Cardiovascular Diagnosis

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Presentation Transcript

Slide 1: 

CARDIOVASCULAR DIAGNOSIS 1

Anatomy of heart : 

Anatomy of heart Chapter 01 2

The Heart : 

The Heart The heart is located in the center of the thorax and contracts 72 times per minute pumping blood throughout the body 3

The Beating Heart : 

The Beating Heart 4

Heart - Front View : 

Heart - Front View The external structures of the heart include the ventricles, the atria, aorta, pulmonary arteries and the pulmonary veins 5

Heart - Section : 

Heart - Section The interior of the heart is composed of the myocardium, four heart valves, four cardiac chambers, and associated vessels 6

Not From Within : 

Not From Within Heart can not get blood for its own need from within the chambers of heart, but has to depend on the coronaries from outside 7

Left Coronary Artery : 

Left Coronary Artery Left coronary artery is the largest of the blood vessels supplying the heart, especially the left ventricle and the left atrium 8

Right Coronary Artery : 

Right Coronary Artery Right coronary artery is the 2nd largest of the blood vessels supplying the heart especially the right ventricle and right atrium 9

Anterior Heart Arteries : 

Anterior Heart Arteries The important branch of the left coronary artery is the left anterior inter-ventricular artery which supplies the anterior surface 10

Posterior Heart Arteries : 

Posterior Heart Arteries Another important branch of left coronary artery is the Deep Circumflex Artery which supplies the posterior surface 11

Symptoms of heart disease : 

Symptoms of heart disease Chapter 02 12

Chest Pain : 

Chest Pain Pain in the center of the chest is very characteristic of diseases of the heart especially those due to coronary artery disease 13

Non Cardiac Chest Pain : 

Non Cardiac Chest Pain Even though chest pain as a presenting symptoms of heart attack is quite characteristic, it is not unique to heart disease 14

Breathlessness on Exertion : 

Breathlessness on Exertion Breathlessness especially on exertion and on lying down occurs in heart disease. Patient may also wake up at night with breathlessness 15

Palpitation : 

Palpitation Palpitation is another important symptom of heart disease. It may occur during exertion or while at rest 16

Hemoptysis : 

Hemoptysis Spitting blood or blood stained sputum, even though more likely to be due to a respiratory disease may also occur in heart disease 17

Bluish coloration : 

Bluish coloration Otherwise called cyanosis, of the lips and tongue is likely to occur in some congenital heart diseases and also in heart failures 18

Peripheral Cyanosis : 

Peripheral Cyanosis Bluish coloration may also occur in heart disease due to the reduced circulation of the peripheral tissues like fingers and toes 19

Leg Swelling : 

Leg Swelling Leg swelling due to accumulation of fluid in the subcutaneous tissues is likely to occur in heart failure 20

Signs of heart disease : 

Signs of heart disease Chapter 03 21

Examination of Pulse : 

Examination of Pulse The right radial artery pulse is palpated in the forearm for at least one minute and studied in detail for the rate and the rhythm 22

The Blood Pressure : 

The Blood Pressure The BP is recorded in the right arm using a sphygmomanometer applied to the upper arm and K sounds auscultated at elbow 23 Coming up – an Animation of BP measurement

Measurement of BP : 

Measurement of BP 24

Jugular Venous Pressure : 

Jugular Venous Pressure The pressure inside the right atrium is reflected in the root of the neck as the jugular venous pressure which is measured and studied 25 Coming up a Video of JVP measurement

Measurement of Jugular venous Pressure : 

Measurement of Jugular venous Pressure 26

Palpation of Heart : 

Palpation of Heart Precordium of the chest is palpated for position of the apex beat, left parasternal heave and presence of any thrills 27

Areas for Auscultation : 

Areas for Auscultation These are the aortic area, the pulmonary area, the second aortic area, the tricuspid Area and the mitral area 28

Auscultation of Heart Sounds : 

Auscultation of Heart Sounds The heart is auscultated for the intensity and quality of the heart sounds and any additional heart sounds 29 Coming up a Video of Auscultation of Heart

Auscultation of The Heart - Video : 

Auscultation of The Heart - Video 30

Auscultation of Heart Murmurs : 

Auscultation of Heart Murmurs The heart is then auscultated carefully for the presence of any heart murmurs either in the systole, diastole 31

Investigations in heart disease : 

Investigations in heart disease Chapter 04 32

Electrocardiogram (ECG) : 

Electrocardiogram (ECG) It is a test that measures the electrical activity of the heart, the rate, rhythm and presence of any ischemia 33

