This document provides information on various cardiovascular tests used to assess heart function and identify heart disorders. It discusses the following tests: medical history and physical examination, laboratory tests of cardiac enzymes and biomarkers, chest radiography, electrocardiography, echocardiography, exercise stress testing, pharmacologic stress testing, and cardiac catheterization. For each test, the document outlines the procedure, what is evaluated, and normal versus abnormal findings.
This document provides information on various cardiovascular tests used to assess heart function. It discusses taking a medical history and conducting a physical exam, including vital signs and heart and lung auscultation. It also outlines several laboratory tests that analyze cardiac biomarkers and enzymes. Additional tests covered include chest x-ray, electrocardiography, echocardiography, exercise stress testing, and cardiac catheterization. Reference values are provided for common cardiac biomarkers like troponin, CK-MB, BNP, and LDH.
This document provides information on various cardiac function tests. It discusses definitions, vital signs assessment including blood pressure, electrocardiograms (ECGs), physical examinations, laboratory tests such as cardiac enzyme and cholesterol tests, and cardiac imaging modalities like echocardiography, CT scans, MRIs, cardiac catheterization, and nuclear imaging. These tests are used to identify heart conditions, evaluate potential heart-related problems, and assess cardiac function and health.
Diagnostic tests are used in cardiology to confirm data from a patient's history and physical assessment. Common tests include blood studies to detect cardiac biomarkers released during injury, imaging studies like echocardiograms and CT scans to visualize the heart structures, and stress tests to evaluate the heart's response to physical or pharmacological stress. Electrocardiograms are also routinely performed to analyze the heart's electrical activity. More invasive procedures like cardiac catheterization can further evaluate conditions and guide treatment. The results of diagnostic tests along with the clinical picture are important for cardiologists to diagnose and manage cardiovascular conditions.
The document discusses cardiac function and testing, focusing on coronary artery disease (CAD) and acute coronary syndrome (ACS). It describes how the heart works normally and what goes wrong in CAD and ACS. Key points include: the heart has electrical and mechanical properties to pump blood through the body; CAD occurs when coronary arteries narrow from atherosclerosis, limiting blood flow; ACS occurs when not enough blood reaches the heart due to a blockage from a plaque rupture; electrocardiograms and cardiac biomarkers help diagnose ACS and determine its type and severity.
Case-1: a 45 years old gentleman presented with this ECG during his follow up in the chamber. He is hypertensive and getting beta-blocker to control of his hypertension
Case-2: A 25 years old gentleman presented with several episodes of diarrhea and vomiting for last 12 hours. He had the following ECG. His K+ level was 2.8 meq/L. .
The U wave is a small (0.5 mm) deflection immediately following the T wave
U wave is usually in the same direction as the T wave.
U wave is best seen in leads V2 and V3.
Many of the conditions causing prominent U waves will also cause a long QT.
Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. Find a good presentation on Acute myocardial infarction here.
Sudden cardiac death is defined as an abrupt loss of consciousness within one hour of the onset of symptoms due to a cardiac cause. The main risk factors include age, race, sex, hereditary factors, lifestyle like smoking and obesity, left ventricular dysfunction, and ventricular arrhythmias. The most common causes are coronary artery disease, cardiomyopathies, acute heart failure, and electrophysiological abnormalities. Management of cardiac arrest focuses on continuous cardiopulmonary support, early defibrillation if needed, advanced life support including intubation, medications, and post-cardiac arrest care like therapeutic hypothermia. The goal is to restore spontaneous circulation and hemodynamic stability through these interventions.
This document provides information on various cardiovascular tests used to assess heart function. It discusses taking a medical history and conducting a physical exam, including vital signs and heart and lung auscultation. It also outlines several laboratory tests that analyze cardiac biomarkers and enzymes. Additional tests covered include chest x-ray, electrocardiography, echocardiography, exercise stress testing, and cardiac catheterization. Reference values are provided for common cardiac biomarkers like troponin, CK-MB, BNP, and LDH.
This document provides information on various cardiac function tests. It discusses definitions, vital signs assessment including blood pressure, electrocardiograms (ECGs), physical examinations, laboratory tests such as cardiac enzyme and cholesterol tests, and cardiac imaging modalities like echocardiography, CT scans, MRIs, cardiac catheterization, and nuclear imaging. These tests are used to identify heart conditions, evaluate potential heart-related problems, and assess cardiac function and health.
Diagnostic tests are used in cardiology to confirm data from a patient's history and physical assessment. Common tests include blood studies to detect cardiac biomarkers released during injury, imaging studies like echocardiograms and CT scans to visualize the heart structures, and stress tests to evaluate the heart's response to physical or pharmacological stress. Electrocardiograms are also routinely performed to analyze the heart's electrical activity. More invasive procedures like cardiac catheterization can further evaluate conditions and guide treatment. The results of diagnostic tests along with the clinical picture are important for cardiologists to diagnose and manage cardiovascular conditions.
The document discusses cardiac function and testing, focusing on coronary artery disease (CAD) and acute coronary syndrome (ACS). It describes how the heart works normally and what goes wrong in CAD and ACS. Key points include: the heart has electrical and mechanical properties to pump blood through the body; CAD occurs when coronary arteries narrow from atherosclerosis, limiting blood flow; ACS occurs when not enough blood reaches the heart due to a blockage from a plaque rupture; electrocardiograms and cardiac biomarkers help diagnose ACS and determine its type and severity.
Case-1: a 45 years old gentleman presented with this ECG during his follow up in the chamber. He is hypertensive and getting beta-blocker to control of his hypertension
Case-2: A 25 years old gentleman presented with several episodes of diarrhea and vomiting for last 12 hours. He had the following ECG. His K+ level was 2.8 meq/L. .
The U wave is a small (0.5 mm) deflection immediately following the T wave
U wave is usually in the same direction as the T wave.
U wave is best seen in leads V2 and V3.
Many of the conditions causing prominent U waves will also cause a long QT.
Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. Find a good presentation on Acute myocardial infarction here.
Sudden cardiac death is defined as an abrupt loss of consciousness within one hour of the onset of symptoms due to a cardiac cause. The main risk factors include age, race, sex, hereditary factors, lifestyle like smoking and obesity, left ventricular dysfunction, and ventricular arrhythmias. The most common causes are coronary artery disease, cardiomyopathies, acute heart failure, and electrophysiological abnormalities. Management of cardiac arrest focuses on continuous cardiopulmonary support, early defibrillation if needed, advanced life support including intubation, medications, and post-cardiac arrest care like therapeutic hypothermia. The goal is to restore spontaneous circulation and hemodynamic stability through these interventions.
