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Cardiovascular Diagnosis

How to arrive at a diagnosis in CVS

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Cardiovascular Diagnosis

  1. 1.
  2. 2. ANATOMY OF HEART <ul><li>Chapter 01 </li></ul>
  3. 3. The Heart <ul><li>The heart is located in the center of the thorax and contracts 72 times per minute pumping blood throughout the body </li></ul>
  4. 4. The Beating Heart
  5. 5. Heart - Front View <ul><li>The external structures of the heart include the ventricles, the atria, aorta, pulmonary arteries and the pulmonary veins </li></ul>
  6. 6. Heart - Section <ul><li>The interior of the heart is composed of the myocardium, four heart valves, four cardiac chambers, and associated vessels </li></ul>
  7. 7. Not From Within <ul><li>Heart can not get blood for its own need from within the chambers of heart, but has to depend on the coronaries from outside </li></ul>
  8. 8. Left Coronary Artery <ul><li>Left coronary artery is the largest of the blood vessels supplying the heart, especially the left ventricle and the left atrium </li></ul>
  9. 9. Right Coronary Artery <ul><li>Right coronary artery is the 2 nd largest of the blood vessels supplying the heart especially the right ventricle and right atrium </li></ul>
  10. 10. Anterior Heart Arteries <ul><li>The important branch of the left coronary artery is the left anterior inter-ventricular artery which supplies the anterior surface </li></ul>
  11. 11. Posterior Heart Arteries <ul><li>Another important branch of left coronary artery is the Deep Circumflex Artery which supplies the posterior surface </li></ul>
  12. 12. SYMPTOMS OF HEART DISEASE <ul><li>Chapter 02 </li></ul>
  13. 13. Chest Pain <ul><li>Pain in the center of the chest is very characteristic of diseases of the heart especially those due to coronary artery disease </li></ul>
  14. 14. Non Cardiac Chest Pain <ul><li>Even though chest pain as a presenting symptoms of heart attack is quite characteristic, it is not unique to heart disease </li></ul>
  15. 15. Breathlessness on Exertion <ul><li>Breathlessness especially on exertion and on lying down occurs in heart disease. Patient may also wake up at night with breathlessness </li></ul>
  16. 16. Palpitation <ul><li>Palpitation is another important symptom of heart disease. It may occur during exertion or while at rest </li></ul>
  17. 17. Hemoptysis <ul><li>Spitting blood or blood stained sputum, even though more likely to be due to a respiratory disease may also occur in heart disease </li></ul>
  18. 18. Bluish coloration <ul><li>Otherwise called cyanosis, of the lips and tongue is likely to occur in some congenital heart diseases and also in heart failures </li></ul>
  19. 19. Peripheral Cyanosis <ul><li>Bluish coloration may also occur in heart disease due to the reduced circulation of the peripheral tissues like fingers and toes </li></ul>
  20. 20. Leg Swelling <ul><li>Leg swelling due to accumulation of fluid in the subcutaneous tissues is likely to occur in heart failure </li></ul>
  21. 21. SIGNS OF HEART DISEASE <ul><li>Chapter 03 </li></ul>
  22. 22. Examination of Pulse <ul><li>The right radial artery pulse is palpated in the forearm for at least one minute and studied in detail for the rate and the rhythm </li></ul>
  23. 23. The Blood Pressure <ul><li>The BP is recorded in the right arm using a sphygmomanometer applied to the upper arm and K sounds auscultated at elbow </li></ul>Coming up – an Animation of BP measurement
  24. 24. Measurement of BP
  25. 25. Jugular Venous Pressure <ul><li>The pressure inside the right atrium is reflected in the root of the neck as the jugular venous pressure which is measured and studied </li></ul>Coming up a Video of JVP measurement
  26. 26. Measurement of Jugular venous Pressure
  27. 27. Palpation of Heart <ul><li>Precordium of the chest is palpated for position of the apex beat, left parasternal heave and presence of any thrills </li></ul>
