Coronary flow imaging
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This document provides information about coronary flow imaging techniques. It discusses visualization of the coronary arteries, heart segmentation, and scan views used. Details are given on quantifying coronary flow reserve using Doppler, including measuring flow velocities in the left anterior descending coronary artery at rest, during stress, and recovery. Examples of normal and pathological coronary flow patterns are shown. The roles of various ultrasound settings and protocols for coronary flow reserve assessment are outlined.
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Coronary physiology
Various coronary physiological measurements can be made in the cardiac catheterization laboratory using sensor-tipped guidewires; they include the measurement of poststenotic absolute coronary flow reserve, the relative coronary flow reserve, and the pressure-derived fractional flow reserve of the myocardium. Ambiguity regarding abnormal microcirculation has been reduced or eliminated with measurements of relative coronary flow reserve and fractional flow reserve. The role of microvascular flow impairment can be separately determined with coronary flow velocity reserve measurements. In addition to lesion assessment before and after intervention, emerging applications of coronary physiology include the determination of physiological responses to new pharmacological agents, such as glycoprotein IIb/IIIa blockers, in patients with acute myocardial infarction. Measurements of coronary physiology in the catheterization laboratory provide objective data that complement angiography for clinical decision-making
Blood supply to cardiac conduction system
The cardiac conduction system receives its blood supply from branches of the left anterior descending coronary artery and right coronary artery. A critical portion of the interventricular conduction system is supplied by the first septal branch of the left anterior descending artery. The bundle of His receives blood supply from both the left anterior descending artery and right coronary artery, with approximately 50% of the blood coming from the septal branch of the left anterior descending artery and atrioventricular nodal branch of the right coronary artery.
FRACTIONAL FLOW RESERVE
This document discusses fractional flow reserve (FFR), which is a technique used to functionally assess the significance of coronary artery stenosis. FFR is defined as the ratio of maximum blood flow in a stenotic artery to maximum blood flow if there was no stenosis. It is calculated as the ratio of mean distal coronary pressure (Pd) to mean aortic pressure (Pa) during maximal hyperemia induced by pharmacological agents. An FFR value below 0.75 is associated with inducible ischemia, while a value above 0.80 indicates an insignificant stenosis in most cases. FFR has advantages over angiography alone in evaluating stenosis as it accounts for vessel characteristics like length and takes collateral flow into consideration.
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Coronary circulation 14 10-14
The document summarizes the anatomy and physiology of the coronary circulation. It describes:
1) The coronary arteries originate from the aorta and branch to form the right and left coronary arteries which further divide to supply the myocardium.
2) The left main coronary artery divides into the left anterior descending artery and left circumflex artery. The right coronary artery supplies the right side of the heart.
3) Coronary blood flow is highest in diastole when the heart muscle is relaxed to perfuse the subendocardial layers of the left ventricle. Various neural and chemical factors regulate blood flow to meet myocardial demand.
Coronary artery anatomy
The right and left coronary arteries originate from the right and left sinuses of the aortic root. The right coronary artery supplies the right ventricle while the left coronary artery supplies the anterior portion of the ventricular septum and left ventricle. The left main coronary artery bifurcates into the left anterior descending artery and left circumflex artery. The left anterior descending artery supplies the majority of the left ventricle while the left circumflex artery supplies the left ventricle free wall. In approximately 70% of cases, the right coronary artery is the dominant artery supplying the posterior portions of the heart.
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The cardiac conduction system receives its blood supply from branches of the left anterior descending coronary artery and right coronary artery. A critical portion of the interventricular conduction system is supplied by the first septal branch of the left anterior descending artery. The bundle of His receives blood supply from both the left anterior descending artery and right coronary artery, with approximately 50% of the blood coming from the septal branch of the left anterior descending artery and atrioventricular nodal branch of the right coronary artery.
