Cardiac CT

Flashcards about Cardiac CT

What does Cardiac CT provide?

3D images of the heart and surrounding structures in detail.

For what type of patients is CT Coronary Arteries (CTCA) primarily used?

Symptomatic patients with suspected CAD.

What does Cardiac CT include?

Calcium Score, Valves & Heart Chambers, Congenital Pathologies, Pre/Post Surgery.

What does RA stand for in cardiac anatomy?

Right Atrium

What does RV stand for in cardiac anatomy?

Right Ventricle

What does LA stand for in cardiac anatomy?

Left Atrium

What does LV stand for in cardiac anatomy?

Left Ventricle

What does Ao stand for in cardiac anatomy?

Aorta/Aortic Root

What does N stand for in cardiac anatomy?

Non-coronary Cusp

What does R stand for in cardiac anatomy?

Right Coronary Cusp

What does L stand for in cardiac anatomy?

Left Coronary Cusp

What does LM stand for in cardiac anatomy?

Left Main

What does LAD stand for in cardiac anatomy?

Left Anterior Descending

What does CX stand for in cardiac anatomy?

Circumflex

What does RCA stand for in cardiac anatomy?

Right Coronary Artery

What is Coronary Artery Disease?

Damage or disease in the heart's major blood vessels.

What causes Coronary Artery Disease?

Buildup of fats and cholesterol on artery walls.

Name common congenital pathologies associated with the heart.

Aortic Valve Stenosis, Patent Ductus Arteriosus, Septal Defects, Tetralogy of Fallot.

What is Aortic Valve Stenosis?

Narrowing of the Aortic Valve.

What are the effects of Patent Ductus Arteriosus?

Extra blood in the lungs, increased Right Heart Pressure.

What are Septal Defects?

Atrial or Ventricular defects leading to increased or decreased heart pressure.

What is Tetralogy of Fallot?

Combination of defects leading to complications.

For whom is CTCA mainly used?

Patients with suspected coronary artery disease who have a low or intermediate risk.

What are the characteristics of low-risk patients requiring CTCA?

Symptoms suggestive of CAD, normal ECG, normal cardiac enzyme tests and no risk factors for CAD.

What are the characteristics of intermediate-risk patients requiring CTCA?

Similar symptoms, negative ECG and cardiac enzymes, but with risk factors for CAD.

Give the pre-requisites for CTCA.

No elevation of serum markers, No ECG changes, No Renal Failure, No Pregnancy.

What are the three potential results of initial tests in the patient pathway for possible ischemic heart disease?

Normal, indicative of heart disease, or equivocal.

What is the next step after receiving an 'equivocal' result for initial tests?

Further investigation, and if equivocal, CTCA.

What kind of Heart Rates are needed to get the best diagnostic accuracy for CT Cardiac examinations?

Slow Heart Rates.

What preparations should be avoided to slow HR?

No Stimulants for 12 hours prior (Caffeine, Alcohol, Tobacco, Exercise).

What type of medication is needed if HR on breath-hold is too high?

A β-Blocker is necessary if HR on breath-hold is >65bpm or irregular.

What is the regular dosage of Oral beta Blockers?

50mg tablet taken 1 hour prior to scan.

What is the dosage of IV beta Blockers?

Up to 15mg IV delivered in 2.5mg titration.

What is the purpose of Vasodilators?

Improve image quality and diagnostic accuracy by relaxing vessel walls and increasing vessel diameter.

What medications are used as Vasodilators?

GTN (Nitroglycerin).

What are the contraindications for Vasodilators (GTN)?

Viagra/Cialis within 72 hours and Patients with low blood pressure.

What are the possible side effects of Vasodilators (GTN)?

May result in increased HR, Can cause blood pressure to decrease, Light-headed/headache.

What is the purpose of CT Calcium Scoring?

Quantitative assessment of coronary artery lesions, hard plaques only, determines total plaque burden.

What does CT Calcium Scoring indicate?

Indicate risk of cardiac event.

Who is calcium scoring for?

Low risk and intermediate risk patients.

What is Patient Prep prior to arrival for Calcium scoring?

No caffeine, alcohol, cigarettes, exercise 12 hours prior, No fasting required, No withholding of medications.

What is Patient Prep prior to Scan for Calcium scoring?

Clothing above the waist removed, Gown open at the front, ECG Leads on patient.

What is the Technique for Calcium scoring?

AP Topogram, Scan range to cover coronary vessels, 120kVp, Tube current per patient, 3mm contiguous slices.

What is the Post Processing for Calcium scoring?

Auto/Manual ‘tagging’ of hard plaques (Synago, Vitrea).

What does a CA score from 1-100 mean?

Low risk (<10% chance of having MI/stroke in next 10 years).

What does a CA score of >400 mean?

High risk (>20% chance of MI/stroke in next 10 years).

What are the potential treatments based on test results?

Can be used to guide treatment options, e.g. individualised statin/lifestyle regime.

What is Bypass Grafts mainly responsible for??

Monitoring post bypass graft surgery.

What should you be aware of when dealing with Post Coronary Artery Bypass Grafts (CABG)?

Patient preparation is identical to CTCA No calcium score required, Extended range, Larger bolus, Test bolus & Scan Delay.

What function does a Transcatheter Aortic Valve Implantation (TAVI) have?

Pre or post surgery evaluation.

What should you be aware of when dealing with Transcatheter Aortic Valve Implantation (TAVI)?

Patient Preparation Similar to CTCA: No GTN and No β-B given, AP and Lateral Full Length Topograms, Contrast Bolus, Imaging

What are the Indications for a Left Artium scan?

Pulmonary Vein Isolation (PVI) and Left Atrial Appendage (LAA) Closure.

What should you be aware of when dealing with a scanning the Left Artium?

Patient Preparation Similar to CTCA: No GTN and No β-B given, Testing Bolus and Scan done

What are the indications for Shunting/Congenital scans?

Patent Foramen Ovale (PFO).

What are some key considerations for Shunting/Congenital?

Patient Preparation Similar to CTCA: No GTN and No β-B given, AP Topogram, Contrast Bolus, and Imaging

What Pre-Exam Observations are needed to recall routine protocols used in CT Cardiac examinations?

Resting HR, BP, medication Hx.

What is the correct Patient position when recalling routine protocols used in CT Cardiac examinations?

Patient Supine Feet-first.

How is the Scan Technique selected

<60/65 bpm = Prospective Gating (High pitch helical/Large Volume),60/65-80bpm = Prospective Gating (Sequential),>80bpm = Retrospective Gating (Spiral/Helical - multiple cardiac cycles)

What is the typical Scan Range

Above coronary arteries to below heart.