Lecture One (Cardio)-Exam 1 Flashcards
What is stable angina? Is it common or uncommon? What has not changed?
Stable angina chest pain with stress and activity. It is the most common type of angina in the United States. It follows a pattern that has been consistent for at least 2 months. That means the following factors have not changed:
* How often your angina events occur
* What causes or triggers your angina
* How long your angina events last
* How well your angina responds to rest or medicines
What is Unstable Angina?
does not follow a pattern. It may be new or occur more often and be more painful than stable angina. Unstable angina can occur with or without physical exertion. Rest or medicine may not relieve the pain
Vasospastic Angina (aka Prinzmetal angina)
* What is it characterized by?
* Attributed to what?
* What happens?
* What can it be to?
- Characterized by chest discomfort/pain at rest with transient EKG changes and a prompt response to nitrates
- Attributed to coronary artery spasm
- Transient decrease in the blood supply to the heart
- Can happen due to exposure to cold, exercise. Cocaine use
What are all the causes of Chest pain? (5 groups)
- Cardiac: angina, MI, pericarditis
- Musculoskeletal: costochondritis, rib problem, muscle strain
- Thoracic problem: pleuritis, pneumonia, pulmonary embolism, pneumothorax
- GI: GERD, esophageal contraction disorders, ulcer
- Other: panic attack, anxiety, shingles
Dyspnea
* What is it?
* What are the two types?
Dyspnea – an uncomfortable awareness of breathing, difficult or labored breathing
* Exertional Dyspnea (Most common): Requires the increased demand of exertion to precipitate symptoms
* Dyspnea at rest: Suggests severe cardiac disease
Paroxysmal nocturnal dyspnea
* What is it?
* What is it caused by?
* Suggests what?
Paroxysmal nocturnal dyspnea (Second most common)
* Patient awakening after being asleep or recumbent for 1 hour or more
* Caused by redistribution of body fluids from the lower extremities into the vascular space and back to the heart, resulting in volume overload
* Suggests a more severe condition
Different than sleep apnea
Orthopnea
* What is this?
* What does it increase?
* What does it suggest?
* Documented based on what?
- Dyspnea that occurs immediately on assuming the recumbent position
- Mild increase in venous return before any redistribution
- Suggests even more severe disease
- Documented based on how many pillows used at night
Syncope and Presyncope (described as lightheadedness and/or dizziness)
* What does it indicate?
Indicates a reduction in cerebral blood flow.
* could also be CNS dx, metabolic conditions, dehydration, inner-ear, orthostatic hypotension, arrhythmia, aortic stenosis, HOCM, vasovagal
Syncope and Presyncope (described as lightheadedness and/or dizziness)
* Usually need to ask more what?
Usually need to ask more questions about what precipitated the symptoms:
* Syncope associated with an arrhythmia is usually sudden
* Syncope from AS or orthostatic hypotension could be experienced upon standing from a seated position quickly
* Syncope from inner ear could be changing overall positions
* Syncope from vasovagal would be from bearing down
Edema (Fluid Retention)
* What can peripheral edema be caused by? (3)
- Congestive heart failure
- Valvular heart disease
- Venous insufficiency: Creates issues with lower extremity wounds, ambulation
Edema (Fluid Retention)
What can be cause Abdominal edema/ascites/bloating?
- Valvular heart disease
- Congestive heart failure
- Liver disease : Edema can create abdominal pain, enlarged liver, decreased appetite, diarrhea, jaundice, gut and hepatic dysfunction due to fluid engorgement (hepatic congestion)
When it comes to edema, what is important to ask patients?
Weight gain- important to ask patients about weight gain. How much and over what amount of time?
In order to know which kind of edema, what does it require you to ask?
◦ Timing?
◦ Position changes?
◦ Unilateral (DVT) or bilateral?
◦ Generalized edema or in one area? Onset acute or chronic?
◦ Medication history?
◦ Systemic disease?
What do you need to be worried about with position changes?
* When will edema not improve?
- Dependent edema caused by venous insufficiency improves with elevation or compression hose
- Edema associated with decreased plasma oncotic pressure (malabsorption, liver failure, nephrotic syndrome) does not change with dependency and will only improve once underlying condition addressed
Palpitations
* What is this?
* What cannot be appreciated?
- a subjective sensation of an irregular or abnormal heartbeat
- Normal resting cardiac activity usually cannot be appreciated
Palpitations:
* What does the patient feel?
