Echo in ischaemic heart disease and Myocardial infarction
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This document discusses the use of echocardiography in evaluating ischemic heart disease and myocardial infarction. It notes that echocardiography can detect regional wall motion abnormalities at rest with stenosis over 85% or with exercise with 50% stenosis. It also discusses limitations where adjacent regions can be affected. The document presents two case studies and discusses features of acute myocardial infarction seen on echocardiography within 5-10 beats of coronary ligation. Complications like papillary muscle rupture, ventricular aneurysms, and right ventricular infarction are also summarized.
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speckle TRACKING.pptx
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The document provides an overview of echocardiographic assessment of aortic valve stenosis. It describes the normal aortic valve anatomy and imaging windows used to visualize the valve. Common causes of aortic stenosis including bicuspid aortic valve and calcific stenosis are discussed. Methods for Doppler assessment of aortic stenosis including peak velocity, mean gradient, and valve area via the continuity equation are summarized. Limitations of these assessment techniques are also noted.
Tte and tee assessment for asd closure 2
1) Transthoracic and transesophageal echocardiography are important modalities for assessing atrial septal defects (ASDs). TTE can identify RV volume overload and septal flattening, while TEE precisely measures defect size and evaluates rim morphology.
2) The four main types of ASDs - ostium secundum, ostium primum, sinus venosus, and coronary sinus defects - have distinguishing echo features. Doppler can demonstrate shunt direction and magnitude.
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Artifacts in echocardiography
1. Artifacts in echocardiography can result in structures appearing that are not present, failing to visualize structures that are, or images that differ in size or shape from reality.
2. Common artifacts include acoustic shadowing from strong reflectors, reverberations between reflectors, beam width issues, range ambiguity, and Doppler artifacts like velocity underestimation and aliasing.
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Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a procedure to dilated the mitral valve in the setting of rheumatic mitral valve stenosis. A catheter is inserted into the femoral vein, advanced to the right atrium and across the interatrial septum. Then the mitral valve is crossed with a balloon and it is inflated to relieve the fusion of the mitral valve commissures effectively acting to increase the mitral valve area and reduce the degree of mitral stenosis. Mitral regurgitation is a potential complication and thus PBMV is contraindicated if moderate or severe regurgitation is present. The Wilkins score examines mitral valve morphology and is determined via echocardiography to assess the likelihood of using PBMV based on certain echocardiographic criteria.
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Speckle-tracking echocardiography (STE) is a technique that uses ultrasound to track speckles in the myocardium frame-by-frame to quantify myocardial deformation. STE can measure longitudinal, circumferential and radial strain as well as ventricular rotation and torsion. The software automatically divides the left ventricle into segments and generates strain curves. STE is more angle-independent than tissue Doppler imaging and not subject to tethering effects. STE is useful for detecting subtle changes in cardiac function and has applications in evaluating coronary artery disease, valvular heart disease, cardiomyopathies and response to treatments like cardiac resynchronization therapy.
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CONTRAST ECHOCARDIOGRAPHY
Contrast echocardiography uses microbubble ultrasound contrast agents to improve image quality. These microbubbles remain in the intravascular space and allow for assessment of cardiac structure, function, and perfusion. Second generation contrast agents use an inert gas encapsulated by albumin or phospholipid shells. They interact with ultrasound by reflecting at fundamental frequencies and resonating to produce harmonic frequencies. Continuous infusion provides steady contrast levels needed for perfusion assessment. Contrast echocardiography is a non-invasive technique that improves evaluation of the heart.
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This document discusses various valvular heart diseases including global burden, aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation. Key points include: rheumatic heart disease is a leading cause in developing countries while age-related calcific disease is most common in developed nations; surgical options depend on severity and include valve repair/replacement; complications can include atrial fibrillation, pulmonary hypertension, and systemic embolism. Medical management focuses on symptom control through medications and lifestyle changes while surgery aims to correct valvular abnormalities.
FFR(fractional flow reserve)
This document discusses fractional flow reserve (FFR), a technique used during coronary catheterization to measure pressure differences across a coronary stenosis and determine if it is causing myocardial ischemia. An FFR value below 0.75 is considered functionally significant while a value above 0.80 rules out ischemia. FFR is useful for evaluating single-vessel disease, left main stenosis, tandem lesions, diffuse disease, grafts, and ostial lesions. Limitations include inability to assess plaque morphology.
