Radiography of the Vascular System (Part 1)

Radiography,

Angiography,

Echocardiography (Ultrasound),

Nuclear Cardiology,

CT,

MRI

Several imaging modalities play an important role in the evaluation of the cardiovascular system and the management of cardiovascular disease. (6)

Chest radiography

provides information about the heart and its shape and size

Chest radiography

It is also excellent for demonstrating the great vessels and vascular changes within the lung fields.

Echocardiography

Encompasses a group of noninvasive sonographic (ultrasound) procedures that can provide detailed information about heart anatomy, function, and vessel patency

Sonographic imaging

may be performed using M-mode, two-dimensional (2-D) imaging, spectral doppler, color doppler, or stress echocardiography

M-mode, 2-Dimensional imaging, Spectral Doppler, color doppler, stress echocardiography

Sonographic imaging may be performed using (5)

Angiography

refers to radiologic imaging of blood vessels after injection of contrast media.

catheter;vessel

In Angiography, To visualize these low-contrast structures, contrast media is injected by a ___ that is placed in the ____ of interest.

Angiography

Positive contrast media are more commonly used, but there are instanced when use of negative contrast media is indicated.

Positive contrast media

Commonly used cm in angiography

Arteriography

imaging of arteries

Venography

imaging of veins

Angiocardiography:

imaging of the heart and associated structures

Nuclear Cardiology

Nuclear medicine procedures used in the assessment of cardiovascular include myocardial perfusion scans, gated cardiac blood pool scans, and PET

Nuclear Cardiology

They are useful in assessing coronary artery disease (CAD), congenital heart disease, and cardiomyopathy.

Myocardial perfusion scan

is the most widely used procedure in nuclear cardiology.

Myocardial perfusion scan

It may be performed on patients with chest pain of an unknown origin, to evaluate coronary artery stenosis, and as a follow-up to bypass surgery, angioplasty, or thrombolysis.

Myocardial perfusion scan

It is especially useful in detecting regions of myocardial ischemia and scarring

Myocardial ischemia and scarring

Myocardial perfusion scan is especially useful in detecting regions of ___ and ___

CT

Is a non-invasive modality used to assess cardiac and vascular disease.

CT

It uses Ct technology with or without IV contrast to visualize the heart anatomy, coronary circulation, and great vessels.

MRI

Is used to detect or monitor cardiac disease and to evaluate the heart’s anatomy and function in patients with both heart disease present at birth and heart diseases that develop after birth.

MRI

It does not use ionizing radiation to produce images, and it may provide the best images of the heart for certain conditions

Circulatory system

consists of the cardiovascular and lymphatic components.

cardiovascular portion

includes the heart, blood, and vessels that transport the blood.

cardio, vascular component

Cardiovascular or blood circulatory, division may be divided further into the ____ (circulation within the heart) and ____ (blood vessel)

vascular or vessel component

is divided into pulmonary (heart to lungs and back) and general, or systemic (throughout the body)

pulmonary, general, or systemic

The vascular or vessel component is divided into ___ (heart to lungs and back) and ____ or ____ (throughout the body).

Heart

is the major organ of the cardiovascular system

Heart

functions as a pump to maintain circulation of blood throughout the body

Vascular Component

comprises a network of blood vessels that carry blood from the heart to body tissues and back to the heart again.

Oxygen, Nutrients, Hormones, Chemicals

Vascular Component Functions:

Transportation of ___, ____, ____, and ____ necessary for normal body activity

waste products

Vascular Component Functions:

Removal of ___ through the kidney and lungs

body temperature, water, electrolyte balance

Vascular Component Functions:

Maintenance of ____ and____ and _____. 

Maintenance of body temperature and water and electrolyte balance.

These functions are performed by the red blood cells, white blood cells, and platelets suspended in plasma

RBC, WBC, Platelets;plasma

Maintenance of body temperature and water and electrolyte balance. These functions are performed by the ___, ___, and _____ suspended in ____

Arteries

Vessels that transport oxygenated blood from the heart to tissues.

Arterioles

The smaller arteries are called

Capillaries

As blood travels through the arterioles, it enters the tissues through the smallest subdivision of these vessels, known as

Veins

Carries deoxygenated blood to the heart.

venous system

extends from venous capillaries to venules to veins

Pulmonary Circulation

The elements of the blood vessel circuit (veins, venules, capillaries, arterioles, and arteries) that supply blood to the lungs and back make up the pulmonary circulation components of the cardiovascular system

Veins, venules, capillaries, arterioles, arteries

The elements of the blood vessel circuit (5)

pulmonary arteries

Arteries generally carry oxygenated blood away from the heart to the capillaries except for the ____ which carry deoxygenated blood to the lungs.

heart

is a muscular organ that pumps blood throughout the body.

mediastinum; diaphragm

Anatomically, the heart lies within the ____ and rests on the ___

myocardium

Cardiac tissue differs from other muscle tissue of the body in its construction and is termed

extensive systemic circulation

The left side of the heart is responsible for the ___

left side; three times

The____ of the heart is responsible for the extensive systemic circulation; the left muscle wall is about ___ as thick as the right side 

R&L Atria, R&L Ventricles

The heart is divided into four chambers

Diagnosing heart failure,

Evaluating congenital heart defects,

Checking for valve disorders,

Monitoring heart and lung function,

Investigating symptoms, 

Follow-up and placement verification

Radiography of the Chest (Heart) Indications (6)

heart failure.

Detecting an enlarged heart, which can be a sign of

pulmonary edema

a common sign of congestive heart failure

pulmonary edema

fluid in the lungs

Cardiac size

is measured by drawing vertical parallel lines down the most lateral points of the heart and measuring between them.

