Triple rule-out CT (TRO-CT) is an imaging exam that evaluates the coronary arteries, pulmonary arteries, and aorta in patients presenting with acute chest pain. It aims to diagnose the cause of chest pain, which could be due to conditions in any of the three vascular territories. The exam involves a contrast-enhanced CT scan of the chest during a single breath-hold. It allows for simultaneous assessment of the entire thorax, improving diagnosis and reducing the need for multiple tests. TRO-CT can help identify life-threatening causes of chest pain such as pulmonary embolism, aortic dissection and coronary artery disease.
Summary and illustrations of various traumatic brain injury including primary and secondary lesions as well as limited information on indications of brain imaging in trauma
Summary and illustrations of various traumatic brain injury including primary and secondary lesions as well as limited information on indications of brain imaging in trauma
USMLE CVS 004 Coronary circulation and venous drainage heart.pdfAHMED ASHOUR
The blood supply to the heart is crucial for its function as a muscular organ that pumps blood to the rest of the body.
The coronary circulation provides oxygen and nutrients to the heart muscle (myocardium).
Understanding the blood supply to the heart is crucial for diagnosing and treating cardiovascular conditions, and interventions such as coronary artery bypass grafting (CABG) may be performed to restore blood flow to the heart muscle in certain cases.
overview of heart and its disease
The heart is a powerful muscle that pumps
blood throughout the body by means of a
coordinated contraction.
The contraction is generated by an
electrical activation, which is spread by a
wave of bioelectricity that propagates in a
coordinated manner throughout the
heart.
It is located in thoracic cavity,
posterior to the sternum ,superior
to the diaphragm between the
lungs.
A human heart beats an average of
100,000 times per day. During that
time, it pumps more than 4,300
gallons of blood throughout
the entire body.
EPICARDIUM:
It is the outer layer of the wall of the heart which is composed of
connective tissue covered by epithelium. It is also known as
visceral pericardium.
2) MYOCARDIUM:
It is the muscular middle layer of the wall of the heart. It is
composed of spontaneously contracting cardiac muscle fibers
which allow the heart to contract. It stimulates heart contraction
to pump blood from the ventricles and relaxes the heart to allow
the arteries to receive blood.
ENDOCARDIUM:
It is the inner layer of the heart which consist of epithelial
tissue and connective tissue.
USMLE CVS 001 Mediastinum anatomy medical chest .pdfAHMED ASHOUR
The mediastinum is the central compartment of the thoracic cavity, located between the lungs.
It is a three-dimensional space that houses various structures within the chest.
The mediastinum extends from the sternum (front of the chest) to the vertebral column (back of the chest) and from the superior thoracic aperture (top of the chest) to the diaphragm (bottom of the chest).
Understanding the anatomy of the mediastinum is crucial for healthcare professionals to interpret diagnostic findings and manage conditions affecting this central compartment of the thoracic cavity.
Hey, these are the slides me n my friends made... Use them if u want to... for viewing the videos used click on the links given ahead.
http://www.youtube.com/watch?v=jzOti_MtmBk
http://www.youtube.com/watch?v=N9MARqmqSf4
http://www.youtube.com/watch?v=yokcKhqq48c
http://www.youtube.com/watch?v=rJZVFRJmc9M
Similar to Triple Rule Out Computed Tomography (20)
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Objective
To assess the validity and efficacy of Triple-rule-out (TRO) computed
tomographic (CT) angiography in diagnosis of different vascular
causes of chest pain.
3. Triple Rule Out CT
TRO-CTA is a specialized computed tomography (CT) imaging exam
tailored to evaluate for pathology within the coronary arteries,
pulmonary arteries, and the aorta in a single CT study, hence the
name ‘triple-rule out’.
4. Why we take TRO-CT?
Acute chest pain is the second most common presentation after abdominal pain
in the emergency department.
represents a major diagnostic challenge in emergency care as it has a broad
differential diagnosis varying from benign causes to life-threatening conditions.
TRO studies are most appropriate and cost-effective when there is a suspicion
for acute coronary syndrome along with other diagnoses such as pulmonary
embolism, acute aortic syndrome, or nonvascular disease in the thorax.