The QT interval is the time from the start of the Q wave to the end of the T wave.
It represents the time taken for ventricular depolarisation and repolarisation, effectively the period of ventricular systole from ventricular isovolumetric contraction to isovolumetric relaxation.
Case-1: A 23 years old gentleman presented with generalized weakness and fatigue , 2 hours after several bouts of vomiting and diarrhea. His serum potassium was 2.3 mEq/L and he had the following ECG.
Case-1: A 45 years old lady presented with sudden severe chest discomfort with excessive sweating for last 2 hours. She was diabetic and dyslipidemic and hypertensive. She had history of taking oral contraceptive pills (OCP).. She had the following ECG.
Case: A 34 years old lady presented with shortness of breath , chest discomfort, palpitations , cough, fever , joint pain and skin rash. Her CXR showed nodular lesion in lung field and cardiomegaly. Her serum BNP level was raised. Her echocardiography showed dilated cardiomyopathy with low ejection fraction. She had the following ECG.
Case: A 34 years old lady presented with shortness of breath , chest discomfort, palpitations , cough, fever , joint pain and skin rash. Her CXR showed nodular lesion in lung field and cardiomegaly. Her serum BNP level was raised. Her echocardiography showed dilated cardiomyopathy with low ejection fraction. She had the following ECG.
Case: A 51 years old gentleman presented with occasional chest discomfort. He was diabetic and smoker. He had a history of myocardial infarction 6 weeks back. He had the following ECG.
This document discusses normal cardiac electrophysiology and the mechanisms of arrhythmias. It begins by describing the normal sinus rhythm and the role of ion channels and gap junctions. It then explains the cardiac action potential and factors that determine the resting membrane potential. Different types of abnormal impulse formation are described, including abnormal automaticity, triggered activity, and reentry. The document outlines evaluation and management of arrhythmias and discusses specific arrhythmias like atrial fibrillation, SVT, and VT. In summary, it provides an overview of cardiac electrophysiology, mechanisms of arrhythmias, evaluation, and treatment approaches.
Case-1: ECG with Normal axis ; Case-2: ECG with left axis deviation
Case-3: ECG with extreme right axis deviation
Case-4: ECG with right axis deviation
Clinical significance of cardiac axis
What is Electrical Axis? Types of electrical axis
What are the Methods of ECG Axis Interpretation? How ECG axis can be determined?
How Ventricular (QRS) Axis is determined in Bundle Branch Blocks ?
What is Undetermined axis/ Indeterminate axis?
What are the causes of abnormal heart axis?
What are the causes of Right Axis Deviation(RAD)?
What are the causes of Left Axis Deviation?
What are the causes of Extreme Axis Deviation (indeterminate axis/ northwest axis)?
This document discusses risk factors, stages, management, and treatment of sudden cardiac death (SCD). It identifies key risk factors for SCD including older age, male sex, coronary artery disease history, high cholesterol, hypertension, smoking, and abnormal heart rhythms. The stages of SCD are described as prodromal, acute symptoms, and circulatory disturbances leading to biological death. Management involves evaluating the patient, performing CPR, using defibrillation and other advanced life support measures, post-resuscitation treatment, and long-term management. Specific protocols are provided for basic life support including CPR, advanced life support, and treating ventricular tachycardia or fibrillation.
This document provides an overview of various cardiac diagnostic tests, including electrocardiograms (ECGs), chest x-rays, stress tests, echocardiograms, nuclear stress tests, Holter monitors, event recorders, PET scans, cardiac catheterization, cardiac MRI, and intravascular ultrasound. It describes what each test is used to evaluate, such as heart size, function, blood flow, or blockages in the coronary arteries. The sensitivity and specificity are provided for some tests. A variety of stress tests are discussed, including treadmill, bicycle, pharmacological, and tilt table tests.
Prepared by MD, PhD., Associate Professor, Marta R. Gerasymchyk, pathophysiology department of Ivano-Frankivsk National Medical University, Ukraine.
For medical students
The document provides an overview of cardiology basics and the physical exam of the heart. It discusses the importance of the heart in pumping blood and removing waste. Key points include:
- The heart's function is determined by cardiac output, which depends on stroke volume and heart rate.
- Auscultation of heart sounds can detect murmurs or arrhythmias while lung sounds may reveal crackles or wheezes.
- Physical exam also involves assessing vital parameters and looking for signs of dyspnea or weakness.
- Common cardiac conditions addressed include murmurs, arrhythmias, congestive heart failure, and atrial thromboembolism in cats.
Cardio-oncology chemotherapy induced cardiomyopathy cases no 2asadsoomro1960
1) This document discusses two cases of chemotherapy-induced cardiomyopathy. The first was a rapidly progressive "tiger heart failure" that led to death before advanced therapies could be applied.
2) The second case involved a man who developed heart failure 17 years ago after chemotherapy for lymphoma but has survived longer through multiple stages of heart failure with guideline-directed medical therapies and devices like CRTD.
3) The author argues that with new treatments like Sacubitril, heart failure may be considered a complex chronic syndrome rather than always a "malignant" condition as was once thought.
This document discusses various cardiac function tests used to evaluate heart health and function. It describes tests such as electrocardiography (ECG), echocardiography, cardiac catheterization, chest X-rays, MRI scans, and cardiac enzyme tests. ECG records the heart's electrical activity to detect abnormalities. Echocardiography uses ultrasound to image the heart's structure and function. Cardiac catheterization directly examines blood flow and pressures within the heart. Chest X-rays and MRI scans provide anatomical images of the heart. Cardiac enzyme tests like CK-MB and troponin levels indicate heart muscle damage. These tests are used to understand and diagnose heart diseases, injuries, and abnormalities.
Case-1:
A 23 years old medical student presented with occasional palpitation, shortness of breath and chest discomfort. He had the following ECG.
A 53 years old gentleman presented with palpitations for last 5 hours. He is smoker, diabetic, dyslipidemic and hypertensive. He had exertional chest discomfort for last 5 years and did coronary angiogram 3 years back and CAG revealed TVD and advised for revascularization. But he refused and was irregular in medication and reluctant for life style modification. He came to emergency department with this ECG.
The document summarizes the past, present, and future of heart failure treatment. In the past (1950s-1970s), treatment focused on rest, sodium restriction, and drugs like digitalis and diuretics. Currently (2000s), guidelines recommend optimal medical therapy including ACE inhibitors, ARBs, beta-blockers, diuretics, and devices like ICDs, CRT, and LVADs which have improved outcomes. The future holds promise for gene and cell-based therapies, left ventricular assist devices, and prevention through understanding of genetic factors influencing heart failure.
The PR interval is the time from the onset of the P wave to the start of the QRS complex.
