Cardiovascular system CVS

INVESTIGATION IN CARDIOVASCULAR DISEASE

ElectrocardiographyECG

Indications

Normal Impulse Conduction
Sinoatrial node AV node Bundle of His Bundle Branches Purkinje fibers

Impulse Conduction & the ECG

Sinoatrial node AV node Bundle of His Bundle Branches Purkinje fibers

Pacemakers of the Heart

SA Node - Dominant pacemaker with an intrinsic rate of 60 - 100 beats/minute. AV Node - Back-up pacemaker with an intrinsic rate of 40 - 60 beats/minute. Ventricular cells - Back-up pacemaker with an intrinsic rate of 20 - 45 bpm.



The “PQRST” P wave - Atrial depolarization

T wave - Ventricular repolarization

QRS - Ventricular depolarization


The standard 12–lead ECG The 12-lead ECG is generated from ten physical electrodes that are attached to the skin. One electrode is attached to each limb and six electrodes are attached to the chest

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The standard 12–lead ECG Three dipole limb leads (I ,II,III), three augmented voltage limb leads(avL,avR,avF) Six unipole chest leads(V1-V6).

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Exercise (stress) ECG
Exercise electrocardiography is used to detect myocardial ischaemia during physical stress and is helpful in the diagnosis of coronary artery disease. A 12-lead ECG is recorded during exercise on a treadmill or bicycle ergometer

Ambulatory ECG(Holter)

Continuous (ambulatory) ECG recordings can be obtained using a portable digital recorder. These devices usually provide limb lead ECG recordings only, and can record for between 1 and 7 days. Ambulatory ECG recording is principally used in the investigation of patients with suspected arrhythmia , such as those with intermittent palpitation, dizziness or syncopy

Chest X-ray

This is useful for determining the size and shape of the heart, and the state of the pulmonary blood vessels and lung fields. Most information is given by a posteroanterior (PA) projection taken in full inspiration

Chest X-Ray

Echocardiography (echo)
Echocardiography, or cardiac ultrasound, is obtained by placing an ultrasound transducer on the chest wall to image the heart structures as a real-time, twodimensional ‘slic

Echocardiography (echo)

Transthoracic echo. Transoesophageal.

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Doppler echocardiography This depends on the Doppler principle that sound waves reflected from moving objects, such as intracardiac red blood cells, undergo a frequency shift. The speed and direction of the red cells, and thus of blood, can be detected in the heart chambers and great vessels

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Transoesophageal echocardiography endoscope-like ultrasound probe which is passed into the oesophagus under light sedation and positioned behind the LA. This produces high-resolution images.

Computed Tomographic Imaging

Useful for imaging the cardiac chambers, great vessels , pericardium, and mediastinal structures and masses And recently even the coronaries (CT coronary angiography).

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Magnetic resonance imaging
Magnetic resonance imaging (MRI) requires no ionising radiation and can be used to generate cross-sectional images of the heart, lungs and mediastinal structures

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Cardiac catheterisation
This involves passage of a preshaped catheter via a vein or artery into the heart under X-ray guidance, which allows the measurement of pressure and oxygen saturation in the cardiac chambers and great vessels, and the performance of angiograms by injecting contrast media into a chamber or blood vessel

Coronary Angiography

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Electrophysiology study

For assessment , diagnosis and treatment of arrhythmias

Radionuclide imaging

Blood pool imaging Myocardial perfusion imaging

Cardiac biomarkers

Brain natriuretic peptide-diagnosis and assess prognosis and response to therapy in patients with heart failure . Cardiac troponins Troponin I and troponin T are structural cardiac muscle proteins that are released during myocyte damage and necrosis, and represent the cornerstone of the diagnosis of acute myocardial infarction.

Others