5. Most common causes of Chest Pain
Acute Coronary Syndrome
Pulmonary Embolism
Acute Aortic Syndrome
6. Causes of Chest pain
Heart related causes
Heart-attack
Angina
Aortic Dissection
Digestive Causes
Chest pain can be caused by disorders of the digestive system,
including:
Heartburn
Swallowing disorders
Gallbladder or pancreas problems
7. Muscle and bone causes
Some types of chest pain are associated with injuries and other
problems affecting the structures that make up the chest wall,
including:
Costochondritis
Injured rib
Lung-related causes
lung disorders can cause chest pain, including:
Pulmonary embolism
Pleurisy
Pulmonary hypertension
8. In many clinical situations, a definite diagnosis of ED chest pain is not
possible solely based on clinical symptoms and laboratory findings.
In addition, most diagnostic modalities (i.e., ECG, cardiac enzymes,
exercise treadmill testing, radionuclide perfusion imaging and stress
echocardiography) other than MDCT are focused on the diagnosis or
exclusion of ACS and do not exclude other life-threatening causes of
acute chest pain.
9. For this reason, Triple Role Out (TRO) protocol with ECG-gating
technology has been proposed to encompass the entire thorax,
allowing simultaneous evaluation of coronary arteries, thoracic aorta
and pulmonary arteries for improving diagnosis of acute chest pain in
a single study.
10. Criteria for TRO_CT study
Clinical presentation – low to moderate risk of ACS
Clinical presentation – non ACS diagnosed considered
Normal ECG or non-specific changes
Patient able to tolerate CT and hold breath
Cardiac rhythm acceptable ECG gated scan
Adequate renal function
11. Exclusion criteria
Contra-indications to iodinated contrast material including known
allergy and renal insufficiency (serum creatinine more than 1.4
mg/dl).
Marked heart failure.
Clinically unfit patients (unable to stop breathing during the
examination).
Extensive calcium score above 1000.
12. Why don’t we take coronary angiography above 1000 calcium score?
Because of blooming artifacts, which can cause erroneous
enlargement of calcification, make less accuracy to determine the
coronary arteries lumen that results in false positive diagnosis.
Fig: (A) shows enlargement in the lumen of RCA because of the blooming artifacts
(B) shows normal in state of RCA
13. Anatomy of Aorta, Pulmonary and Coronary
Aorta
the largest blood vessel in the body.
responsible for transporting oxygen rich blood from your heart to the
rest of the body.
begins at the left ventricle of the heart, extending upward into the
chest to form an arch.
downward into the abdomen, where it branches into the iliac arteries
just above the pelvis.
14. Aortic Root
the portion of the aorta that is attached to the heart.
major part of the aortic root is the aortic valve
allows blood to flow from the heart
to the rest of the body
when it is open and prevents blood
from flowing backwards into the heart when it is closed.
15. Ascending Aorta
begins at the sinotubular junction of the aortic root and extends up
and out from the heart until it connects with the aortic arch.
16. Aortic Arch
the portion of the aorta that is in the shape of an arch and connects the
ascending aorta with the descending aorta.
The major arteries : the brachiocephalic artery,
the left carotid artery and the left subclavian artery.
17. Descending Thoracic Aorta
begins at the end of the aortic arch and continues down into the
abdomen. Two parts:
1. T. aorta(provides blood to the muscles of the chest wall and the
spinal cord.)
2. Ab.Aorta (five arteries that branch from the abdominal aorta: the
celiac artery, the superior mesenteric artery, the inferior
mesenteric artery, the renal arteries and the iliac arteries)
18. celiac artery superior mesenteric artery
inferior mesenteric artery renal arteries iliac arteries
Stomach
Liver
Pancreas
supplies blood to the small
intestine
supplies blood to the large
intestine
blood to the kidneys as well
as the muscles of the
abdominal wall and the lower
spinal cord
blood to the legs and the
organs in the pelvis.
Figure: shows five arteries from the abdominal aorta and their blood
supply
19. Thoracic aorta disease
1. aortic aneurysms and dissections,
2. atherosclerotic disease,
3. infections and
4. traumatic injuries.
Note: Ruptured thoracic aortic aneurysms and aortic dissections represent
life-threatening emergencies that require immediate medical attention.
Thoracic aortic aneurysms affect approximately 15,000 people in the United
States each year
21. The most common types of aortic aneurysms are thoracic and
abdominal. In addition, the following can signal a more serious
condition:
1. Sudden and severe chest pain
2. Fainting
3. Leg pain or numbness
4. Shortness of breath
5. Weakness
22. Coronary Artery
heart is mostly supplied by the two coronary arteries which arise
from the ascending aorta immediately above the aortic valve.
coronary arteries and their branches run on the surface of the heart.
