Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 1 Radiographic Pathology for Technologists, 5 th Edition Chapter 8 Cardiovascular System

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Anatomy and Physiology  Consists of:  Heart  Arteries  Capillaries  Veins  Pulmonary circulation  Systemic circulation

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Anatomy and Physiology  Heart  Location  Atria  Ventricles  Layers  Endocardium  Myocardium  Epicardium  Blood travel  Gas exchange

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Anatomy and Physiology  Cardiac cycle  Systole  Diastole  SA node

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Anatomy and Physiology  Electrocardiography  P wave  PR interval  QRS complex  T wave  QT duration

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Anatomy and Physiology  Circulatory vessels  Arteries Adventitia Adventitia Media Media Intima and lumen Intima and lumen  Veins  Capillaries

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Imaging Considerations  Chest radiography  Heart size  Cardiomegaly  Great vessels  Vascular lung markings  Pneumothorax  Pulmonary emphysema  Bony thorax  Scoliosis  Pectus excavatum

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Imaging Considerations  Chest radiography  Technical factors Patient positioning Patient positioning Technical factors Technical factors Geometric factors Geometric factors Patient factors Patient factors Image critique Image critique  One of most commonly performed radiographic procedures

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Imaging Considerations & Anatomy

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Imaging Considerations  Echocardiography  M-mode echocardiography  2-D echocardiography Real-time imaging Real-time imaging Transesophageal echocardiography (TEE) Transesophageal echocardiography (TEE)  Spectral Doppler  Color Doppler Carotid stenosis, DVT Carotid stenosis, DVT  Stress echocardiography

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Imaging Considerations

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Imaging Considerations  Nuclear cardiology  Used to diagnose CAD, congenital heart disease, and cardiomyopathy  Myocardial perfusion scan Most widely used procedure Most widely used procedure  Gated cardiac blood pool scans Used to evaluate ventricles Used to evaluate ventricles  Positron emission tomography (PET)

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Imaging Considerations

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Imaging Considerations  Computed tomography (CT)  Cardiac scoring  EBCT  Spiral CT  CT angiography (CTA)

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Imaging Considerations

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Imaging Considerations  Magnetic resonance imaging (MRI)  Recently gained in popularity for use in cardiac studies  Uses cine loop  May be ECG gated  Magnetic resonance angiography (MRA)

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Imaging Considerations

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 18 Imaging Considerations  Angiography  Most commonly performed procedure for cardiovascular disease  Diagnostic vs therapeutic

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Imaging Considerations  Therapeutic angiography  Percutaneous transluminal coronary angioplasty (PTCA)  Stent  Thrombolysis  Embolization  Transjugular intrahepatic portosystemic stent (TIPSS)  Percutaneous transluminal angioplasty  Permanent catheterization

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Imaging Considerations

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Congenital and Hereditary Diseases  Fetal circulatory system Foramen ovale Foramen ovale Ductus arteriosus Ductus arteriosus  Incidence of congenital cardiovascular anomalies  Etiology Genetic disorders Genetic disorders Chromosomal aberrations Chromosomal aberrations Environmental factors Environmental factors  Associated complications Murmur Murmur

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Congenital and Hereditary Diseases  Patent ductus arteriosus  Incidence  Diagnosis Echocardiography Echocardiography  Treatment  Prognosis

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Congenital and Hereditary Diseases

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Congenital and Hereditary Diseases  Coarctation of the aorta  Incidence  Diagnosis  Radiographic appearance  Treatment

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 25 Congenital and Hereditary Diseases

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 26 Congenital and Hereditary Diseases  Septal defects  Atrial septal defect  Ventricular septal defect  Cause  Incidence  Diagnosis  Radiographic appearance  Associated complications  Treatment

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Congenital and Hereditary Diseases

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 28 Congenital and Hereditary Diseases  Transposition of the great vessels  Incidence  Diagnosis  Radiographic appearance  Treatment  Prognosis

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 29 Congenital and Hereditary Diseases

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 30 Congenital and Hereditary Diseases  Tetralogy of Fallot  Combination of four defects  Diagnosis  Radiographic appearance  Treatment

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 31 Valvular Diseases  Symptoms  Associated clinical findings  Diagnosis  Noninvasive  Invasive  Cause of chronic valve disease  Rheumatic fever

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 32 Valvular Diseases  Valvular stenosis  Cause  Mitral valve prolapse  Incidence  Diagnosis  Radiographic  appearance  Prophylaxis  Treatment

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 33 Valvular Diseases

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 34 Congestive Heart Failure  Occurrence  Treatment  Left-sided CHF  Causes  Symptoms  Radiographic appearance  Right-sided CHF  Causes  Symptoms  Radiographic appearance

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 35 Congestive Heart Failure

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 36 Cor Pulmonale  Cause  Acute  Pulmonary embolism  Chronic  COPD  Symptoms  Diagnosis  Radiographic appearance  Treatment

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 37 Degenerative Diseases  Atherosclerosis  Most prevalent disease in humans  Incidence  Predilection for aorta, coronary, and cerebral arteries  Risk factors Controlled Controlled Uncontrolled Uncontrolled  Atheroma formations

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 38 Degenerative Diseases  Atherosclerosis  Formation of atheroma Chronic endothelial injury Chronic endothelial injury Lipid theory Lipid theory  Ischemia  Signs and symptoms  Diagnosis  Most common cause of CAD and CVA

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 39 Degenerative Diseases  Coronary artery disease  Cause  Infarct  Associated complications Angina pectoris Angina pectoris  Single most common cause of death in men and women in U.S.

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 40 Degenerative Diseases  Coronary artery disease  Risk factors  Diagnosis  Treatment

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 41 Degenerative Diseases  Myocardial infarction (MI)  Cause Most common—acute thrombus of coronary artery Most common—acute thrombus of coronary artery  Signs and symptoms  Early medical intervention  Diagnosis  Treatment Thrombolytic therapy Thrombolytic therapy PCTA PCTA

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 42 Aneurysms  Outpouching of vessel wall  Causes  Classifications  Saccular Cerebral artery Cerebral artery  Fusiform Distal abdominal aorta Distal abdominal aorta  Dissecting

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 43 Aneurysms

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 44 Aneurysms  Abdominal aortic aneurysm  Majority of aneurysms  Diagnosis  Treatment Surgical repair if greater than 6 cm Surgical repair if greater than 6 cm

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 45 Aneurysms  Thoracic aortic aneurysm  Cause  Diagnosis  Treatment Surgical repair if greater than 6 cm Surgical repair if greater than 6 cm

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 46 Aneurysms  Extremities  Popliteal arteries Bilateral Bilateral In conjunction with AAA In conjunction with AAA Diagnosis Diagnosis

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 47 Venous Thrombosis  Cause  Incidence  Phlebitis  Thrombus  Thrombophlebitis

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 48 Venous Thrombosis  Diagnosis  Sonography  Venography  Treatment

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 49 Venous Thrombosis

Mosby items and derived items ©2009, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 50 Pathology Summary  Additive  Coarctation of aorta  Septal defects  Tetralogy of Fallot  Valvular disease  Congestive heart disease  Cor pulmonale