Radiological examination of the heart and great vessels

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L & rsquo; cardiac imaging includes an arsenal of & rsquo; d & rsquo examination; additional interest is as follows :

Standard chest x-ray :

– Remains the & rsquo; review 1time intention before a :
+ Physical examination
+ suspect electrical tracing ( ECG)
– quick and inexpensive examination.
– Often allows to draw a fairly reliable overall picture of the patient's health.

Echocardiography :

– Technique non invasive, available and inexpensive
– Review key heart disease.

Computed tomography and nuclear magnetic resonance :

The technological advances of machines and the current possibilities of & rsquo; sectional imaging (CT : TDM multi- detectors and MRI), have contributed to the & rsquo; morphological and functional noninvasive exploration of the heart.

cardiac scintigraphy :

– diagnosis of & rsquo tool; isotopic exploration infarction
– Necessary before the following risk factors : Diabetes, Smoking, Hypertension and dyslipidemia
– Asked immediately before abnormal electrical tracing(ECG) : complete left branch block

Technique :
– Injection of a radioactive tracer : Thallium 201 or technetium
– Special sensor: Scintigraphe:
+ Saves the distribution of the injected substance in different parts of the & rsquo; organ examined.
+ This distribution is displayed as a series of points "Glitter" corresponding to the areas marked by the active product.

heart catheterization :

invasive method d & rsquo; relatively old exploration (cardiac and vascular catheterization) is characterized by selective injections of iodinated contrast agent in the heart chambers and the coronary arteries.

Angiography Cardiac / Coronagraphy :

Technique & rsquo; examination having rapidly evolved knowledge of the structures and functioning of the normal and pathological heart by haemodynamic and morphological study of the heart chambers and vessels.
– Catheterization of the & rsquo; femoral artery : left heart or great vessels
– The femoral vein catheterization : right heart

TECHNICAL RESOURCES EXPLORATION :

1- INCIDENCES :

4 clichés: Face, profile, Oblique right anterior (BEANS) / Left anterior oblique

(OAG).

– Standing face shot : Posteroanterior (ray entering from the back, plate on the anterior chest), deep breath and high voltage (115-130kV).

Cliché profile : same conditions, only the & rsquo; incidence changes becoming Side (left part against the plate).

– Cliché and OAD : right part of the body placed against the plate making a 45 ° angle with the RX.

– Cliche in OAG : left side placed against the plate making a 45 ° angle with the RX RADIOGRAPH THORACIC +++++

2- TECHNICAL ACHIEVEMENT AND CONSTANT USED Chest :

– Exposure time : short shot and made Apnea

Distance fover-film : 2m for distance thorax Face

3- QUALITY LAYOUT :

Criteria for checking the quality of the thorax :

  • Distance between the inner edge of the collarbone thorny : equal to the right and left.
  • Epineuse of 3th thoracic vertebra centered (CXR, is Front)
  • Air-fluid level in the gastric pouch (patient standing)
  • diaphragmatic right : at or below the front of the sixth costal arch &) Butts bag costo-diaphragmatic : visible (shot made deep breath)
  • Spine and vessels visible behind the heart : appearance meaning that & rsquo; exposure is correct.

OBLIQUE IMPACT OR CROSS HEART :

RX TO SKEW RIGHT PRIOR (BEANS)
RX TO LEFT FORMER OBLIQUE (PAG) : – rarely indicated / – True heart profile can see all the aorta / – posterior margin / – front edge (YD overcome aortic)

ECHOCARDIOGRAPHY :

  • Technique & rsquo; imaging US, l & rsquo; & rsquo or echocardiography, cardiac ultrasound or & rsquo; Doppler heart, quickly found its place among the medical applications of ultrasound.
  • Non invasive, available, d & rsquo; frequent indication (child, pregnant woman and duration lOmn 30mn )
  • morphological and functional information.

– Morphology and kinetics of heart valves
– Various features of the heart operation

IMAGING SECTIONAL :

CT MULTI-SENSORS HEART AND VASCULAR :

– Morphological and functional exploration of coronary and heart
– Requiring development d & rsquo; special examination with good patient preparation.
– Acquisition synchronized on & rsquo; ECG
– Reconstruct the images in the different phases of the cycle.

CARDIAC MRI :

Reference method for the & rsquo; imaging:
– Congenital heart disease, cardiac tumors
– Large vessels and pericardium

Thanks to :
– A good spatial and temporal resolution
– A Three-dimensional approach
– Excellent contrast between the circulating blood and the myocardium.

Determination parciné MRI :

standardized, Precise and Reproducible.
– ventricular volumes
– d & rsquo fraction; ejection
– myocardial mass
– kinetics segmental

MRI contrast after gadolinium injection : considerable diagnostic value for :
– many diseases:
– tumoral, inflammatory, ischemic
– Specify the & rsquo; d & rsquo etiology; cardiomyopathy.
– Reference method in & rsquo; analysis of myocardial viability (ischemic heart disease)

Major advantage of the & rsquo; MRI :

  • To associate the & rsquo; study of myocardial viability : l & rsquo; analysis of the infusion
  • Functional approach of heart muscle :

– Functions right and left ventricular resting
– When d & rsquo; d provocation tests & rsquo; myocardial ischemia.