RCA
arise from the anterior aortic sinus of the ascending aorta
immediately above the aortic valve.
first runs forwards between the pulmonary trunk and the right
auricle.
23. Then, it descends almost vertically enter the rt. Atrioventricular
groove, the rt. anterior coronary sulcus. At the inferior border of the
heart, it turns posteriorly and runs into the atrioventricular groove,
after the posterior interventricular groove finally anastomosing with
the LCA.
24. LCA
arise from the left posterior aortic sinus of the ascending aorta, immediately
above the aortic valve and enters the left between the pulmonary trunk and the
left auricle. then divides into the anterior interventricular artery also know as left
anterior descending artery which runs downwards in the anterior interventricular
groove to the apex of the heart.
25.
26. Clinical Correlation
Angina Pectoris – since coronary arteries are narrowed, the blood
supply to the cardiac muscles is reduced.
As a result, on exertion, the patient feels moderately severe pain in
region of the left pericardium last as long as 20 mins.
Pain is often referred to the left shoulder and medial side of the arm
and forearm.
Angina pectoris pain occurs on exertion and relieved by rest.
27. Myocardial Infarction
sudden block of the larger branches of either coronary artery usually
leads to myocardial ischaemia followed by the myocardial necrosis
(myocardial infarction).
Part of the heart suffering from MI, stops functioning and often
causes death.
This condition is termed as the heart attack or coronary attack.
28. Clinical features of MI
Sensation of pressure, sinking and pain in the chest that lasts longer
than 30 minutes.
Nausea (or) vomiting, sweating, shortness of breath, and tachycardia.
Pain radiates to the medial side of the arm, forearm, and hand.
Sometimes, it may be referred to jaw or neck.
29. Sites of coronary artery occlusion
The three most common site of CAO are
1. Anterior interventricular artery or LAD (40-50%),
2. RCA (30-40%)
3. Circumflex branch of LCA (15-20%)
NOTE: MI mostly occurs at rest whereas angina occurs on exertion.
30. Blood supply of the major coronary arteries
The 2 main coronary arteries are the left main and right coronary arteries.
Left main coronary artery (LMCA).
The left main coronary artery supplies blood to the left side of the heart
muscle (the left ventricle and left atrium). The left main coronary divides into
branches:
1. The left anterior descending artery branches off the left coronary artery and
supplies blood to the front of the left side of the heart.
2. The circumflex artery branches off the left coronary artery and encircles the
heart muscle. This artery supplies blood to the outer side and back of the heart.
31. Right coronary artery (RCA)
The right coronary artery supplies blood to the right ventricle, the right
atrium, and the SA (sinoatrial) and AV (atrioventricular) nodes, which
regulate the heart rhythm.
The right coronary artery divides into smaller branches, including the right
posterior descending artery and the acute marginal artery.
Together with the left anterior descending artery, the right coronary
artery helps supply blood to the middle or septum of the heart.
34. Types of Circulation
Pulmonary Circulation
the portion of the cardiovascular system that carries oxygen-poor
(deoxygenated) blood from the heart to the lungs and returns
oxygenated blood back to the heart.
deoxygenated blood from the body leaves the right ventricle through
the pulmonary arteries, which carry the blood to each lung.
34
35. Cont.;
pulmonary arteries are the only arteries that carry deoxygenated
blood.
In the lungs, red blood cells release carbon dioxide and pick up
oxygen during respiration.
The oxygenated blood then leaves the lungs through the pulmonary
veins, which return it to the left side of the heart and complete the
pulmonary cycle.
36. Cont.;
The oxygenated blood is then distributed to the body through the
systemic circulation before returning again to the pulmonary
circulation.
37. Fig: The pulmonary circulation carries blood between the heart and lungs.
38. Systemic Circulation
the portion of the cardiovascular system that carries oxygenated
blood from the heart to the body and returns deoxygenated blood
back to the heart.
Oxygenated blood from the lungs leaves the left ventricle through the
aorta.
From here it is distributed to the body's organs and tissues, which
absorb the oxygen through a complex network of arteries, arterioles,
and capillaries.
39. Cont.;
The deoxygenated blood is then collected by venules and flows into
veins before reaching the inferior and superior venae cavae, which
return it to the right heart, completing the systemic cycle.
The blood is then re-oxygenated through the pulmonary circulation
before returning again to the systemic circulation.
