1. Taking a Look Under Your Skin! Andrew Scott

2. A Human Heart

3. The Circulation

4. The Heart Right Atrium Right Ventricle Left Atrium Left Ventricle

5. The Cardiac Cycle

6. The Coronary Arteries The heart is a big muscle so needs a blood supply to work. It doesn’t use the blood inside the heart it has it’s own blood vessels. These arteries are called the coronary arteries and are very important. A coronary artery

7. Heart Diseases UK’s biggest killer 40% of all deaths www.heartstats.org 240,000 PEOPLE DIE OF HEART DISEASE EVERY YEAR!!!!!

8. Coronary Artery Disease KILLS 120,000 PEOPLE PER YEAR!!!

9. Fat in your artery.

10. What happens to all that fat? It can cause chest pain – ANGINA. It gets bigger and can stop the blood to the heart – a HEART ATTACK. OR it can break off and: – Get stuck on the way to the heart – a HEART ATTACK. – Get stuck in your lungs – PULMONARY EMBOLISM. – Get stuck in your brain – a STROKE.

11. Imaging the Heart

12. X-Ray Contrast Angiography X-RAY– All we see is ribs when we x-ray the heart. To see the heart and blood vessels we inject iodine CONTRAST into a vein which absorbs x-rays like bone. Taking pictures of vessels like this is called ANGIOGRAPHY.

13. Angiography of the coronary arteries Fat What the coronary arteries would look like Normal With a plaque What we see in x-ray contrast angiography Vessel wall Blood Thin bit where disease is Normal With a plaque

14. A real x-ray contrast angiography!

15. Ultrasound High frequency sound waves. Put small probe on skin between ribs. See valves and heart moving.

16. Which is best? X-ray Contrast Angiography Is good for seeing coronary arteries. Uses ionising radiation. Need to inject iodine contrast dye. Ultrasound Is good for seeing the valves move. Uses high frequency sound waves. Need to look between the ribs. Both have their uses but neither is ideal.

17. Magnetic Resonance Imaging – MRI

18. What can we get pictures of?

19. Back to the heart!

20. MRI Coronary Angiogram One of my coronary arteries!

21. Movies of the Heart

22. Slicing up the Body

23. Tagging We can see how the different bits of the heart move.

24. Tagging

25. Valve Movement

26. Blood Flow Black – Blood flows in to the screen. White – Blood flows out of the screen.

27. A Faulty Valve Watch for the jet of blood shooting backwards through the valve!

28. Contrast Agent If we inject a gadolinium compound (contrast agent) the magnetic field is increased wherever the contrast agent goes. The increased magnetic field means that the radio wave comes back more quickly.

29. Heart Disease

30. Vascular MRI Kidneys

31. Vascular MRI Aorta and Lungs

32. Pictures of the brain!

33. Pictures of your thoughts! When you use part of your brain, extra blood flows to that part of your brain with more oxygen. Oxyhaemoglobin and deoxyhaemoglobin alter the magnetic field, changing how quick the radio waves come back.

34. Mind Reading

37. A Multi-Disciplinary Team Physicist Clinician (Dr) Radiographer Nurse Receptionist Cleaner Engineer Programmer (physicist) IT support Manager Chemist – Pharmacist

38. Thank you for listening! a.scott07@imperial.ac.uk Andrew Scott PhD Student (in Physics) Cardiovascular Magnetic Resonance Unit Royal Brompton and Harefield NHS Trust. National Heart and Lung Institute, Imperial College.