Thoracic width

is measured by drawing vertical parallel lines down the inner aspect of the widest points of the rib cage, and measuring between them

Cardiothoracic Ratio (CTR)

is frequently expressed as a percentage.

Abnormal

A CTR of greater than 1:2 (50%) is considered ___

Cardiothoracic Ratio (CTR)

Accurate assessment of heart size assumes the projection is PA and that cardiac size is not exaggerated by factors such as patient rotation

left heart contour

consists of the left lateral border of the left ventricle

right heart contour

is the right lateral border of the Right Atrium (RA)

density; adjacent lung

If the heart contours are not clearly seen, this may indicate increase in ___ of the ___.

middle mediastinum

The heart is located in the ___

Aortic Knuckle

represents the left lateral edge of the aorta as it arches backwards over the left main bronchus.

Mediastinal Contours

Displacement or loss of definition of these contours can indicate diseases such as aortic aneurysm or adjacent lunch consolidation

descending thoracic aorta

The contour of the ____ can be seen in continuation from the aortic knuckle.

aortopulmonary window

is located between the Aortic Knuckle (AK) and the Left Pulmonary Artery (LPA)

Aortic Knuckle (AK), Left Pulmonary Artery (LPA)

The aortopulmonary window is located between the ____ and the ____

aortopulmonary window

It is a space where abnormal enlargement of mediastinal lymph nodes can be seen on a chest X-ray.

Cardiomegaly

Pulmonary Edema

Dextrocardia

Mitral Annulus Calcifications

Pacemaker Placement

Symptoms of heart disease,

Assessment of critical conditions,

Diagnostic and monitoring,

Screening

Echocardiography Indications (4)

Chest pain, pressure, or shortness of breath

Dizziness or lightheadedness

Palpations or an irregular heartbeat (arrythmia)

Syncope (fainting) or pre-syncope

Echocardiography

Indications

Symptoms of heart disease: (4) 

• Cardiac arrest or cardiac standstill

• Trauma to the chest, especially penetrating trauma

• Hypotension (low blood pressure)

• Suspected pulmonary embolism

• Acute heart failure

Echocardiography

Indications

Assessment of critical conditions: (5)

Heart size and function, Heart Valves, Structural and other issues, Blood flow

Echocardiography

Key aspects of Interpretations (4)

• Chamber size

• Pumping strength

• Muscle movement

Echocardiography

Key aspects of Interpretations

• Heart size and function: (3)

• Valve function

• Valve disease

• Color doppler

Echocardiography

Key aspects of Interpretations

• Heart Valves: (3)

• Congenital defects

• Blood clots and tumors

• Inflammation

• Aorta

Echocardiography

Key aspects of Interpretations

• Structural and other issues: (4)

• Doppler effect

• Normal vs. abnormal flow

Echocardiography

Key aspects of Interpretations

• Blood flow: (2)

Parasternal Long Axis View

Parasternal Short Axis View- Slide the probe towards the mitral valve; Tilt the probe towards the base of the heart

Apical Views

Subxiphoid View

Inferior Vena Cava View

Echocardiography- Step 1:

Echocardiography- Step 2: (movement of the probe for mitral valve level) & (movement of the probe for aortic valve level)

Echocardiography- Step 3:

Echocardiography- Step 4:

Echocardiography- Step 5:

• LV: Left Ventricle

• RV: Right Ventricle

• LA: Left Atrium

• RA: Right Atrium

• TV: Tricuspid Valve

• MV: Mitral Valve

• AO: Aortic Valve

Apical 5 Chamber (A5C) View: •Structures to identify (7)

Echocardiography- Step 4: Subxiphoid View & Echocardiography- Step 5: Inferior Vena Cava View

What views

Allows to see similar structures as the Apical 4 Chamber view but just approached from a different angle

Useful when having difficulty getting adequate parasternal views.

Cardiac CT Scan

Also known as Coronary CT Angiography (CCTA)

Coronary CT Angiography (CCTA)

Cardiac CT Scan Also known as

• Chest pain evaluation

• Coronary artery disease

• Aortic issues

• Heart valve assessment

• Congenital heart defects

• Planning for surgery or procedures

• Cardiac masses

• Pericardial diseases

• Post-surgery evaluation

Cardiac CT Scan (9)

Evaluating the anatomy and function of the heart chambers

Diagnosing a variety of cardiovascular disorders

Evaluating the effects of coronary artery disease

Planning a patient’s treatment for cardiovascular disorders

Monitoring the progression of certain disorders over time

Evaluating the effects of surgical changes, especially in patients with congenital heart disease.

Cardiac MRI- Indications (6)

4 chamber view

Cardiac MRI- Cardiac Axes

3 chamber view

Cardiac MRI- Cardiac Axes

2 chamber view, 3 chamber view, 4 chamber view, 5 chamber view

Cardiac MRI- Cardiac Axes (4)

5 Chamber View

2 Chamber View

Thoracic Aortography

X-ray examination of the aorta’s main artery in the chest (including the root, ascending aorta, aortic arch, and the descending aorta).

Thoracic Aortography

It uses a catheter to inject a contrast dye directly into the aorta

Thoracic Aortography

Done to diagnose and assess conditions like aortic aneurysms (bulges), dissections (tears), or congenital heart diseases.

Thoracic Aortography

To evaluate the extent of a condition and its effects on the aorta’s branches

Thoracic Aortography

To help plan surgery by providing a detailed map of the aorta and any potential blockages