Iscemic Heart Disease
Terms
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definition
Coronary Artery Disease - Defined as the narrowing of the coronary arteries sufficiency to prevent adequate blood blood flow to the myocardium of the heart. This narrowing may progress to the point that the heart muscle is damaged. (infacted)
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Coronary Artery Disease
Etiology - Artherosclerosis usually develops at the bifurcations
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Coronary Artery Disease
Risk factors -
Post menopause
cigarette smoking
Hypercholesterolemia -
Coronary Artery Disease
Risk Factors: -
Diabetes Mellitus
Obesity
Stress
Oral Contraceptive use
Alchohol consumption -
Coronary Artery Disease
Symptoms: -
Chest Pain
Dyspnea
CHF
MI
Sudden Cardiac Death (30-35%) -
Coronary Artery Disease
Electrocardiogram -
Ventricular arrhythmias
Conduction defects(1st AV block, LBBB) -
Coronary Artery Disease
Cardiac Catherization - Identification of the complications of MI
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Coronary Artery Disease
2D Findings/Evaluation - Determine severity of coexisting valvular regurgitation using CFD
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Describe SWMA
hypokinesis
akinesis
dyskinesis -
hypokinesis-not moving well
akinesis-not moving at all
dyskinesis-moving in the opposit direction -
Coronary Artery Disease
Treatment -
Reduce modifiable risk factors
Excercise
sublingual nitroglycerin, beta blockers, calcium channel blockers, ACE inhibitors
Pacemakers
Coronary stent
CABG -
Coronary Artery Disease
Echo in determination of CAD - Routine echos tend to overlook CAD because the exam if done at rest, when the arteris may still be able to provide adequate blood flow to the heart
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Coronary Artery Disease
Echo in determination of CAD
Best Method? - A stress echo should be performed
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Left Ventricular Dysfunction
Why is it important to determine LV function? - It is important to determine the contractility of the LV since clinical desisions for medical therapy or surgical intervention depend on the status of Left ventricular function
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Left Ventricular Dysfunction
2D Evaluation - Always performa complete exam, including CFD, CW, and PWD, unless you are doing a limited F/U exam
- Methods to determine LV dimension
- Cardiac Output
- Fractional shortening
- FS reflects the change of LV internal dimension throughout the cardiac cycle. Increased FS is observed in pts with hypercontractile ventricles decresed FS is observed in a poorly contracting muscle
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Fractional Shortening
Definition - Fractional Shortening is measured as the ratio of the difference betweeb EDd and ESd to the EDd. This ratio is multified by 100 to obtain the percentage FS
- What is the formula for CO?
- CO=SVxHR
- How is EF similiar to ES?
- It uses the percent change of LV instead of change i the LV diameter
- What is the main function of Cardiac Output?
- To pump oxygenated blood to the peripheral tissues.
- What is stroke Volume?
- The volume of blood ejected by the LV during systole is referred to as the stroke volume
- Cycle time of CO
- Volume of blood ejected by ventricle during a 1 minute cycle
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Thrombi
Diagnosis is based on? - Detection of echoic mass with defined margins clearly id'd throughout cardiac cycle visable in at least 2 echo views
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Thrombi
2D Findings and Evaluations - Segmental WMA, usually akinesis or dyskinesis
- Thrombi Types
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