  28. 28. Areas for Auscultation <ul><li>These are the aortic area, the pulmonary area, the second aortic area, the tricuspid Area and the mitral area </li></ul>
  29. 29. Auscultation of Heart Sounds <ul><li>The heart is auscultated for the intensity and quality of the heart sounds and any additional heart sounds </li></ul>Coming up a Video of Auscultation of Heart
  30. 30. Auscultation of The Heart - Video
  31. 31. Auscultation of Heart Murmurs <ul><li>The heart is then auscultated carefully for the presence of any heart murmurs either in the systole, diastole </li></ul>
  32. 32. INVESTIGATIONS IN HEART DISEASE <ul><li>Chapter 04 </li></ul>
  33. 33. Electrocardiogram (ECG) <ul><li>It is a test that measures the electrical activity of the heart, the rate, rhythm and presence of any ischemia </li></ul>
  34. 34. ECG <ul><li>ECG is used extensively in the diagnosis of heart disease, from congenital disease to myocardial infarction and myocarditis </li></ul>
  35. 35. Holter Monitoring <ul><li>The patient wears a monitor that records electrical activity of their heart (similarly to the recording of an ECG) for 24 hours </li></ul>
  36. 36. X-Ray Chest PA view <ul><li>Chest X-Ray PA view brings into focus the heart and the lungs and the chambers and any enlargement of the heart </li></ul>Coming up a Video of Echocardiography
  37. 37. Echocardiography
  38. 38. Coronary Angiography <ul><li>The narrowing of the coronary vessels can be demonstrated using this radiological technique </li></ul>
  39. 39. CORONARY ARTERY HEART DISEASES - ANGINA <ul><li>Chapter 05 </li></ul>
  40. 40. Definition of Angina <ul><li>Angina is a temporary chest pain, pressure or discomfort due to insufficient blood supply to heart, during exertion </li></ul>
  41. 41. Angina – The Cry of Heart <ul><li>When heart does not get enough blood through coronaries during exertion, it cries for more oxygen, causing the pain </li></ul>
  42. 42. Site of Chest Pain <ul><li>The chest pain in angina is felt in the center of the chest, and is described by an open or closed fist showing the site </li></ul>
  43. 43. Chest Pain Radiation <ul><li>In angina, chest pain usually radiates to the left shoulder, left upper limb and along its inside border and up to the left hand </li></ul>
  44. 44. Other Sites of Radiation <ul><li>In another patient the chest pain may radiate to the neck, jaw, upper abdomen, right shoulders and or the right arms </li></ul>
  45. 45. Severity Of Pain <ul><li>The severity of the chest pain is such that the patient can no longer exert and therefore stops, gasping with pain </li></ul>
  46. 46. Character Of The Pain <ul><li>It is described as either a firm pressure, chest discomfort, crushing or burning or tightness of chest </li></ul>
  47. 47. Other Symptoms <ul><li>Patients may complain about anxiety, dizziness, cold sweating, breathlessness or even presence of a stomach upset </li></ul>
  48. 48. Duration of Chest Pain <ul><li>The pain usually lasts for only 2-3 minutes and is relieved when the patient takes rest or puts medicines under the tongue </li></ul>
  49. 49. It is a Vicious Cycle <ul><li>Initially pain occurs during moderate activity but later it occurs during mild activity, then during normal daily activities </li></ul>
  50. 50. Coronary Atherosclerosis <ul><li>The basic abnormality in of angina is the narrowing of the coronary arteries by progressive atherosclerosis </li></ul>
  51. 51. Plaque Formation <ul><li>Accumulation of lipids in the walls of the artery leads to the formation of an inward elevation called the plaque </li></ul>
  52. 52. Treatment of Angina <ul><li>The treatment of Angina is by using drugs which dilate the coronary arteries like nitroglycerine and vasodilators </li></ul>