40. Fig: The systemic circulation. The systemic circulation brings oxygenated blood to the body cells and tissues and
transports cellular wastes away from the cells and tissues. It is also responsible for temperature regulation and
transport of hormones and other substances around the body.
41. Coronary Circulation
the heart needs its own blood supply, which it gets through the
coronary circulation.
the heart muscle tissue is so thick that it needs blood vessels to
deliver oxygen and nutrients deep within it.
The vessels that deliver oxygen-rich blood to the heart muscle are
called coronary arteries.
42. Cont.;
branch directly from the aorta, just above the heart.
The vessels that remove the deoxygenated blood from the heart
muscle are known as cardiac veins.
44. Patient preparation for TRO
An 18–20-gauge intravenous catheter is placed into a large vein in the
antecubital fossa.
The patient is lying in a supine position with arm in front of him.
ECG leads are positioned above and below the level of the scan to prevent
streak artifact.
The ideal heart rate for ECG-gated studies is a slow regular rhythm, usually
a sinus bradycardia at 50–60 beats per minute.
Oral-blockers may be given at least 1 h before the scan for control of heart
rate.
45. Contrast material and scanning protocol
In order to image both the coronary and pulmonary arteries, a biphasic
injection technique was used: 70 mL of undiluted (ultravist 370) was
injected at 5 mL/s, followed by 25 mL of the same contrast material diluted
with 25 mL of saline, also injected at 5 mL/s.
For injection Protocol we used a bolus tracking technique where we
started contrast medium injection when the HU in the left atrium reached
100 HU then in the second phase we depended on the observation, for
assessment of the opacification of the pulmonary artery.
46. The first phase of the injection opacifies the coronary arteries during
image acquisition, while the second phase of the injection, provides
simultaneous homogeneous enhancement of the pulmonary arteries.
Data acquisition starts from the level of the medial end of the
clavicles to the lower border of the heart in cranio–caudal direction.
47. Fig: Typical Z axis coverage in dedicated coronary CT angiography versus triple rule-out study. A: the field of view in a
dedicated coronary CT angiography is demonstrated. B: note the increased Z axis length in the triple rule-out study
compared with dedicated coronary CT angiography.
48. Data evaluation
For coronary assessment every case was evaluated in the axial plane
and with slab maximum intensity projection images that were rotated
to visualize each vessel in multiple planes.
Vessels with complex plaque were also evaluated with curved
multiplanar reconstruction by using vessel tracking software with
automatic centerline determination.
49. Different parts of the thoracic aorta regarding their diameter,
contrast filling, presence of filling defects, dissections, wall
irregularities, calcification, mural thrombus.
The main pulmonary artery, right and left pulmonary arteries, their
segmental and subsegmental branches, regarding their diameter,
contrast filling, presence of filling defects, wall irregularities,
calcification, mural thrombus.
51. Female patient 37 year old presenting with acute chest pain, dyspnea and hemoptysis. CT axial (A and B),
sagittal (C) and (D) images of pulmonary angiography showing left main and segmental pulmonary embolism
and left sided pleural effusion.
52. Triple rule-out CT angiography images (sagittal and axial views) of two patients with aortic dissection,
with standard (a, b) and low dose (c, d). The diagnostic and image quality were excellent in both patients
in the left descending artery (white arrow), the aorta(white star) and the pulmonary artery (arrowhead).
The first patient had an history of surgical replacement of the ascending aorta.
53. Pros
TRO CT can reduce
(a) time for patient triage,
(b) number of required diagnostic tests,
(c) costs, and
(d) radiation exposure to the patient.
54. Limitations
Beta-blockers that are required for coronary CTA may not be safe in
patients with pulmonary embolism.
Obesity and calcifications limit interpretation, rapid heart rate,
arrhythmias, renal dysfunction and contrast allergies.
55. Conclusion
Since there are a lot of chest pain cases in emergency department , it is difficult
to know the real cause of chest pain.
triple rule out is a relatively new technique, examination the coronary arteries,
pulmonary arteries and aorta in just a single study, which gives us the advantage
of screening emergency patients presenting with chest pain in a rapid and safe
way for detection of their vascular diseases.
In addition, it can reduce the radiation dose to the patient because it investigates
the coronary arteries, pulmonary arteries and aorta in just a single study and we
don’t need to separated studies to check those of them.
That’s why, it is most effective investigation to know the origin of abnormalities
even though it has still challenges.
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