ECG : 

ECG ECG is used extensively in the diagnosis of heart disease, from congenital disease to myocardial infarction and myocarditis 34

Holter Monitoring : 

Holter Monitoring The patient wears a monitor that records electrical activity of their heart (similarly to the recording of an ECG) for 24 hours 35

X-Ray Chest PA view : 

X-Ray Chest PA view Chest X-Ray PA view brings into focus the heart and the lungs and the chambers and any enlargement of the heart 36 Coming up a Video of Echocardiography

Echocardiography : 

Echocardiography 37

Coronary Angiography : 

Coronary Angiography The narrowing of the coronary vessels can be demonstrated using this radiological technique 38

Coronary artery heart diseases - angina : 

Coronary artery heart diseases - angina Chapter 05 39

Definition of Angina : 

Definition of Angina Angina is a temporary chest pain, pressure or discomfort due to insufficient blood supply to heart, during exertion 40

Angina – The Cry of Heart : 

Angina – The Cry of Heart When heart does not get enough blood through coronaries during exertion, it cries for more oxygen, causing the pain 41

Site of Chest Pain : 

Site of Chest Pain The chest pain in angina is felt in the center of the chest, and is described by an open or closed fist showing the site 42

Chest Pain Radiation : 

Chest Pain Radiation In angina, chest pain usually radiates to the left shoulder, left upper limb and along its inside border and up to the left hand 43

Other Sites of Radiation : 

Other Sites of Radiation In another patient the chest pain may radiate to the neck, jaw, upper abdomen, right shoulders and or the right arms 44

Severity Of Pain : 

Severity Of Pain The severity of the chest pain is such that the patient can no longer exert and therefore stops, gasping with pain 45

Character Of The Pain : 

Character Of The Pain It is described as either a firm pressure, chest discomfort, crushing or burning or tightness of chest 46

Other Symptoms : 

Other Symptoms Patients may complain about anxiety, dizziness, cold sweating, breathlessness or even presence of a stomach upset 47

Duration of Chest Pain : 

Duration of Chest Pain The pain usually lasts for only 2-3 minutes and is relieved when the patient takes rest or puts medicines under the tongue 48

It is a Vicious Cycle : 

It is a Vicious Cycle Initially pain occurs during moderate activity but later it occurs during mild activity, then during normal daily activities 49

Coronary Atherosclerosis : 

Coronary Atherosclerosis The basic abnormality in of angina is the narrowing of the coronary arteries by progressive atherosclerosis 50

Plaque Formation : 

Plaque Formation Accumulation of lipids in the walls of the artery leads to the formation of an inward elevation called the plaque 51

Treatment of Angina : 

Treatment of Angina The treatment of Angina is by using drugs which dilate the coronary arteries like nitroglycerine and vasodilators 52

Nitroglycerine : 

Nitroglycerine Nitroglycerine is taken by the patient immediately after chest pain by placing it under the tongue for quick absorption 53

Coronary artery disease - Unstable angina : 

Coronary artery disease - Unstable angina Chapter 07 54

No permanent damage : 

No permanent damage In angina there is no permanent damage to the myocardium as would occur in patients with Myocardial Infarction 55

Coronary Angioplasty : 

Coronary Angioplasty Here the narrowed coronary artery causing the CAD is opened up using a catheter passed through the vessel 56

Coronary Artery Stent : 

Coronary Artery Stent A stent is a rust proof wire mesh placed inside the coronary artery, which costs anything above Rs 50,000 per piece 57

Stent Insertion : 

Stent Insertion A guide wire is advanced across the blocked section of the coronary artery and a balloon is positioned beside the blockage 58

The Result : 

The Result The outcome is relief from chest pain and improved exercise capacity. In 2/3rd of patients, the procedure is successful 59 Coming up an Animation of Angioplasty

Angioplasty : 

Angioplasty 60

Coronary Bypass Surgery : 

Coronary Bypass Surgery Bypass surgery is the alternative option indicated when one or more coronary arteries are seriously blocked 61

Bypass Surgery : 

Bypass Surgery In Bypass surgery, the site of coronary obstruction is bypassed by means of a vein or artery from the patient himself 62

Saphenous Vein Graft : 

Saphenous Vein Graft Here the saphenous vein is harvested from the patient’s own legs and used as a conduit for bypass 63

Internal Mammary Graft : 

Internal Mammary Graft Internal mammary artery graft is used alternatively in selected cases producing a longer term of benefit of up to 10 years 64

Beating Heart Surgery : 

