Lecture 12: Cardiac Diagnostics (cont'd) Flashcards
Transechocardiography: - good for getting a great picture of the valves - looking internally - infective endocarditits because that lining lines the valves as well so of course you can see it
* Invasive
* US transducer is placed at end of endoscope
* Indications = bandages, obese, ventilator, repair of heart valves
* Useful for assess prosthetic valve function, infective endocarditits and aortic dissections
Whats used:
* numbing spray, mild sedation - so the gag reflex isnt activated
* ECG
* Probe via esophagus
* Can take anywhere from 15-30 minutes
Intravascular US Imaging (IVUS)
* 3 D pictures to see the integrity of the artery
* Camera is attached to the catheter
* Helps to determine surgery vs angioplasty
Helps determine acute ishemia, MI, old infarct
12 lead is the normal one
this is a snapshot - unless you have an actual heart attack happening its not going to indicate that theyre ischemic
* will let you see if theres an old MI because remodeling has happened - will imapct electrical conduction
s/s of acute coronary synrome
* angina
* sweating / pale
* elevated troponins - heart attack
actaully im not sure this is right
Cardiac catheterization:
* Diagnostic and treatment
* Shows where the blockage is and how much - goes in radial or femoral artery and travels up to heart and see where/if theres a blcokage - pt can be awake for this
* pressures for pulmonary hypertension
* EF and ventricular integrity
* GOLD STANDRD for diagnosing CAD (coronary artery disease)
* What needs to be done next - bypass, stent, cath? - lets us know what needs to be done next
* Precautions - shellfish allergy, dye has a lot of iodine like shellfish
showing them opening it up and increasing BF
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Cardiac catheterization
Angioplasty = catheter w/ the balloon attached
* balloon goes in and inflates and then deflates –> if blood doesnt return then we need to do the same thing but have a stent attached
Stent - wire mesh that keeps arteries open following angioplasty
Cardiac MR Angiography: - just incorporates use of MRI (good for women because it integrates the small vessels which are not picked up by other methods)
Gold standard for women - small vessel disease
* smaller coronary arteries > common arteries
Looks at all the arteries - useful for carotid
It can also be done for blood flow to the brain
* prevents sichemic stroke
ABGS = arterial blood gases
arterial BP
the BP we take noramlly is a measure of indirect BF while this is direct
stays in pt for length of stay
Pulmonary artery catheter
* Swan-Ganz catheter inserted into the pulmonary artery (via central vein)
* mean pulmonary pressure should be > w/ symptoms of exertion
* Mean pulmonary pressures > = contraidnication
Mean pulmonary pressures > 20 mmHg - symptoms on exertion
Mean pulmonary pressures > 35mmHg - contraindication for ex
* check w/ physican first
goes all the way to RA
* gives info on R heart function, venous returen, vascular tone, and circualting blood volume
multidisplinary team appraoch
not something you want to get pulled - difficult to get in
