Myocardial viability testing is important in patients with coronary disease and severely reduced left ventricular systolic function to determine whether revascularization may improve outcomes by identifying dysfunctional but still viable myocardium. Revascularization of viable myocardium can help recover function and symptoms, whereas predominantly scarred myocardium will not benefit from revascularization.
Unlike other modalities, MRI offers the capability to modulate both the emitted and received signals so that a multitude of tissue characteristics can be examined and differentiated without the need to change scanner hardware.
As a result, from a single imaging session, one could obtain a wealth of information regarding
cardiac function and morphology,
myocardial perfusion & viability,
hemodynamics,
large vessel anatomy.
CMR is now considered the gold standard for the assessment of regional and global systolic function, myocardial infarction (MI) and viability, and the assessment of congenital heart disease.
Myocardial viability testing is important in patients with coronary disease and severely reduced left ventricular systolic function to determine whether revascularization may improve outcomes by identifying dysfunctional but still viable myocardium. Revascularization of viable myocardium can help recover function and symptoms, whereas predominantly scarred myocardium will not benefit from revascularization.
Unlike other modalities, MRI offers the capability to modulate both the emitted and received signals so that a multitude of tissue characteristics can be examined and differentiated without the need to change scanner hardware.
As a result, from a single imaging session, one could obtain a wealth of information regarding
cardiac function and morphology,
myocardial perfusion & viability,
hemodynamics,
large vessel anatomy.
CMR is now considered the gold standard for the assessment of regional and global systolic function, myocardial infarction (MI) and viability, and the assessment of congenital heart disease.
This presentation has been done by a medical student. It is related to a frequent pathology.
My humble work contains the majority of information which will help out anyone wants to grasp what myocardial infarction means.
E-mail : skhayati27@gmail.com
1. A catheter is a hollow flexible tube that can be inserted into a body cavity, duct or vessel.
Catheters thereby allow drainage or injection of fluids , distend a passageway or provide access by surgical instruments.
The process of inserting a catheter is catheterization.
2. They are the stainless steel metallic structures that guides the catheter through the blood vessels for placement. Guide wires are used for both cardiology and radiology angiographic procedures.
CALCIUM MODIFICATION TECHNIQUES IN COMPLEX PCIThieu Minh Son
Coronary artery calcification represents a major challenge associated with adverse outcomes after PCI
To avoid stent failure, optimal plaque preparation of calcified coronary lesions is required
Intracoronary imaging and determination of coronary calcification severity and characteristics are the keys to guiding further treatment decisions.
Available modification techniques includes: Balloon-Based Devices (Non-Compliant Balloons, High-Pressure Non-Compliant Balloons, Cutting Balloons, Scoring Balloons, Intravascular Lithotripsy) and Coronary Atherectomy (Rotational Atherectomy, Orbital Atherectomy, Laser Atherectomy)
The decision relating to which modification technique to use is based on numerous anatomic and technical factors, including the location of the lesion, the concentricity of the calcium pool, operator familiarity/expertise, and local device availability.
Base ECG et l'interprétation du rythme (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Interventional Radiology : Devices and Embolic Agents that a Resident NEEDS T...Saurabh Joshi
Interventional Radiology is full of various devices and materials. The general radiology resident needs to know these in order to impress the examiner. This file also contains information on various embolic agents.
This document discusses intravascular ultrasound (IVUS) as an imaging technique to evaluate coronary arteries. IVUS uses ultrasound waves to image the arterial walls and plaque in cross-section, providing information beyond what can be seen with angiography alone. The summary describes:
1) IVUS uses a catheter-mounted transducer to emit ultrasound waves into the artery and interpret the reflected waves to generate tomographic images of the arterial walls and plaque.
2) IVUS can characterize plaque morphology, distribution, and composition, aiding in diagnosis and treatment planning.
3) Some applications of IVUS include assessing indeterminate lesions, optimizing stent placement, and evaluating stent failures.
SWI , high susceptibility for blood products, iron depositions, and calcifications
makes susceptibility-weighted imaging an important additional sequence for the diagnostic
workup of pediatric brain pathologic abnormalities. Compared with conventional MRI
sequences, susceptibility-weighted imaging may show lesions in better detail or with higher
sensitivity
This presentation has been done by a medical student. It is related to a frequent pathology.