Myocarditis by Shipra Shekhar
Myocarditis is an inflammatory disease of the heart muscle (myocardium) that can be caused by infections or non-infectious triggers. It has variable presentations ranging from mild chest pain to life-threatening cardiogenic shock. Diagnosis involves ECG, cardiac enzymes, echocardiogram, cardiac MRI and endomyocardial biopsy. Treatment focuses on managing arrhythmias, heart failure, and restricting activity in the acute phase. While many cases resolve, some can lead to persistent heart dysfunction or dilated cardiomyopathy.
Aortic dissection ppt
An aortic dissection is a tear in the inner layer of the aorta that allows blood to flow between the layers of the aortic wall, creating a false passageway. It is a medical emergency that requires prompt diagnosis and treatment. Type A dissections, which involve the ascending aorta, require emergency surgery while type B dissections, involving only the descending aorta, are generally treated medically with blood pressure control. Surgical treatment of type A dissections aims to remove the damaged aortic segment and restore blood flow through the aorta using a graft.
Cerebrovascular Vasospasm - Etiopathogenesis and Management
Cerebrovascular vasospasm is a consequence of subarachnoid hemorrhage following aneurysmal rupture. its types, causes, etiology, incidence, diagnois and treatment protocols should be understood for better identification and management of this condition.
carotid stenosis and carotid artery stenting- un update
Carotid artery stenting is an alternative to carotid endarterectomy for treating carotid artery stenosis. The document discusses the indications for and procedures involved in carotid revascularization. It summarizes several key studies comparing stenting to endarterectomy. For symptomatic patients, stenting was found to be non-inferior to surgery with the risk of stroke or death below 6%. Recent advances discussed include new embolic protection devices, stent designs like double layer mesh stents, and the transradial approach to reduce manipulation of complex aortic arches. Overall the document provides an overview of carotid stenting procedures and updates on recent technology improvements aimed at reducing risks.
Coronary artery dissection
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction characterized by a non-traumatic separation of the coronary arterial wall. It most commonly affects younger women and the left anterior descending artery. SCAD results from an intimal tear or bleeding of vasa vasorum that leads to the formation of a false lumen filled with blood. This can cause the artery to narrow and restrict blood flow. SCAD is increasingly recognized and can be caused by conditions affecting connective tissue or hormonal factors during pregnancy. Angiography is used to diagnose SCAD but findings may be subtle, with long diffuse narrowing being most common. Management involves conservative treatment but revascularization may be needed for ongoing ischemia
Cardiac cath complications
The document summarizes various potential complications that can occur during or after cardiac catheterization. The major complications discussed include death, myocardial infarction, stroke, bleeding, vascular injury, and contrast induced nephrotoxicity. Risk factors for complications include patient demographics, cardiovascular anatomy, clinical situation, and operator experience. Local vascular complications like hematoma, pseudoaneurysm, arterial thrombosis are also described. Strategies to prevent complications involve careful technique, minimizing contrast and anticoagulation.
CeAD.pptx
A 35-year-old man presented to the emergency department with neck pain, dizziness and confusion after yanking a fishing rod the previous day. Imaging revealed a left internal carotid artery dissection with an ischemic stroke in the left frontal region. He was started on dual antiplatelet therapy and speech therapy. A follow up after 3 months showed modified Rankin score of 0-1, indicating minimal or no symptoms. Cervico-cephalic artery dissections occur when there is a tear in the artery wall, allowing blood to dissect into the wall and cause a hematoma. They typically present with neck pain, headaches, strokes, or Horner's syndrome. Diagnosis is made using CTA, MRA
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Tof long case
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This document discusses the echocardiographic evaluation of aortic stenosis. It begins by describing normal aortic valve anatomy and various views used to visualize the aortic valve via 2D echocardiography. It then discusses the classification and causes of aortic stenosis, including calcific, rheumatic, and bicuspid aortic valve stenosis. Evaluation techniques covered include determining aortic valve area using the continuity equation and measuring transaortic jet velocity via continuous-wave Doppler. The document concludes by outlining the anatomical assessment of the aortic valve, methods for determining stenosis severity, and hemodynamic progression of untreated aortic stenosis over time.