It reflects conduction through the AV node.
The normal PR interval is between 120 – 200 ms (0.12-0.20s) in duration (three to five small squares).
If the PR interval is > 200 ms, first degree heart block is said to be present.
PR interval < 120 ms suggests pre-excitation (the presence of an accessory pathway between the atria and ventricles) or AV nodal (junctional) rhythm.
Heart muscle disease, is a type of progressive heart disease in which the heart is abnormally enlarged, thickened, and/or stiffened. As a result, the heart muscle's ability to pump blood is less efficient, often causing heart failure and the backup of blood into the lungs or rest of the body.
This document describes various cardiac diagnostic tests including imaging tests and blood tests. It provides details on procedures like chest x-rays, echocardiograms, cardiac catheterization, CT scans, and blood tests like cardiac enzymes and electrolyte levels. Precise positioning of patients and monitoring of vital signs during and after procedures is emphasized to obtain clear images and ensure patient safety.
This document provides information on congestive heart failure (CHF). It begins by defining heart failure and CHF, noting that CHF is characterized by abnormalities in left ventricular function and neurohormonal regulation that cause effort intolerance, fluid retention, and reduced longevity. The document then discusses the pathophysiology of CHF, explaining that it can be caused by conditions like hypertension, diabetes, or myocardial infarction. It also describes the body's compensatory mechanisms in response to reduced cardiac output, such as increased sympathetic discharge, activation of the renin-angiotensin-aldosterone system, and cardiac remodeling. Finally, it lists some common clinical manifestations of CHF like fluid retention, pulmonary congestion, and dysp
This document summarizes key points from an ACLS continuing education presentation on treating acute coronary syndromes. It discusses the importance of BLS/CPR in the chain of survival for cardiac arrest patients. Early recognition, bystander CPR, early defibrillation if VFib/VTach present, and post-resuscitation care including hypothermia treatment and reperfusion if STEMI are critical for good outcomes after ROSC. The document reviews AHA guidelines for cardiac arrest treatment including defibrillation and drug therapy like epinephrine and amiodarone for shockable rhythms and epinephrine for non-shockable rhythms like asystole/PEA.
The document provides an overview of electrocardiogram (ECG) interpretation. It discusses how ECG is an important diagnostic tool that represents the heart's electrical activity. It then covers the steps for interpreting an ECG, including assessing the rate, rhythm, P waves, PR interval, QRS duration, ST segments, T waves, and changes that can indicate conditions like myocardial infarction. The document emphasizes how analyzing ECG findings can provide clinical insights, such as determining whether a patient may benefit from interventions like thrombolysis.
Cardiac diagnostic procedures include laboratory tests, scans, and function tests. Laboratory tests measure cardiac enzyme levels in the blood to detect heart muscle damage from conditions like myocardial infarction. Cardiac scans use radioactive tracers and imaging equipment to visualize the heart and determine myocardial damage, especially following a stress test. Electrocardiograms are a noninvasive way to diagnose heart problems by recording and monitoring the heart's electrical activity and detecting irregularities, defects, or damage.
1. Electrocardiography records the electrical activity of the heart and is used to detect cardiac disorders like myocardial infarction. Biomarkers released after heart muscle cell damage are measured from blood tests to diagnose conditions.
2. Common biomarkers for detecting myocardial infarction include cardiac troponins, CK-MB, myoglobin which are elevated at different time periods after symptoms begin. Imaging tests like echocardiography and cardiac catheterization evaluate the heart's structure and function.
3. Stress tests physically or pharmacologically stress the heart to detect ischemia, and coronary angiography uses contrast dye to visualize blockages in heart arteries. Various biomarkers, imaging, and stress tests are used to diagnose and manage cardiac disorders.
This document provides an overview of cardiac anatomy, physiology, and assessment. It discusses the components of the cardiac conduction system including the sinoatrial node, atrioventricular node, bundle of His, and Purkinje fibers. It also describes how electrocardiograms work and the parts of an ECG strip. Key aspects of cardiac function like contractility, preload, afterload, and stroke volume are defined. The document outlines steps for assessing a patient's cardiac status including vital signs, risk factors, and diagnostic tests.
The QT interval is the time from the start of the Q wave to the end of the T wave.
It represents the time taken for ventricular depolarisation and repolarisation, effectively the period of ventricular systole from ventricular isovolumetric contraction to isovolumetric relaxation.
Case-1: A 23 years old gentleman presented with generalized weakness and fatigue , 2 hours after several bouts of vomiting and diarrhea. His serum potassium was 2.3 mEq/L and he had the following ECG.
Case-1: A 45 years old lady presented with sudden severe chest discomfort with excessive sweating for last 2 hours. She was diabetic and dyslipidemic and hypertensive. She had history of taking oral contraceptive pills (OCP).. She had the following ECG.
Case: A 34 years old lady presented with shortness of breath , chest discomfort, palpitations , cough, fever , joint pain and skin rash. Her CXR showed nodular lesion in lung field and cardiomegaly. Her serum BNP level was raised. Her echocardiography showed dilated cardiomyopathy with low ejection fraction. She had the following ECG.
Case: A 34 years old lady presented with shortness of breath , chest discomfort, palpitations , cough, fever , joint pain and skin rash. Her CXR showed nodular lesion in lung field and cardiomegaly. Her serum BNP level was raised. Her echocardiography showed dilated cardiomyopathy with low ejection fraction. She had the following ECG.
Case: A 51 years old gentleman presented with occasional chest discomfort. He was diabetic and smoker. He had a history of myocardial infarction 6 weeks back. He had the following ECG.
This document discusses normal cardiac electrophysiology and the mechanisms of arrhythmias. It begins by describing the normal sinus rhythm and the role of ion channels and gap junctions. It then explains the cardiac action potential and factors that determine the resting membrane potential. Different types of abnormal impulse formation are described, including abnormal automaticity, triggered activity, and reentry. The document outlines evaluation and management of arrhythmias and discusses specific arrhythmias like atrial fibrillation, SVT, and VT. In summary, it provides an overview of cardiac electrophysiology, mechanisms of arrhythmias, evaluation, and treatment approaches.
Case-1: ECG with Normal axis ; Case-2: ECG with left axis deviation
Case-3: ECG with extreme right axis deviation
Case-4: ECG with right axis deviation
Clinical significance of cardiac axis
What is Electrical Axis? Types of electrical axis
What are the Methods of ECG Axis Interpretation? How ECG axis can be determined?
How Ventricular (QRS) Axis is determined in Bundle Branch Blocks ?
What is Undetermined axis/ Indeterminate axis?
What are the causes of abnormal heart axis?