My humble work contains the majority of information which will help out anyone wants to grasp what myocardial infarction means.
E-mail : skhayati27@gmail.com
1. A catheter is a hollow flexible tube that can be inserted into a body cavity, duct or vessel.
Catheters thereby allow drainage or injection of fluids , distend a passageway or provide access by surgical instruments.
The process of inserting a catheter is catheterization.
2. They are the stainless steel metallic structures that guides the catheter through the blood vessels for placement. Guide wires are used for both cardiology and radiology angiographic procedures.
CALCIUM MODIFICATION TECHNIQUES IN COMPLEX PCIThieu Minh Son
Coronary artery calcification represents a major challenge associated with adverse outcomes after PCI
To avoid stent failure, optimal plaque preparation of calcified coronary lesions is required
Intracoronary imaging and determination of coronary calcification severity and characteristics are the keys to guiding further treatment decisions.
Available modification techniques includes: Balloon-Based Devices (Non-Compliant Balloons, High-Pressure Non-Compliant Balloons, Cutting Balloons, Scoring Balloons, Intravascular Lithotripsy) and Coronary Atherectomy (Rotational Atherectomy, Orbital Atherectomy, Laser Atherectomy)
The decision relating to which modification technique to use is based on numerous anatomic and technical factors, including the location of the lesion, the concentricity of the calcium pool, operator familiarity/expertise, and local device availability.
Base ECG et l'interprétation du rythme (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Interventional Radiology : Devices and Embolic Agents that a Resident NEEDS T...Saurabh Joshi
Interventional Radiology is full of various devices and materials. The general radiology resident needs to know these in order to impress the examiner. This file also contains information on various embolic agents.
This document discusses intravascular ultrasound (IVUS) as an imaging technique to evaluate coronary arteries. IVUS uses ultrasound waves to image the arterial walls and plaque in cross-section, providing information beyond what can be seen with angiography alone. The summary describes:
1) IVUS uses a catheter-mounted transducer to emit ultrasound waves into the artery and interpret the reflected waves to generate tomographic images of the arterial walls and plaque.
2) IVUS can characterize plaque morphology, distribution, and composition, aiding in diagnosis and treatment planning.
3) Some applications of IVUS include assessing indeterminate lesions, optimizing stent placement, and evaluating stent failures.
SWI , high susceptibility for blood products, iron depositions, and calcifications
makes susceptibility-weighted imaging an important additional sequence for the diagnostic
workup of pediatric brain pathologic abnormalities. Compared with conventional MRI
sequences, susceptibility-weighted imaging may show lesions in better detail or with higher
sensitivity
This document summarizes information about acute myocardial infarction (AMI) associated with pregnancy. Some key points:
- AMI during pregnancy is rare but risk is increased 3-4x during pregnancy compared to non-pregnant women of similar age. It can occur during any trimester or postpartum.
- In a review of 150 cases from 2006-2011, 75% of patients were over 30 years old and AMI was most commonly located in the anterior wall of the left ventricle.
- The leading causes of AMI in pregnant/postpartum women were coronary artery dissection (43% of cases), atherosclerosis (27%), and blood clots (17%).
- Risk factors include age
Heart Failure in Haiti (French) Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Heart Failure in Haiti (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Tous ce qu'il faut savoir en 2017 sur les syndromes coronariens de la physio , physiopathologie , diagnostique , prise en charge pré hospitalière et prise en charge intra-hospitalière
Conseil et vaccination du voyageur en pharmacieIpsos France
Valneva a fait appel à l'expertise d'Ipsos Healthcare pour réaliser une étude sur les comportements et les attentes des Français en matière de santé dans le cadre d'un voyage prévu hors de l'Union Européenne dans les 12 prochains mois. Les résultats révèlent le rôle essentiel des pharmaciens dans la préparation sanitaire des voyages à l'international.
Organisé par le CIIRPO, ce webinaire fait le point sur les différents types de boiteries chez les brebis et les béliers illustrées de photos. Les modes de prévention et les traitements possibles sont cités.
