Cardiac biometry
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- Current guidelines for fetal echocardiography involve qualitative assessment of heart structures and standardized anatomic measurements if growth problems are suspected. - The document discusses statistical methods like percentiles and z-scores that can be used to determine normal cardiac parameters based on gestational age or fetal size measurements. - Two tables were developed to predict fetal cardiac dimensions and their standard deviations based on femoral length, menstrual age, or biparietal diameter, allowing calculation of z-scores to assess abnormality.
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Fetal biometry parameters are ultrasound measurements used to indirectly assess fetal growth and well-being, including biparietal diameter, head circumference, abdominal circumference, and femoral length. These measurements are used in formulas to estimate gestational age and fetal weight. Intrauterine growth restriction is defined as a birth weight below the 10th percentile for gestational age and can be symmetrical, affecting overall growth, or asymmetrical, primarily impacting abdominal growth. Ultrasound biometry, particularly abdominal circumference, allows accurate prenatal diagnosis of growth issues.
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Pearls and pitfalls presentation in ovarian torsion
Pearls and pitfalls presentation in ovarian torsionSpecial Fetal Care Unit Ain Shams University Hospital
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Metabolic bone disease
This document discusses metabolic bone diseases, including their composition, calcium and phosphate metabolism, and specific diseases. It provides details on osteoporosis, rickets/osteomalacia, Paget's disease, and renal osteodystrophy. The composition of bone includes collagen, proteoglycans, and hydroxyapatite. Calcium and vitamin D intake recommendations are outlined for different populations. PTH, calcitonin, vitamin D, and alkaline phosphatase roles in calcium regulation are summarized. Osteoporosis risk factors and management strategies are highlighted.
Cardiac enzymes
Cardiac enzymes are markers that are tested when myocardial infarction (MI) is suspected. While normally present, their levels significantly increase when there is damage to the heart muscle. Different enzymes peak at varying times after MI onset, from 3-4 hours for troponin T to 48-72 hours for lactic dehydrogenase. Drawing samples 6 hours apart can detect rising enzyme levels that help diagnose MI. Troponin I and Creatine Phosphokinase are highly specific for MI.
Presentation1.pptx, radiological imaging of skeletal dysplasia
This document provides radiological images and descriptions of several skeletal dysplasias. It discusses conditions such as cleidocranial dysplasia, which can cause respiratory distress in newborns. Other conditions summarized include osteopoikilosis, mucopolysaccharidoses, multiple epiphyseal dysplasia, metaphyseal dysplasia, spondyloepiphyseal dysplasia, chondroectodermal dysplasia, achondroplasia, fibrous dysplasia, and dysplasia epiphysealis hemimelica. For each condition, the document highlights features visible in imaging and clinical symptoms.
Skeletal dysplasia final
Skeletal dysplasias are a heterogeneous group of genetic disorders that result in abnormalities of bone or cartilage growth and structure. They occur due to mutations that affect endochondral ossification. Achondroplasia is the most common type of skeletal dysplasia and dwarfism, caused by mutations in the FGFR3 gene. It is characterized by disproportionate short stature with short arms and legs, frontal bossing of the head, midface hypoplasia, spinal stenosis and risks of neurological complications. Diagnosis is based on clinical and radiological findings including characteristic changes to the long bones, skull and vertebrae.
Z score presnetation
The document discusses z-scores and how they are used to standardize scores in a normal distribution. A z-score represents the number of standard deviations a data point is from the mean. It is calculated by subtracting the mean from the data value and dividing by the standard deviation. Examples are given to demonstrate how to calculate z-scores and use them to determine percentiles and the percentage of cases above or below a given score.
Radiological approach to Congenital skeletal dysplasia
This document provides an overview of skeletal dysplasias and their radiological diagnosis. It defines osteochondrodysplasias as abnormalities of bone and cartilage growth due to abnormal gene expression, and dysostoses as altered bone formation in the first 6 weeks of life with a fixed phenotype. International classifications of osteochondrodysplasias are described, along with imaging approaches for antenatal ultrasound and post-natal skeletal surveys. Specific skeletal dysplasias are then discussed in more detail based on their classification group, with a focus on characteristic radiological findings for each condition. The Radiological Electronic Atlas Of Malformation Syndromes And Skeletal Dysplasias (REAMS) is also introduced as an online
Z scores
In statistics, the standard score is the (signed) number of standard deviations an observation or datum is above the mean. Thus, a positive standard score represents a datum above the mean, while a negative standard score represents a datum below the mean. It is a dimensionless quantity obtained by subtracting the population mean from an individual raw score and then dividing the difference by the population standard deviation. This conversion process is called standardizing or normalizing (however, "normalizing" can refer to many types of ratios; see normalization (statistics) for more).Standard scores are also called z-values, z-scores, normal scores, and standardized variables; the use of "Z" is because the normal distribution is also known as the "Z distribution". They are most frequently used to compare a sample to a standard normal deviate (standard normal distribution, with μ = 0 and σ = 1), though they can be defined without assumptions of normality.