  53. 53. Nitroglycerine <ul><li>Nitroglycerine is taken by the patient immediately after chest pain by placing it under the tongue for quick absorption </li></ul>
  54. 54. CORONARY ARTERY DISEASE - UNSTABLE ANGINA <ul><li>Chapter 07 </li></ul>
  55. 55. No permanent damage <ul><li>In angina there is no permanent damage to the myocardium as would occur in patients with Myocardial Infarction </li></ul>
  56. 56. Coronary Angioplasty <ul><li>Here the narrowed coronary artery causing the CAD is opened up using a catheter passed through the vessel </li></ul>
  57. 57. Coronary Artery Stent <ul><li>A stent is a rust proof wire mesh placed inside the coronary artery, which costs anything above Rs 50,000 per piece </li></ul>
  58. 58. Stent Insertion <ul><li>A guide wire is advanced across the blocked section of the coronary artery and a balloon is positioned beside the blockage </li></ul>
  59. 59. The Result <ul><li>The outcome is relief from chest pain and improved exercise capacity. In 2/3 rd of patients, the procedure is successful </li></ul>Coming up an Animation of Angioplasty
  60. 60. Angioplasty
  61. 61. Coronary Bypass Surgery <ul><li>Bypass surgery is the alternative option indicated when one or more coronary arteries are seriously blocked </li></ul>
  62. 62. Bypass Surgery <ul><li>In Bypass surgery, the site of coronary obstruction is bypassed by means of a vein or artery from the patient himself </li></ul>
  63. 63. Saphenous Vein Graft <ul><li>Here the saphenous vein is harvested from the patient’s own legs and used as a conduit for bypass </li></ul>
  64. 64. Internal Mammary Graft <ul><li>Internal mammary artery graft is used alternatively in selected cases producing a longer term of benefit of up to 10 years </li></ul>
  65. 65. Beating Heart Surgery <ul><li>Here stabilization devices are used to reduces the motion of target vessels and the bypass under taken with out Heart-Lung machine </li></ul>Coming up a Video of Beating Heart Surgery
  66. 66. Beating Heart Surgery Coming up a Video of Robot Assisted Bypass Surgery
  67. 67. Robot Assisted Surgery
  68. 68. MYOCARDIAL INFARCTION <ul><li>Chapter 08 </li></ul>
  69. 69. Heart Attack <ul><li>A heart attack or acute myocardial infarction (MI) occurs when one of the coronary arteries is blocked </li></ul>
  70. 70. Total Occlusion <ul><li>In angina there is only up to 70-80% occlusion; but in Acute Myocardial Infarction, there is 100% occlusion </li></ul>
  71. 71. Myocardial Infarction <ul><li>The area of myocardium which is totally deprived of blood supply becomes a non contracting scar tissue </li></ul>Coming up an animation of Thrombus Formation
  72. 72. Thrombus Formation
  73. 73. Who Gets Heart Attack? <ul><li>Any body can get a heart attack above the age of 30 years, irrespective of the sex, race and country of origin </li></ul>
  74. 74. Females and Heart Attack <ul><li>Females are generally protected from heart attack because of estrogen in their body during menstruating age </li></ul>Coming up an Animation about Risk Factors of MI
  75. 75. Risk Factors for MI
  76. 76. Sudden Death <ul><li>Importance of Myocardial Infarction, is that it can cause sudden, unexpected death, even in very young people </li></ul>Coming up a Animation about Complications of MI
  77. 77. Complications of MI Coming up a Video of Cardio Pulmonary Resuscitation
  78. 78. Cardiopulmonary Resuscitation Coming up an Animation of Automated Defibrillation
  79. 79. Automated Defibrillation
  80. 80. ECG wave tracings in MI <ul><li>Various phases of MI can be seen in ECG wave tracings during the acute phase, fully evolved phase, resolution phase and chronic phase </li></ul>
  81. 81. ST Elevation MI <ul><li>ST elevation Myocardial Infarction is the most important type of Myocardial infarction leading to sudden cardiac arrest and death </li></ul>
  82. 82. Thrombolytic Therapy <ul><li>If the patient can be brought sufficiently early to the hospital, the blood clot can be dissolved using certain drugs like streptokinase </li></ul>Coming up a Video of Emergency Ambulance Service