Il s'agit des stratégies de descente sur le terrain consistant a mettre en œuvre la qualité d'une bonne supervision au cours d'une campagne de poliomyélite
1. IRM cardiaque…
…et Cardiologie Interventionnelle
J. RISCHNER,
Hôpital Albert SCHWEITZER, COLMAR
Journées Paramédicales Samedi 26 novembre 2016
2. Des modalités de réalisation différentes…
Coronarographie
u Abord artériel
u Rayon X
u Hôpital de jour ou
hospitalisation
conventionnelle
u Contre-indications relatives
u insuffisance rénale
u Allergie à l’iode
IRM
u Non invasive
u Non irradiante
u Ambulatoire
u Contre-indications absolues
u Clips chirurgicaux ferromagnétiques
intracérébraux et corps étrangers métalliques
intra-oculaires (travailleurs de métaux)
u Dispositifs médicaux implantés (pace-maker,
neurostimulateurs, implants cochléaires…)
3. Guide de bonnes pratiques et recommandations en
imagerie cardiaque en coupe
u Journal de Radiologie, Tome 90, Septembre 2009 (SFR)
u Archives of cardiovascular diseases, Supplements, Tome 1 n°1
Septembre 2009 (SFC)
4. Étapes d’une exploration cardiaque par IRM
1. Vérification de l’absence de CI à l’IRM
2. Installation, apprentissage des apnées, synchronisation à l’ECG
3. Repérage anatomique : « Pile » de coupes axiales centrées sur la région cardiaque et les
gros vaisseaux (sang blanc ou sang noir)
4. Étude de la fonction : séquences ciné « sang blanc » : 2 cavités, 4 cavités, petit axe
5. Étude morphologique (« sang noir ») : étude T2 ( inflammation), étude T1 (dépôts
lipidiques)
6. Injection de Gadolinium : perfusion
7. +/- Angio3D (aorte, RVPA…)
8. Rehaussement tardif à 10 min
5. IRM et douleurs thoraciques…
u Homme de 29 ans
u Tabagisme sevré depuis 1 an.
u GEA récente.
u Douleurs thoraciques fluctuantes, sans lien avec l’effort
u ECG : RSR, repolarisation SP
u Biologie : troponine T=0,77 ; CRP=15
u Coronarographie normale
6. Analyse de la cinétique du VG
4 cavités ou HLA 2 cavités ou VLA
7. Quantification de la FEVG par volumétrie
classe I
Planimétrie de 8 à 10
coupes « petit
axe » (contours
endocardiques)
Mesures en télésystole et
en télédiastole
FEVG=(VTD-VTS)/VTD
Masse myocardique = (Contours épicardiques-contours endocardiques)
x 1,05 en télédiastole
8. PILES DE COUPES PETIT AXE
(DOUBLE OBLIQUITÉ)
Huit à 10 coupes de 6-8 mm tous les 10-12 mm permettent de couvrir l’ensemble du VG
Mesure des volumes avec la méthode de Simpson
(applicable dans tous les cas, même si le VG est déformé)
9. Étude post gado : myocardite
Multiples zones de
rétention tardive
sous-épicardiques
de gadolinium
Mahrholdt, Circulation 2004;109:1250-8
10. Un autre cas de douleurs thoraciques
u Jeune fille de 19 ans
u Tabagisme ½ paquet/jour
u Contraception oestroprogestative
u Antécédents paternels de maladie coronaire (<45ans)
u Douleurs thoraciques durant 48 heures, fluctuante avec pesanteur
des 2 bras
u Troponine T à l’admission : 0,16 (n<0,03)
11.