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This document discusses fractional flow reserve (FFR), which is a technique used to functionally assess the significance of coronary artery stenosis. FFR is defined as the ratio of maximum blood flow in a stenotic artery to maximum blood flow if there was no stenosis. It is calculated as the ratio of mean distal coronary pressure (Pd) to mean aortic pressure (Pa) during maximal hyperemia induced by pharmacological agents. An FFR value below 0.75 is associated with inducible ischemia, while a value above 0.80 indicates an insignificant stenosis in most cases. FFR has advantages over angiography alone in evaluating stenosis as it accounts for vessel characteristics like length and takes collateral flow into consideration.
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- She developed respiratory acidosis and was intubated. Atrial fibrillation was also found.
- She was treated with antibiotics for possible sepsis, amiodarone for atrial fibrillation, and beta blockers were increased to control heart rate.
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The document summarizes the anatomy and physiology of the coronary circulation. It describes:
1) The coronary arteries originate from the aorta and branch to form the right and left coronary arteries which further divide to supply the myocardium.
2) The left main coronary artery divides into the left anterior descending artery and left circumflex artery. The right coronary artery supplies the right side of the heart.
3) Coronary blood flow is highest in diastole when the heart muscle is relaxed to perfuse the subendocardial layers of the left ventricle. Various neural and chemical factors regulate blood flow to meet myocardial demand.
Coronary artery anatomy
The right and left coronary arteries originate from the right and left sinuses of the aortic root. The right coronary artery supplies the right ventricle while the left coronary artery supplies the anterior portion of the ventricular septum and left ventricle. The left main coronary artery bifurcates into the left anterior descending artery and left circumflex artery. The left anterior descending artery supplies the majority of the left ventricle while the left circumflex artery supplies the left ventricle free wall. In approximately 70% of cases, the right coronary artery is the dominant artery supplying the posterior portions of the heart.
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The document discusses the physiology of coronary blood flow and the microcirculation. Some key points include:
- Coronary blood flow is determined not only by proximal pressures but also by active compression and decompression of the microcirculation.
- Distal coronary pressure is influenced by both pressure transmitted from the aorta and pressure arising from the microcirculation.
- Fractional flow reserve (FFR) provides a measure of maximum achievable blood flow through a stenosis compared to a normal artery, indicating the functional significance of the stenosis.
- An FFR below 0.80 accurately identifies lesions causing ischemia, while a value above 0.80 reliably excludes ischemia.
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- Fractional flow reserve (FFR) provides a measure of maximum achievable blood flow through a stenosis compared to a normal artery, indicating the functional significance of the stenosis.
- An FFR below 0.80 accurately identifies lesions causing ischemia, while a value above 0.80 reliably excludes ischemia.
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The document provides details on the history, technique, views, and risks of cardiac catheterization and coronary angiography. It discusses how cardiac catheterization was first performed on animals in 1844 and humans in 1929. Key developments include the introduction of percutaneous techniques in 1953, transseptal catheterization in 1959, and selective coronary arteriography in 1959. The document outlines standardized views used to visualize the left and right coronary arteries, as well as techniques, risks, and considerations for coronary angiography procedures.
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The document summarizes coronary artery anatomy. It describes the origins and branches of the right coronary artery and left coronary artery. The right coronary artery typically arises from the right coronary sinus and supplies the right ventricle. The left main coronary artery bifurcates into the left anterior descending artery and circumflex artery. It also discusses common anatomical variations such as anomalous origins, fistulas, and intrinsic abnormalities like stenosis.
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This document discusses PiCCO (Pulse Contour Cardiac Output) monitoring. PiCCO enables assessment of a patient's hemodynamic status by measuring various volumetric and cardiac parameters. It requires a central venous pressure catheter and arterial line. PiCCO works by transpulmonary thermodilution, using cold saline injections to calculate volumes, and pulse contour analysis of the arterial waveform to provide continuous cardiac output monitoring. The document defines various parameters measured by PiCCO like preload, contractility, lung function, and afterload, and provides normal ranges. It also outlines indications, contraindications and the decision tree for hemodynamic monitoring using PiCCO.
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- Myocardial ischemia occurs when oxygen demand exceeds supply. Coronary autoregulation and flow reserve help maintain adequate flow.
