Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2
Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2
Diagnostic Imaging Cardiovascular(Left) Cardiac CT was performed in an elderly woman presenting with anterior ST elevations and increased troponin, wh Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2ho refused cardiac cath and was hemodynamtcally stable. Curved MPR image of the left anterior descending artery E3 shows no evidence of coronary artery disease. (Right) Two-chamber image during systole (same patient) shows severe hypokinesis of the LV apex C3wlth preserved contractility of the basal Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2 to mid LV segments, consistent with stress cardiomyopathy.Section 8 - Coronary Artery Disease Approach to Coronary Heart Disease IntroductionCoronaryEbook Diagnostic imaging cardiovascular (2nd edition): Part 2
artery disease IS a leading cause of morbidity and mortality in Western countries. The underlying pathology is the development of atherosclerotic plaDiagnostic Imaging Cardiovascular(Left) Cardiac CT was performed in an elderly woman presenting with anterior ST elevations and increased troponin, wh Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2est in a number of forms, such as stable coronary artery disease, acute coronary syndrome, heart failure, and sudden cardiac death.Clinical Manifestations of Coronary Artery DiseaseStable Coronary Artery DiseaseIn stable coronary artery disease, atherosclerotic plaque deposits in the coronary arteri Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2es lead to Significant narrowing of the coronary lumen with subsequent obstruction of the coronary blood stream. This results in deficit in oxygen supEbook Diagnostic imaging cardiovascular (2nd edition): Part 2
ply of the downstream myocardium during situations of increased demand (typically physical exercise). There is no close correlation between the anatomDiagnostic Imaging Cardiovascular(Left) Cardiac CT was performed in an elderly woman presenting with anterior ST elevations and increased troponin, wh Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2length of the lesion, the amount of dependent myocardium, the resistance of the microvasculature, and the amount of collateral flow from other coronary territories. Revascularization serves to treat symptoms and improve prognosis and is usually recommended when the amount of ischemic myocardium exce Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2eds 10% of the left ventricular mass.Acute Coronary SyndromesAcute coronary syndromes have a mechanism that IS different from stable coronary artery dEbook Diagnostic imaging cardiovascular (2nd edition): Part 2
isease. Typically, the index event IS the rupture (most frequently) or erosion (less frequently) of the fibrous cap of an atherosclerotic plaque. MateDiagnostic Imaging Cardiovascular(Left) Cardiac CT was performed in an elderly woman presenting with anterior ST elevations and increased troponin, wh Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2he ruptured plaque. This thrombus can obstruct coronary blood flow, and depending on the degree of obstruction and downstream myocardial damage, the resulting clinical manifestation is either completely silent or symptomatic in the form of unstable angina, non-ST-elevation myocardial infarction, or Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2ST-elevation myocardial infarction. Treatment is usually emergent and includes both medication to counter thrombus aggregation and mechanical intervenEbook Diagnostic imaging cardiovascular (2nd edition): Part 2
tions to restore blood flow.Heart FailureAcute coronary syndromes, including myocardial infarction, can remain clinically silent; therefore, substantiDiagnostic Imaging Cardiovascular(Left) Cardiac CT was performed in an elderly woman presenting with anterior ST elevations and increased troponin, wh Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2 left ventricular function is the first clinical manifestation of coronary artery disease, and patients with newly identified heart failure need to be worked up for the presence of coronary artery obstruction.613Diagnostic Imaging CardiovascularEspecially when left ventricular functional impairment Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2is regional and not homogeneous, coronary artery disease should be strongly suspected.Sudden Cardiac DeathSudden death IS a possible first manifestatiEbook Diagnostic imaging cardiovascular (2nd edition): Part 2
on of coronary artery disease. The underlying event IS almost uniformly arrhythmia. (Acute mechanical complications, such as myocardial rupture secondDiagnostic Imaging Cardiovascular(Left) Cardiac CT was performed in an elderly woman presenting with anterior ST elevations and increased troponin, wh Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2n. It can either occur in the context of an acute coronary syndrome or be triggered by the sudden ischemia, or it can occur in patients with heart failure due to old, often previously unknown, myocardial infarction.Diagnostic StrategiesStable Coronary Artery DiseaseTwo diagnostic strategies exist fo Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2r the diagnosis of stable coronary artery disease. The underlying process is the presence of coronary stenoses that lead to myocardial ischemia. TestiEbook Diagnostic imaging cardiovascular (2nd edition): Part 2
