Diagnostic Imaging Signs of CVD .pptx

Outward Signs and Symptoms of Cardiovascular Disease & Diagnostic Imaging in the Cardiovascular System Dr Elizabeth Peters & Dr Kat Telford Learning outcomes  Describe common findings on general observation of patients presenting with potential cardiovascular disease To relate these signs and s...

Outward Signs and Symptoms of Cardiovascular Disease & Diagnostic Imaging in the Cardiovascular System Dr Elizabeth Peters & Dr Kat Telford Learning outcomes  Describe common findings on general observation of patients presenting with potential cardiovascular disease To relate these signs and symptoms to pathophysiological processes in cardiovascular disease To describe the principles of imaging of the cardiovascular system, including x-ray, ultrasound scanning and angiography To describe the circumstances in which investigation with ultrasonography is indicated To describe the circumstances in which investigation with angiography is indicated 03/03/2023 School of Medicine 2 Outward Signs and Symptoms  There is much to be learned from general observation of patients with cardiovascular disease  Signs of cardiovascular disease can be apparent in the hands, face, neck, trunk and lower limbs  This is an integral part of cardiovascular examination 03/03/2023 School of Medicine 3 03/03/2023 School of Medicine 4 Name, Department Pathophysiology of Atheroma 03/03/2023 5 Hypercholesterolemia can result in xanthomas Hypercholesterolaemia can also cause corneal arcus (seen here as the white ring on the outer iris) In hypercholesterolaemia, cells of the dermis can become laden with lipid, resulting in a particular form of cutaneous xanthelomatosis 03/03/2023 School of Medicine 6 Raynaud’s Phenomenon •Spasm of arteries cause episodes reduced blood flow •Primary Raynaud’s can be caused by stress and cold •Secondary Raynaud's can occur due a connective tissue disorder such as scleroderma or lupus, injuries to the hands, smoking, and certain medications •This ‘white’ phase of Raynaud’s phenomenon may be followed by a ‘cyanotic’ phase. •In severe cases, infarction and gangrene may result. School of Medicine 7 03/03/2023 8 Signs and symptoms of Heart Failure School of Medicine 03/03/2023 9 School of Medicine Central Cyanosis  In patients with chronic respiratory and/or cardiovascular disease, central cyanosis may be seen  This boy has an unrepaired ventricular septal defect and secondary pulmonary hypertension  It is important to examine the tongue for signs of cyanosis 03/03/2023 10 Peripheral Oedema 03/03/2023 School of Medicine 11 Pathophysiology of Heart Failure School of Medicine Diagnostic Imaging in the Cardiovascular System X-Ray Imaging  X-ray imaging utilizes the ability of high frequency electromagnetic waves to pass through soft parts of the human body largely unimpeded  X-rays are usually generated in vacuum tubes by bombarding a metal target with high-speed electrons  Images are produced by passing the resulting radiation through the patient’s body on to a photographic plate or digital recorder to produce a radiograph 03/03/2023 School of Medicine 14 Chest X-ray (Normal)  Position and size/shape of aortic arch  Clear lung fields  Cardiac size  Costophrenic angle (not sharp/blunt)– indicative of lung disease/pleural effusion 03/03/2023 School of Medicine 15 Abnormal Chest X-ray CCF 03/03/2023 16 Ultrasound Scanning the Principles  2.5 - 5 MHz frequency sound waves for echocardiography  Pulses of sounds are ‘fired’ into tissue  ‘Echoes’ are received by the ultrasound probe  The time taken for an echo to be returned to the transducer is a reflection of the distance between the transducer and the surface off which the sound waves are being reflected  100 pulses per second so looks like a moving image on screen  When looking at the heart this technique is called echocardiography 03/03/2023 School of Medicine 17 When is Echocardiography Indicated? 03/03/2023 School of Medicine Suspected valvular heart disease Suspected abnormal left ventricular function Suspected left ventricular hypertrophy Suspected atrial fibrillation Embolus with a suspected cardiac source Suspected pericardial disease (e.g. pericarditis or pericardial effusion) Suspected pulmonary embolism Suspected infective endocarditis Suspected congenital heart defect (e.g. VSD) 18 ECHO 03/03/2023 School of Medicine 19 Doppler Echocardiography This form of echocardiography allows the investigator to label objects that are moving (e.g. blood cells) As the cells move away from the probe, their echoes take longer to come back Forwards and backwards direction of blood flow can be mapped 03/03/2023 School of Medicine 20 Angiography - Principles • Radio-opaque dye injected into the arteries in question (often coronary circulation) • This is done via a cannula introduced via another artery in the body (e.g. the femoral or brachial artery) • A succession of x-rays are then taken and shown in real time • This allows the radio-opaque dye in the blood to be visualised and shows the extent of perfusion of the arteries and their branches 03/03/2023 School of Medicine 21 Coronary Angiography • Indicated in patients with symptoms of cardiac ischaemia/infarction • Useful in determining the site of narrowing/blockage of the coronary arteries • Also used to help guide balloon catheterisation or stenting of the affected artery 03/03/2023 School of Medicine 22 Limb Angiography  Same technique as before but in a leg. What is wrong here? 03/03/2023 School of Medicine 23 Kahoot Quiz https://play.kahoot.it/v2/lobby?quizId=045d316f-a47f-4d39-a857-f3a5d054c1ee 03/03/2023 School of Medicine 24 Summary Described common findings on general observation of patients with cardiovascular disease Related these symptoms and signs to pathophysiological processes in cardiovascular disease Describe the principles of imaging of the cardiovascular system, including x-ray, ultrasound scanning and angiography Describe the circumstances in which investigation with ultrasonography is indicated Describe the circumstances in which investigation/management with angiography is indicated 03/03/2023 School of Medicine 25 Questions?