* What is more and less common causes?
Perceived heart stopping transiently (pausing) or the occurrence of isolated forceful beats or both:
* More commonly caused by premature ventricular contractions PVC’s or PACs
* Pt feels either the compensatory pause or the resultant more forceful subsequent beat or both
* Less commonly caused by SVT or AF ( a sensation of a rapid heart rate that may be regular or irregular)
What is an hpi? What does it start with?
- Chronology of the events leading up to the patient’s current complaints.
- Start with chief complaint (CC) and then ask pertinent questions
Cardiac History:
* What is it important to assess?
Important to assess Cardiac/Atherosclerotic risk factors
* Atherosclerotic cardiovascular disease is the most common form of heart disease in industrialized nations
* Presenting signs and symptoms can range from unimpressive and minimal to sudden death.
What are the risk factors for cardiac disease? (8)
- Early FH of atherosclerotic disease, Men <55 years old, women <65
- DM, uncontrolled. Duration of time with DM
- Lipid disorders (especially elevated LDL)
- HTN, controlled vs uncontrolled
- Smoking
- Functional status: Lack of exercise
- high stress levels
- Obesity
Inspection for cardio:
* What do you need to look at for general appearance
* What are the two different chest wall deformities?
General appearance:
* distress? Skin (temperature, color), nails (splinter hemorrhages, Janeway lesions)
Chest wall deformities:
* Pectus excavatum – sternum sinks into the chest, concave
* Pectus carinatum- sternum projects forward, convex
Inspection for cardio:
* What may not be visible?
* What is used to estimate RA filling pressures? What can it be seen with?
PMI (point of maximal impulse) – may not be visible (feel like a pulse)
* You feel it if heart is enlarged and in HF
JVP – used to estimate RA filling pressures
* Can be seen with right sided HF, pericardial tamponade, PE
Palpations of cardio:
* What does the PMI give an estimate of?
* What is the location?
- Gives estimate on size of the heart
- Location: 4-5th intercostal space (nipple level) in mid clavicular line
Palpation: Thrills
* What is it?
* What does it signify?
* Cen be felt when?
Thrills – palpable murmur (Feels like a vibration, cat purring)
* Signifies at least a grade IV/VI murmur
* Can be felt in disease peripheral arterial vessels as well
Auscultation of cardio
* What are the points?
* What are the positions?
* Use both what and why?
- Listening to the key cardiac auscultation points
- Positional: seated upright, supine, left lateral decubitus
- Use both the bell and diaphragm
* The bell is most effective at transmitting lower frequency sounds
* diaphragm is most effective at transmitting higher frequency sounds.
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Vital signs: Blood Pressure
* What is one of the keystones of the of the cardiovascular physical exam?
* What is imperative?
* Dx of systemic HTN involves what?
* Orthostatic BP, the pt should be what?
Again: she skipped
Fill in
When checking a peripheral pulses, it tells you what? (3)
- Cardiac rate and rhythm
- Average of the blood pressure
- Assessment of the adequacy of the arterial conduit
What is the allen test?
Fill in
Vital signs:
Peripheral Pulse: Cardiac Rate and Rhythm
* Determine where?
* How do you find the rate?
- Determine in a convenient peripheral artery, such as radial
- Count for 15 seconds, then multiply x 4. Normal 60-100bpm
What are causes of tachy and bradycardia?
- Tachycardia: Strenuous exercise, fever, stress,anxiety, certain medications, street drugs can lead to sinus,anemia, overactive thyroid, or damage from aMI or CHF
- Bradycardia: SSS, complete heart block, natural aging, A response of the vagus nerve affecting the heart, High pressure inside the skull (intracranial pressure), MI, OSA, medications, hypothyroid
Rhythm
* Can assess what?
* Some cardiac contractions during rhythm disturbances do not do what?
- Can assess if pulse is regular, NSR or irregular, Afib
- Some cardiac contractions during rhythm disturbances do not generate a stoke volume sufficient to cause a palpable peripheral pulse
KNOW
Different strokes, different folks
* What does a Bounding high-amplitude carotid pulse mean?
* What does a weak carotid pulse mean?
* What does a low amplitude, slow rising pulse mean?
- Bounding high-amplitude carotid pulse suggest an increase in stroke volume and should be accompanied by a wide pulse pressure.