ng can aim either at identifying the ischemic myocardium under exercise or at the direct visualization of coronary artery stenoses.Since not all coronDiagnostic Imaging Cardiovascular(Left) Cardiac CT was performed in an elderly woman presenting with anterior ST elevations and increased troponin, wh Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2with suspected stable coronary artery disease is the noninvasive identification of stress-induced myocardial ischemia. It can be achieved with physical exercise (treadmill or bicycle exercise) or pharmacologic stress (dipyridamole or dobutamine to increase contractility and myocardial oxygen demand Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2or adenosine to achieve maximum vasodilation and "steal" effects). Commonly used tests include single-photon emission computed tomography (SPECT) andEbook Diagnostic imaging cardiovascular (2nd edition): Part 2
positron emission tomography (PET) myocardial perfusion and metabolic imaging, stress echocardiography, and stress magnetic resonance (MR) imaging.AnoDiagnostic Imaging Cardiovascular(Left) Cardiac CT was performed in an elderly woman presenting with anterior ST elevations and increased troponin, wh Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2) coronary angiography. It IS limited by the fact that not all stenoses cause ischemia and hence require revascularization, and if a stenosis IS detected. It may be difficult to determine whether it mandates treatment. Invasive coronary angiography can be combined with measurement of the fractional Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2flow reserve (FFR), which quantifies the relationship of mean arterial blood pressure before and after the stenosis during maximum vasodilation achievEbook Diagnostic imaging cardiovascular (2nd edition): Part 2
ed by adenosine. Currently, FFR is considered the gold standard to identify myocardial ischemia, and FFR values < 0.8 indicate that the respective lesDiagnostic Imaging Cardiovascular(Left) Cardiac CT was performed in an elderly woman presenting with anterior ST elevations and increased troponin, wh Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2y and specificity. Also, ischemia testing cannot identify coronary atherosclerotic plaque, which is nonobstructive but might have implications for the future cardiovascular event risk. Anatomic imaging, on the other hand, often identifies stenoses, and the treating physician (and patient) may feel c Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2ompelled to perform revascularization, even though not all stenoses cause relevant ischemia. Additionally, invasive coronary angiography IS associatedEbook Diagnostic imaging cardiovascular (2nd edition): Part 2
with potential complications, and noninvasive coronary angiography by CT suffers from limited image quality, which, if misinterpreted, can lead to faDiagnostic Imaging Cardiovascular(Left) Cardiac CT was performed in an elderly woman presenting with anterior ST elevations and increased troponin, wh Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2ikelihood, and also local expertise with the various diagnostic tests. The most frequently applied strategy encompasses initial testing for ischemia, followed, if positive, by anatomic imaging. Coronary Visualization by CT, however, may be a suitable alternative to reliably rule out coronary stenose Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2s, especially in patients who do not have a high likelihood of being diseased.Acute Coronary SyndromesAcute coronary syndromes encompass a wide spectrEbook Diagnostic imaging cardiovascular (2nd edition): Part 2
um from unstable angina to ST-segment elevation myocardial infarction (STEMI). In STEMI, electrocardiography is the only test performed and leads to iDiagnostic Imaging Cardiovascular(Left) Cardiac CT was performed in an elderly woman presenting with anterior ST elevations and increased troponin, wh Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2 angiography can be made. It includes laboratory testing (troponin) complemented by echocardiography to exclude differential diagnoses (acute pulmonary embolism, aortic dissection) and assess regional as well as global left ventncular function. It may also include testing for ischemia. Coronary CT a Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2ngiography plays an increasingly important role to rule out coronary artery disease, especially in patients who present with acute chest pain but haveEbook Diagnostic imaging cardiovascular (2nd edition): Part 2
a relatively low pretest likelihood of acute coronary disease.PreventionPrevention of the first acute coronary event is an important goal in coronaryDiagnostic Imaging Cardiovascular(Left) Cardiac CT was performed in an elderly woman presenting with anterior ST elevations and increased troponin, wh Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2 estimate the risk and the necessity of risk-lowering treatment by statins, aspirin, or antihypertensive medication. It is increasingly recognized that imaging may also contribute to risk stratification (e.g., coronary calcium), but the role of imaging in primary prevention has not been definitely c Ebook Diagnostic imaging cardiovascular (2nd edition): Part 2larified. It remains uncertain which individuals will benefit from imaging in the context of primary prevention.Summary614Diagnostic Imaging CardiovasEbook Diagnostic imaging cardiovascular (2nd edition): Part 2
cularNumerous diagnostic strategies are available to address the various clinical manifestations of coronary artery disease. No single test is perfectGọi ngay
Chat zalo
Facebook