Cardiology 101Let’s talk about the basics

Jacob D. Mason EMT,RCIS

Objectives: Name three invasive cardiac tests used to diagnose cardiac abnormalities.

Review Anatomy/Physiology of The Heart.

Describe a commonly used cardiac screening test.

Describe the difference between left and right heart cath.

Name two entry points for access.

Anatomy/Physiology Review

► Deoxygenated blood enters Right Atrium

► Thru Tricuspid Valve into Right Ventricle

► Thru Pulmonic Valve to Lungs via Pulmonary Arteries

► Pick up Oxygen in the Lungs

Anatomy/Physiology Review

► From Lungs to Left Atrium via Pulmonary Veins

► Thru Mitral Valve into Left Ventricle

► Thru Aortic Valve into Aorta to Body

► First Arteries off the Aorta: Right and Left Coronary Arteries

3 Distinct layers of the heart

Coronary Artery Layers

Cardiac Diagnostics

12 Lead EKG Picture of the electrical activity of the heart

Injury, ischemia & infarction

Conduction abnormalities

Arrhythmias

Hypertrophy

Laboratory Studies

Cardiac enzymes: CK, CK-MB, Troponin

BMP: K, BUN, Cr, GFR

CBC: WBC, Hgb & Hct, Plt

Coags: PT, PTT, INR

Lipid profiles

Cardiac Imaging

Echo

Nuclear

MRI

CT

Angiography

Cardiac Echo:Echocardiography = ULTRASOUND

Structural abnormalities

o Valve function

o Wall motion

o Presence of clots in LV

o Shunts ( “ Bubble” studies)

Transthoracic echo TTE

o Maybe combined with stress test

Transesophageal echo TEE

Stress test:Exercise Stress Testing

Gathers information about how well your heart works during physical activity.

Nuclear Stress Testing

Combines stress with imaging

Compares resting with stressed images

Cardiac Thalium Imaging:Nuclear Stress Testing

Persantine, Dobutamine, Adenosine Preferred: Lexiscan

Radioactive isotopes are injected into the IV to visualize heart muscle

Patient Data 44-year-old male, 72", 385 lbs. Medical history ofDiabetes Mellitus type 2, morbid obesity, and Gastroesophageal Reflux disease.

Note that the Xpress.Cardiac WBR image reconstruction enables superb visualization of both the anterior and inferior walls in spite of extreme patient obesity.

Cardiac computed tomographyEvaluation of

► Heart Muscle

► Coronary Arteries

► Pulmonary Veins

► Thoracic & Abdominal Aorta

► Pericardium

Stent placement

Why does the physician order a heart cath?

Reasons for Cardiac Cath► Patient Symptoms

– Chest Pain– Shortness of Breath– Fatigue

► Physical and History– Murmur– Diabetes– Hyperlipidemia– Smoker– Family History– Known CAD

► Abnormal 12 Lead ECG– STEMI– NSTEMI

► Positive Stress Test– Pharmacologic– Treadmill test– Nuclear Scan– Stress-Echocardiogram

Left heart cath vs Right heart cath

Assessment of the Arterial

(Left sided chambers & vessels) of the Heart

Assessment of the Venous (Right sided chambers &

vessels) of the Heart

Left heart cath Right heart cath

What happens during a left heart cath► Quantify the severity of the disease and it’s effect on the heart

► Make patient assessment prior to heart surgery

► Find out if a congenital heart defect is present and how severe it is

► Check blood flow in the coronary arteries

Pressure measurements in the chambers & major vessels

Measurement of cardiac output

Valve measurements

Evaluation of valves, shunts, septal abnormalities, cardiomyopathies, pulmonary HTN

What happens during a right heart cath

Coronary angiogram

Left anterior descending ( LAD ) Right coronary artery( RCA )Left circumflex ( LCX )

Right heart cath

The optimal puncture site for femoral artery

access is 1-2 cm below the inguinal

ligament.

Right femoral artery

Anatomy access

Inguinal ligament

Access site

Anatomy access

Ulnar artery

Is the blood vessel, with oxygenated blood, of

the medial aspect of the forearm.

Radial artery

Is the main blood vessel with oxygenated blood

of the lateral aspect of the forearm.

Anatomic Review

Allen’s test1) The hand is elevated and the patient is asked

to make a fist for about 30 seconds.

2) Pressure is applied over the ulnar and the radial arteries to occlude both of them.

3) Still elevated, the hand is then opened. It should appear blanched (pallor can be

observed at the finger nails).

4) Ulnar pressure is released and the color should return in 7 seconds.

Both arteries are open

Release ulnar with radial occluded

Occlude both ulnar and radial

Allen’s test used test to determine whether the patency of the radial or ulnar artery is normal.