What are the causes of Right Axis Deviation(RAD)?
What are the causes of Left Axis Deviation?
What are the causes of Extreme Axis Deviation (indeterminate axis/ northwest axis)?
This document discusses risk factors, stages, management, and treatment of sudden cardiac death (SCD). It identifies key risk factors for SCD including older age, male sex, coronary artery disease history, high cholesterol, hypertension, smoking, and abnormal heart rhythms. The stages of SCD are described as prodromal, acute symptoms, and circulatory disturbances leading to biological death. Management involves evaluating the patient, performing CPR, using defibrillation and other advanced life support measures, post-resuscitation treatment, and long-term management. Specific protocols are provided for basic life support including CPR, advanced life support, and treating ventricular tachycardia or fibrillation.
This document provides an overview of various cardiac diagnostic tests, including electrocardiograms (ECGs), chest x-rays, stress tests, echocardiograms, nuclear stress tests, Holter monitors, event recorders, PET scans, cardiac catheterization, cardiac MRI, and intravascular ultrasound. It describes what each test is used to evaluate, such as heart size, function, blood flow, or blockages in the coronary arteries. The sensitivity and specificity are provided for some tests. A variety of stress tests are discussed, including treadmill, bicycle, pharmacological, and tilt table tests.
Prepared by MD, PhD., Associate Professor, Marta R. Gerasymchyk, pathophysiology department of Ivano-Frankivsk National Medical University, Ukraine.
For medical students
The document provides an overview of cardiology basics and the physical exam of the heart. It discusses the importance of the heart in pumping blood and removing waste. Key points include:
- The heart's function is determined by cardiac output, which depends on stroke volume and heart rate.
- Auscultation of heart sounds can detect murmurs or arrhythmias while lung sounds may reveal crackles or wheezes.
- Physical exam also involves assessing vital parameters and looking for signs of dyspnea or weakness.
- Common cardiac conditions addressed include murmurs, arrhythmias, congestive heart failure, and atrial thromboembolism in cats.
Cardio-oncology chemotherapy induced cardiomyopathy cases no 2asadsoomro1960
1) This document discusses two cases of chemotherapy-induced cardiomyopathy. The first was a rapidly progressive "tiger heart failure" that led to death before advanced therapies could be applied.
2) The second case involved a man who developed heart failure 17 years ago after chemotherapy for lymphoma but has survived longer through multiple stages of heart failure with guideline-directed medical therapies and devices like CRTD.
3) The author argues that with new treatments like Sacubitril, heart failure may be considered a complex chronic syndrome rather than always a "malignant" condition as was once thought.
This document discusses various cardiac function tests used to evaluate heart health and function. It describes tests such as electrocardiography (ECG), echocardiography, cardiac catheterization, chest X-rays, MRI scans, and cardiac enzyme tests. ECG records the heart's electrical activity to detect abnormalities. Echocardiography uses ultrasound to image the heart's structure and function. Cardiac catheterization directly examines blood flow and pressures within the heart. Chest X-rays and MRI scans provide anatomical images of the heart. Cardiac enzyme tests like CK-MB and troponin levels indicate heart muscle damage. These tests are used to understand and diagnose heart diseases, injuries, and abnormalities.
Case-1:
A 23 years old medical student presented with occasional palpitation, shortness of breath and chest discomfort. He had the following ECG.
A 53 years old gentleman presented with palpitations for last 5 hours. He is smoker, diabetic, dyslipidemic and hypertensive. He had exertional chest discomfort for last 5 years and did coronary angiogram 3 years back and CAG revealed TVD and advised for revascularization. But he refused and was irregular in medication and reluctant for life style modification. He came to emergency department with this ECG.
The document summarizes the past, present, and future of heart failure treatment. In the past (1950s-1970s), treatment focused on rest, sodium restriction, and drugs like digitalis and diuretics. Currently (2000s), guidelines recommend optimal medical therapy including ACE inhibitors, ARBs, beta-blockers, diuretics, and devices like ICDs, CRT, and LVADs which have improved outcomes. The future holds promise for gene and cell-based therapies, left ventricular assist devices, and prevention through understanding of genetic factors influencing heart failure.
The PR interval is the time from the onset of the P wave to the start of the QRS complex.
It reflects conduction through the AV node.
The normal PR interval is between 120 – 200 ms (0.12-0.20s) in duration (three to five small squares).
If the PR interval is > 200 ms, first degree heart block is said to be present.
PR interval < 120 ms suggests pre-excitation (the presence of an accessory pathway between the atria and ventricles) or AV nodal (junctional) rhythm.
Heart muscle disease, is a type of progressive heart disease in which the heart is abnormally enlarged, thickened, and/or stiffened. As a result, the heart muscle's ability to pump blood is less efficient, often causing heart failure and the backup of blood into the lungs or rest of the body.
This document describes various cardiac diagnostic tests including imaging tests and blood tests. It provides details on procedures like chest x-rays, echocardiograms, cardiac catheterization, CT scans, and blood tests like cardiac enzymes and electrolyte levels. Precise positioning of patients and monitoring of vital signs during and after procedures is emphasized to obtain clear images and ensure patient safety.
This document provides information on congestive heart failure (CHF). It begins by defining heart failure and CHF, noting that CHF is characterized by abnormalities in left ventricular function and neurohormonal regulation that cause effort intolerance, fluid retention, and reduced longevity. The document then discusses the pathophysiology of CHF, explaining that it can be caused by conditions like hypertension, diabetes, or myocardial infarction. It also describes the body's compensatory mechanisms in response to reduced cardiac output, such as increased sympathetic discharge, activation of the renin-angiotensin-aldosterone system, and cardiac remodeling. Finally, it lists some common clinical manifestations of CHF like fluid retention, pulmonary congestion, and dysp
This document summarizes key points from an ACLS continuing education presentation on treating acute coronary syndromes. It discusses the importance of BLS/CPR in the chain of survival for cardiac arrest patients. Early recognition, bystander CPR, early defibrillation if VFib/VTach present, and post-resuscitation care including hypothermia treatment and reperfusion if STEMI are critical for good outcomes after ROSC. The document reviews AHA guidelines for cardiac arrest treatment including defibrillation and drug therapy like epinephrine and amiodarone for shockable rhythms and epinephrine for non-shockable rhythms like asystole/PEA.
The document provides an overview of electrocardiogram (ECG) interpretation. It discusses how ECG is an important diagnostic tool that represents the heart's electrical activity. It then covers the steps for interpreting an ECG, including assessing the rate, rhythm, P waves, PR interval, QRS duration, ST segments, T waves, and changes that can indicate conditions like myocardial infarction. The document emphasizes how analyzing ECG findings can provide clinical insights, such as determining whether a patient may benefit from interventions like thrombolysis.
