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Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology...

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Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine
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Page 1: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Cardiovascular Imaging Module II

Vincent Brinkman, MD and

Sharon Roble, MD

Division of Cardiology

The Ohio State University

College of Medicine

Page 2: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Cardiovascular Imaging Module II

Describe the use of echocardiography with Doppler recordings in the diagnosis of congenital and valvular heart disease

Note: All of the Cardiac Medical Illustrations were adapted from Patrick J. Lynch and C. Carl Jaffe, (Yale University, 2006) and used under their Creative Commons license.

Page 3: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

2D Imaging

Provides information on structure and anatomy.

Page 4: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

2D Imaging – Cardiac Function

Normal Abnormal

Page 5: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

3D Imaging

Page 6: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

2D Imaging – Bicuspid Aortic Valve

Bicuspid aortic valve Normal

Page 7: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Bicuspid Aortic Valve - MRI

Page 8: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

2D Imaging - Masses

Normal Atrial Myxoma

Left VentricleLeft Ventricle

Left AtriumLeft Atrium

Page 9: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

2D Imaging – Masses with MRI

Page 10: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Tissue Characterization – Myocardial Fibrosis

Kim et al., NEJM 2000; 343: 1445-1453

Myocardial Fibrosis

Page 11: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Doppler ECHO

3 m/s

6 m/s

3 m/sV

elo

cit

y

Time

3 m/s

Pulse Wave

Continuous Wave

6 m/s

Page 12: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Doppler ECHO

Pulse region

Pulse WaveContinuous Wave

Velocity in the LVOT

Page 13: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Color Doppler

Aortic Valve

Mitral Valve

Left Atrium

Left Ventricle

Red = Towards Blue = Away

Page 14: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Mitral Regurgitation

Normal Mitral Regurgitation

Page 15: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Atrial Septal Defect

Right Atrium

Left Atrium

Secundum ASD

Page 16: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

ASD – Saline Contrast Study

Right Atrium

Left Atrium

Page 17: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Tricuspid Regurgitation

Normal

Pulmonary Hypertension & Tricuspid Regurgitation

Right Ventricle

Right Atrium

Tricuspid Regurgitation

Page 18: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Pulmonary Hypertension

Pressure 1

Pressure 2

Bernoulli’s Principle

or

Pressure Difference ≈ 4v2

Page 19: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Bernoulli Equation

Peak Velocity = 4 m/sΔP = 4v2

ΔP = 64mmHg(Normal RVSP is < 32mmHg)

Page 20: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Ventricular Septal Defect

VSD

Left Ventricle

Right Ventricle

VSD

Page 21: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Ventricular Septal Defect – Bernoulli’s Principle

Peak Velocity = 4.3 m/sΔP = 4v2

ΔP = 74mmHg

Page 22: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Aortic Stenosis

Left Ventricle

Aortic Valve

Aorta

Page 23: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Aortic Stenosis – Bernoulli Equation

V = 4.4 m/sΔP = 4v2

ΔP = 77mmHg(Normal is < 10mmHg)

Page 24: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Aortic Stenosis – “Extra Credit”

How do we calculate the aortic valve area?

Continuity Equation

Area Out = (Velocity in) x

(Area in) / (Velocity out)

Continuity Equationor

Flow In = Flow Out

Simplified… AreaIN x VelocityIN = AreaOUT x VelocityOUT

(AreaIN x VelocityIN) / VelocityOUT = AreaOUT

Page 25: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Cardiac Imaging Summary

Cardiac imaging can be used to diagnose many conditions.

2D Echocardiography shows us anatomy, structure and function.

Cardiac MRI can also give us “tissue characterization.” Color Doppler imaging shows us flow and can diagnose

a variety of valvular and congenital abnormalities Doppler ECHO gives us velocities and helps us to

diagnose problems as well as calculate pressures and hemodynamics.

Page 26: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

Cardiovascular Imaging Part 2 Quiz

Page 27: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

The End…

Page 28: Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine.

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