Skeletal dysplasia : Radiodiagnosis
A number of skeletal dysplasia are covered in this ppt with basic information and radiographic images.
Metabolic Bone Disease
This document summarizes various metabolic bone diseases. It discusses diseases of mineralization like osteomalacia and rickets, which are caused by deficiencies in vitamin D, phosphate, or calcium. It also covers diseases of bone turnover, including Paget's disease, hyperparathyroidism, and osteoporosis, which is characterized by low bone mineral content and increased fracture risk in the elderly. Finally, it briefly mentions diseases with high bone mineral content like osteopetrosis.
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H.A Regional examination Unit#02,Chapter#04.pptx
H.A Regional examination Unit#02,Chapter#04.pptxPKLI University- Institute of Nursing and Allied Health Sciences Lahore , Pakistan.
The document provides guidance on performing a physical examination, beginning with an overview of the general survey, vital signs, and pain assessment. It describes how to observe the patient's general appearance, measure vital signs like blood pressure and temperature, and evaluate pain. Key steps include observing the patient's state of health, dress, posture, and skin while ensuring accurate measurement of vital signs and thorough pain assessment using techniques like COLDERR. The document aims to guide healthcare practitioners in conducting a complete initial physical evaluation of the patient.H.A Regional examination Unit#02,Chapter#04.pptx
H.A Regional examination Unit#02,Chapter#04.pptxPKLI University- Institute of Nursing and Allied Health Sciences Lahore , Pakistan.
UNIT#02
Regional Examinations
C H A P T E R#04 (Part 1)
Beginning the Physical Examination:
General Survey, Vital Signs, and Pain
Presentation (2).pptx
This document provides an overview of techniques for examining the cardiovascular system in dogs, including:
1. Physical examination techniques like auscultation of heart sounds and palpation of the chest wall to detect murmurs, thrills, and abnormalities.
2. Diagnostic imaging tools like thoracic radiography to evaluate heart size and shape, and look for signs of pulmonary edema or effusion.
3. Electrocardiography to analyze heart rate, rhythm, and intervals to detect arrhythmias or chamber enlargement.
The document describes what each exam can reveal and how findings are interpreted to evaluate for heart disease and abnormalities.
IMAGING OF FETAL CVS AND ITS ANOMALIES
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- While VSD was initially suspected, further evaluation of the left ventricular outflow tract was needed as VSD can be associated with other conditions like transposition of the great arteries or tetralogy of Fallot.
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Normal chest x ray
This document provides guidance on interpreting a normal chest X-ray. It outlines key views (PA, AP, lateral), proper positioning, and critical structures to examine including the trachea, heart, lungs, diaphragm and bones. Specific points of analysis are described for each area, such as ensuring 5-7 visible ribs on inspiration. Assessment approaches are given like the cardio-thoracic ratio and recognizing under or over-penetration. The document emphasizes having a systematic process and focusing on prominent rather than rare findings when interpreting chest X-rays.
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This document discusses the assessment, investigation, and treatment of chronic stable angina. It defines chronic stable angina as chest pain or discomfort that is reproducibly associated with exertion or stress and relieved by rest. The document outlines how to evaluate patients presenting with chest pain through history, physical exam, risk factor assessment, and probability estimation models. It recommends initial tests like ECG, cardiac biomarkers, and stress testing. Treatment focuses on lifestyle changes, medications like aspirin, beta-blockers, calcium channel blockers, and revascularization if needed. Regular patient follow up and education are also emphasized.
cradiovascular_system.ppt
The document provides an overview of the cardiovascular system, including the heart structures and circulation. It describes the layers of the heart, chambers, valves, conduction system, and blood vessels. Assessment techniques for the cardiovascular system are covered, such as inspection, palpation, percussion, and auscultation of various anatomical locations. Abnormal cardiovascular findings and objectives for promoting cardiovascular health are also summarized.
cradiovascular_system.ppt
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BLOOD PRESSURE-WPS Office.pptx
Blood pressure is routinely measured and has four main components - systolic, diastolic, equipment (sphygmomanometer and stethoscope), and measurement procedures. It can be measured invasively or non-invasively. Non-invasive methods include auscultation, palpation, and oscillometry. Precautions must be taken to ensure accurate readings, and it is indicated for screening, monitoring treatment effectiveness, and assessing medical risks. Proper technique and regular measurement are essential for patient care and management.