Cardiac diagnostic procedures include laboratory tests, scans, and function tests. Laboratory tests measure cardiac enzyme levels in the blood to detect heart muscle damage from conditions like myocardial infarction. Cardiac scans use radioactive tracers and imaging equipment to visualize the heart and determine myocardial damage, especially following a stress test. Electrocardiograms are a noninvasive way to diagnose heart problems by recording and monitoring the heart's electrical activity and detecting irregularities, defects, or damage.
1. Electrocardiography records the electrical activity of the heart and is used to detect cardiac disorders like myocardial infarction. Biomarkers released after heart muscle cell damage are measured from blood tests to diagnose conditions.
2. Common biomarkers for detecting myocardial infarction include cardiac troponins, CK-MB, myoglobin which are elevated at different time periods after symptoms begin. Imaging tests like echocardiography and cardiac catheterization evaluate the heart's structure and function.
3. Stress tests physically or pharmacologically stress the heart to detect ischemia, and coronary angiography uses contrast dye to visualize blockages in heart arteries. Various biomarkers, imaging, and stress tests are used to diagnose and manage cardiac disorders.
This document provides an overview of cardiac anatomy, physiology, and assessment. It discusses the components of the cardiac conduction system including the sinoatrial node, atrioventricular node, bundle of His, and Purkinje fibers. It also describes how electrocardiograms work and the parts of an ECG strip. Key aspects of cardiac function like contractility, preload, afterload, and stroke volume are defined. The document outlines steps for assessing a patient's cardiac status including vital signs, risk factors, and diagnostic tests.
The document provides an overview of a course on cardiovascular diseases (CVD). The 16-hour course will cover the etiology, pathophysiology, manifestations, risk factors, and management of various CVDs. It will also address diagnostic tests, medications, treatments, and rehabilitation services for CVD patients. The main objective is for students to acquire knowledge and skills to promote health, prevent illness, diagnose, manage and coordinate rehabilitation of CVD patients. Specific topics to be covered include anatomy and physiology of the heart and vessels, assessment of the cardiovascular system, and common CVDs and their management.
Cardiovascular assessment involves evaluating factors that influence cardiovascular health such as high cholesterol, smoking, diabetes, and hypertension. It should include examining the patient's past medical history, current lifestyle, family history, and performing a physical exam. Laboratory tests such as cardiac enzymes, lipid profile, and imaging studies like ECG, echocardiogram, and cardiac catheterization are used to diagnose cardiovascular conditions. Risk scores can help predict the risk of future cardiovascular events based on multiple risk factors. A thorough cardiovascular assessment is important for identifying risks and managing cardiovascular disease.
Interpretation of Clinical Lab Data [CARDIAC] for newbies.pdfsamthamby79
This document provides an overview of common diagnostic tests used to evaluate heart disease, including symptoms, imaging, stress testing, and cardiac enzyme levels. Key points include: chest X-ray and echocardiogram are used to examine the heart and vessels, ECG detects arrhythmias and ischemia, nuclear imaging with agents like thallium-201 assess perfusion and viability, stress testing like exercise or pharmacological methods increase demand to detect ischemia, and cardiac enzymes like CK-MB and troponin rise with myocardial injury and are diagnostic of heart attack. The document provides details on techniques, normal ranges, and clinical applications of these important cardiac diagnostic evaluations.
A myocardial infarction (MI or heart attack) occurs when blood flow to part of the heart is blocked, damaging heart muscle cells. This is usually caused by a buildup of fatty deposits in the coronary arteries. An MI can be life-threatening and is characterized by chest pain or discomfort. Diagnosis involves ECG changes, elevated cardiac enzyme levels, and symptoms. Treatment focuses on restoring blood flow, relieving pain, and preventing further damage.
The document provides an overview of cardiology topics including:
- Three invasive cardiac tests used to diagnose abnormalities: cardiac catheterization, coronary angiogram, and stress tests.
- The anatomy and physiology of the heart including blood flow through chambers and valves.
- Common cardiac screening and imaging tests like EKGs, echocardiograms, nuclear stress tests, and cardiac CTs.
- The differences between left and right heart catheterization, with left assessing arteries and right assessing veins and pressures.
- Access points for catheterization including the femoral artery and radial artery, assessed with Allen's test.
This document provides an overview of cardiovascular testing, including:
1) Different types of cardiovascular testing like echocardiography, electrocardiography, and cardiac biomarkers are discussed for diagnosing, monitoring, and predicting prognosis of cardiovascular disorders.
2) Average heart rates of different mammals ranging from elephants at 28 beats/min to mice at 700 beats/min are listed.
3) Details of the anatomy and physiology of the heart and circulatory system are reviewed.
Cardiac Function Tests_Lecture_2-4.pptxBayanAlsaadi
This document discusses various cardiac function tests and markers. It begins by defining heart failure and acute myocardial infarction. It then discusses angina, distinguishing between stable and unstable types. Various cardiac markers are discussed including creatine kinase (CK), lactate dehydrogenase (LDH), and aspartate transaminase (AST). CK exists in three isoenzyme forms with CK-MB being most specific to cardiac tissue. LDH catalyzes the interconversion of pyruvate and lactate. Elevated levels of these enzymes can indicate cardiac tissue damage. Interpretation of cardiac marker levels aids in diagnosis of conditions like myocardial infarction.
This case presentation describes a 42-year-old man who presented with chest heaviness radiating to his arms and back for the past 6-7 months. His medical history includes surgery for anal fistula. Various tests were performed, including ECG, echocardiogram, treadmill test, and coronary angiogram. The coronary angiogram revealed triple vessel disease. The diagnosis was determined to be coronary artery disease with triple vessel disease, along with atherosclerosis, angina pectoris, silent ischemia, and subclinical hypothyroidism.
Dr. Awadhesh Kumar Sharma is an interventional cardiologist who has had an excellent academic career. The goal of this session is to provide a basic understanding of ECG waves and intervals, how to interpret ECGs, and describe key aspects of using ECGs clinically. An ECG represents the heart's electrical activity and can be used to identify arrhythmias, ischemia, chamber abnormalities, and other conditions. It is important to carefully analyze standardized ECGs by examining features like rhythm, intervals, voltages and assessing for any abnormalities.
This document provides guidelines and templates for critical care documentation, including summaries of a patient's history and physical exam, daily progress notes, procedure notes, and discharge summaries. It outlines what information should be included in each section, such as vital signs, cardiac exam findings, lab results, assessments, and treatment plans by body system. It also provides guidelines for fluid and electrolyte replacement and blood component therapy.