  83. 83. Call the Ambulance
  84. 84. Non ST Elevation MI <ul><li>Here the patient has no ST elevation in the ECG. But at the same time there is death of the myocardial tissue which is not easily reversible </li></ul>Coming up an Animation about Final Outcome
  85. 85. Final Outcome
  86. 86. HYPERTENSIVE HEART DISEASE <ul><li>Chapter 09 </li></ul>
  87. 87. Definition <ul><li>Hypertension is defined as sustained and abnormal elevation of arterial blood pressure of at least 140 mmHg systolic and 90 mmHg diastolic </li></ul>
  88. 88. Importance <ul><li>If left untreated hypertensive patients can end up with several complications in the due course of the illness </li></ul>
  89. 89. Complications of HTN <ul><li>Hypertension is a very important predisposing cause of heart disease, kidney disease, as well as stroke </li></ul>
  90. 90. What is blood pressure? <ul><li>It is the pressure exerted on the lateral walls of the blood vessels by the blood from within the vessel </li></ul>
  91. 91. Why We Need Blood Pressure? <ul><li>Blood pressure is needed to push the blood along the blood vessels to reach the various tissues of the body </li></ul>
  92. 92. Essential Hypertension <ul><li>In Primary or Essential Hypertension both the systolic as well as diastolic blood pressures are elevated to almost an equal extend </li></ul>
  93. 93. Sodium in Food <ul><li>Sodium is an element that the human body needs to function properly and especially to regulate the blood pressure and blood volume </li></ul>
  94. 94. Sodium and Hypertension <ul><li>For individuals who are sodium-sensitive, an increased intake of sodium through food may contribute to high blood pressure </li></ul>
  95. 95. The values <ul><li>Persons with BP in the normal ranges are normal. Those having BP in the borderline are called pre-hypertensives </li></ul>
  96. 96. Normal Blood Pressure <ul><li>The normal blood pressure is 120/70 to 140/90. It is advisable to maintain a BP in or around 130/80 mmHg under any circumstances </li></ul>
  97. 97. Isolated Systolic Hypertension <ul><li>In some patients with hypertension especially old people, only the systolic Blood Pressure is found to be elevated </li></ul>
  98. 98. White Coat Hypertension <ul><li>In these cases high blood pressure is seen only when recorded by the doctor in the clinic or hospital surroundings </li></ul>
  99. 99. Symptoms <ul><li>Most patients with hypertension have no specific symptoms. Others may complain about dizziness, vertigo or epistaxis </li></ul>
  100. 100. Headache and Hypertension <ul><li>Headache is seen only in patients with more severe hypertension. In these patients it is localized to the back of the head </li></ul>
  101. 101. The Silent Killer <ul><li>Hypertension is considered as a silent killer because even in the absence of symptoms it can cause heart attack or stroke </li></ul>Coming up an Animation of Effects of Hypertension
  102. 102. Effects of Hypertension
  103. 103. Hypertension and Heart <ul><li>The heart muscles thicken to make up for increased blood pressure. It is the left ventricle which gets the brunt of the enlargement </li></ul>
  104. 104. Left Ventricular Hypertrophy <ul><li>The left ventricle is markedly thickened in this patient with severe hypertension that was remaining untreated for many years </li></ul>Coming up an Animation of Effect of HTN on Heart
  105. 105. The Effect On The Heart
  106. 106. Hemiplegia <ul><li>Occlusion of the middle cerebral artery results in sudden paralysis of upper and lower limbs called as a stroke or hemiplegia </li></ul>
  107. 107. Intracerebral Hemorrhage <ul><li>Perhaps a more important and dangerous complication of hypertension is bleeding in to the brain, causing unconsciousness </li></ul>
