1. INVESTIGATION IN CARDIOVASCULAR DISEASE

2. Electrocardiography ECG Process of recording the electrical activity of the heart over a period of time using electrodes placed on a patient's body.electrodes

3. Indications Assess cardiac rhythm and conduction To assess for myocardial ischaemia and infarction Determine hypertrophy of the chamber Determine electrolyte imbalances Evaluate and monitor the effect of drugs

4. Normal Impulse Conduction Sinoatrial node AV node Bundle of His Bundle Branches Purkinje fibers

5. Impulse Conduction & the ECG Sinoatrial node AV node Bundle of His Bundle Branches Purkinje fibers

6. Pacemakers of the Heart SA Node - Dominant pacemaker with an intrinsic rate of 60 - 100 beats/minute. AV Node - Back-up pacemaker with an intrinsic rate of 40 - 60 beats/minute. Ventricular cells - Back-up pacemaker with an intrinsic rate of 20 - 45 bpm.

7. The “PQRST” P wave - Atrial depolarization T wave - Ventricular repolarization QRS - Ventricular depolarization

8. The standard 12–lead ECG The 12-lead ECG is generated from ten physical electrodes that are attached to the skin. One electrode is attached to each limb and six electrodes are attached to the chest

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10. The standard 12–lead ECG Three dipole limb leads (I,II,III), three augmented voltage limb leads(avL,avR,avF) Six unipole chest leads(V1-V6).

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13. Exercise (stress) ECG Exercise electrocardiography is used to detect myocardial ischaemia during physical stress and is helpful in the diagnosis of coronary artery disease. A 12-lead ECG is recorded during exercise on a treadmill or bicycle ergometer

14. Ambulatory ECG(Holter) Continuous (ambulatory) ECG recordings can be obtained using a portable digital recorder. These devices usually provide limb lead ECG recordings only, and can record for between 1 and 7 days. Ambulatory ECG recording is principally used in the investigation of patients with suspected arrhythmia, such as those with intermittent palpitation, dizziness or syncopy

15. Chest X-ray This is useful for determining the size and shape of the heart, and the state of the pulmonary blood vessels and lung fields. Most information is given by a posteroanterior (PA) projection taken in full inspiration

16. Chest X-Ray

17. Echocardiography (echo) Echocardiography, or cardiac ultrasound, is obtained by placing an ultrasound transducer on the chest wall to image the heart structures as a real- time, twodimensional ‘slic

18. Echocardiography (echo) Transthoracic echo. Transoesophageal.

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22. Doppler echocardiography This depends on the Doppler principle that sound waves reflected from moving objects, such as intracardiac red blood cells, undergo a frequency shift. The speed and direction of the red cells, and thus of blood, can be detected in the heart chambers and great vessels

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25. Transoesophageal echocardiography endoscope-like ultrasound probe which is passed into the oesophagus under light sedation and positioned behind the LA. This produces high-resolution images.

26. Computed Tomographic Imaging Useful for imaging the cardiac chambers, great vessels, pericardium, and mediastinal structures and masses And recently even the coronaries (CT coronary angiography).

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28. Magnetic resonance imaging Magnetic resonance imaging (MRI) requires no ionising radiation and can be used to generate cross-sectional images of the heart, lungs and mediastinal structures

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30. Cardiac catheterisation This involves passage of a preshaped catheter via a vein or artery into the heart under X-ray guidance, which allows the measurement of pressure and oxygen saturation in the cardiac chambers and great vessels, and the performance of angiograms by injecting contrast media into a chamber or blood vessel

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32. Electrophysiology study For assessment, diagnosis and treatment of arrhythmias

33. Radionuclide imaging Blood pool imaging Myocardial perfusion imaging

34. Cardiac biomarkers Brain natriuretic peptide-diagnosis and assess prognosis and response to therapy in patients with heart failure. Cardiac troponins Troponin I and troponin T are structural cardiac muscle proteins that are released during myocyte damage and necrosis, and represent the cornerstone of the diagnosis of acute myocardial infarction.

35. Others