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Medical Terminology 2.

0: Cardiovascular System: Lesson 3: Diagnostic Procedures and Therapeutic Interventions Learning Objectives
After completing this lesson, you should be able to: Identify the words parts used to build diagnostic procedures and therapeutic interventions related to the cardiovascular system. Define terms used to describe the diagnostic procedures and therapeutic interventions related to the cardiovascular system. Pronounce and spell terms used to describe the diagnostic procedures and therapeutic interventions related to the cardiovascular system. Recognize and use the word parts and terms related to diagnostic procedures and therapeutic interventions for patients with cardiovascular disease.

ReviewSuffix, Prefix, and Combining Forms Valvul/o valve Ather/o fat, plaque -tomy process of cutting -mission sending Cutane/o skin -ectomy removal Echo- - reflected sound -al, -ac, -ary, -ous, eal, -ic, -ar pertaining to Trans- - across -centesis surgical puncture to remove fluid Cardi/o, coron/o heart Re- - again Ventricul/o ventricle -genesis formation Myocardi/o heart muscle Tom/o slice Angi/o, vascul/o vessel -plasty surgical repair -pathy disease De- - removal Pulmon/o lung Sclera/o hard Electr/o electricity Lumen/o - lumen Son/o sound -gram record -graphy process of recording -therapy treatment Per- - through Esophag/o esophagus

Ultra- - beyond Extra- - outside Corpor/o body Peri- - surrounding Lip/o lipid, fat My/o muscle Case Study: Mr. Manuel Sanchez
Mr. Sanchez is an 85-year-old retired Air Force colonel. He suffers from chronic heart disease and is visiting his cardiologist for his quarterly evaluation. His history indicates chronic hypertension, chronic congestive heart failure, and abnormalities of his cardiac rhythm. Mr. Sanchez tells his doctor that he has developed significant weakness and excessive fatigue over the last month or so. Vital signs are B/P 184/98, pulse 52, and respirations 22. The doctor is concerned by the slow pulse rate and high blood pressure and orders an electrocardiogram and laboratory tests to determine the cause.

Laboratory Tests
Several laboratory tests are commonly used to estimate a patient's risk of developing cardiovascular disease. These diagnostic tests are also used to obtain an accurate diagnosis of existing cardiovascular disease.

lipid profile: A blood test to measure the lipids (cholesterol and triglycerides) in the circulating blood. coronary heart disease: Any of the abnormal conditions affecting the arteries of the heart and producing pathologic effects, particularly a diminished flow of nutrients and oxygen to the myocardium. cholesterol: 1. A waxy lipid (of the group called sterols) found only in animal tissues; promotes absorption and transport of fatty acids and acts as the precursor of the steroid hormones, the sex hormones, and the synthesis of vitamin D at the surface of the skin. 2. The preparation of cholesterol used as an emulsifying agent in pharmaceuticals. cardiac enzymes test: A blood test that measures the amount of cardiac enzymes characteristically released during a myocardial infarction; examines the amount of lactate dehydrogenase (LDH) and creatine phosphokinase (CPK) in the blood. myocardial infarction: Necrosis of a portion of the myocardial muscle due to obstruction in a coronary artery caused by atherosclerosis or to a thrombus or spasm. Also called heart attack.

Noninvasive Imaging Procedures


The majority of diagnostic procedures for cardiovascular disorders use imaging techniques. These can be either invasive or noninvasive. Chest x-rays are used to evaluate the size and shape of the heart. Positron emission tomography (PET) (-mission=sending, tom/o=slice, -graphy=process of recording) refers to a computerized nuclear medicine procedure that uses inhaled or injected radioactive substances to help identify how much a patient will benefit from revascularization (opening up a blocked vessel) procedures. Magnetic resonance imaging (MRI) is a type of body scan that uses a large magnet and radio waves to look at organs and structures inside the body. It is used to detect areas of myocardial infarction, stenoses (sing. stenosis), and areas of blocked blood flow or circulation.

Click the More Information tab to learn about other noninvasive imaging procedures. Imaging techniques can identify defects in the anatomy of the heart. They are used to diagnose problems with the heart valves, such as aortic stenosis or mitral valve prolapse. These techniques can help to determine the overall function of the heart muscle. Echocardiography (echo-=reflected sound, cardi/o=heart) uses ultrasonic (ultra-=beyond, son/o=sound, -ic=pertaining to) waves directed through the heart to study the structure and motion of the heart. Transesophageal echocardiogram (TEE) (trans-=across, through, esophag/o=esophagus, -eal=pertaining to, -gram=record) is a procedure that images the heart through a transducer introduced into the esophagus. Myocardial perfusion imaging (myocardi/o=myocardium, -al=pertaining to) uses radionuclides or radioactive thallium to diagnose coronary artery disease, or CAD, valvular (valvul/o=valve, -ar=pertaining to) or congenital heart disease, and cardiomyopathy (cardi/o=heart, my/o=muscle, -pathy=disease).

Noninvasive Cardiac Monitoring Techniques


Noninvasive techniques may be used to monitor the workings of the heart. A nuclear stress test uses radioactive thallium or technetium Tc99m sestamibi to take pictures of the patient's heart while the patient is exercising on a treadmill. The test can be used to determine which parts of the heart are healthy and functioning normally and which are not. Electrocardiography (ECG) (electr/o=electricity) is a process of recording the electrical activity of the heart muscle. Holter monitors provide portability so that the heart's reaction to daily activities can be recorded.