Beating Heart Surgery Here stabilization devices are used to reduces the motion of target vessels and the bypass under taken with out Heart-Lung machine 65 Coming up a Video of Beating Heart Surgery

Beating Heart Surgery : 

Beating Heart Surgery 66 Coming up a Video of Robot Assisted Bypass Surgery

Robot Assisted Surgery : 

Robot Assisted Surgery 67

Myocardial infarction : 

Myocardial infarction Chapter 08 68

Heart Attack : 

Heart Attack A heart attack or acute myocardial infarction (MI) occurs when one of the coronary arteries is blocked 69

Total Occlusion : 

Total Occlusion In angina there is only up to 70-80% occlusion; but in Acute Myocardial Infarction, there is 100% occlusion 70

Myocardial Infarction : 

Myocardial Infarction The area of myocardium which is totally deprived of blood supply becomes a non contracting scar tissue 71 Coming up an animation of Thrombus Formation

Thrombus Formation : 

Thrombus Formation 72

Who Gets Heart Attack? : 

Who Gets Heart Attack? Any body can get a heart attack above the age of 30 years, irrespective of the sex, race and country of origin 73

Females and Heart Attack : 

Females and Heart Attack Females are generally protected from heart attack because of estrogen in their body during menstruating age 74 Coming up an Animation about Risk Factors of MI

Risk Factors for MI : 

Risk Factors for MI 75

Sudden Death : 

Sudden Death Importance of Myocardial Infarction, is that it can cause sudden, unexpected death, even in very young people 76 Coming up a Animation about Complications of MI

Complications of MI : 

Complications of MI 77 Coming up a Video of Cardio Pulmonary Resuscitation

Cardiopulmonary Resuscitation : 

Cardiopulmonary Resuscitation 78 Coming up an Animation of Automated Defibrillation

Automated Defibrillation : 

Automated Defibrillation 79

ECG wave tracings in MI : 

ECG wave tracings in MI Various phases of MI can be seen in ECG wave tracings during the acute phase, fully evolved phase, resolution phase and chronic phase 80

ST Elevation MI : 

ST Elevation MI ST elevation Myocardial Infarction is the most important type of Myocardial infarction leading to sudden cardiac arrest and death 81

Thrombolytic Therapy : 

Thrombolytic Therapy If the patient can be brought sufficiently early to the hospital, the blood clot can be dissolved using certain drugs like streptokinase 82 Coming up a Video of Emergency Ambulance Service

Call the Ambulance : 

Call the Ambulance 83

Non ST Elevation MI : 

Non ST Elevation MI Here the patient has no ST elevation in the ECG. But at the same time there is death of the myocardial tissue which is not easily reversible 84 Coming up an Animation about Final Outcome

Final Outcome : 

Final Outcome 85

HYPERTENSIve heart disease : 

HYPERTENSIve heart disease Chapter 09 86

Definition : 

Definition Hypertension is defined as sustained and abnormal elevation of arterial blood pressure of at least 140 mmHg systolic and 90 mmHg diastolic 87

Importance : 

Importance If left untreated hypertensive patients can end up with several complications in the due course of the illness 88

Complications of HTN : 

Complications of HTN Hypertension is a very important predisposing cause of heart disease, kidney disease, as well as stroke 89

What is blood pressure? : 

What is blood pressure? It is the pressure exerted on the lateral walls of the blood vessels by the blood from within the vessel 90

Why We Need Blood Pressure? : 

Why We Need Blood Pressure? Blood pressure is needed to push the blood along the blood vessels to reach the various tissues of the body 91

Essential Hypertension : 

Essential Hypertension In Primary or Essential Hypertension both the systolic as well as diastolic blood pressures are elevated to almost an equal extend 92

Sodium in Food : 

Sodium in Food Sodium is an element that the human body needs to function properly and especially to regulate the blood pressure and blood volume 93

Sodium and Hypertension : 

Sodium and Hypertension For individuals who are sodium-sensitive, an increased intake of sodium through food may contribute to high blood pressure 94

The values : 

The values Persons with BP in the normal ranges are normal. Those having BP in the borderline are called pre-hypertensives 95

Normal Blood Pressure : 

Normal Blood Pressure The normal blood pressure is 120/70 to 140/90. It is advisable to maintain a BP in or around 130/80 mmHg under any circumstances 96

Isolated Systolic Hypertension : 

Isolated Systolic Hypertension In some patients with hypertension especially old people, only the systolic Blood Pressure is found to be elevated 97

White Coat Hypertension : 

