Professional Documents
Culture Documents
*
(Imagings)*
Physical Exam in CV System
Cardiac Cycles 1. Hemodynamic
Pressure
2. Volumetric flow
3. Hemodynamic
resistance
4. Compliance
5. Laplace law
6. Poiseuilles Law
Cross Section
View
()
LA
RA LV
bb RV
RA
RV LV
1) Diagnostic clues
Barrel chest
(emphysema)
Pectus carinatum* Barrel Pectus Pectus Straight
(pigeon chest); Marfan Chest excavatus carinatum spine
Pectus excavatus*
Marfan 2) Impact on impedance*
Straight spine PE - vibration energy
MVP Low frequency, sonic
Ankylosing spondylitis Electric
Imaging *Left
Left parasternal bulge mastectomy
Ultrasound (ECHO)
Obese or thin chest wall*
Radiation ECG
Left mastectomy** X-ray, CT, MRI Expected findings?
Thorax () Anomaly
Impacts on Clinical Diagnosis, PE, and Imaging Tests
1) Diagnostic clues
Barrel chest
(emphysema)
Pectus carinatum* Barrel Pectus Pectus Straight
(pigeon chest); Marfan Chest excavatus carinatum spine
Pectus excavatus*
Marfan 2) Impact on impedance*
Straight spine PE - vibration energy
MVP Low frequency, sonic
Ankylosing spondylitis Electric
Imaging *Left
Left parasternal bulge mastectomy
Ultrasound (ECHO)
Obese or thin chest wall*
Radiation Tall R in V3-4
ECG
Left mastectomy** X-ray, CT, MRI Expected findings?
Thorax () Anomaly
Impacts on Clinical Diagnosis, PE, and Imaging Tests
1) Diagnostic clues
Barrel chest
(emphysema)
Pectus carinatum* Barrel Pectus Pectus Straight
(pigeon chest); Marfan Chest excavatus carinatum spine
Pectus excavatus*
Marfan 2) Impact on impedance*
Straight spine PE - vibration energy
MVP Low frequency, sonic
Ankylosing spondylitis Electric
Imaging *Left
Left parasternal bulge mastectomy
Ultrasound (ECHO)
Obese or thin chest wall*
Radiation Tall R in V3-4
ECG
Left mastectomy** X-ray, CT, MRI Expected findings?
Echo Windows (Air-free Window)
TTE - 4 Widows
3) Suprasternal
1) Parasternal
TEE
Esophsgus
LA
2) Apical Approach
(Landmarks)
Louis angle
Latitude ()
Intercostal
spaces
AA PA
Longitude ()
Parasternal
Mid-clavicular TA
Apex
Axillary line
anterior, mid- *LA
posterior
Mid-clavicular
Line
Pulmonic valve
Aortic Isthmus
LA
Aortic valve
annulus
Nerve Palsy
Ortner syndrome
Enlarged PA, LA
SVC
AO AO
SVC
AO
LAA
...
MPA SVC MPA
LAA
RA ... RA
LV
RV LV
.. RV
-
AO
PA
LAA
RAA
AO
RV LV
PA
MV
RA
TV LV
RV
Apex
-
(Long-axis) (Short-axis)
Long- Long-
axis axis
Short-
axis RV
Short-
LV axis
Apex
-
Right
PV
AV
AO
PA
RA MV TV
RV LV
PA
A
AV
MV
RA RA (right, anterior, caudal)
TV LV
LA (left, posterior, cephalid)
RV
Apex RV (right, anterior);
LV (left, posterior)
PV (left, anterior, cephalid);
AV (right, posterior, caudal)
Echo Windows (Air-free Window)
TTE - 4 Widows
3) Suprasternal
1) Parasternal
TEE
Esophsgus
LA
2) Apical Approach
Neighborhood Anatomic Relations
Left recurrent Esophagus
laryngeal nerve
Aortic Isthmus
LA
Aortic valve
annulus
Nerve Palsy
Ortner syndrome
Enlarged PA, LA
Case Example
Chest radiogram *PE
Cardiac PE Diffuse
ECG/Radiograph precordial
/Echo Correlates heave
RV rocking
motion
Palpable P2
ECG *PE
PA, Loud, P2
Apex
Echocardiography
D-shape
LV
Coronary Arteries
Right Coronary Artery Left Coronary Artery
Front
LAD
Cx
RCA
RCA Cx
LAD
Back LAD
RCA Cx
LAD
RCA
AV node
His bundle
Right bundle
Right bundle
LAO
Right BB
LAO
Blood supplies Complete AV block in AMI
SA node Inferior MI
55% RCA; AV junctional block;
45% LCX Transient and self limiting
AV node Anterior MI - Large infarct Left bundle (cascade like)
90% RCA; with tri-fascicular block (also
Supeior and Inferior divisions
10%, LCX affecting right bundle);
As a rule, poor prognosis Blood supply: LAD
Application of Vector Concept and Anatomy in ECG
z y A
( x, y, z ) Same vectors A
C
A
B
z
x A
B
y A
x D C
Scaler
Simplely, magnitude; no direction A+B+C=D
Normal ECG
I I
II III II III
q (+)
r R
r r
(+) r
(+)
V1 V3 V6
S S q S
Horizontal Plane
LV
o
RVH
RV Normal LVH
o
o
Horizontal Plane - RVH
s V6
o o
R R
R
V2 V6
s S
Posterior MI
() Normal ECG
V1-3R (
)
Horizontal Plane - Anteroseptal MI
R
S S
S
r
R (+)
(+) (+) r
V1 V3 V6
S S S