- Myocardial viability refers to dysfunctional tissue with limited scarring that has potential for functional recovery after revascularization through mechanisms like stunned myocardium and hibernation.
- Various techniques can assess viability including cardiac imaging and evaluating improvement in function after revascularization. Viability assessment aids decisions about revascularization
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Coronary circuln 07 02-2012
The coronary circulation supplies blood to the heart muscle. The right and left coronary arteries branch to form a dense capillary network around each cardiac muscle cell. Coronary blood flow is regulated by metabolic demand of the heart as well as mechanical factors related to the cardiac cycle. During systole, compressive forces within the heart reduce coronary flow, while flow increases during diastole when the vessels dilate. Multiple chemical and neural factors also control resistance within the coronary vasculature to match blood supply with myocardial oxygen requirements. Imbalances can lead to ischemia if demand outpaces supply.
Ischemic heart disease_Myocardial infarction_
Ischemic heart disease (IHD) results from inadequate blood flow to the heart muscle. There are four main clinical syndromes: angina, myocardial infarction (MI), chronic IHD, and sudden cardiac death. MI, also called a heart attack, is caused by necrosis of heart muscle due to ischemia. It is usually the result of a coronary artery becoming blocked by a blood clot, causing severe chest pain and potential heart damage or death if not promptly treated. Complications of MI can include cardiac rupture, arrhythmias, heart failure, and aneurysm formation. The risk of complications depends on infarct size, location, and thickness of the damaged heart muscle.
Ischemic Heart Disease
1. Ischaemic heart disease is caused by an imbalance between myocardial oxygen supply and demand, usually due to atherosclerosis limiting blood flow in the coronary arteries.
2. The main types of ischaemic heart disease are stable angina, unstable angina, myocardial infarction (STEMI and NSTEMI), and sudden cardiac death. Clinical presentation and ECG/biomarker findings are used to distinguish these conditions.
3. Treatment involves lifestyle modifications and medications like nitrates, beta-blockers, and calcium channel blockers to reduce oxygen demand and increase supply. Revascularization procedures like PCI or CABG may also be used in certain patients.
Coronary circulation
The coronary circulation consists of the arterial supply, venous drainage and lymphatic drainage of the heart. The heart receives its blood supply from the right and left coronary arteries. The right coronary artery supplies the right atrium and ventricle while the left coronary artery supplies the left atrium and ventricle. Coronary blood flow is regulated by physical, chemical, neural and hormonal factors to meet the metabolic demands of the heart. Coronary artery disease can lead to conditions like angina pectoris and myocardial infarction due to reduced blood supply to the heart muscle.
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Coronary flow imaging
- 1. Coronary Flow Imaging Demo Teaching – Cardiac Application US Marketing
- 2. Next arguments Coronary Arteries Heart Segmentation Scan Views Example
- 3. Coronary Arteries Left CA Right CA LCx VCs AOa AP LAD PDA Vene P VCi LCx PDA LCx: Left Circumflex Artery LAD: Left Anterior Descendig PDA: Posterior Descending Artery
- 4. Heart Segmentation: Segments in LAX and SAX
- 5. Heart Segmentation: Segments in 4Ch and 2Ch