Echo assesment of rv function
This document discusses the limitations and techniques for assessing right ventricular (RV) function using echocardiography. It is difficult to accurately evaluate RV volume, delineate borders, and image the entire RV using echocardiography due to its complex crescent shape. However, the document recommends using RV fractional area change, tricuspid annular plane systolic excursion, tissue Doppler S' velocity, and Tei index to quantitatively assess RV systolic function as they are reproducible methods. RV dimensions, wall thickness, and outflow tract size can also provide information on RV size and function. Assessment of RV diastolic function includes parameters like E/A ratio, E/E' ratio, and deceleration time.
Asd investigations and management
This document discusses the investigation and management of atrial septal defects (ASD). Key points include:
ECG, echocardiography, chest x-ray and cardiac catheterization are used to diagnose ASD. Echocardiography can image the interatrial septum from various views and detect flow between the atria with color Doppler. ASDs are often asymptomatic but can cause complications like pulmonary hypertension. Small and moderate ASDs may be treated with percutaneous device closure while larger defects or those with complications may require surgical repair via patch. The take home message is that small ASDs can often be asymptomatic for life while larger defects cause issues in adulthood, and definitive treatment is via device
Basic pacing concepts
The document provides an overview of basic pacing concepts including:
- Types of pacemakers such as single chamber, dual chamber, and triple chamber systems.
- Components of a pacemaker system including the pulse generator, leads, and electrical concepts such as voltage, current, and impedance.
- Factors that can affect pacing thresholds and how to test the pacemaker circuit including identifying high and low impedance conditions.
Pregnant heart 111
This document discusses pregnancy and valvular heart disease. It notes that pregnancy places significant strain on the heart and can negatively impact both mother and fetus if the mother has an existing heart condition. It provides details on common valvular heart conditions like mitral stenosis, aortic stenosis, and mechanical heart valves. It discusses physiological changes during pregnancy, risks associated with different conditions, management approaches including medical therapy and delivery planning, and important considerations for monitoring and treatment. The goal is to carefully manage high-risk pregnancies involving heart conditions to optimize outcomes for both mother and baby.
Pulmonary stenosis presentation
This document discusses pulmonary stenosis, including its investigation and management. Some key points:
- ECG and echocardiography are recommended for initial evaluation and follow-up every 5-10 years. Cardiac catheterization is recommended if Doppler peak jet velocity is over 3m/s.
- Balloon valvuloplasty is recommended for symptomatic patients with gradients over 30mmHg or asymptomatic patients over 40mmHg. It produces excellent short and long-term results.
- Follow-up depends on severity but is usually visits at 6-12 months, 5 years, and every 10 years post-procedure. Pregnancy is generally tolerated for asymptomatic patients but activity should be limited in second half.
Dyslipidemia by dr. topu
This document summarizes clinical guidelines for cholesterol management and cardiovascular risk reduction. It compares the 2013 ACC/AHA guidelines to previous NCEP ATP III guidelines. The new guidelines have a focus on reducing atherosclerotic cardiovascular disease risk rather than just coronary heart disease risk. They recommend high-intensity statin therapy for more patient groups based on revised risk assessment categories and calculators. Key changes include expanding statin benefit to those with diabetes or a 7.5% or higher 10-year risk without cardiovascular disease. Management of high triglycerides is also discussed.
Mitral Stenosis Case presentation
This document contains a medical case report for a 40-year-old male electrician named Rubel who was admitted to the hospital for shortness of breath and easy fatigability for the past two months. Upon examination, a murmur was detected consistent with mitral stenosis. Further tests revealed the patient has chronic rheumatic heart disease with moderate mitral stenosis and pulmonary hypertension. He was started on medication and may require a mitral valve procedure or surgery going forward.
Asd case dr. bayazid
A 40-year-old woman presented with recurrent palpitations and breathlessness since childhood. She reports palpitations that worsen with exertion and swelling of her body. On examination, she has clubbing and a thrill present in her pulmonary and tricuspid areas. Her past medical history is notable for multiple visits to local doctors for breathlessness where she was told of an abnormal heart condition.
