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1、The ABCs of The ABCs of Heart DiseaseHeart DiseaseWilliam Herring, M.D. 2003In Slide Show mode, to advance slides, press spacebar or click left mouse buttonWilliam Herring, M.D.Albert Einstein Medical CenterPhiladelphia, PAWilliam Herring, M.D.Albert Einstein Medical CenterPhiladelphia, PA 2000With
2、AcknowledgementFor Its Creation toBernard J. Ostrum, M.D.With AcknowledgementFor Its Creation toBernard J. Ostrum, M.D. 2000What It Is?An approach ?For congenital or acquired heart disease in adults ?Asking systematic set of questions?Answers based on certain fundamental observations?Visible on fron
3、tal chest x-ray aloneCardioCardio- -thoracic thoracic RatioRatio50%Here is a heart that is larger than 50% of the cardiothoracic ratio, but it is still a normal heart. This is because there is an extracardiac cause for the apparent cardiomegaly. On the lateral film, the arrows point to the inward di
4、splacement of the lower sternum in a pectus excavatum deformity.Sometimes, CTR is less than 50% But Heart is Abnormal?Obstruction to outflow of the ventricles?Ventricular hypertrophy?Must look at cardiac contours50%Then Right Ventricle is EnlargedWhich Ventricle is Enlarged?If Heart Is Enlarged, And
5、 Aorta is BigThen Left Ventricle is Enlarged50%Which ventricle is enlarged?The best way to determine which ventricle is enlarged is to look at the corresponding outflow tract for each ventricle?Aorta for the LV?MPA for the RVWhich Ventricle is Enlarged?Once one ventricle is enlarged, its impossible
6、to tell if other ventricle is also enlargedAscending AortaAscending Aorta“Double density” of LA enlargement“Double density” of LA enlargementRight atriumRight atriumLeft ventricleLeft ventricleIndentation for LAIndentation for LAMain pulmonary arteryMain pulmonary arteryAortic knobAortic knobThe Car
7、diac ContoursThe Cardiac ContoursAscending AortaAscending Aorta“Double density” of LA enlargement“Double density” of LA enlargementRight atriumRight atriumLeft ventricleLeft ventricleIndentation for LAIndentation for LAMain pulmonary arteryMain pulmonary arteryAortic knobAortic knobThe Cardiac Conto
8、ursThe Cardiac ContoursThe PulmonaryThe Pulmonary VasculatureVasculatureFive States of the Pulmonary Vasculature?Normal?Pulmonary venous hypertension?Pulmonary arterial hypertension?Increased flow?Decreased flowWhat Were Going to Evaluate?Right Descending Pulmonary Artery?Distribution of flow in the
9、 lungs?Upper versus lower lobes?Central versus peripheralWhat to EvaluateWhat to Evaluate1 13 32 22 2Right Descending Pulmonary ArteryRight Descending Pulmonary ArteryServes right middle and lower lobesServes right middle and lower lobes1. Right Descending Pulmonary Artery1. Right Descending Pulmona
10、ry Artery1. Right Descending Pulmonary Artery1. Right Descending Pulmonary ArteryDiameter can be measured (before bifurcation)Diameter can be measured (before bifurcation)RDPA than flow to apicesIn erect position, blood flow to bases than flow to apicesSize of vessels at bases is normally than size
11、of vessels at apexYou cant measure size of vessels at the left base because the heart obscures themNormal tapering of vessels from central to peripheralNormal tapering of vessels from central to peripheralCentral vessels give rise to progressively smaller peripheral branchesCentral vessels give rise
12、 to progressively smaller peripheral branches3. Normal Distribution of Flow Central versus peripheral3. Normal Distribution of Flow Central versus peripheral1 13 32 22 2Normal Vasculature - reviewNormal Vasculature - reviewRDPA 17 mmUpper lobe vessels equal to or larger than size of lower lobe vesse
13、ls = CephalizationUpper lobe vessels equal to or larger than size of lower lobe vessels = CephalizationVenous HypertensionVenous HypertensionPulmonary Arterial HypertensionPulmonary Arterial HypertensionRDPA usually 17 mmRDPA usually 17 mmMain Pulmonary Artery projects beyond tangent lineMain Pulmon
14、ary Artery projects beyond tangent line23Rapid cutoff in size of peripheral vessels relative to size of central vesselsRapid cutoff in size of peripheral vessels relative to size of central vesselsCentral vessels appear too large for size of peripheral vessels which come from them = PruningPulmonary
15、 Arterial HypertensionPulmonary Arterial Hypertension31Increased FlowIncreased FlowRDPA usually 17 mmRDPA usually 17 mmAll of blood vessels everywhere in lung are bigger than normalIncreased FlowIncreased FlowDistribution of flow is maintained as in normalGradual tapering from central to peripheralL
16、ower lobe vessels bigger than upper lobeNormalNormalIncreased FlowIncreased FlowIncreased FlowIncreased FlowPAHPAHUnrecognizable most of the timeDecreased FlowDecreased FlowSmall hilaFewer than normal blood vesselsThe Pulmonary Vasculature?Normal?Pulmonary venous hypertension?Pulmonary arterial hypertension?Increased flow?Decreased flow
