ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary...
-
Upload
duongtuyen -
Category
Documents
-
view
234 -
download
1
Transcript of ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary...
![Page 1: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/1.jpg)
ECG, Holter ECG and
Echocardiography
Division of CardiologyTaha Othmane
![Page 2: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/2.jpg)
EHO Taha 2013
Heart Beat Anatomy
Sinus Node
(SA Node)
• The Heart’s ‘Natural
Pacemaker’
- 60-100 BPM at rest
SINUS NODE
![Page 3: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/3.jpg)
EHO Taha 2013
Heart Beat Anatomy
AV NODESinus Node
(SA Node)
Atrioventricular
Node (AV Node)
• Receives impulse from
SA Node
• Delivers impulse to the His-
Purkinje System
• 40-60 BPM if SA Node fails to
deliver an impulse
![Page 4: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/4.jpg)
EHO Taha 2013
Heart Beat Anatomy
BUNDLE OF HISSinus Node
(SA Node)
Atrioventricular
Node (AV Node)
Bundle of His
• Begins conduction to
the Ventricles
• AV Junctional Tissue:
40-60 BPM
![Page 5: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/5.jpg)
EHO Taha 2013
Heart Beat Anatomy
Atrioventricular
Node (AV Node)
Sinus Node
(SA Node)
Bundle of His
Bundle Branches
Purkinje Fibers
• Bundle Branches
• Purkinje Fibers
• Moves the impulse through
the ventricles for contraction
• Provides ‘Escape Rhythm’:
20-40 BPM
THE PURKINJE NETWORK
![Page 6: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/6.jpg)
EHO Taha 2013
Impulse Formation In SA Node
![Page 7: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/7.jpg)
EHO Taha 2013
Atrial Depolarization
![Page 8: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/8.jpg)
EHO Taha 2013
Delay At AV Node
![Page 9: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/9.jpg)
EHO Taha 2013
Conduction Through Bundle Branches
![Page 10: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/10.jpg)
EHO Taha 2013
Conduction Through Purkinje Fibers
![Page 11: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/11.jpg)
EHO Taha 2013
Ventricular Depolarization
Action potential
Inflow of sodium
![Page 12: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/12.jpg)
EHO Taha 2013
Plateau Phase (phase 2) of Repolarization
Action potential
Outflow of calcium and
potassium
![Page 13: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/13.jpg)
EHO Taha 2013
Final Rapid (Phase 3) Repolarization
Action potential
Outflow of potassium
![Page 14: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/14.jpg)
EHO Taha 2013
Making ECG (Standard conditions)
• Positioning electrodes
• Reference pulse
• Speed of ECG-paper
![Page 15: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/15.jpg)
EHO Taha 2013
Standard conditions
Positioning electrodes
![Page 16: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/16.jpg)
Standard conditions
EHO Taha 2013
Reference pulse
![Page 17: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/17.jpg)
EHO Taha 2013
Standard conditions
Speed of ECG-paper
![Page 18: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/18.jpg)
EHO Taha 2013
Evaluating ECG
• Rhythm
• Frequency
• Heart axis
• Transit times
• Transition zone
• Repolarization
![Page 19: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/19.jpg)
EHO Taha 2013
Heart rate
300/4 = 75/min
1 2 3 4
300 Rule
![Page 20: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/20.jpg)
EHO Taha 2013
I
avF
Heart axis
I-avF Rule
![Page 21: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/21.jpg)
EHO Taha 2013
Heart Axis
Lead I Lead avF Heart axis
Positive Positive Normal axis
Positive Negative Left axis
Negative Positive Right axis
Negative Negative Indeterminate
I
avF
I-avF Rule
![Page 22: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/22.jpg)
EHO Taha 2013
Intervals and timing
Normal Ranges in Milliseconds:
• PR Interval 120 – 200 ms
• QRS Complex 60 – 100 ms
• QT Interval 360 – 440 ms
![Page 23: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/23.jpg)
EHO Taha 2013
Pathological changes
• P wave
• PR interval
• QRS complex
• ST segment
• T wave
• QT interval
![Page 24: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/24.jpg)
EHO Taha 2013
P-wave
Increased P-wave amplitude (> 2.5 mm)
Stenosis of pulmonal, tricuspidal valve
Pulmonary Hypertension
![Page 25: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/25.jpg)
EHO Taha 2013