This document provides an overview of acute coronary syndrome (ACS), which includes ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). It discusses the epidemiology, pathophysiology, clinical presentation, workup, and management of these conditions. Key points include that ACS is usually caused by rupture of an atherosclerotic plaque and thrombosis in a coronary artery. STEMI is characterized by ST elevation on ECG and elevated cardiac enzymes, while NSTEMI shows ST depression/T-wave inversion and elevated enzymes without ST elevation. UA presents with chest pain but normal cardiac enzymes and nonspecific ECG changes.
This document provides an overview of cardiovascular medical training. It begins with an introduction to the cardiovascular system, including the heart, blood vessels, and blood. It then defines blood pressure and discusses blood pressure regulation through the autonomic nervous system, kidneys, and renin-angiotensin-aldosterone system. The document concludes by explaining hypertension and its complications, which can include damage to vessels, the heart, brain, and kidneys. Left uncontrolled, hypertension increases the risk of heart attack, stroke, heart failure, and other conditions.
A 21-year-old male presented with progressive dyspnea, exercise intolerance, weakness, cough, chest pain, and syncopal attacks. Clinical examination revealed an irregular heart rate of 40 bpm and a muffled heart sound. ECG showed sinus bradycardia with junctional escape rhythm. Echocardiogram found mild apical hypokinesia and diastolic dysfunction. Cardiac MRI based on Lake Louise Criteria was consistent with myocarditis showing increased T2 signal and focal delayed enhancement. The patient was treated with anti-inflammatory drugs, steroids, and colchicine but required a permanent pacemaker due to complete heart block.
Cardiac diagnostics and laboratory tests Dr. Rima Das
The document provides information on various cardiac diagnostic and laboratory tests including:
1. ECG - Analyzes electrical events of the cardiac cycle and can provide insight into pathophysiology. Important aspects to analyze include rhythm, intervals, axis, and waves.
2. Treadmill test - Progressive exercise test to evaluate cardiovascular response. Used to detect ischemia by analyzing ECG changes, symptoms, and hemodynamics.
3. Echocardiography - Ultrasound of the heart to assess structure, function, valves, and flow. Provides different views of the heart chambers and valves.
4. Holter monitoring - Mobile ECG recording over 24-72 hours to detect arrhythmias and ST-T changes
Cardiovascular diseases are diagnosed through a variety of laboratory tests, imaging studies, and procedures. Common diagnostic tests include blood tests, chest X-rays, electrocardiograms (ECGs), stress tests, echocardiograms, computed tomography (CT) scans, magnetic resonance imaging (MRI), and coronary angiography. These tests help identify issues like damaged heart muscle, blood vessel blockages, and structural abnormalities to accurately diagnose the cause of a patient's cardiac symptoms or condition.
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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1. CARDIOVASCULAR TESTING
SUBJECT: CLINICAL PHARMACY
NAME: Atika Siddiqua
CLASS: PharmD
COLLEGE: Sultan ul Uloom
College of Pharmacy, Hyderabad.
GUIDED BY:
Dr. S.P. Srinivas Nayak, Assistant
professor, SUCP.
2. CARDIOVASCULAR TESTING
Cardiovascular tests are used to assess the function of the heart and to identify the disorders
associated with the pathological heart function. Following are the tests used to assess cardiovascular
function:
1. History
2. Physical Examination
3. Laboratory Tests- Cardiac Biomarkers And Enzymes
4. Chest Radiography
5. Electrocardiography
6. Echocardiography
7. Exercise Stress Testing
8. Pharmacologic Stress Testing
9. Electrophysiologic Study
10. Cardiac Catheterization
11. Angiography
12. Computed Tomography
13. Magnetic Resonance Imaging
3. 1. HISTORY:
A comprehensive history should be taken, which includes:
• The chief complaint (current symptoms- their duration, quality, frequency, severity
and impact on daily activities)
• Medical history (previous Cardiovascular problems and comorbid conditions)
• Family history of cardiovascular disorders
• Social history (diet, amount of regular physical activity, tobacco use, alcohol intake,
and illicit drug use)
2. PHYSICAL EXAMINATION:
A comprehensive physical examination should be done, with particular attention to
cardiovascular system, which includes:
• Vital signs
B.P: Hypertension or Hypotension
Heart rate: Tachycardia or Bradycardia
Rhythm: Regular or regularly irregular or irregularly irregular
4. Respiratory rate: Tachypnoea
Temperature: Fever
• Examination of the Chest (palpation, percussion and auscultation):
In the patient with chest pain, a thorough lung examination should be performed to
exclude a pulmonary cause.
Palpation: The anterior chest wall is palpated to assess for the presence of
tenderness in the sternal area.
Percussion: Percussion of the posterior chest is done to determine if a
pleural effusion is present.
Auscultation: Auscultation of the lungs is performed to assess for the
presence of pneumonia, airway obstruction, pleural effusion, or pulmonary
oedema.
• Examination of the heart (sounds and murmurs):
Normal heart sounds include: -S1 - on closure of mitral and tricuspid valves
-S2 - on aortic and pulmonary valves
Abnormal heart sounds or Gallops: -S3 - immediately after S2 (early diastole)
-S4 - just before S1 (ventricular contraction)
5. Murmurs: Murmurs are auditory vibrations that occurs as blowing,
whooshing or rasping sound resulting from turbulent blood flow within the
heart chambers or across the valves.
Types of murmurs:
1. Innocent or physiological murmurs: They result from rapid, turbulent
blood flow in the absence of cardiac disease. They are also heard
commonly in healthy children (who often have an increased cardiac
output) and may persist into young adulthood. Fever, anxiety, anaemia,
hyperthyroidism, and pregnancy increase the intensity of a physiologic
murmur.
2. Abnormal murmurs:
- Can be graded from 1 to 6 i.e., from softest to loudest; based on
intensity.
- Can be classified as follows based on duration:
i. Systolic murmurs: occur during ventricular contraction. They begin
with or after S1 and end at or before S2, depending on the origin of
the murmur. They are classified based on time of onset and
termination within systole: midsystolic or holosystolic (pansystolic).
6. ii. Diastolic murmurs: occur during ventricular filling. They begin with or
after S2, depending on the origin of the murmur.
iii. Continuous murmurs: begin in systole and continue without
interruption into all or part of diastole.
7. 3. LABORATORY TESTS- CARDIAC ENZYMES & BIOMARKERS:
These are proteins that are released from the recently necrotic myocytes into the blood
due to myocardial infarction or injury and can be detected by specific bio-chemical
assays.