- Weak carotid pulse suggests a reduced stroke volume
- A low-amplitude, slow-rising pulse, may have thrill, suggests aortic stenosis
Strength of the pulse is graded how?
graded 1-4 on documentation for physical exam
* 1 is weak
* 2 is normal
* 3-4 is hyperdynamic
KNOW
Different strokes, different folks
* What does bifid pulse mean?
* What does dicotic pulse mean?
* What does Pulsus alternans pulse mean?
- A bifid pulse (beating twice in systole) can be a sign of hypertrophic obstructive cardiomyopathy, severe aortic regurgitation, or combo moderately severe aortic stenosis and regurgitation
- Dicrotic pulse (an exaggerated, early, diastolic wave) is found in severe heart failure
- Pulsus alternans (alternate strong and weak pulses) also a sign of severe ventricular heart failure, pericardial effusion
Vital signs: Peripheral pulse
* What should you check and why? What age group is this important in?
Special situations may check abdominal aorta and others
* Particularly important to palpate the abdominal aorta in older individuals because increase risk of abdominal aortic aneurysms in those >70 years old.
Vital signs: Peripheral pulse
* What are bruits? How do you hear it?
Bruits are a clue to significantly obstructed large arteries
* Bruits are sought with the stethoscope over carotids, abdominal aorta, and femoral arteries.
Vital signs: Jugular venous pulse
* What does it provide information about?
* Right internal jugular ideal for what?
* Characteristics of the right IJ pulse is valuable to assess what? What are the normal two waves?
- Provide information about the central venous pressure and right-heart function
- Right internal jugular ideal for assessing central venous pressure (attached directly to the SVC)
- Characteristics of the right IJ pulse is valuable for assessing right-heart function
* Normal venous pulse has two distinct waves: a and v
What are the jugular venous pressure waveform?
Physical exam: Edema
* What is edema?
* What is generalized edema? When does it occurs?
Edema- affecting 1 or 2 body areas
Generalized edema- affecting the whole body- more severe
* Anasarca: generalized accumulation of fluid in the interstitial space
* Occurs when there is a difference in oncotic pressure between the intravascular blood vessel and surrounding tissue. Hint: albumin
* Seen in: HF, renal failure, liver failure, or lymph conditions
Physical exam: Edema
* What happens with the heart?
Right-heart failure or venous return restricted from entering the heart
* venous pressure in the abdomen increases
* Leads to hepatosplenomegaly and eventually ascites
Physical exam: Edema
* Should focus on what?
* How do you document edema?
- Should focus on identifying the pattern of edema: bilateral, unilateral, etc
- Documenting edema: should identify the area, side, severity, warmth, redness, pain
Peripheral edema
* Detected by what?
* Pitting reflects what? Usually seen where?
* What does nonpitting edema suggest?
* Acute onset of unexplained Unilateral leg edema should raise suspicion of what?
* Ascites and then lower extremity edema in who?
- Detected by presence of pitting (pressure applied to area for at least 5 seconds)
- Pitting reflects movement of the excess interstitial water in response to pressure. Usually seen in dependent areas (lower extremities or in bed-bound, sacrum . Scrotal edema in males.
- Nonpitting edema suggests lymphatic obstruction or hypothyroidism
- should raise suspicion of DVT
- Ascites and then lower extremity edema in cirrhotic patients because of increased venous pressure below the diseased liver.
Physical Exam:Edema
* What can it be with redness, pain, warmth over area? (2)
* What does chronic venous insufficiency cause?
Redness, pain, warmth over area
* Acute DVT
* cellulitis
Chronic venous insufficiency:
* causes skin to have a brawny, reddish hue and commonly involves the medial malleolus
* Worsening has marked sclerotic and hyperpigmented tissue, may lead to venous ulcers over the medial malleolus. Ulcerations may progress to deep, weeping erosions.
Central Venous Pressure:
* Provides what?
* Used to do what?
* What is the normal range?
- Provides information about the filling pressure of the right side of the heart
- Used to assess fluid status and cardiac function
- Normally CVP range approximately 2-8 mmHg
Pulmonary artery pressure (PAP)
* Provides what?
* What is normal pressure?
* How do you measure it?
- Provides information about the function of the right side of the heart as well as pulmonary circulation
- Normal systolic pressure: approximately 15-30 mmHg, normal diastolic pressure 4-12mmHg
- Measured using a pulmonary artery catheter (swan-ganz catheter)
Mean arterial pressure (MAP)
* What does it reflect?