P-wave
Widened P-wave (> 80 ms)
Lift atrial enlargement (mitral stenosis orregurgitation)
![Page 26: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/26.jpg)
EHO Taha 2013
P-wave
Biphasic P-wave
Mitral stenosis or regurgitation Aortic stenosis or regurgitation Hypertension
![Page 27: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/27.jpg)
EHO Taha 2013
P-wave
Absence of P-wave
Sino-atrial block
AV nodal rhythm
![Page 28: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/28.jpg)
EHO Taha 2013
PR interval
Prolonged PR-interval (>220 ms)
AV block Drugs (digoxin, beta blockers) Ischemia
![Page 29: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/29.jpg)
EHO Taha 2013
PR interval
Shortened PR interval (<120 ms)
WPW, LGL Ectopic atrial rhythm
![Page 30: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/30.jpg)
EHO Taha 2013
QRS
Narrow QRS complex
Sinus rhythm Supraventricular extranodal tachyarrhythmia
(flutter, fibrillation, SVES)
![Page 31: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/31.jpg)
EHO Taha 2013
QRS
Increased QRS amplitude
Ventricular hypertrophy Fever, anemia
![Page 32: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/32.jpg)
EHO Taha 2013
Decreased QRS amplitude
Pericardial fluid Extensive myocardial infarction Myocarditis, myocardial fibrosis
QRS
![Page 33: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/33.jpg)
EHO Taha 2013
QT interval
Prolonged QT-interval (QTc>440 ms)
Hypokalemia, hypocalcemia Alkalosis Cardiomyopathies Mitral valve prolapse Drug effects
![Page 34: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/34.jpg)
EHO Taha 2013
QT interval
Shortened QT-interval (QTc<300 ms)
Hyperkalemia, hypercalcemia, hypermagnesemia
acidosis Digoxin effect
![Page 35: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/35.jpg)
EHO Taha 2013
ST depression
• Ischemia, infarction
• Ventricular hypertrophy
• Mitral prolapse
• Myocarditis
• bundle branch block
• Digoxin effect
• Hypokalemia
ST segment
![Page 36: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/36.jpg)
EHO Taha 2013
ST segment
ST elevation
• Ischemia, infarction
• Ventricular aneurysm
• Prinzmetal angina
• Acute pericarditis
• LBBB
atypical
typical
![Page 37: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/37.jpg)
EHO Taha 2013
T wave
Negative T wave
Ischemia, infarction Pericarditis, myocarditis Ventricular hypertrophy DCM Digoxin effect
![Page 38: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/38.jpg)
EHO Taha 2013
T wave
High T wave: (>5 mm)
Ischemia, hyperacute myocardial infarction
Hyperkalemia Ventricular hypertrophy
![Page 39: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/39.jpg)
EHO Taha 2013
T wave
Flat or low T wave
Hypokalemia Pericardial fluid, myocarditis Ischemia, anterior acute myocardial
infarction
![Page 40: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/40.jpg)
EHO Taha 2013
ECG
• Organic and unavoidable complement of physical examination,
• Palpitations,
• Suspicion of myocardial ischemia,
• Suspicion of rhythm disorder (tachy- ,bradycardia),
• Efficacy of applied therapy
Indication
![Page 41: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/41.jpg)
EHO Taha 2013
Holter ECG
Recording the heart's electrical activity for24 to 48 hours
![Page 42: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/42.jpg)
EHO Taha 2013
Holter ECG
Beside everyday normal activities
![Page 43: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/43.jpg)
EHO Taha 2013
Holter ECG
Event-registration
palpitation
Presycopal symptoms
chest discomfort
![Page 44: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/44.jpg)
EHO Taha 2013
Holter ECG
ECG Analysis
– Automatic
– Manual
![Page 45: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/45.jpg)
EHO Taha 2013
Holter ECG
The temporal comparison of ECG abnormalities and symptoms.
• Temporal association between symptoms andobserved ECG abnormalities ?
• ECG abnormalities explain the symptoms?
![Page 46: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/46.jpg)
EHO Taha 2013
Holter ECG
• Palpitations,
• Syncope, presyncope, dizziness,
• Efficacy of applied therapy,
• Myocardial ischemia
• Heart rate variability
• Pacemaker function
Indication
![Page 47: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/47.jpg)
EHO Taha 2013
Echocardiography
• Using the conventional ultrasound techniques toform two-dimensional slices of the heart.
