Examination methods in cardiology L.Křivan D:\FN%20Brno_modra_obdelnik.jpg History •Heart disease in patient´s history •Family history •Risk factors ( gender, age, smoking, cholesterol, diabetes) •Physical performance •Syncope •Arrhythmias •Medication General inspection of the patient •Cyanosis Reduced hemoglobin in capillary blood > 50g/l General inspection of the patient General inspection of the patient septické embolisace u IE 2 General inspection of the patient paličkovité prsty Auscultation of the heart auskultační místa heart_sounds_chest_wall Blood pressure Hypertension BP > 140/90 mmHg Hypotension SBP < 100 mmHg Noninvasive •ECG – arrhythmias, ischaemia, previous MI, LV hypertrophy, ionic disorders • • •X - RAY – CT index, lung congestion, valvular diseases ECG (Willem Einthoven 1893) leadIIevents ECG history 150px-Einthoven_ECG2 220px-Willem_Einthoven_ECG ECG – limb leads ecg2 limbleads ECG- precordial leads A013c%20ECG%20chest%20leads Tumor in left hemithorax • fluidothorax l Cardiac tamponade • perikard výpotek After pericardial punction • perikard výúpotek po punkci Pulmonary oedema PNO Noninvasive assessment of CAD •Bicycle treadmil test – submaximal aerobic frequency (200 – age) depressions and elevations of ST . • •Treadmil echocardiography – segmental hypokinesis during hypoperfusion • •Dobutamin. echokard. – farmacologic tachycardia G:\ergometrie 1.jpg Positive treadmill test • C:\Users\24243\Desktop\strongly-positivetmt11.jpg Noninvasive assessment of arrhythmias •ECG Holter – detection of arrhythmia in 24 h (up to 7 days) •R – test, rhythm card –5 days – 3 months monitoring •ILR – 3 years monitoring in pts with arrhythmias, unexplained syncope C:\Users\24243\Desktop\HMEKG.jpg C:\Users\24243\Desktop\reveal-linq-in-body-375.jpg Noninvasive assessment of LV function •ECHO – kinetics of the heart chambers, pericardium, valves, valvular diseases, detection of thrombi , atrial and ventricular septal deffects • http://faculty.ksu.edu.sa/almasri/Pictures%20Library/Heart%20Echocardiography%20Diagram.jpg C:\Users\24243\Desktop\Standard-parasternal-long-axis-view.png C:\Users\24243\Desktop\Ultrasound_of_human_heart_apical_4-cahmber_view.gif C:\Users\24243\Desktop\Mitralis-PW.jpg Cardiac MRI C:\Users\24243\Desktop\RTEmagicC_MR_Myxom_03_gif.gif C:\Users\24243\Desktop\MRI jizva.jpg Structure of the heart wall -Scars -Myocarditis -ARVC NMR LS CT of the heart C:\Users\24243\Desktop\CT srdce.png picture No CT AG of aorta C:\Users\24243\Desktop\CT AG AAA.jpg Invasive CAD assessment •Selective angiography – examination of coronary artery stenoses with high accuracy Coronary artery disease C:\Users\24243\Desktop\progrese aterosklerozy.jpg C:\Users\24243\Desktop\ateroskleroza.png Chest pain STE MI C:\Users\24243\Desktop\STEMI.png Total oclusion of left descending artery PCI guiding wire in the artery After treatment with PTCA Invasive assessment of arrhythmias •Electrophysiology – capacity of the conduction systém, induction and precise classiffication of arrhythmias – followed by RFA IKEG Výsledek obrázku pro radiofrequency ablation catheter Most common SVTs http://ecgguru.com/sites/default/files/styles/scale_650px_width/public/AF100.jpg?itok=D3nvpZ2u Catether placement during AVNRT ablation P9040231 kopie PK CS HS PS RF Atrial fibrilation RFA x Cryoablation • VT in structural heart disease Reentry – possible in tissues with different conduction time Invasive assessment of ventricular function •Ventriculography – 2D imaging of ventricular function • C:\Users\24243\Desktop\pig tail cathether.jpg Invasive assessment of ventricular function •Ventriculography – 2D imaging of ventricular function • Invasive cardiac monitoring •Swan-Ganz catether – measurement of pressure in PA, cardiac output •Arterial blood pressure – beat to beat BP monitoring C:\Users\24243\Desktop\BP monitoring.jpg C:\Users\24243\Desktop\monitor-de-ecg-con-importantes-bradicardia-sinusal-presion-arterial-saturaci on-de-oxigeno-y-la-presion-sanguinea-no-invasiva-hffb7r.jpg Invasive monitoring of PCW, cardiac output D:\PAP.bmp D:\Pulmonary_artery_catheter_english.jpg Invasive monitoring of PCW, cardiac output D:\PCW.jpg D:\PCWP.jpg