* What does it provide?
* How do you calculate MAP?
* What is the normal range?
* What do you need a min. MAP of?
- Reflects the average pressure in a person’s arteries during one cardiac cycle
- Provides insight into the overall perfusion pressure of the organs and tissues
- MAP = diastolic blood pressure + (1/3) x (systolic blood pressure – diastolic blood pressure)
- Normal range approximately 70-100mmHg
- A MAP of at least 60mmHg is generally considered necessary for adequate perfusion of vital organs such as the kidneys and brain
Cardiac Index (CI)
* What does it measure?
* What does it provide?
* What is the formula?
* What is the normal range?
* How do you measure it?
- Measures the cardiac output (CO) relative to a persons body surface area (BSA)
- Provides insight into how efficiently the heart is pumping blood relative to the size of the individuals body
- Formula: CI = CO/BSA
- Normal range 2.0-4.0 L/min/m2
- Typically measured using Swan-Ganz catheter
Cardiac output (CO)
* What does it measure?
* What is it a key indicator of?
* What is the formula?
* What is the normal range?
- Measures the volume of blood pumped by the heart in one minute
- Key indicator of the hearts ability to meet the body’s metabolic demands for oxygen and nutrients
- Formula: CO = HR x SV
- Normal cardiac output ranges from 4-8 L/min
Stroke Volume (SV)
* What is it?
* What is the formula?
* What is EDV and ESV?
- The volume of blood ejected by the left ventricle with each beat
- Formula: SV = EDV – ESV
- EDV: volume of blood in the ventricle at the end of diastole
- ESV: volume of blood in the ventricle at the end of systole
Systemic Vascular Resistance (SVR)
* What does it measure?
* What does it provide?
* What is the formula?
* What is the normal range?
- Measures the resistance offered by the systemic circulation to the flow of blood from the heart
- Provides insight into how hard the heart has to work to pump blood through the body’s vessels – resistance the heart must overcome to pump blood through the systemic circulation
- Formula: SVR = ((MAP – CVP)/ CO) x 80
- Normal range typically between 800-1200 dynes-sec/cm5
What is the normal heart sounds?
The cardiac cycle + normal heart sounds
* What is the only thing that you can hear on auscultation?
* Which sound is which?
Normally only the closing of the heart valves can be heard on auscultation
* Tricuspid and mitral valves (AV/atrioventricular valves) = S1 (occurs during systole)
* Aortic and Pulmonic valves (SL/semilunar valves) = S2 (occurs during diastole)
What is diastole and systole?
Period of ventricular filling = diastole
* AV valves are open and semilunar valves are closed (S2)
Period of ventricular contraction = systole
* AV valves closed and semilunar valves are open (S1)
What is S1 and S2?
- S1(Lub) aka open- best heard at the apex, mitral closes first – split sound- not appreciated well
- S2 (Dub) aka close- indicating end of systole- Best heard in aortic & pulmonic valve areas- Higher pitched & shorter in duration than S1- Louder than S1 in most areas except apex
Abnormal Heart Sounds: S3
* What is it caused by?
* Where can you hear it?
* When does it occur?
* Resembles what?
* Can be normal in who?
- Caused by rapid ventricular filling in early diastole (systolic failure) due to dilated/distended chamber
- Low-pitched, best heard with bell of stethoscope at apex in LLDP
- Occurs just after S2
- Resembles a galloping horse, “KENTUCKY”
- Can be a normal finding in children & young adults and pregnancy
When is S3 abnormal and why?
Abnormal in people >30 years of age, usually indicates
* LV dysfunction, Dilated Cardiomyopathy, s/p acute MI,
* Large PE
* Mitral or Tricuspid regurgitation
* diastolic volume overload from anemia,
* thyrotoxicosis
Fourth Heart Sound(S4)
* Occurs when?
* Where can it be heard?
* Can be what?
* Absent in who?
* Always what?
* What word can be used to help you remember?
- Occurs at the end of diastole (atrial kick)
- S4 occurs just before S1
- Low-pitched, best heard with bell at apex
- Can be left-or right-sided
- Absent in atrial fibrillation/flutter as there is no effective atrial contraction
- Always an abnormal heart sound
- “Tennessee” – the ten represents S4
Fourth Heart Sound(S4)
* What does it result from? What conditions?