• routinely used in the diagnosis, management, and follow-up of patients with any suspected or known heart diseases
![Page 48: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/48.jpg)
EHO Taha 2013
Echocardiography
• Ultrasound: sound frequency is higherthan 20000 Hz,
• Hatching ultrasound: piezoelectricity,
• Ultrasound propagation: the frequency is constant, the wavelength decreases,
• Ultrasound reflection: some of reflectfrom the borderline of mediums withdifferent impedance
![Page 49: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/49.jpg)
EHO Taha 2013
Echocardiography
• Suitable system can reconstruct the image using the reflected acoustic energy
![Page 50: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/50.jpg)
EHO Taha 2013
Echocardiography
TTE (transthoracal):
• standard test
• transducer (or probe) is placed on the chest wall of the subject, and images are taken through the chest wall
![Page 51: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/51.jpg)
EHO Taha 2013
Echocardiography
TEE (transeosophegeal):
• If the standard test can’tprovide information or ifmore information is needed.
• An ultrasound transducer at its tip is passed into the patient's eosophagus
![Page 52: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/52.jpg)
EHO Taha 2013
Echocardiography (views)
![Page 53: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/53.jpg)
EHO Taha 2013
Echocardiography (Techniques)
• Two demensional (2D)
• M mode
• Color doppler
![Page 54: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/54.jpg)
Echocardiography (2D)
Two-dimensional representation of the structures
EHO Taha 2013
![Page 55: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/55.jpg)
EHO Taha 2013
Echocardiography (2D)
Morphological description and comparison of the structural elements
![Page 56: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/56.jpg)
EHO Taha 2013
Echocardiography (2D)
Detection of pathological processes (egpericardial fluid)
![Page 57: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/57.jpg)
EHO Taha 2013
Echocardiography (M mode)
Demonstrating the movement of different boundary of heart in the function of time
![Page 58: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/58.jpg)
EHO Taha 2013
Echocardiography (M mode)
To measure thewall-thicknessand dimensions of cavities
![Page 59: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/59.jpg)
EHO Taha 2013
Echocardiography (M mode)
To determine parameters (EF and FS)
![Page 60: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/60.jpg)
EHO Taha 2013
Echocardiography (doppler)
Continuous Wave:• continuously emitted and
detected sound waves
• detect the high-speed (aorticoutflow velocity)
![Page 61: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/61.jpg)
EHO Taha 2013
Echocardiography (doppler)
Pulsed Wave:
• Sequentiallyemitted and detected sound waves
• detect the low-speed(mitral inflowvelocity)
![Page 62: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/62.jpg)
EHO Taha 2013
Echocardiography (doppler)
The representation and measurement of hemodynamic conditions:
• Flow-velocity (aortic outflow, mitralinflow)
• Transvalvular pressure gradient
![Page 63: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/63.jpg)
EHO Taha 2013
Indications of Echocardiography
Valvular heart disease
(suspected or known)
• heart murmur
• Valve stenosis, insufficiency
![Page 64: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/64.jpg)
EHO Taha 2013
Indications of Echocardiography
Heart tumors, suspected thrombus
• Atrial myxoma
• Intracardiacthrombus(peripheral emboliccomplications)
![Page 65: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/65.jpg)
EHO Taha 2013
Indications of Echocardiography
Acute coronarysyndrome (ACS)
• Wall motiondisorder
• Complications (wallrupture, aneurysm)
![Page 66: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/66.jpg)
EHO Taha 2013
Indications of Echocardiography
Suspicion of
Heart failure orcardiomyopathy
![Page 67: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/67.jpg)
EHO Taha 2013
Indications of Echocardiography
Pericardial disease
• Pericadial effusion
• constrictivepericardial disease
![Page 68: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/68.jpg)
EHO Taha 2013
Three demensional ECHO
![Page 69: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/69.jpg)
EHO Taha 2013
Contraindications!
No contraindications in accomplishing
new or control ECG, Holter-ECG and
echocardiography
![Page 70: ECG, Holter ECG and Echocardiography€¦ · Stenosis of pulmonal, tricuspidal valve Pulmonary Hypertension. EHO Taha 2013 P-wave Widened P-wave (> 80 ms) Lift atrial enlargement](https://reader038.fdocuments.in/reader038/viewer/2022111906/5b8a71907f8b9a9b7c8c6d7d/html5/thumbnails/70.jpg)
EHO Taha 2013
THANK YOU