Cardiac Investigations 2�Angio/Stent/Holter/Pacemaker

S S Danbauchi

Objectives

• To learn that Investigations are part of managing CVD patients

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• Learn about the relevance of different investigations;

specific and non-specific cardiac investigations.

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• To learn about Holter Monitoring and indications of Pacemaker insertion

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• To learn about angiography and indications, angioplasty and stenting.

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Reminder

• History taking (70- 90 %)
• Physical examination (15 -20%)

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Differential Diagnosis

• Investigations (5 - 10 %)

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• Diagnosis (confirmed)

What Is Cardiovascular Disease?

Cardiovascular disease is an umbrella term that refers to diseases affecting the heart and blood vessels.

Some of these conditions include:

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• Hypertension—a common, often asymptomatic disorder characterized by elevated blood pressure persistently exceeding 140/90 mm Hg.

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• Coronary Heart Disease—a general term that describes diseases of the heart caused by atherosclerotic deposits, or plaque, that result in a narrowing of the coronary arteries. Heart attacks and chest pain fall under the category of coronary heart disease.

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• Stroke—arterial blockage or bleed that inhibits blood flow to the brain.

Anatomy and blood supply of the heart

Anatomy of the heart

Electrical system of the heart

Non-specific Investigations

• Urine microscopy/analysis
• FBC or WCC and differentials
• ESR
• Urea, electrolytes, creatinine, Uric acid
• FBS RBS 2hrs pp
• Lipid profile

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Biomarkers

Specific

• CPK- CKM- MB
• Troponins
• ANP-BNP�

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Non- specific

• ALT
• AST
• LDH
• CRP

Specific Investigations

• Chest x-ray
• Electrocardiography
• Exercise Electrocardiography TMT
• Ultrasound/Echocardiography
• Exercise echocardiography
• Transesophageal echocardiography

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Specific Investigations

• Blood culture
• Pericardial fluid analysis
• Angiography
• CT scan/CT angiography
• MRI
• Radionuclide studies - Thallium

Electrocardiography

Tests that are used to show electrical problems in your heart.

• Electrocardiogram (ECG or EKG)
• Exercise Stress Tests(Stress ECG)
• Electrophysiology Studies (EPS)
• Holter Monitoring/24 - 48 hours,30 days

Holter Monitoring

Holter Piece

Holter Monitoring

Holter

Holter Monitoring

Uses of Holter Monitoring

Holter Uses

Pacemaker Functions

Types of Pacemakers

Pacemaker

Catoon of Pacemaker inside the Heart

Permanent Pacemaker

Indications of Pacemaker

Types of Pacemakers

Indications of Pacemaker

Pacemaker Rhythm

Complications of Pacemaker insertion

Pacemaker battery under the skin

CORONARY ANGIOGRAPHY/ANGIOPLASTY/ STENTING

Angiography

Definition of angiography

Angiography Procedure

Angiography Procedure

Procedure of angiography

Importance of angiography

Types of Angioplasty

• Cerebral artery angiography/angioplasty
• Carotid angiography/angioplasty
• Coronary artery angiography/angioplasty
• Renal artery angiography/angioplasty
• Peripheral artery angiography/angioplasty

Angiography

Tests that are used mainly to show problems with circulation in the Coronary arteries, and how blood is pumped through the heart and body.

• Cardiac Catheterization
• Coronary Angiogram
• Renal artery circulation
• Cerebral circulation
• Peripheral artery circulation

Indications for angiography

Indications for coronary angiography

Coronary Circulation: Arterial Supply

Figure 18.7a

Management of Coronary artery Disease

Indications �Clinical indications for PCI include the following:�

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• Acute ST-elevation myocardial infarction (STEMI)
• Non–ST-elevation acute coronary syndrome (NSTE-ACS)
• Unstable angina
• Stable angina
• Anginal equivalent (eg, dyspnea, arrhythmia, or dizziness or syncope)
• High risk stress test findings

Contraindications for PCI

• Arteries < 1.5 mm in diameter
• Diffusely diseased saphenous vein grafts
• Other coronary anatomy not amenable to PCI

Typical Cardiac Catheterization Laboratory

Coronary Angiography

Angiography- Circumflex artery disease

Angiography - LAD disease

RCA angiography/angioplasty

Different views of Coronary angiography

Angiography Right coronary artery

Angiography of cerebral arteries

Stent

Characteristics of stents

Types of Stents

Stent Designs

Types of stents

Stenting of Coronary artery

Stent being deployed

Summary

• Cardiovascular disease investigations includes Non-specific and Specific
• Holtermonitoring is a specific investigation for defining, establishing and quantitating arrhythmias/prognosticating
• Holter is also used for monitoring anti-arrhythmic medications
• Angiography is a specialised imaging technic for defining diseases arterial circulation in different parts of the body
• Angiography can be used to define cardiac anatomy

END