  108. 108. Treatment of High BP <ul><li>Maintaining the blood pressure within the normal ranges for months and years is perhaps more difficult </li></ul>
  109. 109. Advice to High BP patients <ul><li>Every patient with hypertension is advised to check BP regularly so that sudden increase may not occur </li></ul>
  110. 110. Regular Exercise <ul><li>By doing regular exercise the tone of the muscles in the walls of the arteries remain reduced and thus BP is lowered </li></ul>
  111. 111. Low Salt Intake <ul><li>Low salt intake is an essential component of management of hypertension irrespective of the degree of BP rise </li></ul>
  112. 112. Pappads, Pickles, Fried, Dried <ul><li>Pappads, pickles, fried items and dried fish contain large quantities of salt. Hence all hypertensive's should avoid these </li></ul>
  113. 113. Beta Blockers <ul><li>Atenelol is one such drugs used in the treatment of hypertension especially in the early stages </li></ul>
  114. 114. Calcium Channel Blockers <ul><li>Nifedipine is a calcium channel blocker used for the control of mild to moderate hypertension </li></ul>
  115. 115. ACEIs and ARBs <ul><li>Angiotensin Converting Enzyme inhibitors and Angiotension Receptor Blockers are the other drugs </li></ul>
  116. 116. VALVULAR HEART DISEASES <ul><li>Chapter 10 </li></ul>
  117. 117. The Heart Valves <ul><li>The valves of the heart open and close to control the flow of blood entering or leaving the heart </li></ul>
  118. 118. The Four Valves <ul><li>There are four valves in the heart: namely the aortic, the mitral, tricuspid, and the pulmonary valve </li></ul>
  119. 119. The Heart Valves <ul><li>The valves are designed to control the direction of blood flow through the heart. Their opening and closing produce the heart sounds </li></ul>
  120. 120. Mitral stenosis <ul><li>It is a heart valve disorder that narrows the mitral valve opening reducing the amount of blood that flows through it </li></ul>
  121. 121. Mitral Regurgitation <ul><li>Mitral valve may develop damage due to rheumatic fever and become leaky resulting in blood regurgitating into the left atrium </li></ul>
  122. 122. Aortic Stenosis <ul><li>Aortic valve gets constricted due to valve damage preventing blood from flowing into the aorta </li></ul>
  123. 123. Aortic Regurgitation <ul><li>The aortic valve, when affected by disease cannot prevent back flow of blood in to the left ventricle </li></ul>
  124. 124. HEART FAILURE <ul><li>Chapter 11 </li></ul>Coming up an Animation about Heart Failure
  125. 125. Heart Failure
  126. 126. Pulmonary Edema <ul><li>As the heart fails, pressure in the vein going through the lungs starts to rise. fluid is pushed into the air spaces (alveoli) </li></ul>
  127. 127. Pulmonary Edema in X- Ray <ul><li>Pulmonary edema can be seen in the X-Ray chest as a fluffy non-homogenous opacities of both hila of lungs </li></ul>Coming up an Animation of Ventricular Assist Device
  128. 128. Left Ventricular Assist Device Coming up a Video of Heart Transplantation
  129. 129. Heart Transplantation Coming up an Animation of Total Artificial Heart
  130. 130. Total Artificial Heart
  131. 131. CONGENITAL ACYANOTIC HEART DISEASES <ul><li>Chapter 12 </li></ul>
  132. 132. Atrial Septal Defect <ul><li>It is a congenital heart defect where the wall between the right and left atrium has a hole and blood flows between the two atria </li></ul>
  133. 133. Ventricular Septal Defect <ul><li>Ventricular septal defect is an abnormal opening in the wall that separates the right and left ventricles </li></ul>
  134. 134. Patent Ductus Arteriosus <ul><li>Here there is an abnormal communication between the aorta and the pulmonary artery which is normally present in infants </li></ul>
  135. 135. CONGENITAL CYANOTIC HEART DISEASES <ul><li>Chapter 13 </li></ul>
  136. 136. Tetralogy of Fallot <ul><li>It is a birth defect of the heart consisting of 4 abnormalities that results in insufficiently oxygenated blood pumped to the body </li></ul>