• CARDIAC TROPONIN: Troponin is a protein complex consisting of three units: TnC,
TnI, TnT. These contractile proteins (cTn I & cTnT) are found only in cardiac
myocytes, hence cTn is preferred marker, since, it is the most sensitive and tissue
specific biomarker. cTn is detectable in the blood 2 to 4 hours after the onset of
symptoms and remain detectable for 5 to 10 days.
• CREATINE KINASE: It is also known as creatine phosphokinase (CPK) or
phosphocreatine kinase. It plays an important role in the intracellular energy
transport from mitochondria to myofibrils. CKP consists of two protein subunits for
muscle (M) and for brain (B), which combine to form 3 isoenzymes- CK-MM, CK-
MB, CK-BB. CK-MB can be detected in the blood 2 to 4 hours after onset of
symptoms and remains detectable in the blood for 48 to 72 hours.
8. • SERUM MYOGLOBIN: It is a heme protein with small molecular weight and is used
as an early marker. It is released rapidly within 1 hour following myonecrosis and
returns to normal in 24 hours.
• C-REACTIVE PROTEIN: It is an acute phase reactive protein produced by liver. CRP
concentrations are measured accurately by a highly sensitive CRP (hs-CRP) assay.
• B- TYPE NATRIURETIC PEPTIDE (BNP): It is a cardiac specific peptide first
identified in porcine brain extracts and hence the name Brain Natriuretic Peptide.
It is a neuro hormone released by ventricular myocardium in response to volume
overload.
• N- TERMINAL PRO BNP: It is a more stable form of BNP. It is formed by the
enzymatic cleavage of pre-pro-BNP, a precursor of BNP.
• LACTATE DEHYDROGENASE (LDH): LDH is an enzyme that catalyses the reversible
formation of lactate from pyruvate in the final step of glycolysis. The major
limitation to LDH is the lack of specificity as it is found in many organs like Heart,
liver, lungs, kidney, skeletal muscle, RBC and lymphocytes. It has five major
isoenzymes (LDH 1 - LDH 5). It rises in 24 to 48 hours, peaks at 2-3 days, and
returns to normal in 8- 14 days after onset of chest pain.
9. • ASPARTATE AMINOTRANSFERASE (AST): It is an enzyme that transfers the amino
group in amino acid synthesis. It is widely distributed in the liver, heart, skeletal
muscle, RBCs, kidney and pancreas. Serum AST levels rises within 12 hours of onset
of pain, peaks in 24 to 48 hours and returns to normal in 3 to 4 days.
11. 4. CHEST RADIOGRAPHY:
Chest radiography is a standard study in evaluating patients presenting with symptoms
suggestive of heart failure or ACS. Chest X- ray uses small amount of radiation to produce
images of the heart, lungs and the chest bones on a radiogram. Chest X-ray provides
detailed information about the position and size of the heart, its chambers as well as its
adjacent structures. In addition, the presence and degree of pulmonary congestion
indicates elevated left ventricular end diastolic pressure (LVEF) resulting from infarction
of the left ventricle.
■ Views:
Postero - anterior view: The X ray beam from the machine comes from the
posterior (back) and moves through the anterior (front) of the chest while
the patient is standing.
Lateral view: The X rays penetrate the chest from the sides while the patient
is standing sideways with his arms raised up.
12. POSTEROANTERIOR VIEW LATERAL VIEW
5. ELECTROCARDIOGRAPHY (ECG):
The electrical activity of the heart can be recorded by placing electrodes on the chest
and this recording is called as an Electrocardiogram (ECG). Normal ECG wave form is
composed of following waves:
• P-waves: represent atrial depolarization
• QRS complex of waves: represent ventricular depolarization
• T- waves: represent ventricular repolarization
13. ECG may be demonstrated into additional key components known as intervals or
segments:
• PR interval: time from the onset of P wave to the start of QRS complex of waves.
It represents conduction through AV node. Normal duration: 0.12 to 0.16 secs.
• ST segment: time from the ending of OQS complex of waves to the starting of T
wave. Normal duration: 0.08 to 0m12 secs.
• QT interval: time from the starting of QRS complex of waves to the ending to T
wave. Normal duration: 0.40 secs.
14. The classic ECG changes consistent with acute presentation of myocardial ischemia or infarction are:
(1) T-wave inversion,
(2) ST-segment elevation, and
(3) ST-segment depression
15. PROCEDURE:
1. 12 LEAD ECG: It is the standard and conventional method which uses multiple
leads to record the electrical potential difference between electrodes placed on
the surface of the body. 12 leads are used out of which 6 are limb leads (I, II, III,
aVR, aVL, aVF) and 6 chest leads (V1 to V6). Different leads provide specific
information on different aspects of heart chambers and coronary artery.
4 types of leads used are:
• Bipolar leads: Electrodes are connected to two limbs one being a positive
pole and other being a negative pole. They are: Limb leads I, II, III.
• Unipolar leads: They have two poles, one being an active and other being
inactive. The positive pole is active and the negative pole is inactive. It is of 2
types:
1. Augmented limb leads: They are limb leads aVR, aVL, aVF.
Augmented vector right (+ve electrode: right arm, -ve electrode:
left arm and left foot.)
Augmented vector left (+ve electrode: left arm, -ve electrode: right
arm and left foot)
16. Augmented vector foot (+ve electrode: left foot, -ve electrode:
right arm and left arm)
2. Precordial leads: They are Active electrodes placed directly on 6 points
in the chest and do not require augmentation. They are:
LEAD LOCATION
V1 4th intercostal space near right sternal
margin
V2 4th intercostal space near left sternal
margin
V3 between V2 and V4
V4 5th intercostal space at the midclavicular
line
V5 Anterior axillary line directly lateral to
V4
V6 anterior axillary space directly lateral to
V5
Leads V1 and V2 are called right sided precordial leads, leads V3 and V4
are midprecordial leads, and leads V5 and V6 are called left sided
precordial leads.
19. 2. AMBULATORY ECG OR HOLTER MONITORING: AECG is used to detect
abnormalities during ordinary activities. During continuous Holter monitoring, the
patient wears a portable ECG recorder, which is attached to 2 to 4 leads placed on
the chest wall. The device is typically worn for 24 to 48 hours, after which the
continuous ECG recording is scanned by computer to detect abnormalities or
arrhythmias.
Holter monitor with ECG reading
Electrodes Heart
ECG reading showing heart rhythm
Holter monitor
20. 6. ECHOCARDIOGRAPHY:
It is a diagnostic procedure which uses ultrasound waves (frequency >20000 Hz) to
produce 2D or 3D images of the heart muscle. It determines the size, shape, movement
of valves and heart chambers and flow of blood through the heart.
