Lateral

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Increased cardiothoracic ratio: Left atrial enlargement can cause an overall increase in the size of the heart, leading to an increased cardiothoracic ratio. This is measured by comparing the width of the heart to the width of the thoracic cage. A value above the normal range may suggest cardiac enlargement.

Straightening of the left heart border: The left atrium, when enlarged, can push against the left lung, causing a straightening of the left heart border on the CRX. This can be seen as a loss of the normal convexity of the left heart border.

Double density shadow: In some cases, a chest X-ray may reveal a double density shadow behind the heart, known as the "double density sign." This occurs when an enlarged left atrium partially obscures the pulmonary vessels behind it.

Left atrial appendage: The left atrial appendage, which is a small pouch-like structure connected to the left atrium, may become more prominent on a CRX in cases of left atrial enlargement. It can appear as a bulge or an increased density near the left atrium.

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200-250 cc

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increased vascular markings, vascular redistribution

Alveolar edema-bilateral hilar clouding. "butterfly" or "bats wing" appearance

thickening of the interstitium, most commonly observed as Kerley B lines, which are short horizontal lines seen in the periphery of the lung fields.

25 millimeters per second (mm/s)

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register the direction, amplitude and duration of the heart's electrical activity, as seen from 6 different positions in the frontal plane

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between -30° (aVL) and +90º (aVF).

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• SA node: 60–100 bpm

• AV node: 40–60 bpm

• Purkinje fibres: 20–40 bpm

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If the SA node fails, a backup pacemaker may arise in the AV node or proximal bundle of His (conducting at 40-60 bpm)

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there is a delay in the conduction of electrical signals through the AV node, resulting in a prolonged PR interval

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Type I (Wenckebach): there is a progressive lengthening of the PR interval until a beat is dropped (a P wave is not followed by a QRS complex). This type of block often occurs at the level of the AV node and is usually not associated with significant symptoms. It's commonly seen in young and healthy individuals.

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there is an intermittent blockage of electrical impulses between the atria and ventricles, resulting in occasional dropped beats without the progressive lengthening of the PR interval seen in type I. This type of block often occurs below the level of the AV node in the bundle branches or His-Purkinje system.

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also known as complete heart block or atrioventricular dissociation, is the most severe form of heart block. In this condition, there is a complete blockage of electrical signals between the atria and ventricles. As a result, the atria and ventricles beat independently of each other. The atria maintain their own rhythm, while the ventricles generate their own rhythm, typically slower than the atrial rate.

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Pulmonary hypertension: Increased pressure in the pulmonary circulation places an additional workload on the right ventricle as it pumps blood against higher resistance.

Chronic lung diseases: cause changes in the pulmonary circulation and increased pulmonary artery pressure

Pulmonary valve disorders: Pulmonary valve disorders, such as pulmonary valve stenosis or regurgitation, can impose increased pressure on the right ventricle, leading to RVH.

Pulmonary embolism: A pulmonary embolism occurs when a blood clot or other material blocks one or more arteries in the lungs. The resulting obstruction can increase pulmonary artery pressure, causing strain on the right ventricle and potentially leading to RVH.

a negative U wave in lead II

Left axis deviation: LVH can cause a shift in the electrical axis of the heart. On the ECG, this may be seen as a leftward shift of the QRS axis.

Wide QRS complex: prolonged QRS duration indicating delayed ventricular depolarization.

Impulses in the ectopic area are usually due to LV aneurysm and/or dyskinesis (paradoxical outward motion of the heart wall, e.g., due to anterior wall MI).

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Impulses at the left sternal border are usually caused by RV contraction in patients with pressure and/or volume overload of the RV

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Usually due to a dilated aorta or pulmonary artery respectively

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S1 = closing of mitral valve

When the left ventricle contracts (systole-QRS complex), the mitral valve closes before the aortic valve opens. This avoids backflow into the left atrium during ventricular contraction.

S2 = closing of the aortic valve

When the left ventricle relaxes (diastole-T wave), the aortic valve closes before the mitral valve opens because of the relatively high pressure in the aorta.

S3 = associated with rapid ventricular filling

S4 = associated with atrial contraction and the forceful ejection of blood into a non-compliant ventricle

Flat-primarily designed to listen to high-frequency sounds.

Bell-designed to listen to low-frequency sounds. These low-frequency sounds include certain heart murmurs (e.g., diastolic murmurs) and some vascular sounds.

Corrugated-versatile and can be adjusted to listen to both high-frequency and low-frequency sounds

Crackles are often heard in conditions that involve fluid accumulation or airway inflammation.

