Cardio Imaging Flashcards
What are the indications for an echocardiogram?
Evaluative congenital heart defects, changes in heart size, pumping strength (ejection fraction and CO), damage to heart muscle, valvular dysfunction, presence of pericardial effusion, guidance of pericardiocentesis
What are the three types of an echocardiogram?
Transthoracic echocardiogram (TTE)
Doppler echo
Stress echo
What are the pros for TTE?
Usually first line cardiac imaging modality bc its widely available, noninvasive and no radiation risk
What are the risks for echocardiogram?
During stress echo, exercise (not the echo) may cause temporary dysrhthymia and rarely heart attacks
What are the pros for a Doppler echo?
Finds blood flow abnormalities in cardiac arteries missed by traditional ultrasound
What are the indications for the a continuous wave Doppler?
Measures high velocities
Pulmonary HTN or aortic stenosis
What are the indications for pulsed Doppler?
Assess low velocities
Mitral/tricuspid inflow, atrial appendage flow, ventricular outflows
What are the indications for a color flow Doppler?
Assess regurgitation, intracardiac shunts (ASD, VSD), and pulmonary vein flow
What are the risks for a Doppler echo?
None
What are transducer positions?
Usually performed with patient left lateral decubitus
Left handed scanning is more ergonomic and lower risk of sonographer othropedic injuries
An apical view US is best for viewing what?
Heart chambers
What is the MC congenital cardiac anomaly?
Ventricular septal defect
What are the sx for a septal defect?
Small lesions may be asymptomatic with harsh pansystolic murmur
Large lesions may cause signs of heart failure
What is the modality of choice for septal defects?
An echo allows direct visualization of the septal defect with no radiation exposure
CTA with EKG-gating allows for direct visualization of the defect but with risk of what?
Radiation exposure
What is coarctation of the aorta?
Aortic narrowing near insertion of the ductus arteriosus
What are the sx for coarctation of the aorta?
HTN in UE, weak pulses in LE (brachial-femoral delay)
What is the imaging of choice for coarctation of the aorta?
Echo establishes sx and severity in most pts
CTA can be a complimentary imaging tool important prior to intervention
What are the indications for a multiple gated acquisition (MUGA) scan?
Detect for causes of reduced ejection fraction (ie. Heart failure, damaged myocardium from MI or cardiomyopathy)
Can help answer why a pt has angina, dizziness, dyspnea or fatigue
What are the pros for a MUGA scan?
Accurate, reproductive, non-invasive
Measured EF is more precise vs other cardiac tests
Can localize abnormally functioning myocardium to find blocked coronary arteries
What are the risks for a MUGA scan?
Low level of radioactivity unions to cause any short/long term damage, allergic reaction to tracer
When is a MUGA scan contraindicated?
Renal disease, pregnant women or breastfeeding
What is the gold standard for CAD?
Coronary angiography
Wha are the indications for a coronary angiography?
CAD, angina, acute MI, valvular disease, CHF
What are the contraindications for coronary angiography?
Renal failure, contrast medium allergy, coagulopathy, uncontrolled HTN, decompensated HF, GI hemorrhage, pregnancy, active infection
What are the cons for coronary angiography?
Expensive, procedural risks
What are the indications for CT?
Locate aneurysm, blockages, blood clots, vascular malformations, stenosis, injury, vessel rupture/dissection, pulmonary embolism
What are the risks for CT?
Minimal radiation exposure, allergic reaction to contrast, tissue damage via contrast leakage
What are the pros for CT?
Quick, non-invasive, may eliminate need for surgery, allows surgeries to be performed more accurately, cheaper than catheter angiography
What are the contraindications for CT?
Severe kidney disease
What is the most posterior most of the heart on CT?
LA
What is the most anterior part of the heart on a CT?
RV
What is aortic dissection?
Longitudinal intimal tear forming a false lumen
Associated with chronic HTN and Marfan’s
What are the sx of aortic dissection?
Sudden onset tearing chest pain radiating to the back, unequal BP in arms, diminished or unequal peripheral pulses, new diastolic murmur from aortic regurgitation
What is the imaging of choice for aortic dissection?
CXR shows mediastinal widening
CTA is choice of imaging bc it can diagnose/classify the dissection and evaluate for distal complications
What is thoracic aortic aneurysm?
Associated with cystic medial degeneration seen in Marfan’s
Aortic root dilation can lead to aortic regurgitation and associated sx
What are the sx for thoracic aortic aneurysm?
Mass effect on airway and esophagus
What is the imaging of choice for choice aortic aneurysm?
CTA
What is a posterioanterior (PA) film?
Pt facing film plate with X-ray tube behind them
Most commonly used
What is an anterioposterior (AP) film?
Pts back a giants film plate with X-ray machine in front
What is the importance of the PA/AP CXR views?
In AP view the mediastinum appears widened due to AP magnification
Don’t consider the heart to be enlarged if viewing in AP
What are some DDx for cardiomegaly?
CHF, HTN with left ventricular hypertrophy, valvular disease, cardiomyopathies, pulmonary dz with RV hypertrophy, myocarditis, normal athletic heart
What is the imaging of choice for cardiomegaly?
CXR is sufficient to dx cardiomegaly
Other imaging modalities can be used to narrow down the differential
What are some DDx for widened mediastinum?
Anthrax, aortic dissection, thoracic aortic aneurysm, pneumomediastinum, mediastinal mass
What is the imaging of choice for widened mediastinum?
CXR is sufficient to dx
Other imaging modalities can be used to narrow down the differential