Chapter 5
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Chapter 5
The cardiovascular system ensures that muscles and bones receive oxygenated blood. Common procedures to evaluate heart health include stress testing, nuclear heart scans, and echocardiography. Stress testing monitors the heart's response to physical exertion to detect issues like coronary heart disease. Nuclear heart scans use radioactive tracers and cameras to capture heart images at rest and under stress to evaluate muscle damage, pumping ability, and blood flow. Echocardiography uses ultrasound to create moving pictures of the heart to examine valves, structure, muscle function, and blood clots. Regular checkups using these non-invasive procedures can help prevent dangerous heart issues.
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Presentation2.pptx technique chest 2
Technique Of Chest Radiography
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Heart valve disease
In heart valve disease, one or more of the valves in your heart doesn't work properly.
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Your heart valve disease treatment depends on the heart valve affected and the type and severity of the valve disease. Sometimes heart valve disease requires surgery to repair or replace the heart valve.Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (leaflets or cusps) that open and close once during each heartbeat. Sometimes, the valves don't open or close properly, disrupting the blood flow through your heart to your body.
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Stenosis. In valve stenosis, the valve flaps become thick or stiff, and they may fuse together. This results in a narrowed valve opening and reduced blood flow through the valve.
Atresia. In this condition, the valve isn't formed, and a solid sheet of tissue blocks the blood flow between the heart chambers.Several factors can increase your risk of heart valve disease, including:
Older age
History of certain infections that can affect the heart
History of certain forms of heart disease or heart attack
High blood pressure, high cholesterol, diabetes and other heart disease risk factors
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Death
cardiac catheterization and coronary angiography (1).pptx
Cardiac catheterization is a common outpatient procedure that provides information about heart conditions by inserting a catheter into the heart. It can measure pressures, oxygen levels, and assess ventricular function and wall motion. The procedure involves inserting a catheter into veins or arteries to access the right and left sides of the heart. Coronary angiography uses dye and x-rays to visualize the coronary arteries and diagnose blockages. Risks include heart attack, stroke, infection and kidney damage.
cardiac catheterization and coronary angiography (1).pptx
Cardiac catheterization is a common outpatient procedure that provides information about heart conditions by inserting a catheter into the heart. It can measure pressures, oxygen levels, and assess ventricular function and wall motion. The procedure involves inserting a catheter into veins or arteries to access the right and left sides of the heart. Coronary angiography uses dye and x-rays to visualize the coronary arteries and diagnose blockages. Risks include heart attack, stroke, infection and kidney damage.
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Overview of the uses of sonoelastography in Gynecology
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Normal early pregnancy imaging
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Sonoelastography of the uterine cervix as a new
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Cardiac biometry
- 1. Cardiac Biometry Dr. Omneya Nagy Elmakhzangy Special Fetal Care Unit Ain Shams University
- 2. • Current practice guidelines for fetal echocardiography are largely based on a qualitative assessment of heart structures using standardized procedures that may include anatomic measurements for suspected growth problems.
- 4. Statistical methods for determing normal cardiac parameters
- 5. Percentiles • A percentile (or a centile) is a measure used in statistics indicating the value below which a given percentage of observations in a group of observations fall
- 6. Z-score • A Z-Score is a statistical measurement of a score's relationship to the mean in a group of scores. A Z-score of 0 means the score is the same as the mean. A Z-score can also be positive or negative, indicating whether it is above or below the mean and by how many standard deviations.
- 8. Percentile or z-score? • From a practical perspective, it is much easier to interpret an aortic valve diameter that is2.5 standard deviations (SDs) below the mean as opposed to simply knowing that measurement is less than the 5th percentile for somatic size or MA.