Results from atrial contraction against a non-compliant stiff ventricle (diastolic dysfunction)
Associated conditions:
* Systemic hypertension (uncontrolled HTN)
* aortic stenosis
* HOCM
Fill in
Heart murmurs:
* Abnormal heart sounds heard during what?
* Generated by?
* 100% what?
- Abnormal heart sounds heard during systole or diastole
- Generated by the turbulent flow of blood across an abnormal valve (if valves are dysfunctional then you hear this)
- 100% physical exam finding
Fill in for grading murmurs
Innocent flow murmurs usually grades how?
* What groups do you see this in?
Innocent flow murmurs usually grades 1-2 and occur early is
systole
* Heard in 80% of children
* Pregnancy
* Adults who are thin of physically well trained
How we should think about murmurs
- When is the sound occurring during the Cardiac cycle?
- Duration?
- Characterisitcs?
- Intensity?
- What is another question you could ask?
Mid Systolic:
* Also termed what?
* begins how?
* What are examples?
- Also termed systolic ejection murmur (SEM)
- begins just after the S1 heart sound and terminates just before the P2 heart sound, so S1 and S2 will be distinctly audible.
- Ex: Innocent, aortic stenosis, HOCM, pulmonic stenosis, ASD
Holosystolic (pansystolic)
* Begins how?
* What are examples?
begins with or immediately after the S1 heart sound and extends up to the S2, making them difficult, if not impossible, to hear
* Ex: Mitral regurgitation, tricuspid regurgitation, VSD
Throughout
Late systolic
* begins how?
* What is the example?
begins significantly after S1 and may or may not extend up to the S2
* Ex: Mitral valve prolapse (into LA and comes back dt being bigger)
What are the midsystolic, holosystolic and late systolic murmurs?
What are the early diastolic, mid/late diastolic and other rare murmurs?
What is the austin flint murmer?
The Austin Flint murmur is a rumbling diastolic murmur best heard at the apex of the heart that is associated with severe aortic regurgitation and is usually heard best in the fifth intercostal space at the midclavicular line (bc you hear it hit the base of heart)
* MID TO LATE DIASTOLIC
Know
High-pitched murmur
* Heard best with what?
* What is the cause?
* What are examples?
- Heard best with the diaphragm of stethoscope
- Large pressure gradient across the pathologic lesion
- Example: Aortic Stenosis since large pressure gradient between LV and aorta
Low-pitched murmur
* Heard best when?
* What is the pressure gradient?
* What are examples?
- Heard best with the bell of the stethoscope
- pressure gradient is low.
- Example: mitral stenosis is low-pitched since there is a lower pressure gradient between the LA and the LV during diastole
How can you describe the sound of murmer?
Location of murmer
* Why is location important?
The anatomic location where the murmur is best heard is an important factor in determining the etiology of the lesio
What are all the different locations of listening points of the heart?
- A = aortic valve post (right upper-sternal border or RUSB)
- P = pulmonic valve post (left upper-sternal border or LUSB)
- T = tricuspid valve post (left lower-sternal border or LLSB)
- M = mitral valve post (apex)
- E = “Erb’s point”
Both the aortic and pulmonic listening posts are considered what?
are considered to be near the “base” of the heart.
Murmers:
* Usually most intense where?
* What are examples?
Dynamic Cardiac Maneuvers
Dynamic/improved auscultation
* Can be more accurate than what?
* Changes what?
- Can be more accurate than traditional method for dx of origin
- Changes the intensity, duration, and characteristics of the murmur by bedside maneuvers that alter hemodynamics
Dynamic Cardiac Maneuvers
Dynamic/improved auscultation
* The maneuver either does what? Give examples?
What are dyamic cardiac maneuvers?
Inspiration:
* Inspiration increases what? How?
* Murmurs increase and decrease? Why?
* Best done in what?
Squatting:
* Increases what?
* What murmur is increase? Why?
Squatting
* What murmur is decreased? Why?
Squatting
* What is preload?
* What is afterload?
standing:
* Decreases what?
* What murmur is increase? Decreased?
Valsalva
* Increases what pressure?
* What is markedly decreased?
* What happens to murmers? What is the exception?
Valsalva
* Perform for how long? why?
