13th Block

Circulation system

DIGNOSTIC PROCEDURE IN
CARDIOVASCULAR DISEASE

P. Pujowaskito
P. Pujowaskito
© 2011 General Ahmad Yani University
 Introduction

Diagnostic: Diagnostic:

Primary Prevention Therapy and

Secondary Prevention

Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 10A):23S-27S

 Introduction

Non Invasive Procedures: ECG, Lab, X-ray, Diagnostic: IVUS

Angiography
Treadmill, Holter, Echocardiography,
Nuclear imaging

Diagnostic non Invasive Invasive Procedure

Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 10A):23S-27S

 Diagnostic Procedure
• Non Invasive • Invasive
– Vena Puncture – Angiography
– Arterial Puncture
– Ambulatory BP measurement
– Thorax X ray
– EKG
– Holter
– Exercise test
– Echocardiography
– Doppler Examination
– CT Angiography
Venapuncture
 Venapuncture

Phlebotomy at
antecubital (in front of the elbow) vein
 Central Venous Access and
Monitoring
Placement of a venous catheter in a vein that leads directly
to the heart (external & internal jugular, subclavian, antecubiti, femoral):

•measurement of central venous pressure (CVP)

•venous access when no peripheral veins are available
•administration of vasoactive/inotropic drugs which cannot
be given peripherally
•administration of hypertonic solutions including total
parenteral nutrition
•haemodialysis/plasmapheresis
Arterial puncture
Arterial puncture
Arterial puncture
Arterial puncture complication
Arterial Blood Analysis
BP Measurement
Ambulatory BP
Measurement
 Thorax X Ray
Surface markings of the valves in relationship
to the radiological outline of the heart

Aorta
Pulmonary artery
Superior
vena cava Pulmonary valve
Aortic valve
RA Left atrial appendage

RV Mitral valve
LV
Tricuspid valve 5th rib
 Chest x-ray showing cardiomegaly with left ventricular
predominance and fluffy opacification in both fields, particularly on
the right side, indicative of pulmonary oedema
 Ukuran Jantung.
• Cardio-thoracic ratio : Diameter terlebar
jantung dibanding diameter terlebar
dinding dalam thorax
{A+B:C1+C2}.Normal < 0.5.
• Arcus Aorta :D+E < 4 cm
• Aorta knob : dari grs tengah ketepi kiri AO
: E < 2 cm
• Batas kanan : dari grs tengah: A < 5cm
 M

E
D

A B

C1 C2

M
ECG
Holter Monitor
 Exercise stress test
– Assess general cardiovascular function
– Checks for exercise-induced problems

• Master step
test
• Ergometri
• Treadmill
Exercise stress test
 Echocardiography

• Etiologic Evaluation
of Heart Failure
• Evaluation of LV
Systolic Function
• Evaluation of LV
Diastolic Function
• Evaluation of RV
Function
 Echocardiography
• Etiologic Evaluation of Heart Failure
– Ischemic Heart Disease
– Hypertension
– Valvular Heart Disease
– Congenital Heart Disease
– Miocardial Primary disease unknown etiology
(Dilatative cardiomyopathy /congestive,
hyperthrophyc and restrictive)
 Echocardiography
• Evaluation of LV Systolic Function
– M – mode : Fractional Shortening and
Ejection Fraction/EF
– Two dimension: visualisation of all cardiac
anatomy, direct measurement of myocardial
contraction, myocardial mass and vessels
size, LV volume, Global LV systolic function,
Wall Motion Score Index
– Doppler Echocardiography evaluation of
cardiac output
 Echocardiography
• Evaluation of LV Diastolic Function
1) active relaxation
2) pasive rigidity
• Doppler Index:
• mitral inflow velocity
• mitral E – wave deceleration time
• Isovolemic Relaxation Time
• Pulmonary Vein Systolic and Diastolic velocity
• Pulmonary Vein Atrial Systolic Reversal
• Different of PVa and mitral A wave duration
• New parameter:
• Mitral annular velocity
• color M-mode flow propagation
Evaluation of LV Diastolic Function
 Echocardiography
• Evaluation of RV Function
– Evaluation of RV Systolic Function
• Tricuspid Annular Plane Excursion (TAPSE)
• Tissue Doppler Imaging annulus tricuspid
 Echocardiography
• Evaluation of RV Diastolic Function
– Measurement of vena cava inferior (VCI)
diameter 1cm before RA, and VCI colaps
during inspiration
 Doppler Examination
• Doppler Studies
– Assessment of blood flow in peripheral vessels
– Microphone records sounds of blood flow
• Can detect obstruction
CT Angiografi
CT Angiografi
CT Angiografi
CT Angiografi
 Diagnostic Tests
• Cardiac
Catheterization
– Visualize inside of
heart, measure
pressure, assess valve
and heart function
– Determine blood flow
to and from heart
 Diagnostic Tests
• Angiography
– Visualization of blood
flow in coronary artery
– Obstruction assessed
and treated
• Basic catheterization
• Balloon angioplasty
 Diagnostic Tests

• Blood tests
– Assess triglyceride and cholesterol levels
– Electrolytes
– Hb, hematocrit, cbcs
• Arterial Blood Gas Determination
– Essential for pts with shock, MI
– Check current oxygen levels, acid-base balance
 CHF—Diagnostic Tests
• Radiographs
• Catheterization
• Arterial blood gases
Atherosclerosis—Diagnostic Tests
• Serum lipid levels
• Exercise stress test
• Radioisotope
 MI—Diagnostic Tests
• ECG
• Serum enzyme and
isoenzyme test
• High serum levels of
myosin and troponin
• Abnormal electrolytes
• Leukocytosis
• Arterial blood gases
• Pulmonary artery
pressure measure
– Determines ventricular
function
 13 th
Block
Circulation system

TQ, 4 your attention

© 2009 General Ahmad Yani University
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