- 9. Normalization according to what? • In fetal life, centiles are usually normalized to gestational age. However, as the size of the fetus can vary hugely with a several-fold difference by late pregnancy. • Interpretation of the size of the various cardiac structures requires normalization against some parameter of fetal size.(BPD, FL )
- 10. Components of Cardiac Biometry . How to measure ? And How to interpret?
- 11. Aortic and pulmonary valve annulus • When? During ventricular systole • Where ? Just below the level of the cusps of the valve • Normal: Aortic valve is equal to or slightly smaller than pulmonary valve
- 12. Long-axis view of the left ventricle showing the aortic valve Short-axis view, showing the pulmonary valve
- 13. Aortic Valve Pulmonary valve
- 14. Tricuspid and Mitral valve annulus • When ? During ventricular Diastole • Where? Just below the level of the cusps • Normal : Mitral valve is equal to or slightly smaller than tricuspid valve
- 16. Right and left ventricular length • Should be equal . The length is measured above levels of the cusps •
- 17. Cardiothoracic circumference ratio • Measured in the standard 4 chamber view • The CT circumference ratio should be always less then 0.5 throughout gestation. It slowly increased through gestation • ~ 11 weeks: 0.38 • ~ 17-20 weeks: 0.45 • term: 0.5
- 18. Aortic arch and isthmus diameter
- 19. Main pulmonary artery and ductus arteriosus measurements
- 20. End-diastolic ventricular diameter • Where? just inferior to the atrioventricular valve leaflets
- 21. Thickness of the ventricular free walls and interventricular septum • Where? just inferior to the atrioventricular valves.
- 22. • Additional measurements if warranted, including: • ο Systolic dimensions of the ventricles; • ο Transverse dimensions of the atria; and • ο Diameters of branch pulmonary arteries.
- 23. Determining the standard Deviation (z- score)
- 24. The Lee. et al study (2009) • A retrospective cross-sectional study of 2735 fetuses was performed for standard biometry (biparietal diameter (BPD) and femoral diaphysis length (FDL)) and an assessment of menstrual age (MA). • The goal :The main goal was to develop new z- score reference ranges for common fetal echocardiographic measurements
- 25. Parameter Slope Intercep t Correlation coefficient Femoral diaphysis length Aortic valve end-systolic diameter 0.0054 0.239 0.904 Pulmonary valve end-systolic diameter 0.0103 0.150 0.994 Left ventricular end-diastolic diameter 0.0135 0.395 0.991 Right ventricular end-diastolic diameter 0.0138 0.466 0.952 End-diastolic cardiac circumference 0.145 0.700 0.990 Menstrual age Aortic valve end-systolic diameter 0.0165 0.064 0.948 Pulmonary valve end-systolic diameter 0.0253 −0.048 0.990 Left ventricular end-diastolic diameter 0.0394 0.059 0.993 Right ventricular end-diastolic diameter 0.0394 0.132 0.962 End-diastolic cardiac circumference 0.341 −1.456 0.992 Biparietal diameter Aortic valve end-systolic diameter 0.0063 0.111 0.940 Pulmonary valve end-systolic diameter 0.0091 0.0338 0.988 Left ventricular end-diastolic diameter 0.0125 0.248 0.974 Right ventricular end-diastolic diameter 0.0147 0.198 0.988 End-diastolic cardiac circumference 0.118 −0.178 0.994
- 27. Forget about tables • In summary : 2 tables were developed • 1-Linear models for prediction of fetal cardiac dimensions based on femoral diaphysis length, menstrual age and biparietal diameter • 2-Linear models for predicted standard deviations of fetal cardiac dimensions based on femoral diaphysis length, menstrual age and biparietal diameter • Somehow put these two together you get an equation to calculate the z-score • Once u got your z-score you now can know the standard deviation of your measurement from the mean value for this measurement .
- 28. • Clinical example for z-score calculation • Femoral diaphysis length (FDL) = 30 mm • Aortic valve (Ao) diameter = 3.5 mm • From Table 1 • Predicted Ao diameter = (0.119 × 30) − 0.577 = 3.0 mm • From Table 2 • Predicted SD = (0.0054 × 30) + 0.239 = 0.4 mm • z =Aoobserved − Aopredicted = 3.5 − 3.0 = 1.25 Predicted SD 0.4 • The aortic diameter z-score is +1.25 SDs above the predicted mean for this femur length and therefore is within the normal range.
- 29. Do I need to do this?? • Luckily “NO” • All what you need is to get your measurements and a software on your machine will do the math.