White Coat Hypertension In these cases high blood pressure is seen only when recorded by the doctor in the clinic or hospital surroundings 98

Symptoms : 

Symptoms Most patients with hypertension have no specific symptoms. Others may complain about dizziness, vertigo or epistaxis 99

Headache and Hypertension : 

Headache and Hypertension Headache is seen only in patients with more severe hypertension. In these patients it is localized to the back of the head 100

The Silent Killer : 

The Silent Killer Hypertension is considered as a silent killer because even in the absence of symptoms it can cause heart attack or stroke 101 Coming up an Animation of Effects of Hypertension

Effects of Hypertension : 

Effects of Hypertension 102

Hypertension and Heart : 

Hypertension and Heart The heart muscles thicken to make up for increased blood pressure. It is the left ventricle which gets the brunt of the enlargement 103

Left Ventricular Hypertrophy : 

Left Ventricular Hypertrophy The left ventricle is markedly thickened in this patient with severe hypertension that was remaining untreated for many years 104 Coming up an Animation of Effect of HTN on Heart

The Effect On The Heart : 

The Effect On The Heart 105

Hemiplegia : 

Hemiplegia Occlusion of the middle cerebral artery results in sudden paralysis of upper and lower limbs called as a stroke or hemiplegia 106

Intracerebral Hemorrhage : 

Intracerebral Hemorrhage Perhaps a more important and dangerous complication of hypertension is bleeding in to the brain, causing unconsciousness 107

Treatment of High BP : 

Treatment of High BP Maintaining the blood pressure within the normal ranges for months and years is perhaps more difficult 108

Advice to High BP patients : 

Advice to High BP patients Every patient with hypertension is advised to check BP regularly so that sudden increase may not occur 109

Regular Exercise : 

Regular Exercise By doing regular exercise the tone of the muscles in the walls of the arteries remain reduced and thus BP is lowered 110

Low Salt Intake : 

Low Salt Intake Low salt intake is an essential component of management of hypertension irrespective of the degree of BP rise 111

Pappads, Pickles, Fried, Dried : 

Pappads, Pickles, Fried, Dried Pappads, pickles, fried items and dried fish contain large quantities of salt. Hence all hypertensive's should avoid these 112

Beta Blockers : 

Beta Blockers Atenelol is one such drugs used in the treatment of hypertension especially in the early stages 113

Calcium Channel Blockers : 

Calcium Channel Blockers Nifedipine is a calcium channel blocker used for the control of mild to moderate hypertension 114

ACEIs and ARBs : 

ACEIs and ARBs Angiotensin Converting Enzyme inhibitors and Angiotension Receptor Blockers are the other drugs 115

Valvular heart diseases : 

Valvular heart diseases Chapter 10 116

The Heart Valves : 

The Heart Valves The valves of the heart open and close to control the flow of blood entering or leaving the heart 117

The Four Valves : 

The Four Valves There are four valves in the heart: namely the aortic, the mitral, tricuspid, and the pulmonary valve 118

The Heart Valves : 

The Heart Valves The valves are designed to control the direction of blood flow through the heart. Their opening and closing produce the heart sounds 119

Mitral stenosis : 

Mitral stenosis It is a heart valve disorder that narrows the mitral valve opening reducing the amount of blood that flows through it 120

Mitral Regurgitation : 

Mitral Regurgitation Mitral valve may develop damage due to rheumatic fever and become leaky resulting in blood regurgitating into the left atrium 121

Aortic Stenosis : 

Aortic Stenosis Aortic valve gets constricted due to valve damage preventing blood from flowing into the aorta 122

Aortic Regurgitation : 

Aortic Regurgitation The aortic valve, when affected by disease cannot prevent back flow of blood in to the left ventricle 123

heart failure : 

heart failure Chapter 11 124 Coming up an Animation about Heart Failure

Heart Failure : 

Heart Failure 125

Pulmonary Edema : 

Pulmonary Edema As the heart fails, pressure in the vein going through the lungs starts to rise. fluid is pushed into the air spaces (alveoli) 126

Pulmonary Edema in X- Ray : 

Pulmonary Edema in X- Ray Pulmonary edema can be seen in the X-Ray chest as a fluffy non-homogenous opacities of both hila of lungs 127 Coming up an Animation of Ventricular Assist Device

Left Ventricular Assist Device : 

Left Ventricular Assist Device 128 Coming up a Video of Heart Transplantation

Heart Transplantation : 

Heart Transplantation 129 Coming up an Animation of Total Artificial Heart

Total Artificial Heart : 

