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Analyze the....
Echocardiography
2d - limited to 30 degrees
3d - 1980's
When you rotate the transuceer to 90 degrees - you get a short acid view of the hesrt
Lateral wall
Calculate ejection fraction - amount of blood ejected from the heart in one single minute
Turn the patient to left side --> transducer to pmi --> imaging the heart from the apex to the
back
You can sample the blood flow of the ventricle at dierent points
If blood is away -
Transesophageal
1990's
Better pictures
Disadvantage: invasive
Intravascular
1980
MRI
You cant do mri on patients with pacemakers, artifical headt valves, metallic objects
Done if you have trouble getting a good image of the heart with us
Expensive
Ct scan
Exercise testing
Treadmill
Sensitivity: 50-60%
Spec: 85-90%
Patients qith severe coronary artery disease: greater than 3 ( diagnose them easily)
Bicycle ergometer
Arm ergometer
Less radiation
Take patient to treadmill --> exercise --> peak exercise --> inject isotope --> stop exercise -> nuclear scan
Image the myocardium --> determine areas not getting enough blood flow
Patients eho are at risk of heart attack, unstable angina, having a heart attack
Image the perfusion at rest with radioisotope --> few hours later inject persantine --> inject
another dose of isotope --> imGe the heart again
Drugs used are vasodilators --> inc blood fow to the normal portion of the heart -->
increased absorption
Areas with less blood flow --> less radioisotope ( absent to very little isotope absorbed)
EKG
Holter montioring
Outpatient procedure
2 lead system
HRV
A way of determining the activity of the sympathetic and para of the heart
Normally, there is a variation of the heart rate becase of the sympa and para activity
Trans-telephonic recorders
If patient feel palpitations --> plug to the device --> transmits to hospital to get actual ekg
recording
Ekg but it samples the heart for 100 or 200 heart beats
Determine any conduction or activation abnormalities which are usually a source of arrythmias
Electrophysiology test
Intracardiac electrocardiography
Deliver electrical impulse through the catheter --> trigger abnormal heart beats
Last resort
Coronary Angiography
Visualization of the coronary arteries using a radiocontrast dyes
Iodine dyes
Steroids
...
Transbrachial
Transfemoral
Easier
Radial approach
Noninavsive
Ultrafast ct