CVD investigations

Question 1

Echocardiography

Answer 1

• Use of ultrasound to investigate the structure and function of
the heart
• Ultrasound waves – frequency 1-10MHz
• Ultrasounds travel through some structures (e.g. blood) and are reflected off others (e.g. muscle and bone)
• A picture is built up by the computer from the reflected waves and based on the time it took them to be received back at the
transducer

Question 2

Two-dimensional echocardiography

Answer 2

Provides standard views of the heart and gives
information on:
 Valve structure and function
 Left ventricular contractility
 Size of chambers
 Pericardial disease

Question 3

Doppler echocardiography

Answer 3

Used for the assessment of:
 Valve stenosis and regurgitation
 Atrial and ventricular septal defects
 Pulmonary hypertension

Question 4

Echocardiogram LV function and EF

Answer 4

≥ 50% = good LV function
40-49% = moderate LV function
< 40% = poor LV function

Question 5

Coronary Angiography

Answer 5

• Confirms diagnosis
Shows site and severity of blockages (stenoses)
• Helps determine best option
Medical management
Revascularisation procedure to improve oxygen supply to
heart muscle

Question 6

Angiography

Answer 6

1 Catheter inserted
into femoral artery
2 Catheter is
advanced into
the abdominal
aorta
3 Radio-opaque
dye is infused to
outline the
coronary anatomy

Question 7

Which arteries are more commonly used in angiography?

Answer 7

Brachial or radial artery also
used - in fact more often than
the femoral artery – less
complications with bleeding

Question 8

Myocardial Perfusion Scans

Answer 8

• Perfusion Scans – dye injected to see if ischaemia is reversible at rest and during stress
• CT scan - Uses x-rays to build up 3D images of heart and used in 2 ways:
1. Calcium scores in CA’s - direct correlation between amount of calcium found and risk of events
2.CT coronary Angiogram - Diagnosis of CAD - visualise
lumen, stenosis & plaque with contrast enhanced CT

Question 9

Myocardial Perfusion Scans

Answer 9

• Injection of radio isotope (e.g. thallium) detects areas of ischaemic myocardium at rest
• Can distinguish areas of myocardium that become ischaemic during exercise (= physiological stress) or pharmacological stress
• Pharmacological stress: use of substances like Dipyridamole (dilates healthy coronary arteries but not diseased arteries
redistributing blood away from diseased vessels), Adenosine (as above), and Dobutamine (increases heart rate and contractility – mimics the effects of exercise)

Question 10

CT angiogram (myocardial CT scan)

Answer 10

• High accuracy and predictive value
• Patency of CABG, assess LV mass, LVF, Stroke volume, EF,
wall motion abnormalities
• Cardiac masses, thrombus, aortic pathology

Question 11

Cardiac MRI

Answer 11

• Gold standard non invasive investigation
• Structure – ventricular mass, (LV hypertrophy)
• Pumping ability –, LV Function, cardiomyopathies, myocardial viability, perfusion & infarction
• Valve competency
• Stress induced ischaemia with dobutamine or adenosine – mimic effect of exercise on heart
• Unless MRI compatible unable to use with ICD’s or
pacemakers