Cardiology 101 back to the basics
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Transcript of Cardiology 101 back to the basics
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.