Perform only for MAX 10 seconds as these two murmurs will decrease over time and you don’t want to decrease cerebral and coronary blood flow for extended time
What is this:
* high-pitched, “diamond shaped” crescendo-decrescendo, midsystolic ejection murmur heard best at the right upper sternal border radiating to the neck and carotid arteries.
Aortic stenosis
What is this:
◦ high-pitched, “blowing” holosystolic murmur best heard at the apex.
◦ Mitral regurgitation
What is this:
* soft, high-pitched, early diastolic decrescendo murmur heard best at the 3rd intercostal space on the left (Erb’s point) on end expiration, with the patient sitting up and leaning forward.
Aortic regurgitation
Electrocardiography (ECG or EKG)
* What does is analysis?
* What type of disorders?
* What can it tell? (3)
◦ Analysis of cardiac rhythm
◦ Metabolic and Toxic disorders
◦ Chamber enlargement
◦ Acute coronary syndromes
◦ Conduction Abnormalities
ECG monitoring devices
* What is used in hospitals, ERs, between ambulance and ER?
* Cont. what?
* What is another type?
◦ Telemetry: used in hospitals, ERs, between ambulance and ER.
◦ Continuous recorders
◦ Intermittent recorders (loop recorders)
The role of wearable and implantable monitors
What is a pro and con of zio patch?
- Pro: ease of placement, monitor rhythm continuous for up to 14 days, comprehensive report, can shower/bathe and exercise
- Con: compliance with wearing
The role of wearable and implantable monitors
- What is the pros and cons of holter monitor?
- Pros: continuous rhythm monitoring, useful to assess heart rate control for patients with persistent/permanent Afib
- Cons: only worn for 24-48 hours, no getting the area wet, more cumbersome to wear (3-5 leads and device), interpreting repor
The role of wearable and implantable monitors
What is the pro and cons of 30 day event monitor?
- Pro: prolonged rhythm monitoring, smaller device, less leads to wear
- Cons: only records when triggered by patient or with auto trigger, no getting the area wet, interpreting report
The role of wearable and implantable monitors
What are the pros and cons implantable loop recorder?
- Pro: Multiple companies with products, evaluates rhythm continuously and can be patient activated as well, lasts for up to 3 years, small, does not disrupt every day life
- Cons: Surgical procedure to implant, may have monthly co- payments for monitoring services, interpreting results monthly
The role of wearable and implantable monitors
What is a smart watch and kardia?
Echocardiography (Echo)
* What are the two types?
* Ultrasound transducer placed where?
* Indicated in patients that need to detect what?
* Assess the function of what?
* Provides what?
- Transthoracic (TTE) vs Transesophageal (TEE)
- Ultrasound transducer placed various positions on anterior chest and obtain cross-sectional images of the heart and great vessels.
- Indicated in patients that need to detect anatomic abnormality of the heart and great vessels.
- Assess the function of cardiac chambers and valves through the cardiac cycle
- Provides objective measurements
Echocardiogram Benefits
* _ - Time
* Expensive and inexpensive?
* Available?
* Wealth of what?
* Noninvasive vs invasive?
* No risk of what?
* Can be performed where?
* Immediately available what?
* Can be combined with what?
Echocardiogram Disadvantages
* Dependent on what?
* Some patients have poor what? What are patient examples?
* Knowing which type of echo is needed to do what?
Transesophageal Echocardiography (TEE)
* What is it?
* Much higher what?
* Detects what?
Placement of smaller ultrasound probes for placement in the esophagus behind the heart
◦ Much higher resolution images of posterior cardiac structures
◦ Detects left atrial thrombi, small mitral valve vegetations, mitral valve anatomic abnormalities
Example of Echocardiogram Measurements GENERAL
* What are the variety of measurements to assess severity of Aortic Stenosis by Echo imaging? (3)
Example of Echocardiogram Measurements PERSONAL
* Variety of measurements to assess severity of Aortic Stenosis by Echo imaging?
- What is a doppler?
- Color-flow Doppler echocardiography is most commonly used. what does it show?
Magnetic Resonance Imaging (MRI)
* Comprehensive evaluation of what?
Magnetic Resonance Imaging (MRI)
* What is the advantage?
* Helpful for what?
- Advantage is no exposure to radiation or iodinated IV contrast,
Noniodinated gadolinium-based contrast agents used - Helpful for evaluating patients with poor-quality echo due to limited acoustic windows