Asd long case
A 55-year-old female presented with complaints of breathlessness, cough, palpitations and weakness for several months. Examination findings included elevated heart rate, elevated jugular venous pressure, ejection systolic murmur, and basal crepitations. ECG and echocardiogram revealed atrial septal defect with pulmonary hypertension. She was diagnosed with atrial septal defect with congestive cardiac failure and moderate pulmonary hypertension. She was started on medical management including diuretics, ACE inhibitors and digoxin. Surgical or device closure of the defect was recommended.
Atrial Firbrilation rubayet
This document summarizes the 2016 European Society of Cardiology guidelines for the management of atrial fibrillation. It begins with an introduction stating that AF remains a major cause of stroke, heart failure, and other cardiovascular issues worldwide. It also notes that the number of AF patients is predicted to rise significantly. The document then discusses common problems seen with AF patients in critical care and outpatient settings. It lists "do nots" in AF management, such as not using antiplatelet therapy alone for stroke prevention. It provides recommendations on rate control, rhythm control, anticoagulation for stroke prevention, and managing bleeding. It asks about determining the CHA2DS2-VASC score for a hypothetical patient case and discusses
Acute rheumatic fever
This document provides information on acute rheumatic fever (ARF), including its definition, incidence, pathophysiology, diagnosis, management, and secondary prevention. ARF is an autoimmune response to Group A streptococcal infection that causes inflammation of the heart, joints, brain and skin. It predominantly affects school-aged children and those in low socioeconomic conditions. Accurate diagnosis is important to avoid over- or under-treatment. Management involves treating streptococcal infections, suppressing inflammation, and long-term antibiotic prophylaxis to prevent recurrence.
Perioperative Cardiovascular Risk assessment
The document provides guidelines for perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. It was developed by an expert panel representing multiple medical societies. The guidelines include recommendations on preoperative risk assessment, management of valvular heart disease and pulmonary hypertension, use of cardiovascular implantable electronic devices, and approaches to predicting and reducing perioperative cardiac risk. A stepwise approach to preoperative cardiac assessment and management is presented based on urgency of surgery and estimated risk of major adverse cardiac events.
Heart failure imrose
Heart failure is a clinical syndrome characterized by symptoms such as breathlessness and fatigue caused by structural or functional abnormalities of the heart. It is a leading cause of hospitalization in people over 65. Up to 50% of heart failure patients die within 5 years of diagnosis.
The document discusses classifications of heart failure based on ejection fraction and functional capacity. It provides guidelines on the management of acute heart failure, including treatments to reduce congestion and increase perfusion. Chronic heart failure treatment focuses on reducing mortality and hospitalizations through optimized medical therapy including ACE inhibitors, beta-blockers, MRAs, and newer drugs like sacubitril/valsartan. Device therapies like ICDs and CRT are recommended for
Drugs in Heart Failure samia
This document discusses drugs used to treat heart failure. It defines heart failure and provides global statistics on prevalence. The goals of pharmacotherapy are to relieve symptoms, improve cardiac function, prevent disease progression and prolong survival. Drugs discussed include ACE inhibitors, ARBs, beta-blockers, aldosterone antagonists, ARNIs, diuretics, digoxin, ivabradine, and omega-3 fatty acids. Recommendations are provided on use of these drugs for heart failure with reduced ejection fraction based on guidelines. The document also briefly discusses treatment of heart failure with preserved ejection fraction.
Tetralogy of Fallot long case discussion
Ms. Lamia, a 10-year old girl from Potuakhali, Barisal, presented with breathlessness for 2-3 weeks and bluish discoloration of her skin since childhood. Examination found central cyanosis, clubbing, and a grade 3/6 ejection systolic murmur, suggesting congenital cyanotic heart disease, most likely Tetralogy of Fallot. Medical management and potential surgical options were discussed.
Aortic dissection dr.tapu
This document provides an overview of aortic dissection, including:
- King George II's death in 1760 which was one of the first documented cases.
- The first successful surgical repair was performed by DeBakey in 1955.
