Doppler Ultrasound, PTCA, Cardiac Enzyme Studies


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These slides describe cardiovascular procedures such as Doppler ultrasound, percutaneous transluminal coronary angioplasty, and cardiac enzyme studies

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Doppler Ultrasound, PTCA, Cardiac Enzyme Studies

  1. 1. Doppler Ultrasound Percutaneous Transluminal Coronary Angioplasty (PTCA) Cardiac Enzyme Studies <ul><li>By Hana Jakubickova </li></ul>
  2. 2. Doppler Ultrasound <ul><li>A form of ultrasound that can detect and measure blood flow </li></ul><ul><li>Depends on the Doppler effect, a change in frequency of a wave resulting here from the motion of a reflector, the red blood cell </li></ul><ul><li>Named after Austrian physicist Christian Doppler who proposed Doppler effect in 1842 </li></ul>
  3. 3. Doppler Ultrasound
  4. 4. Doppler Ultrasound Description <ul><li>During Doppler ultrasound, a handheld instrument (transducer) is passed lightly over the skin above a blood vessel. </li></ul><ul><li>The transducer sends and receives sound waves that are amplified through a microphone. </li></ul><ul><li>The sound waves bounce off solid objects, including blood cells. </li></ul>
  5. 5. Doppler Ultrasound Description (cont.) <ul><li>The movement of blood cells causes a change in pitch of the reflected sound waves (Doppler effect). If there is no blood flow, the pitch does not change. </li></ul><ul><li>Information from the reflected sound waves can be processed by a computer to provide graphs or pictures that represent the flow of blood through the blood vessels. </li></ul>
  6. 7. Doppler Ultrasound Use <ul><li>Blood clots </li></ul><ul><li>Poorly functioning </li></ul><ul><li>valves in the leg veins, </li></ul><ul><li>which can cause blood or other fluids to pool in the legs (venous insufficiency) </li></ul>
  7. 8. Doppler Ultrasound Use (cont.) <ul><li>Heart valve defects and congenital heart disease </li></ul><ul><li>A blocked artery (arterial occlusion) </li></ul><ul><li>Decreased blood circulation into the legs (peripheral artery disease) </li></ul><ul><li>Bulging arteries (aneurysms) </li></ul><ul><li>Narrowing (stenosis) of an artery </li></ul>
  8. 9. Doppler Ultrasound of an Artery
  9. 10. Doppler Ultrasound Types <ul><li>Color Doppler - estimates the average velocity of flow within a vessel by color coding the information. The direction of blood flow is asigned by the color red or blue, indicating flow toward or away from the ultrasound transducer </li></ul>
  10. 11. Doppler Ultrasound Types (cont.) <ul><li>Duplex Doppler – uses standard ultrasound methods, and also a computer that converts the Doppler sounds into a graph. This graph gives information about the speed and direction of blood flow through the blood vessel being evaluated. </li></ul>
  11. 12. Doppler Ultrasound Types (cont.) <ul><li>Pulsed Doppler – this method allows a sampling volume or “gate” to be positioned in a vessel visualized on the gray-scale image, and displays a graph of the full range of blood velocities within the gate versus time. The amplitude of the signal is approximately proportional to the number of red blood cells and is indicated as a shade of gray </li></ul>
  12. 13. Doppler Ultrasound Types (cont.) <ul><li>Power Doppler – this device depicts the amplitude, or power, of Doppler signals rather than frequency shift. This allows detection of a larger range of Doppler shifts and thus better visualization (up to five times) of small vessels, but at the expense of directional and velocity information </li></ul>
  13. 14. Doppler Ultrasound Test <ul><li>Non-invasive </li></ul><ul><li>Safe - no known risk, will not harm a fetus </li></ul><ul><li>Little or no discomfort during the test (you may feel pressure of the inflated blood pressure cuff, if used; and, the gel may feel cold) </li></ul>
  14. 15. Percutaneous Transluminal Coronary Angioplasty (PTCA) <ul><li>Is performed to open blocked or narrowed </li></ul><ul><li>coronary arteries caused by coronary artery disease (CAD) </li></ul><ul><li>and to restore arterial </li></ul><ul><li>blood flow to the heart </li></ul><ul><li>tissue without open </li></ul><ul><li>heart surgery </li></ul>
