Examination methods in cardiology
L.Křivan
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
General inspection of the patient
Auscultation of the heart
Blood pressure
Noninvasive
• ECG – arrhythmias, ischaemia, previous MI, LV
hypertrophy, ionic disorders
• X - RAY – CT index, lung congestion, valvular
diseases
ECG (Willem Einthoven 1893)
ECG history
ECG – limb leads
ECG- precordial leads
Tumor in left hemithorax
Cardiac tamponade
After pericardial punction
Pulmonary oedema
PNO
Stomach in the chest
Noninvasive assessment of CAD
• Bicycle treadmil test – submaximal aerobic frequency
(220 – age) depressions and elevations of ST .
• Treadmil echocardiography – segmental hypokinesis
during hypoperfusion
• Dobutamin. echokard. – farmacologic tachycardia
Positive treadmill test
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
Noninvasive assessment of LV function
• ECHO – kinetics of the heart chambers, pericardium,
valves, valvular diseases, detection of thrombi , atrial
and ventricular septal deffects
Cardiac MRI
Structure of the heart
wall
- Scars
- Myocarditis
- ARVC
CT of the heart
CT AG of aorta
Invasive CAD assessment
• Selective angiography – examination of coronary
artery stenoses with high accuracy
Coronary artery disease
Chest pain STE MI
Stop in ramus interventricularis anterior
PCI 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
Nejčastější SVT
Catether placement during AVNRT ablation
PK
CSHS
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
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
Invasive monitoring of PCW, cardiac output
Invasive monitoring of PCW, cardiac output