- It involves a tear in the inner layer of the aorta that allows blood to enter and force open the middle layer.
- Presentation includes sudden, severe chest pain that may radiate to the back. Early mortality can be as high as 5% per hour without treatment.
- Risk factors include hypertension, connective tissue disorders like Marfan syndrome, and aortic abnormalities.
- Diagnosis involves features like widened mediastinum on C
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Echo in ischaemic heart disease and Myocardial infarction
- 1. Page 1 Gerard P. Aurigemma MD Board Review Course 2017 Echo in Ischemic Heart Disease and Myocardial Infarction Echo and CAD • Regional wall motion abnormalities at rest may not be seen until the luminal diameter stenosis exceeds 85% – with exercise, a coronary lesion of 50% can result in regional dysfunction • Echocardiography can overestimate the amount of ischemic or infarcted myocardium, as wall motion of adjacent regions may be affected by: – Tethering – Disturbance of regional loading conditions – Stunning • Wall thickening and motion should be considered • Regional wall motion abnormalities may occur in the absence of CAD
- 2. Page 2 ASE Guidelines 2005 ASE Guidelines 2005
- 3. Page 3
- 5. Page 5 Case #1 Case #1
- 8. Page 8 15 Diagnostic Role in Acute MI • Regional wall motion abnormality – Occurs within 5-10 beats of acute coronary ligation – Rate and amplitude of endocardial excursion decreased – Reduced wall thickening or wall thinning
- 9. Page 9 Which of the following patients has the acute MI? A B C 1. Patient A 2. Patient B 3. Patient C 4. All of the above 5. None of the above
- 10. Page 10 What is the diagnosis? 1. LAD territory infarction with a septal aneurysm 2. LAD ischemia but no aneurysm 3. Volume loaded LV due to left sided valve disease 4. None of the above Violent LBBB
- 11. Page 11
- 12. Page 12 Courtesy Rick Grimm, Cleveland Clinic Foundation G:GPAslides.3 70 year old woman, complains of indigestion for 1 day then collapse Admitted to MICU with shock Fellow is called to do an echo
- 13. Page 13 G:GPAslides.3 G:GPAslides.3 What can be said with confidence about this patient’s diagnosis? 1. She likely has a large MI 2. She probably has an RCA occlusion 3. Shock is due to LV dysfunction 4. This is probably her first coronary event
- 14. Page 14
- 15. Page 15 G:GPAslides.3 Papillary muscle rupture Clinical features • Rare complication of acute MI • New systolic murmur and CHF day 3 to 5 post-MI • Usually (82%) first coronary event in patient without collateral circulation; 50% 1 vessel disease • Often small area of necrosis • Poor prognosis (90% mortality) and depends on extent of rupture G:GPAslides.3 Papillary muscle rupture • Posteromedial papillary muscle 6-12x more common • anterolateral papillary muscle has LAD and LCx supply • Usually single head rupture Papillary muscle head Papillary muscle base
- 16. Page 16
- 17. Page 17 Ventricular Aneurysm Echocardiographic features • LV cavity shape distorted during diastole and systole • Wall thin and motion paradoxical • Wide-neck typically with neck diameter = aneurysm diameter • Hinge points connecting site with contractile myocardium may be seen • Sensitivity of echo: 93 to 100% • 85 to 95% involve cardiac apex • Thrombus present in 34% Aneurysm Pseudoaneurysm
- 18. Page 18 G:GPAslides.3 Left ventricular pseudoaneurysm: Clinical and pathologic features Myocardial rupture contained by adherent parietal pericardium and thrombus Small, narrow-neck channel connecting ventricle and aneurysm sac Walls of the pseudoaneurysm composed of pericardium rather than thin-walled myocardial scar of true aneurysm pseudoaneurysm
- 19. Page 19
- 20. Page 20 G:GPAslides.3 Right Ventricular Infarction Commonly accompanies LV inferior MI (25% -33%) Results from occlusion of RCA proximal to the RV marginal branches, LCX, or apex of RV from “wrap-around” LAD Hemodynamics characterized by disproportionate elevation of right-sided filling pressures with reduced cardiac output EKG: V4R ST elevation sensitive and specific