  15. 16. PTCA Procedure <ul><li>A special catheter (long hollow tube) is inserted into the coronary artery to be treated. </li></ul><ul><li>This catheter has a tiny balloon as its tip. </li></ul><ul><li>The balloon is inflated once the catheter has been placed into the narrowed area of the coronary artery. </li></ul>
  16. 17. PTCA Procedure (cont.) <ul><li>The inflation of the </li></ul><ul><li>balloon compresses </li></ul><ul><li>the fatty tissue in </li></ul><ul><li>the artery and </li></ul><ul><li>makes a larger </li></ul><ul><li>opening inside the </li></ul><ul><li>artery for improved blood flow. </li></ul>
  17. 18. PTCA Procedure (cont.) <ul><li>The use of fluoroscopy (a special type of x-ray that obtains real- time </li></ul><ul><li>moving images) assists the </li></ul><ul><li>physician in the location of </li></ul><ul><li>blockages in the coronary </li></ul><ul><li>arteries as the contrast dye </li></ul><ul><li>moves through the arteries. </li></ul>
  18. 19. PTCA Procedure – Stent Placement <ul><li>Is a procedure used in PTCA </li></ul><ul><li>A tiny, expandable </li></ul><ul><li>metal coil (stent) is </li></ul><ul><li>inserted into the newly </li></ul><ul><li>opened area of the </li></ul><ul><li>artery to help keep the </li></ul><ul><li>artery from narrowing or closing again. </li></ul>
  19. 20. PTCA Risks of the Procedure <ul><li>Bleeding at the catheter insertion site (usually groin) </li></ul><ul><li>Blood clots or damage to the blood vessels at the insertion site </li></ul><ul><li>Blood clot within the vessel treated by PTCA/stent </li></ul>
  20. 21. PTCA Risks of the Procedure (cont.) <ul><li>Infection at the catheter insertion site </li></ul><ul><li>Cardiac arrhythmia (abnormal heart rhythm) </li></ul><ul><li>Myocardial infarction </li></ul><ul><li>Chest pain or discomfort </li></ul><ul><li>Rupture of the coronary artery </li></ul>
  21. 22. Cardiac Enzyme Studies <ul><li>Blood tests that measure the level of the enzyme creatine phosphokinase (CPK, CK) and the protein troponin (TnI, TnT) in the blood </li></ul><ul><li>Sometimes include the levels of lactate dehydrogenase (LDH) </li></ul><ul><li>and glutamic oxaloacetic </li></ul><ul><li>transaminase (GOT) </li></ul>
  22. 23. Cardiac Enzyme Studies (cont.) <ul><li>Low levels of these enzymes and proteins are normally found in the blood </li></ul><ul><li>If the heart muscle is injured (for example from heart attack), the enzymes and proteins leak out of damaged heart muscle cells, and their levels in the bloodstream rise </li></ul>
  23. 24. Cardiac Enzyme Studies Purpose of the Test <ul><li>To determine whether a person is having a heart attack or is threatened by a heart attack (unstable angina) </li></ul><ul><li>To check for injury to the heart after bypass surgery </li></ul><ul><li>To determine if a procedure (such as PTCA) has successfully restored blood flow through a blocked artery </li></ul>
  24. 25. Cardiac Enzyme Studies Results
  25. 26. Cardiac Enzyme Studies Results – General Guide <ul><li>Troponin (TnI and TnT) </li></ul><ul><li>Normal - TnI less than 0.3 micrograms/liter </li></ul><ul><li>TnT less than 0.1 micrograms/liter </li></ul><ul><li>Abnormal - typically rise within 4 to 6 hours after a heart attack, reach their highest levels within 10 to 24 hours </li></ul><ul><li>Falls to normal levels within 10 days </li></ul>
  26. 27. Cardiac Enzyme Studies Results – General Guide (cont.) <ul><li>Total Creatine phosphokinase (CPK) </li></ul><ul><li>Normal - </li></ul><ul><li>Men : 55 – 170 international units/liter </li></ul><ul><li>Women : 30 – 135 international units/liter </li></ul><ul><li>Abnormal – rise within 4 to 8 hours after a heart attack, reach their highest levels within 12 to 24 hours </li></ul><ul><li>Returns to normal within 3 to 4 days </li></ul>
  27. 28. Questions?
  28. 29. <ul><li>Sources </li></ul><ul><li>Wikipedia, the free encyclopedia (Last modified on June 19, 2009). Doppler Effect. Retrieved June 22, 2009, from </li></ul><ul><li> Definition of Doppler Ultrasound. Retrieved June 22, 2009, from </li></ul><ul><li>Stanford Medicine. Percutaneous Transluminal Coronary Angioplasty/Stent Placement. Retrieved June 22, 2009, from </li></ul><ul><li> </li></ul>