Imaging Flashcards
What should be ordered for almost all patients presenting with chest pain or dyspnea?
Chest x-ray
CXR has low sensitivity for the detection of _____ heart disease, but some findings have fairly high specificity (e.g. for ____ enlargement).
CXR has low sensitivity for the detection of structural heart disease, but some findings have fairly high specificity (e.g. for chamber enlargement).
CXR is sensitive for the detection of _____ processes that result from cardiac disease.
CXR is sensitive for the detection of pulmonary processes that result from cardiac disease.
e.g. pulmonary edema, pleural effusion
What is echocardiography?
Basically a cardiac ultrasound
High frequency (ultrasonic) waves generated by a piezoelectric element travel through the body
These waves are reflected at interfaces where there are differences in the acoustic impedance of adjacent tissues.
The reflected waves return to the transducer and are recorded, then processed into an image.
What is M Mode echocardiography?
A form of echocardiography based on one-dimensional (“ice-pick”) analysis of the heart in motion.
Provides both high spatial and temporal resolution, and it is used to measure the thickness of the ventricle walls and the volumes of cardiac chambers.
Not really used much anymore.
What is 2D echocardiography?
Have 2 primary probe positions, with multiple angulations (multiple ultrasonic beams are transmitted from transducer through a wide arc). The returning signals are integrated to produce 2D images of the heart on a video monitor.
Most used method today.
Identify the chambers shown in this image:
Identify the chambers shown in this image:
Identify the chambers shown in this image:
What is color flow doppler imaging?
Depicts blood flow direction and velocity
Identifies regions of turbulent (i.e. high velocity) flow
Particularly useful for assessing valvular abnormalities (regurgitation and stenosis)
Transesophageal echocardiography:
Patient is mildly sedated for outpatient procedure. Echo probe is passed down the esophagus (and into the stomach).
Gold standard for exclusion of intracardiac (especially left atrial appendage) thrombus. Optimal imaging for left-sided (mitral and aortic) valves.
Also used in cardiac surgery cases
An echo should be ordered for all patients who present with ____ or ____.
An echo should be ordered for all patients who present with new heart failure or dyspnea of unclear etiology.
A(n) ____ is the ideal diagnostic study to evaluate the structure and function of the heart.
A(n) echo is the ideal diagnostic study to evaluate the structure and function of the heart.
_____ is the gold standard for evaluation of valvular structure and function.
Echocardiography is the gold standard for evaluation of valvular structure and function.
Risk of toxicity with echo?
No inherent risk or toxicity
Low-intermediate expense
Nuclear imaging detectors (cameras) image nuclear isotopes to indicate areas of _____. Explain.
Nuclear imaging detectors (cameras) image nuclear isotopes to indicate areas of hypoperfusion.
Typically comparing stress and rest.
Marker for myocardial perfusion
Increases specificity and sensitivity of stress tests for detection of ischemia.
What does this image show?
Note the uniform uptake of tracer at rest, with areas of poor uptake after stress.
The images are processed and presented in multiple orthogonal views.
In this case, the ischemia is in the lateral wall and apex.
Right heart vs. left heart catheterization:
Right Heart Catheterization (RHC or Swan Ganz): performed via the venous route to measure pressures on the right side of the heart and out into the pulmonary artery (lungs)
Left Heart Catheterization (LHC): Performed via the arterial route to perform an angiogram (shoot dye) into the coronary arteries, but can also look at pressures on the left side of the heart
Pulmonary artery wedge pressure:
Closely matches the left atrial pressure in most individuals
Used to estimate the left ventricular diastolic pressure
Venous access is lower risk than arterial access
Elevated PCWP indicates Left sided heart failure
The pulmonary artery wedge pressure closely matches the ____ pressure in most individuals
The pulmonary artery wedge pressure closely matches the left atrial pressure in most individuals
The pulmonary artery wedge pressure is used to estimate the _____ pressure
The pulmonary artery wedge pressure is used to estimate the left ventricular diastolic pressure
The _______ pressure is used to estimate the left ventricular diastolic pressure
The pulmonary artery wedge pressure is used to estimate the left ventricular diastolic pressure
_____ access is lower risk than ____ access
Venous access is lower risk than arterial access
Elevated _____ indicates left sided heart failure
Elevated pulmonary artery (capillary) wedge pressure indicates left sided heart failure
Elevated pulmonary artery (capillary) wedge pressure indicates _______.
Elevated pulmonary artery (capillary) wedge pressure indicates left sided heart failure
Cons of cardiac catheterization:
Cardiac catheterization is invasive (albeit minimally)
Involves exposure to radiation and contrast dye.
Expensive.
Cardiac catheterization (Right Heart/Pulmonary Artery/Swan-Ganz catheterization) is the gold standard test for assessing ____ and ____.
Cardiac catheterization (Right Heart/Pulmonary Artery/Swan-Ganz catheterization) is the gold standard test for assessing intracardiac pressures and cardiac output.
_______ is the gold standard test for assessing intracardiac pressures and cardiac output.
Cardiac catheterization (Right Heart/Pulmonary Artery/Swan-Ganz catheterization) is the gold standard test for assessing intracardiac pressures and cardiac output.
Unlike other imaging tests, ___ doesn’t use ionizing radiation or carry any risk of causing cancer.
Unlike other imaging tests, MRI doesn’t use ionizing radiation or carry any risk of causing cancer.
Cardiac MRI creates both ____ and ____ pictures of your heart and major blood vessels
Cardiac MRI creates both still and moving pictures of your heart and major blood vessels
Compare/contrast CT and MRI for cardiac imaging:
- CT and MRI are non-invasive, but require exposure to radiation (CT) and contrast dye. They both are expensive (particularly MRI) and require specialized expertise.
- CT with vascular protocol should be ordered for any patient suspected of having thoracic aortic disease. MRI should be ordered for characterization of structure and function that is unclear by echocardiography.
- CT coronary angiography can define coronary anatomy and identify severe coronary artery disease.
- MRI is the gold standard for assessing cardiac structure and function (esp. complex congenital heart disease) and can offer some characterization of myocardial tissue
___ with vascular protocol should be ordered for any patient suspected of having thoracic aortic disease. ___ should be ordered for characterization of structure and function that is unclear by echocardiography.
CT with vascular protocol should be ordered for any patient suspected of having thoracic aortic disease. MRI should be ordered for characterization of structure and function that is unclear by echocardiography.
CT with vascular protocol should be ordered for any patient suspected of having ______. MRI should be ordered for characterization of _____ and ____ that is unclear by echocardiography.
CT with vascular protocol should be ordered for any patient suspected of having thoracic aortic disease. MRI should be ordered for characterization of structure and function that is unclear by echocardiography.
CT with ______ should be ordered for any patient suspected of having thoracic aortic disease. MRI should be ordered for characterization of structure and function that is unclear by _____.
CT with vascular protocol should be ordered for any patient suspected of having thoracic aortic disease. MRI should be ordered for characterization of structure and function that is unclear by echocardiography.
________ can define coronary anatomy and identify severe coronary artery disease.
CT coronary angiography can define coronary anatomy and identify severe coronary artery disease.
___ is the gold standard for assessing cardiac structure and function (esp. complex congenital heart disease) and can offer some characterization of myocardial tissue.
MRI is the gold standard for assessing cardiac structure and function (esp. complex congenital heart disease) and can offer some characterization of myocardial tissue.