12. Analyse du myocarde :
atteinte ischémique
Analyse séquence sang
noir «T2fatsat » :
Hypersignal T2
septum moyen
Simonetti, Radiology 2001;218:215-23
Rétention tardive sous-endocadique de gadolinium 10 min après IV
Petit axe 4 cavités ou HLA 2 cavités ou VLA
13. Cinétique du gadolinium et cardiopathie ischémique
Courtoisie : Dr P. Croisille
DIU imagerie cardiaque en coupes
14. 2 prises en charge différentes
Myocardite
Ø Repos 1 mois, arrêt de travail
Ø Bilan biologique étiologique
peu rentable
Ø Sérologies virales…
Infarctus
Ø Traitement Aspirine/Statine
Ø Contre-indication aux
oestroprogestatifs
Registre CRIMINAL :
- douleurs thoraciques >10 minutes
- élévation significative de la troponine
- coronarographie : absence de lésion significative
15. Une phase aiguë…
u Monsieur D, 61 ans
u FDR : tabagisme, HTA, dyslipidémie
u ATCD
u MVTE sous AVK au long cours
u AVC ischémique sylvien profond 2012
u SCA ST+ antérieur H3
u Conditionnement pharmacologique
u Plavix 600mg, Aspégic 250 mg IV, Héparine SC
17. IRM à J7 :
hypokinésie VG sévère et obstruction microvasculaire
18. Encore une phase aiguë…
u Monsieur B, 48 ans
u FDR : tabagisme actif
u ATCD : coxarthrose, hernie C5-C6
u SCA ST+ H3
u Conditionnement pharmacologique
u Brilique 90mgx2, Aspégic 250 mg IV
u Intégrilin à la 30ème min
21. Corrélation
entre taille de l’hypersignal et taille de l’IDM
Kim, 1996, Circulation 1996;94(12):3318-26.
TTC
22. Un infarctus passé inaperçu…
u Monsieur M. 56 ans
u Dyslipidémie, tabagisme actif 10 cigarettes/j,
hérédité coronarienne, IMC=25
u Asymptomatique
u ECG systématique : ondes Q en DIII, et aVF
u Echographie : hypokinésie inférieure
25. Étude de la viabilité
Épaisseur du
myocarde
Extension intra-
myocardique
de la nécrose
Extension transmurale du gadolinium
(rehaussent tardif):
1 à 50% de l’épaisseur du myocarde :
segment viable et amélioration de la
cinétique post-revascularisation
>75% de l’épaisseur du myocarde :
pas de viabilité
Entre 50 et 75% de l’épaisseur du
myocarde : faible dose de dobutamine
Choi, Circulation 2001;104:1101-07
26. Des pontages qui involuent trop vite…
u Monsieur G. 71 ans, triple pontage en 2007
u AMIG-IVA, saphène-marginal, saphène-CD3
u Epreuve d’effort très positive électriquement à 150W
u Coronarographie du 26/1/2016 :
u Occlusion des 3 pontages
u Sténose serrée IVA ostiale puis CTO IVA2
u Sténose serrée 1ère marginale et circonflexe distale
u Sténose serrée CD1
u Angioplastie avec stents actifs CD1, 1ère maginale et circonflexe
distale le 24/2/2106
30. Encore un pluritronculaire avec 1 CTO
u Monsieur W. 68 ans, HTA, DNID, tabagisme actif, surcharge
pondérale.
u Antécédents d’IDM antérolatéral en 1993
u SCA le 19/5/2016
u Coronarographie
u Lésions significatives bissectrice et IVA1 traitées par
angioplastie et stents actifs
u Occlusion chronique CD1
31. Viabilité absente en territoire antérolatérale
Viabilité préservée en territoire inférieur
33. Parfois, on créé volontairement des IDM!
Après alcoolisation
septale
Source: irmcardiaque.com
34. u Caractérisation tissulaire : atteinte ischémique ou inflammatoire?
Diagnostic positif d’IDM quand la coronarographie est normale.
Registre CRIMINAL!
u Phases aiguës : bilan lésionnel, potentiel de récupération du
myocarde. Informations pronostiques, la désobstruction coronaire,
ce n’est pas tout!
Atouts de l’IRM cardiaque :
une mine d’informations pour le cathéteriseur!
35. u Etude de la viabilité : quelles sont les bonnes indications de
désobstruction de CTO?
u La CMH : documentation de l’obstruction sous aortique avant
d’envisager une alcoolisation septale
Atouts de l’IRM cardiaque :
une mine d’informations pour le cathéteriseur!
36. IRM CARDIAQUE
Fonction VG/VD
Cardiopathie ischémique
Valvulopathies
Congénital
Cardiopathies non
ischémiques
Pathologie
péricardique
Masse intra-
cardiaque
Pathologie
de l’aorte
…