Examples: Pneumonia, CHF, pulmonary edema, interstitial lung disease, bronchiectasis.

Wheezes result from airway narrowing or constriction, causing turbulent airflow.

Examples: Asthma, bronchospasm, allergic reactions, chronic bronchitis, COPD.

Cardiac Troponins (Troponin I and Troponin T)

Myoglobin:

Creatine Kinase (CK) and CK-MB Isoenzyme

Lactate Dehydrogenase (LDH):

Ordered for patients with symptoms such as chest pain, shortness of breath, palpitations, or edema, as well as individuals with known or suspected heart diseases.

TTE is usually performed by a trained cardiac sonographer or echocardiography technologist.

TEE is performed by sonographer.

An ambulatory ECG reading

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An event recorder with a memory loop is a cardiac monitoring device used to record episodes of a patient’s heart arrhythmias. Patients who experience infrequent and unpredictable episodes of cardiac symptoms are the best candidates for these external or implantable devices that allow a recording of the episode and the time preceding the symptoms.

After using the event recorder the physician will gather the results and analyze the heart rhythm data. Some devices can have the data sent electronically or should be mailed.

Right Heart Catheterization: involves the insertion of a catheter into the right atrium, right ventricle, and the pulmonary artery. It is primarily performed to assess the hemodynamics and pressures within the right side of the heart and pulmonary circulation.

Left Heart Catheterization with LV and Hemodynamics: involves the insertion of a catheter into the left atrium and left ventricle. It is performed to assess the hemodynamics and pressures within the left side of the heart and the coronary arteries (coronary angiography)

A nuclear stress test not only uses EKG's but also includes inducing the patient with a small amount of radioactive substance called a radiotracer such as thallium or sestamibi and trace it through a special gamma camera to see how efficiently the heart is pumping blood and blood circulation.

This test is more advanced and provides more information and it would be provided for someone who has had an underlying heart condition, currently using heart medication, and to evaluate if the treatments are working or if the patient requires further advanced treatment such as surgery.

Computed tomography angiography (CTA) is a diagnostic imaging technique that combines the use of a computed tomography (CT) scanner with the injection of a contrast agent to visualize blood vessels throughout the body. CTA provides detailed three-dimensional images of the blood vessels, allowing for the evaluation of their structure, integrity, and any potential abnormalities. Here are some key points about CTA:

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MRI is particularly well-suited for visualizing soft tissues, such as organs, muscles, tendons, ligaments, and the brain. It provides excellent contrast resolution, allowing for detailed evaluation of these structures. CT, on the other hand, is better suited for visualizing bones, calcifications, and dense structures.

Lack of ionizing radiation: MRI does not use ionizing radiation like CT scans do. This makes it a preferred choice, especially in situations where repeated or frequent imaging is necessary, such as for monitoring chronic conditions or assessing pediatric patients. It is also preferred for certain populations, such as pregnant women.

Better differentiation of tissues: MRI can differentiate between

A PET scan is performed by first administering FDG (18-Fluorodeoxyglucose - metabolic agent/glucose analogue taken up by myocardial cells) and either 13-N ammonia or Rubidium-82 (blood flow tracers), intravenously. The patient is then placed in the PET scanner, where they will remain there for about 30-45 minutes on average

The PET scan is considered to be the "gold standard" in pursuit of knowledge to myocardial viability.

Useful in assessing myocardial viability (myocardial cells after myocardial injury), the test can reveal function of tissues and organs. PET scans can reveal areas in the heart with decreased blood flow! This is useful in evaluating the next step a patient and the provider will take - CABG or angioplasty

A unique ECG technique in which multiple electric signals from the heart are averaged to remove interference and reveal small variations in the QRS complex

Unlike a standard ECG recording, which requires only a few seconds, SAECG recording requires a few minutes (usually about 7-10 minutes), as the machine must record multiple subsequent QRS potentials to remove interference due to skeletal muscle and to obtain a statistically significant average trace.

Requires special software

is an electrocardiographic phenomenon that involves variations in the morphology or amplitude of the T waves on consecutive heartbeats. It is considered a marker of increased vulnerability to ventricular arrhythmias, particularly ventricular tachycardia and ventricular fibrillation.

T-wave alternans can be observed on a standard electrocardiogram (ECG) or during specialized tests such as exercise stress testing or ambulatory monitoring.

1. Indications: Ejection fraction.

2. Monitoring effects of chemotherapeutic agents

Uses a tracer dose of radioactivity (technetium 99m or TC-99m) which essentially “labels” the red blood cells that are flowing through the heart.

see chart

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