KULIAH BLOK 10

DIAGNOSTIC AND THERAPEUTIC PROCEDURE

IN CARDIOVASCULAR DISEASE
Nizamuddin Ubaidillah MD FIHA
Faculty of Medicine Jenderal Ahmad Yani University
Cardiology and Vascular Medicine Department Udayana Army Hospital
Cardiovascular Disease Pathology and Pathophysiology*

*Mechanism and Process of CVD

Diagnostic and
Therapeutic
Procedure ?

https://bestpractice.bmj.com/topics/en-gb/3000201/complications
Cardiovascular Disease Pathology and Pathophysiology*

*CVD Continuum

Adeel Jamil, et.al. Circulation 2020

Link Between Pathophysiology and Diagnostic Procedure

Schematic Bridging Process-Pathophysiology-Mode

Introduction in Cardiovascular Diagnostic

Definitions

• Diagnostic investigation in cardiology are

methods of identifying heart conditions associated
with unhealthy and pathologic heart function
• Divides into
– Invasive
– Non-Invasive
Introduction in Cardiovascular Diagnostic

Kinds Non Invasive Invasive

Stethoscope Coronary Angiography

Electrocardiography/Holter Monitor Intravascular Ultrasound/IVUS

Artery/Vein Pressure OCT (Optimal Coherence Tomography)

Echocardiography CVP/Central Venous Pressure

Doppler Vascular Ultrasound

Sphygmomanometer/ABPM/ABI

Cardiac CT-Scan

MRI/CMR

Nuclear Heart Scan

Chest X-Ray
Non Invasive Cardiovascular Diagnostic

Stethoscope

Laennec Stethoscope
Introduction in Cardiovascular Diagnostic

Stethoscope

• What We
Found
Non Invasive Cardiovascular Diagnostic

Sphygmomanometer
1905 during a
conference at the
Imperial Medical
Academy in St
Petersburg, Dr
Nicolai Sergeevich
Korotkoff
announced a new
method to
determine blood
pressure
 Non Invasive Cardiovascular Diagnostic

Sphygmomanometer

Factor
Affecting BP

Nao, et.al. Journal of Hypertension 2017,

35:421–441 a
Non Invasive Cardiovascular Diagnostic

ABPM/ Ambulatory BP Measurement

24 Hour BP Measure
more accurately reflect a
patient's blood pressure
and correlate more
closely with end-organ
complications than blood
pressure levels measured
in the physician's office
Non Invasive Cardiovascular Diagnostic

ABPM/ Ambulatory BP Measurement

Non Invasive Cardiovascular Diagnostic

ABI/ Ankle Brachial Index

Purpose for
PAD
Assessment
Non Invasive Cardiovascular Diagnostic

ABI/ Ankle Brachial Index

Non Invasive Cardiovascular Diagnostic

Chest X-Ray

Surface markings of the valves in relationship

to the radiological outline of the heart
Non Invasive Cardiovascular Diagnostic

Chest X-Ray
Cardiac Silhouette
Non Invasive Cardiovascular Diagnostic

Chest X-Ray M

• Cardio-thoracic ratio : Widest Cor

Diameter compared with widest inner E
D
wall thoracic diameter
{A+B:C1+C2}.Normal < 0.5.
• Arcus Aorta :D+E < 4 cm
• Aorta knob : from midline to edge of
Aorta : E < 2 cm A
• Right border: from midline: A < 5cm B
C1 C2
Non Invasive Cardiovascular Diagnostic

Electrocardiography
 Non Invasive Cardiovascular Diagnostic

Holter ECG

• Holter monitor held for 24 hours

• Record electrical activity of the
heart
• Patient at the same time records
their diary of activities
• Can revealed hidden abnormal
electrical activity of the heart
such bradiarrhythmia and
tachyarrhythmia
Non Invasive Cardiovascular Diagnostic

Holter ECG

Bradiarrhythmia

Tachyarrhythmia
Non Invasive Cardiovascular Diagnostic

Exercise Test

Assess general cardiovascular function Type

Checks for exercise-induced problems
Master Step Test

Treadmill Test

Ergocycle Test

Arm ergometer test

Nuclear stress test

Non Invasive Cardiovascular Diagnostic

Exercise Test
Non Invasive Cardiovascular Diagnostic

Exercise Test
Non Invasive Cardiovascular Diagnostic

Exercise Test
 Non Invasive Cardiovascular Diagnostic

Echocardiography

• Etiologic Evaluation of
Heart Failure
• Evaluation of LV Systolic
Function
• Evaluation of LV
Diastolic Function
• Evaluation of RV
Function
Non Invasive Cardiovascular Diagnostic

Echocardiography
 Non Invasive Cardiovascular Diagnostic

Doppler Vascular Ultrasound

• Doppler Studies
– Assessment of blood flow in peripheral vessels
– Microphone records sounds of blood flow
 Can detect stenosis
 Can detect obstruction
 Non Invasive Cardiovascular Diagnostic

CT Cardiac

• Main Purpose: morphology

– Detection and analysis of coronary artery
disease
– Depict of coronary artery vasculature
• Possible to obtain functional
information in same scan
– Contractility of myocardium
– Valve morphology and function
– Viability of myocardium with “perfusion
CT”
Non Invasive Cardiovascular Diagnostic

CT Cardiac
Non Invasive Cardiovascular Diagnostic

Cardiac Magnetic Resonance/CMR

Ability
Non Invasive Cardiovascular Diagnostic

Cardiac Magnetic Resonance/CMR

Non Invasive Cardiovascular Diagnostic

Nuclear Heart Scan

Non Invasive Cardiovascular Diagnostic

Nuclear Heart Scan

Invasive Cardiovascular Diagnostic

Central Venous Pressure/ Swan Ganz Catheter

Invasive Cardiovascular Diagnostic

Central Venous Pressure/ Swan Ganz Catheter

Invasive Cardiovascular Diagnostic

Coronary Angiography

– Visualize inside
of heart,
measure
pressure, assess
valve and heart
function
– Determine blood
flow to and from
heart
– To determine
vessel and
obstruction of
vessel
Invasive Cardiovascular Diagnostic

Coronary Angiography
Invasive Cardiovascular Diagnostic

Coronary Stenting
Invasive Cardiovascular Diagnostic

Percutaneous Transluminal Coronary Angioplasty/PTCA

Invasive Cardiovascular Diagnostic

Intravascular Ultrasound/ IVUS

Invasive Cardiovascular Diagnostic

Optical Coherence Tomography/ OCT

Invasive Cardiovascular Diagnostic

Optical Coherence Tomography/ OCT

TERIMA KASIH