- 7. Coronary Arteries Origin SVC Coronary Arteries Origin PA RA IVC The role of Heart Strings is to prevent the flaps reversal into the right atrium R N L RV Chordae Tendinae (Heart Strings) Aortic Valve Papillary muscles
- 8. Doppler: CFR quantification Images and data courtesy of Prof. Rigo
- 9. Doppler: Quantification of Coronary Flow Reserve (CFR) for LAD (Left Anterior Descending Coronary Artery) Ultrasound findings of coronary arteries: LAD (Prox-Mid tracts) Prox LAD AORTA Pulmunary AURICOLA Feasibility 78% pts Mid LAD Normal values MFV=35±9 cm/s Images and data courtesy of Prof. Rigo Rigo, Cardiovascular Ultrasound 2008
- 10. LAD I = Proximal Tract 44 cm/s Images and data courtesy of Prof. Rigo
- 11. LAD II = Medial Tract 36 cm/s Images and data courtesy of Prof. Rigo
- 12. Doppler: Quantification of Coronary Flow Reserve (CFR) for LAD (Left Anterior Descending Coronary Artery) Ultrasound findings of coronary arteries: LAD (Mid-Distal tract) Rigo, Cardiovascular Ultrasound 2008 Lad: mid-distal tract Feasibility 98% pts Images and data courtesy of Prof. Rigo Normal values MFV=25±7 cm/s
- 13. LAD III = Distal Tract 31 cm/s Images and data courtesy of Prof. Rigo
- 14. Images and data courtesy of Prof. Rigo
- 15. Doppler: Quantification of Coronary Flow Reserve (CFR)
- 16. Images and data courtesy of Prof. Rigo
- 17. Doppler: Quantification of Coronary Flow Reserve (CFR) Example of Pathological coronary flow pattern (stenosis) LV MID LAD Proximal LAD LAD I 42 cm/s 94 cm/s 94 cm/s Distal LAD TTD NON INVASIVE Images and data courtesy of Prof. Rigo LAD III Rigo et al ESCcm/s 35 2010
- 18. Images and data courtesy of Prof. Rigo
- 19. Doppler: CFR quantification Coronary Flow Reserve (CFR) is the study of coronary flow velocity during a Stress examination Flow velocity is measured on the Left Anterior Descending Coronary Artery (LAD) within the 3 segments: (Proximal, Medial and Distal) during Rest, Dipyridamole Stress and Recovering Phases. Example of pathological Coronary Flow Pattern (Stenosis) The customer needs to verify the coronary flow during the REST and after the STRESS Images and data courtesy of Prof. Rigo
- 20. Images and data courtesy of Prof. Rigo
- 21. Doppler: CFR quantification Reserve is performed using: 1) Phased Array probe 2) Color Doppler (for the visualization of the Coronary Artery Flow) 3) Pulsed Wave Doppler (for the Coronary Flow analysis) and Clinical Protocol of Dipyridamole Stress Echocardiography
- 22. Stress Test with CRF (Coronary Flow Reserve) Images and data courtesy of Prof. Rigo
- 23. Doppler: CFR quantification The assessment of Coronary Blood Flow characteristics is meaningful also regarding basal cardiac activity without any externally induced cardiac stress Typical Left Anterior Descending Coronary Artery blood flow. Velocities at basal cardiac activity can be seen in the following image:
- 24. MyLab60/70/ClassC/Twice Preset – Cardio & CFI Preset Cardio Adulti - 8.0 8.0 CFI Cardio Based B-Freq TEI - Gen-M TEI - Gen-M Angle 75°/70° 75°/70° Gray Map 7 7 Dynamic Range 11/9 9 Compres. Dyn. 2 2 Density 1 1 CFM-Freq HD CFM Filter Density 2,3/2,5Mhz 1 2 1 Col. Map VV13 Smooth Persist PRF Med 3 3,5K/4.0hz 2,8/2,5 0 2 1 VV13 (Color Priority - 255) Med 8 1.5/2Khz 2.5 2.1 6.0 (for CW about 2.0m/s) 0 4 5/6 8 5 cw 300 (600 CW) Med MedMax cw small 2.5 2.1 Scale about 0.60 m/s - 1.25 m/s 8 10 6 PW 8/5 CW 100/150 Fast MedMax cw Foc. 1 1 Enhance 2 2 Power 100% 100% Persist 1/2 1/2 Sview on on Format PW-Freq CW-Freq X-View 4-3-6 4-3-6 PRF Post-Processing Scan Colorize Range Dyn Gray Map Compr. Din Slope 50 - Rej 20 Slope 50 - Rej 20 - Sat 240 - Sat 240 fast 0/10 10 7 2 fast 0/10 10 7 2 Colorize Sample V. Gray Map Range Dyn Filter Scan Ris FFT
- 25. Thank you Demo Teaching – Cardiac Application US Marketing