WORKING:
High frequency sound waves transmitted from a hand-held transducer bounce off the
tissue and are reflected back to the transducer, where the waves are collected and used
to construct a real time image of the heart, displayed on an electric monitor.
PROCEDURE:
Two types of approaches used are:
1. Transthoracic Echocardiography (TTE): It is performed with the transducer
positioned on the anterior chest wall. It is non-invasive, painless, highly accurate and
quick.
2. Transesophageal Echocardiography (TEE): It is performed with the transducer placed
in the esophagus. It is invasive procedure and must be performed under supervision.
21. TTE
Esophagus
Transesophageal echocardiogram (TEE)
bound
waves Echocardiogram monitorTEE
transducer
Heart
TEE
Following transducer placement, several modes are possible:
1. 2-dimensional Echocardiography (2D ECHO): The placed transducer records the
images in multiple views of the heart, and each view provides a wedge-shaped image.
2. 3-dimensional Echocardiography (3D ECHO): It uses an ultrasound probe with an
array of transducers to be able to slice the heart in an infinite number of planes in an
anatomically appropriate manner and to reconstruct 3D images of the anatomic
structures.
22. 3. Doppler Echocardiography: It is used to detect the velocity and direction of blood
flow by measuring the change in frequency produced when ultrasound waves are
reflected from the RBCs. Colour enhancement allows the velocity and direction of the
blood flow to be visualized with different colours. Blood flow towards the transducer is
displayed in red and blood flow away from the transducer is displayed in blue. Increased
velocity is displayed in brighter shades of each colour.
2D ECHO
24. 7. EXERCISE STRESS TESTING:
Normally, the coronary arteries dilate to four times their usual diameter in response to
increased metabolic demands for oxygen and nutrients. Coronary arteries with
atherosclerosis, however, dilate much less, compromising blood flow to the myocardium
and causing ischemia.
PROCEDURE:
• In an exercise test, the patient walks on a treadmill or pedals a stationary bicycle.
• Exercise intensity is increased according to the established protocols, for example,
in Bruce protocol, the speed and grade of the treadmill is increased every 3 mins.
• Following are monitored during the test, ECG, heart rate, heart rhythm, B.P,
ischemic changes including chest pain, dyspnoea, dizziness, leg cramping and
fatigue.
• A resting supine and standing ECG is recorded, together with the resting B.P. The
reason for terminating the exercise is noted.
• The exercise test laboratory should be equipped with full resuscitation equipment
including a defibrillator.
26. 8. PHARMACOLOGIC STRESS TESTING:
Pharmacologic stress testing is indicated in those who are unable to do exercise or are
contraindicated to exercise stress test.
• Two vasodilating agents, dipyridamole and adenosine are administered
intravenously, to mimic the effects of exercise by maximally dilating the coronary
arteries.
Dipyridamole causes coronary vasodilation by blocking the cellular uptake of
adenosine, thereby increasing the extracellular adenosine concentration.
Since methylxanthines (i.e., caffeine and theophylline) block adenosine binding
and interfere with its action, foods and beverages containing caffeine should not
be ingested at least 24 hours before its administration.
Dipyridamole is administered intravenously at 0.142mg/kg/min for 4 mins.
Adenosine is administered intravenously at 0.140 mg/kg/min for 6 mins.
• Positive inotropic agents like dobutamine can also be used in patients in whom
vasodilators are contraindicated.
27. Dobutamine is a synthetic catecholamine and is an inotropic agent that increases
heart rate and myocardial contractility, thereby increasing the myocardial oxygen
demands.
Since beta blockers and calcium channel blockers may interfere with the heart rate,
they should be discontinued before the test.
Dobutamine is administered intravenously by infusion at 5 mcg/kg/min for 3 mins,
followed by infusions of 10, 20, 30, 40 mcg/kg/min every 3 mins until a target
Heart rate is achieved.
9. ELECTROPHYSIOLOGIC STUDY (EPS):
An electrophysiologic study is an invasive test used to evaluate the
electrical conductivity of the heart to check for abnormal heart rhythm.
PROCEDURE:
A small, thin, wire electrode is inserted into the heart via femoral or
subclavian vein by using a special type of X ray movie called fluoroscopy
as the guidance. Once in the heart, the electrodes measure the electrical
signals of the heart and arrhythmias can be detected.
28. 10. CARDIAC CATHETERIZATION:
Cardiac catheterization involves the introduction of a catheter through the femoral or
radial artery, which is advanced to the heart chamber or large blood vessels guided by
fluoroscopy. Then intracardiac pressure, haemodynamic data and blood flow in the heart
chamber and coronary arteries is measured.
Catheter with balloon
Inflated balloonAlternative
compressessite
the plaque
Catheter
insertion site
29. 11. ANGIOGRAPHY:
Coronary angiography or angiocardiography or coronary arteriography is a technique
where contrast media is injected into the coronary arteries. On X ray exposure, heart
and blood vessels are outlined and examined to assess the location and severity of
coronary atherosclerotic lesions. Therapeutic interventions like Percutaneous Coronary
Intervention (PCI), angioplasty or stent placement may be performed during
catheterization.
12. CARDIAC CT SCAN (CCT):
Computerized Tomography, is A medical imaging method that uses a combination of X
rays and a computer to create pictures of organs, bones and other tissues. A series of
images from many angles are produced, and by using a computer a cross sectional
picture of the heart is produced. It is used to assess the cardiac structure and evaluation
of aortic and pulmonary disease.
30. 13. CARDIAC MAGNETIC RESONANCE IMAGING (CMR):
It is a medical imaging technology that uses powerful magnets and radio waves to create pictures of
the body. Single MRI images produced are called slices. Many images are produced which can be
combined to produce 3D models. MRI scanner is large tube inside which the patients lies during the
scan.
PRINCIPLE:
• The single proton of the nucleus of a hydrogen atom vibrates or resonates when exposed to
magnetic energy.
• When many hydrogen nuclei resonate in response to changes in a magnetic field, they emit
radiofrequency energy.
• The MRI machine detects this emitted energy, and converts it to an image.
• Hydrogen nuclei are used because hydrogen atoms are present in water molecules (H2O), and
therefore are present in every tissue of the body.
• Subtle differences in the hydrogen atoms between various parts of a tissue, emit different
amounts of energy.
• These energy differences show up as different shades of Gray on the MRI which is helpful in
detecting areas of cardiac tissue that have poor blood flow (in CAD) or that has been
damaged (in heart attack).
31. REFERENCES:
1. Pharmacotherapy: A Pathophysiologic Approach, 10e, Joseph T. DiPiro, Robert L.
Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael Posey, Mc Graw Hill
publication.
2.https://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=14607
8550