Invasive Imaging Techniques


Cardiac catheterization (cardi/o=heart, -ac=pertaining to) refers to the threading of a catheter (thin, flexible tube) into the heart to collect diagnostic information about various cardiovascular structures. This procedure can be enhanced with additional techniques.

Angiocardiography (angi/o=vessel) includes an injection of a radiopaque substance during cardiac catheterization to enhance its evaluation. Digital subtraction angiography (DSA) takes X-ray pictures of the carotid arteries after a special dye has been injected into the bloodstream. Pulmonary artery catheter is a long, thin cardiac catheter with a tiny balloon at the tip that is fed into the femoral artery near the groin and extended up to the left ventricle to determine left ventricular function.

Therapeutic Interventions
A blockage in a coronary artery may require a surgical procedure known as coronary artery bypass graft (CABG). This open-heart surgery involves grafting a piece of healthy blood vessel from one location (leg) into a coronary artery to reroute blood around the blockage. Extracorporeal circulation (ECC) (extra-=outside, corpor/o=body, -eal=pertaining to) uses a cardiopulmonary machine to do the work of the heart during the open-heart procedure. Port-access coronary artery bypass (PACAB) allows the heart to continue beating on its own while a minimal incision is made over the blocked artery, and an artery from the chest wall is used as the bypassa procedure known as minimally invasive coronary artery bypass. Click the More Information tab to learn about restoring normal cardiac rhythms.

Cardiovascular System: Lesson 3: Diagnostic Procedures and Therapeutic Interventions Therapeutic InterventionsRestoring Normal Cardiac Rhythm
Several therapeutic interventions can be used to restore a normal heart rhythm in patients with cardiovascular disease.

cardiopulmonary resuscitation (CPR): The basic emergency procedure for life support, consisting of artificial ventilation and manual external cardiac massage. cardiac pacemaker: An apparatus that electrically stimulates the heart muscle as a way to regulate the heart rate, most commonly to increase the heart rate in severe bradycardia. cardiac defibrillator: Either external or implantable device that provides an electronic shock to the heart to restore a normal rhythm. left ventricular assist device: Mechanical pump device that assists a patient's weakened heart by pulling blood from the left ventricle into the pump and then ejecting it out into the aorta. LVADs may be used on those patients awaiting a transplant. Artificial Valves and Transplantation

Some patients with heart disease require valve repair or artificial valve replacement, while others may require a heart transplant. Commissurotomy (-tomy=process of cutting) is a process that separates thickened, adherent leaves of a stenosed mitral valve in the heart. Artificial valves, like the ones shown here, are often used to replace defective mitral valves. Heart transplantation is when the entire diseased heart is removed and replaced with a donor heart.

Revascularization Procedures
Revascularization procedures include atherectomy and laser angioplasty. Atherectomy (ather/o=fat/plaque, -ectomy=removal) is a treatment for atherosclerotic (scler/o=hard, -ic=pertaining to) heart disease. The procedure involves removing plaque through a catheter with a rotating shaver blade.

Laser angioplasty (-plasty=surgical repair) is another procedure for plaque removal. A laser is used instead of a shaver. The procedure may be used by itself or with balloon angioplasty.

Click the More Information tab to learn about revascularization procedures. Transmyocardial revascularization (TMR) (trans-=through, myocardi/o=myocardium, re-=again, vascul/o=vessel) is a series of holes made in the heart tissue with a laser to increase blood flow by stimulating the growth of new blood vessels (angiogenesis angi/o=vessel, -genesis=formation). Pericardiocentesis (peri-=surrounding, -centesis=surgical puncture to remove fluid) is the aspiration of fluid from the pericardium to relieve cardiac tamponade, a condition in which fluid builds up in the pericardial space. A radio frequency catheter ablation is the destruction of abnormal cardiac electrical pathways that cause arrhythmias.

Angioplasty
Angioplasty (angi/o=vessel, -plasty=surgical repair) is a procedure used to widen vessels narrowed by stenoses or occlusions usually as the result of coronary artery disease.

balloon angioplasty: Angioplasty using a balloon catheter that is inflated inside an artery, stretching the intima and leaving a ragged interior surface after deflation, which triggers a healing response and breaking up of plaque. See also percutaneous transluminal angioplasty. percutaneous transluminal coronary angioplasty (PTCA):

Procedure for treating atherosclerotic heart disease and angina pectoris by flattening certain arterial plaques against the vessel wall to improve circulation. The procedure is performed under ultrasonic or radiographic visualization and involves threading a catheter through the blood vessel to the atherosclerotic plaque and inflating and deflating a balloon at the tip of the catheter several times before removing the catheter. valvuloplasty: Repair of a stenosed heart valve through the use of a balloon-tipped catheter Varicose Vein Surgical Treatment
Treatment of varicose veins focuses on rerouting blood flow from the damaged veins to functional veins. Ligation and stripping is an older treatment used to tie off (ligate) and remove (strip) varicose veins of the legs. Hemorrhoidectomy (-ectomy=removal) is the surgical excision of hemorrhoids. Sclerotherapy (scler/o=hard, -therapy=treatment) is used for both hemorrhoids and varicose veins of the legs. A substance is injected into the offending vein that causes it to form (hardened) scar tissue that effectively closes off the vein.

Case Study: Mr. Manuel Sanchez


The results of Mr. Sanchez's electrocardiogram show the presence of a blockage of the heart's electrical conduction system. This is slowing his heart rate and producing his feelings of fatigue and weakness. The cardiologist recommends the placement of an internal cardiac pacemaker. This will keep Mr. Sanchez's heart rate within a normal range. Mr. Sanchez is pleased to learn that his problems can be fixed and agrees to the surgery to implant the pacemaker.