EXAMINATION TECHNIQUES IN CARDIOLOGY •Non-invasive methods • • • •Invasive methods • •(by puncture needle or catheter) NON – INVASIVE METHODS Basic – used together with examination of patients •Inspection •Palpation •Percussion •Auscultation •PHONOCARDIOGRAPHY •S1 •S2 •S3 •S1 •S2 •S3 X-ray RTG Helán •Chest x-ray provides useful information about cardiac size and shape, as well as the state of the pulmonary vasculature, and may identify noncardiac causes of the patient´s symptoms ELECTROCARDIOGRAPY •A routine 12-lead ECG •The major importance of the ECG is to assess cardiac rhythm and determine the presence of left ventricle hypertrophy or prior myocardial infarction or QRS width •Normal ECG excludes left ventricle dysfunction Clipboard04.bmp ELECTROCARDIOGRAPY •HOLTER MONITORING • 24-hour ECG record • • ü estimation of heart rate variability § time analysis § spectral analysis • C:\Documents and Settings\ja2\Dokumenty\Přednášky medici\HRV002.jpg ELECTROCARDIOGRAPY •HOLTER MONITORING • ülate potencials C:\Documents and Settings\ja2\Dokumenty\Přednášky medici\late potencial001.jpg Reveal - implantable recorder • reveal & act white carelink_pgmr §small device, without electrodes §recorder of ECG during syncope • - activation by patients • - or autoactivation §continuously monitoring 36 month, 42 min episodes at memory §simple implantation, simple evaluation. •Patient Activator and Reveal® Plus ILR • •Medtronic CareLink® Programmer • BLOOD PRESSURE MEASUREMENT •AUSCULTATORY METHOD •OSCILOMETRIC METHOD BLOOD PRESSURE MEASUREMENT •AMBULATORY BLOOD PRESSURE MONITORING - ABPM • img010.jpg BLOOD PRESSURE MEASUREMENT •continuously beat-to-beat measurement •Peňáz principle - photopletysmography • IMG_0869 05 Obrázek1 P2290047 01 02 •We need than pressure in the cuff corresponded to the pressure of the digital artery •Method: photopletysmography •Recorded photoelectric plethysmogram •The new term: Transmural pressure – Pt (the pressure across the wall of the artery) •BP, Pc (pressure in cuff), Pt •We estimated: BP=Pc - - - Pt=0 - - - photoplethysmogram registered the highest amplitude of oscilation --- we measure the MAP •Step by step increase of Pc, in the moment of the highest amplitude – feed-back loop started for obtained(keeping) the constant volume of the finger Peňáz patent • •He used the signal from the photocell to control the pressure of the outer cuff so that the volume of the finger did not change. •This has achieved that pressure in the cuff monitors blood pressure in the artery. ECHOCARDIOGRAPHY most widespread methods img004.jpg img004.jpg •APICAL VIEW img005.jpg •PARASTERNAL LONG-AXIS VIEW img006.jpg COMPUTED TOMOGRAPHY •CT is a fast, simple, noninvasive technique that provides images of the myocardium and great vessels; •CT uses x-rays to create tomographic slices of objects-this is acomplished by rotating an x-ray bea around the object and measuring the trasmission of x-rays through the object at many angles,called projections • Clipboard03.bmp aorta Left anterior descending artery left atrium Left circumflex •Based on the magnetic properties of hydrogen nuclei •Used to quantify accurately EF, ESV, EDV, cardiac mass •Without the need for ionizing radiation • • MAGNETIC RESONANCE IMAGING Clipboard02.bmp NUCLEAR CARDIOLOGY •Nuclear (or radionuclid) imaging requires intravenous administration of isotopes •Single photon emission computed tomography SPECT and positron emission tomography PET Clipboard01.bmp INVASIVE TECHNIQUES •CARDIAC CATHETERIZATION •Right heart catheterization – uses a balloon-tipped flotation catheter that is inserted into the femoral or jugular vein. Using fluoroscopic guidance, the catheter is advanced to the right atrium - right ventricule – pulmonary artery and pulmonary wedge position (as a surrogate for left atrial pressure = wedge pressure) INVASIVE TECHNIQUE •CARDIAC CATHETERIZATION •Left heart catheterization – with the aid of fluoroscopy, the catheter is guided to ascending aorta – across the aortic valve into left ventricule (inserted into a.femoralis,a.axillaris, a.brachialis) •A needle-tipped catheter to puncture the atrial septum during right heart catheterization •+ coronary angiography img007.jpg INVASIVE TECHNIQUE •How do we use cardiac catheterization? • üPressure measurement üBlood flow measurement üBiopsy of tissue üBlood samples for oxygen-saturation analysis to screen for intracardiac shunts üElectric potentials measurement • Intracardiac Echocardiography Is an intravascular ultrasound modality that provides diagnostic imaging of cardiac structures from within the heart. The first catheters used high frequency tranducers (20-40 MHz) containing a single ultrasound crystal that rapidly rotated at the end of catheter C:\Documents and Settings\ja2\Dokumenty\Přednášky medici\intrakardiální echo007.jpg INVASIVE TECHNIQUE •ELECTROPHYSIOLOGY EXAMINATION img009.jpg img009.jpg C:\Documents and Settings\ja2\Dokumenty\Přednášky medici\aktivační mapa003.jpg C:\Documents and Settings\ja2\Dokumenty\Přednášky medici\propagační mapa004.jpg •Activation map - Activation map of right atrium • in left sloping projection - Sinus rhythm • •Activation propagation map - propagation of left ventricular map C:\Documents and Settings\ja2\Dokumenty\Přednášky medici\voltážová mapa005.jpg C:\Documents and Settings\ja2\Dokumenty\Přednášky medici\sítová mapa006.jpg •Voltage map – red color – places with • a lower voltage, violet – healthy myocardium •Voltage map in network design – •visibility of the catheter 3D map by system NavX Electro-anatomy mapping of left atrium •Ouško •LSPV •LIPV •RSPV •RIPV •Mitrální anulus Radio –frequency ablation - for atrial fibrilation