary angioplasty, is a procedure used to treat the narrowed coronary arteries of the heart and angina in patients.

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14
Q

what is a coronary angiogram

A

xray used to see coronary arteries

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15
Q

what does STEMI stand for

A

ST elevation myocardial infarction

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16
Q

what are the 3 chest pain characteristics

A
  • typical
  • atypical
  • non anginal
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17
Q

anginal pain is:
- constricting discomfort in from of chest, neck, shoulder, jaw or arms

  • precipitated by physical extertion
  • relieved by rest or GTN

if patient responds yes to 3,2 or 1 of these questions, what type of chest pain characteristic are they experience and what must be done

A
  • yes to all 3 = typical angina
    (refer for cardiac CT)

-yes to 2 = atypical angina
(refer for cardiac CT)

  • yes to 1 = non anginal chest pain
    (if specific ECG changes, cardiac CT)
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18
Q

if there is cardiac chest pain, what are the 3 lines/ levels of imaging pathway the patient undergoes

A

1st line = cardiac CT
2nd line= Functional imaging
3rd line = percutaneous angiography

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19
Q

what percentage of cardiac vessel stenosis seen on a cardiac CT is enough to be likely to be the cause of symptoms

A

greater than 70% stenosis

(less than 50% = unlikely to be cause, 50-70% = maybe cause)

20
Q

usually less than 50% stenosis in cardiac vessels is unlikely to be cause of chest pain, but in which artery is 50% stenosis considered significant

A

left main stem / left coronary artery

21
Q

what is inferior wall perfusion defect

A

The degree of reversibility of a perfusion defect is identified on post-stress images as an area of decreased radiopharmaceutical activity that improves or disappears on rest or redistribution images.

perfusion abnormalities that are seen both on stress and rest myocardial perfusion images, are termed fixed or irreversible defects, which most often suggests an area of prior myocardial infarction, particularly if the defect is severe

22
Q

nuclear medicinal examination of heart can be performed under pharmacological stress and at rest, what medication can be given to make the heart stress/increase heart rate/increase contractility

A

dobutamine

(excersise can also be done but incompatible in MR scanner)

23
Q

radioactive tracer administered during nuclear medicine cardiac scan

A
24
Q

normally myocardium perfuses equally at stress and rest, infarctions show as fixed defect on stress and rest. what does this mean?

A

Non-reversible defect (fixed) shows no significant changes in activity between post-stress or rest images.

Severe fixed defect most likely represents scarring or fibrosis from prior MI, but a mild or moderate fixed defect may indicate hibernating myocardium or prior nontransmural MI.

25
Q

what is reversible ischaemia

A

Reversible myocardial ischemia is a common disease that occurs in patients with atherosclerosis of coronary artery, myocardial microcirculation disturbance, and other infrequent etiologies. It is mainly due to the blood perfusion insufficiency of the myocardium.

26
Q

reversible ischaemia shows as defect on stress but not on rest

A
27
Q

what happens to the contractility of ischaemic myocardium under excersise

A
  • cannot maintain contractility if iscaemic
28
Q

what is the exercise tolerance test

A
  • treadmill
  • ECG monitoring
  • progressive excersise
  • stop when finished or if specific ECG changes
29
Q

go to iPad camera roll and look at ct of the arteries and main vessels

A
30
Q

what are 3 forms of treatments for coronary artery disease

A
  • medication e.g beta blockers, nitrates, calcium channel blockers
  • angioplasty + stent
  • bypass grafting
31
Q

what is bypass grafting

A

involves taking a blood vessel from another part of the body (usually the chest, leg or arm) and attaching it to the coronary artery above and below the narrowed area or blockage.

32
Q

when might you use angioplasty and stents or bypass grafting

A

angioplasty = larger vessels and symptoms not controlled with meds

bypass grafting = left main stem disease, unfavourable anatomy for stems, symptoms not controlled

33
Q

what is dilated cardiomyopathy

A

heart muscle which makes the muscle walls become stretched and thin (dilated)

34
Q

what is hypertrophic cardiomyopathy

A

heart muscle becomes thickened

35
Q

what is pericardial effusion

A

the buildup of extra fluid in the space around the heart

36
Q

what is pericarditis

A

Pericarditis is inflammation of the lining around your heart, which causes chest pain

37
Q

what is constrictive pericarditis

A

a condition in which granulation tissue formation in the pericardium results in loss of pericardial elasticity leading to restriction in the ventricular filling.

38
Q

what is myocarditis

A

inflammation of heart muscle

39
Q

what is mitral regurgitation

A
  • valve between left heart chambers done close properly
40
Q

what is the most common defect/ mutation of the aortic valve

A
  • bicuspid
  • usually it is tricuspid
41
Q

what is aortic dissection

A

a tear in the internal face of the aorta leads to dissection through the laminas and formation of a new lumen (false lumen) and acute drop in systemic blood pressure,

42
Q

what is coarctation

A

a birth defect in which a part of the aorta is narrower than usua

43
Q

what is atrial septal defect

A

a birth defect of the heart in which there is a hole in the wall (septum) that divides the upper chambers (atria) of the hear

44
Q

what is an abdominal aortic aneurysm

A

An abdominal aortic aneurysm (AAA) is a swelling in the aorta, the artery that carries blood from the heart to the tummy

  • fatal if bursts, high internal bleeding
45
Q

what is a bilateral pulmonary embolism

A

Bilateral massive pulmonary thromboembolism is a life-threatening condition wherein patients present with circulatory and respiratory collapse.

  • large blood clot is the cause

RAD415 PT2 (14 decks)

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