  137. 137. Transposition of the great vessels <ul><li>Here the position of the two major vessels that carry blood away from the heart - the aorta and the pulmonary artery - is switched (transposed) </li></ul>
  138. 138. DISORDERS OF HEART RHYTHM <ul><li>Chapter 14 </li></ul>
  139. 139. Sinus Bradycardia <ul><li>It is a cardiac rhythm characterized by a slowness of the heartbeat, usually at a rate under 60 beats per minute </li></ul>
  140. 140. Ventricular tachycardia <ul><li>It is a rapid resting heart rate initiated within the ventricles, typically at 160 - 240 beats per minute </li></ul>
  141. 141. Sick Sinus Syndrome <ul><li>It is a collection of heart rhythm disorders that include alternating slow and fast heart rhythms </li></ul>
  142. 142. Cardiac Pacemaker <ul><li>A pacemaker is a small, battery-operated electronic device inserted under the skin to help the heart beat regularly at an appropriate rate </li></ul>
  143. 143. DISEASES OF ENDOCARDIUM <ul><li>Chapter 15 </li></ul>
  144. 144. Infective Endocarditis <ul><li>It involves the heart valves and is most commonly found in people who have underlying heart disease </li></ul>
  145. 145. Infective Endocarditis <ul><li>Sources of the infection may be due to transient bacteremia, which is common during minor surgical procedures </li></ul>
  146. 146. Surgical Procedures <ul><li>These are commonly done dental, upper respiratory, urologic, and lower gastrointestinal diagnostic and surgical procedures </li></ul>
  147. 147. Vegetations <ul><li>The infection can cause growths called as vegetations on the heart valves, the lining of the heart, or the lining of the blood vessels. </li></ul>
  148. 148. Embolism <ul><li>These growths may be dislodged and send clots to the brain, lungs, kidneys, or spleen resulting in what is called an embolism </li></ul>Coming up an Animation of Cerebral Embolism
  149. 149. Cerebral Embolism
  150. 150. DISEASES OF MYOCARDIUM <ul><li>Chapter 16 </li></ul>
  151. 151. Myocarditis <ul><li>It is acute inflammation of the muscle of heart due to infections especially of viral etiology like Coxachie B </li></ul>
  152. 152. Cardiomyopathy <ul><li>It is a disease affecting the muscle of the heart resulting in thickness and loss of function. It is of three varieties </li></ul>
  153. 153. Hypertrophic Cardiomyopathy <ul><li>It is a condition in which there is primary thickening of the muscle of the heart in the inter-ventricular septum resulting in an obstruction </li></ul>
  154. 154. Dilated Cardiomyopathy <ul><li>Here the thickening of the myocardium results in dilation and  functioning of the chambers of heart especially the ventricles </li></ul>
  155. 155. DISEASES OF PERICARDIUM <ul><li>Chapter 17 </li></ul>
  156. 156. Pericardium <ul><li>It is a thin double-layered sac which encloses the heart. Fluid contained within the layers lubricates constantly rubbing surfaces </li></ul>
  157. 157. Pericarditis <ul><li>It is caused by inflammation of the pericardium, the sac-like covering of the heart and resulting in pain </li></ul>
  158. 158. Pericardial Effusion <ul><li>It is a collection of fluid in excess of the normal quantity, in the pericardium, producing compression of the heart </li></ul>
  159. 159. Cardiac Tamponade <ul><li>It is a compression of the heart caused by blood or fluid accumulation in the space between the layers of the pericardium of heart </li></ul>
  160. 160. Summary <ul><li>Heart Diseases are many </li></ul><ul><li>Coronary Artery Disease is important </li></ul><ul><li>Hypertensive Heart Disease too </li></ul><ul><li>Valvular Heart Disease is still common </li></ul><ul><li>Congenital Heart Disease is rare </li></ul><ul><li>Investigations help us in diagnosis </li></ul><ul><li>Early Treatment is advisable </li></ul><ul><li>Prevention is better than cure </li></ul>