Adult Echocardiography Lecture 10 Coronary Anatomy holdorf

Anterior view

Anterior View

Posterior view

Coronary Perfusion Left anterior descending (LAD) Anterior wall Anterior septum LV Apex From where do the coronaries originate? In the left and right aortic sinus of Valsava

Coronary Perfusion Left Circumflex Lateral wall Posterior wall What is meant by “Right Dominance?” When the right coronary gives rise to the posterior descending artery (occurs 85% of the time)

Coronary Perfusion Right Inferior Wall Inferior Septum RV apex RV free wall Which coronary supplies the interatrial septum? Right- which also usually supplies the SA and AV nodes.

Coronary Distribution

Which coronary artery feeds the infero-septal wall? Right coronary artery

Other Imaging Modalities Nuclear Medicine -cardiolite

Ventricular wall anatomy Short Axis (SA) Basal Anterior Anterolateral Infero-lateral Inferior Infero-septal Antero-septal

Mid-Cavity Short AXIS (SA) Anterior Antero-lateral Infero-lateral Inferior Infero-septal Antero-septal

Apical Short Axis (SA) Anterior Lateral Inferior Septal

Exercise Echo (Stress)

Stress Echo - Premise Transient exercise induced ischemia results in wall motion abnormalities which are detected with echocardiography. Reliable Easy to perform Clinically established

Ischemic Cascade Ischemia vs. Stress

Utilization of Stress Echocardiography Detection of CAD Evaluation of ambiguous treadmill outcomes (digitalis, resting ECG abnormalities) Functional significance of anatomic lesions Quantitation of left ventricular performance Post MI evaluation (prognosis/functional capacity) Post PTCA evaluation : percutaneous transluminal coronary angioplasty  Non cardiac surgery pre-operative assessment

Know the indications for stress echo Know that in multi-vessel disease, stress echo is better than nuclear stress scans. Which of the following drugs is used in Nuclear Stress tests? Thallium Inderal is a beta blocker Single vessel disease is best with NM Multi vessel disease is best with Echo

Indications To aid in the diagnosis of chest pain To determine the severity and prognosis of CAD To guide post MI rehab To evaluate cardiac arrhythmias To screen high risk or asymptomatic patients with multiple risk factors

Stress Echo analysis Regional wall motion Systolic wall thickening Wall motion score Ejection fraction response Doppler velocities

ECG interpretation Morphology, degree and duration of ST segment depression ST segment elevation Duration of exercise Exercise induced hypotension or arrhythmias

Image interpretation Captured systolic frame, ECG gated 6 to 8 frames, 40-80 sec intervals Continuous loop format, variable speed playback, minimized heart motion and respiratory interference Side by side rest and exercise display. Quad screen.

Normal Stress Response Normal response to stress includes all the following Hyper-dynamic walls Systolic thickening Decreased systolic cavity Normal diastolic dimensions

Normal Stress Response What would be a contraindication to performing a stress test on an athlete with chest pain? Chest pain at rest (unstable angina)