Total Artificial Heart 130

Congenital acyanotic heart diseases : 

Congenital acyanotic heart diseases Chapter 12 131

Atrial Septal Defect : 

Atrial Septal Defect It is a congenital heart defect where the wall between the right and left atrium has a hole and blood flows between the two atria 132

Ventricular Septal Defect : 

Ventricular Septal Defect Ventricular septal defect is an abnormal opening in the wall that separates the right and left ventricles 133

Patent Ductus Arteriosus : 

Patent Ductus Arteriosus Here there is an abnormal communication between the aorta and the pulmonary artery which is normally present in infants 134

Congenital cyanotic heart diseases : 

Congenital cyanotic heart diseases Chapter 13 135

Tetralogy of Fallot : 

Tetralogy of Fallot It is a birth defect of the heart consisting of 4 abnormalities that results in insufficiently oxygenated blood pumped to the body 136

Transposition of the great vessels : 

Transposition of the great vessels Here the position of the two major vessels that carry blood away from the heart - the aorta and the pulmonary artery - is switched (transposed) 137

Disorders of heart rhythm : 

Disorders of heart rhythm Chapter 14 138

Sinus Bradycardia : 

Sinus Bradycardia It is a cardiac rhythm characterized by a slowness of the heartbeat, usually at a rate under 60 beats per minute 139

Ventricular tachycardia : 

Ventricular tachycardia It is a rapid resting heart rate initiated within the ventricles, typically at 160 - 240 beats per minute 140

Sick Sinus Syndrome : 

Sick Sinus Syndrome It is a collection of heart rhythm disorders that include alternating slow and fast heart rhythms 141

Cardiac Pacemaker : 

Cardiac Pacemaker A pacemaker is a small, battery-operated electronic device inserted under the skin to help the heart beat regularly at an appropriate rate 142

Diseases of Endocardium : 

Diseases of Endocardium Chapter 15 143

Infective Endocarditis : 

Infective Endocarditis It involves the heart valves and is most commonly found in people who have underlying heart disease 144

Infective Endocarditis : 

Infective Endocarditis Sources of the infection may be due to transient bacteremia, which is common during minor surgical procedures 145

Surgical Procedures : 

Surgical Procedures These are commonly done dental, upper respiratory, urologic, and lower gastrointestinal diagnostic and surgical procedures 146

Vegetations : 

Vegetations The infection can cause growths called as vegetations on the heart valves, the lining of the heart, or the lining of the blood vessels. 147

Embolism : 

Embolism These growths may be dislodged and send clots to the brain, lungs, kidneys, or spleen resulting in what is called an embolism 148 Coming up an Animation of Cerebral Embolism

Cerebral Embolism : 

Cerebral Embolism 149

Diseases of myocardium : 

Diseases of myocardium Chapter 16 150

Myocarditis : 

Myocarditis It is acute inflammation of the muscle of heart due to infections especially of viral etiology like Coxachie B 151

Cardiomyopathy : 

Cardiomyopathy It is a disease affecting the muscle of the heart resulting in thickness and loss of function. It is of three varieties 152

Hypertrophic Cardiomyopathy : 

Hypertrophic Cardiomyopathy It is a condition in which there is primary thickening of the muscle of the heart in the inter-ventricular septum resulting in an obstruction 153

Dilated Cardiomyopathy : 

Dilated Cardiomyopathy Here the thickening of the myocardium results in dilation and functioning of the chambers of heart especially the ventricles 154

Diseases of pericardium : 

Diseases of pericardium Chapter 17 155

Pericardium : 

Pericardium It is a thin double-layered sac which encloses the heart. Fluid contained within the layers lubricates constantly rubbing surfaces 156

Pericarditis : 

Pericarditis It is caused by inflammation of the pericardium, the sac-like covering of the heart and resulting in pain 157

Pericardial Effusion : 

Pericardial Effusion It is a collection of fluid in excess of the normal quantity, in the pericardium, producing compression of the heart 158

Cardiac Tamponade : 

Cardiac Tamponade It is a compression of the heart caused by blood or fluid accumulation in the space between the layers of the pericardium of heart 159

Summary : 

Summary Heart Diseases are many Coronary Artery Disease is important Hypertensive Heart Disease too Valvular Heart Disease is still common Congenital Heart Disease is rare Investigations help us in diagnosis Early Treatment is advisable Prevention is better than cure 160

Slide 161: 

161 MAY YOUR HEARTS WORK FOR EVER

Slide 162: 

Thank You 162

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