TECHNICAL PROTOCOL :

Different sequences are used to provide :
1- morphological assessment in:
-conventional anatomical planes
-Specific plans of the heart
2- Analysis of cardiac functional parameters :
– ventricular mass – d & rsquo fraction; ejection – Volume d & rsquo; ejection
– Thickness infarction – Kinetics segmental and global &) Volumes ventricular end-diastolic and systolic TV
3- hemodynamically including sequences in phase contrast for quantization: Flow rates / speeds (pulmonary- systemic)
4- Analysis of the infusion 1is passing infarction
5- MRA with gadolinium
6- delayed enhancement (myocardial viability) +++++

SCINTIGRAPHY HEART :

myocardial scintigraphy : Further examination to assess the: heart function (perfusion, metabolism, cellular integrity…).

INTEREST :
Confirm or coronary character & rsquo; chest pain by identifying the & rsquo; perfusion status infarction
Myocardial scintigraphy coupled to a: -Test d & rsquo; effort and / or drug stimulation.

1- normal vasculature :

homogeneous fixing
Perfusion tracer uptake in the myocardium : normal
Normal test
Pain presented by the patient are not d & rsquo; CHD

2- abnormal vascularization :

It is more or less extensive and is characterized by : tracer uptake defect on the myocardium
A 2th passing under the camera 3, 4, indeed 24 hours, to compare the initial images to images taken at rest.

CARDIAC CATHETERIZATION :

Insert a probe opaque to X-rays in the right cavities through the femoral vein and left cavities by & rsquo; femoral artery.

INTEREST :

1- Measure intracardiac and intravascular pressure

2- Take blood samples

3- lnjecter various indicators to measure cardiac output and detect an intracardiac shunt

4- lnjecter the iodinated contrast agent for a morphological and functional study of cavities / vessels: – ANGIO-CARDIOGRAPHIE – CORONOGRAPHIE

INDICATION OF EVERY MEANS & rsquo; EXPLORATION :

COUPLE : RX STANDARD + ECHOCARDIOGRAPHIE
Broad indications before or after electrical examination (ECG)
CT HEART

TWO TYPES & rsquo; INDICATIONS :
– APPROPRIATE
– NOT APPROPRIATE

RELEVANT INDICATIONS :

– INDICATIONS CLASSIC:
– Pulmonary embolism / Aortic dissection
– Evaluation of aneurysms of the & rsquo; aorta
– ANATOMY REVIEW
– DIAGNOSTIC RESULTS OF CORONARY PATIENTS

INDICATIONS NOT APPROPRIATE :

  • acute chest pain and ECG modification with or increase in cardiac enzymes.
  • Patient at high risk or with a positive intermediate functional test.
  • asymptomatic patient, low risk after myocardial revascularization (bypass Surgery, Stent)
  • Characterization of the plaque
  • Measuring the aortic valve area
  • Realization of single calcium score in the symptomatic patient or proven coronary

SCINTIGRAPHY :

– Myocardial viability (detection of necrosis)
– cardiac shunts

CATHETERIZATION / angiography :

  • Acquired valvular heart disease
  • congenital
  • ischemic heart disease
  • Pulmonary arterial hypertension or heart failure
  • Post Heart Surgery
SEMIOTICS RX STANDARD

– Cut , Morphology of the cardiac silhouette
– Container and contents.

CHEST X-RAY PROFILE LEFT :

  • ovoid heart
  • front edge :

– upper arc (ascending aorta)
– lower arc (right ventricle : CEO)

  • top edge :

– 1/3 inferior (right ventricle : CEO)
– 2/3 superior (right ear : FROM)

SEMIOLOGY ABNORMAL :

1- DILATATION / CARDIAC HYPERTROPHY CAVITIES
2- BIG SHIPS
– Aortic Coarctation
– NEVRYSME OF & rsquo; AORTA
– DISSECTION L & rsquo; AORTA

Expansion of the & rsquo; right atrium :
Enlargement of the & rsquo; lower right arch that seems more convex.
– Hyper-convexity and overhang of & rsquo; arc Lower Right (AID)
In case of :
– atresia triscupide
– CIA high flow

Dilatation of the right ventricle :
Train:

  • Projection of & rsquo; lower left arch with rounded appearance
  • Pointe raised.

Hypertrophic Dilation RV :
– Overhang of & rsquo; lower left arc raised edge (heart in the shoe & rsquo; extreme)
– Obstacle in the pulmonary route ( valvular stenosis or trunk of the & rsquo; pulmonary artery)
– Heart in shoe : Tétratologie of Fallot : complex heart defect that combines between severe stenosis of the pulmonary route with important HVD

Dilation of the pulmonary artery :
causes : Abnormal protrusion of & rsquo; average arc.

Expansion of the & rsquo; aorta :
causes : projection of & rsquo; arc top right

LAYOUT CHEST :

View pathological calcifications that may affect :
– heart valves -the pericardium
– the vessel wall including the & rsquo; aorta

CONCLUSION :

The technical means for the & rsquo; exploration heart and great vessels are numerous but the choice depends:
– studied pathology
– Patient Clinical Status
– electrical tracing
– Availability of devices & rsquo; exploration.

– If the information is sufficient, preferably starting the & rsquo; exploration by d & rsquo technique, minimally invasive imaging or completely harmless in case the & rsquo; ultrasound B-mode and Doppler cardiovascular.

– Each technique provides one or more semiotic signs of its own and the & rsquo; combination of different types & rsquo; review, is often complementary.

The standard cliché remains essential that the technical achievement must be respected ( quality criteria )

L & rsquo; echocardiography examination 1time intention: morphological and functional

L & rsquo; imaging noninvasive cut :
– Coronary CT =
– MYOCARDIAL VIABILITY MRI =

Dr Lecheheb's course – Faculty of Constantine