Sistim Kardiovaskuler.normal
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Sistim KardiovaskulerSistim Kardiovaskuler
Dr. Budiawan A. SpRad.Dr. Budiawan A. SpRad.
Penilaian jantung dari foto thoraks:Penilaian jantung dari foto thoraks:
1. situs ( kedudukkan jantung )1. situs ( kedudukkan jantung )
2. ukuran pembesaran jantung2. ukuran pembesaran jantung
3. pembuluh darah besar ( aorta dan 3. pembuluh darah besar ( aorta dan arteri arteri
pulmonalis)pulmonalis)
Ukuran jantungUkuran jantungCara yang mudah dengan Cara yang mudah dengan membandingkan lebar jantung membandingkan lebar jantung dengan lebar dada ( pada foto dengan lebar dada ( pada foto thoraks)thoraks)Dikenal dengan nama Cardiothoracis Dikenal dengan nama Cardiothoracis ratio (CTR)ratio (CTR)CTR: a + bCTR: a + b
c1 + c2c1 + c2Normal : 48 – 50 %Normal : 48 – 50 %
L
ab
c1 c2
Jantung terlihat kecil ( pada Jantung terlihat kecil ( pada emfisema paru / COPD)emfisema paru / COPD)
Posisi pengambilan foto memegang Posisi pengambilan foto memegang peranan.peranan.
Posisi AP / PA.Posisi AP / PA.
RADIOANATOMIRADIOANATOMI
Proyeksi posteroanterior (PA)Proyeksi posteroanterior (PA)
Proyeksi lateralProyeksi lateral
Proyeksi Oblik kanan depan ( Right Proyeksi Oblik kanan depan ( Right Anterior Oblique)Anterior Oblique)
Proyeksi oblik kiri depan ( Left Proyeksi oblik kiri depan ( Left Anterior Oblique)Anterior Oblique)
Posteroanterior (PA)Posteroanterior (PA)Batas jantung kanan:Batas jantung kanan:– Vena cava superiorVena cava superior– Atrium kananAtrium kanan– Sinus kardiofrenikus Sinus kardiofrenikus
kanankanan
Batas jantung kiri:Batas jantung kiri:– Arkus aortaArkus aorta– Pinggang jantung Pinggang jantung
(penonjolan A.Pulmonalis)(penonjolan A.Pulmonalis)– Aurikel atrium kiri ( sukar Aurikel atrium kiri ( sukar
dilihat biasanya tdk dilihat biasanya tdk menonjol)menonjol)
– Ventrikel kiri Ventrikel kiri ( membentuk apeks ( membentuk apeks jantung)jantung)
Proyeksi lateralProyeksi lateralBatas depan:Batas depan:– Lengkung aorta Lengkung aorta – Ventrikel kananVentrikel kanan
Batas belakangBatas belakang– Atrium kiriAtrium kiri– Ventrikel kiriVentrikel kiri– Biasanya berada Biasanya berada
didepan vertebrae didepan vertebrae thorakal ruang thorakal ruang dibelakang ventrikel kiri dibelakang ventrikel kiri disebut disebut retrocardiac retrocardiac space.space.
Proyeksi oblik kanan depanProyeksi oblik kanan depanRight Anterior Oblique ( RAO)Right Anterior Oblique ( RAO)
Batas depan:Batas depan:– Arkus aortaArkus aorta– Ventrikel kananVentrikel kanan– Diantara ventrikel dan Diantara ventrikel dan
aorta tampak a.Pulmonalis aorta tampak a.Pulmonalis yg bila membesar akan yg bila membesar akan tampak menonjol.tampak menonjol.
Batas belakangBatas belakang– Atrium kiri ( 1/3 tengah) Atrium kiri ( 1/3 tengah)
yang melekat pada yang melekat pada esofagusesofagus
Bila atrium kiri membesar Bila atrium kiri membesar akan mendorong esofagus akan mendorong esofagus kebelakang atau kebelakang atau kesamping kanan.kesamping kanan.
– Atrium kananAtrium kanan
Proyeksi Oblik kiri depanProyeksi Oblik kiri depanLeft Anterior ObliqueLeft Anterior Oblique
Batas depan:Batas depan:– Aorta asendens dan arkus Aorta asendens dan arkus
aortaaorta– Aurikel atrium kanan dan Aurikel atrium kanan dan
atrium kananatrium kanan– Ruang dibawah arkus Ruang dibawah arkus
aorta disebut aorta disebut Aortic Aortic windowwindow
Batas belakangBatas belakang– Atrium kiriAtrium kiri– Ventrikel kiriVentrikel kiri
Berguna untuk menilai Berguna untuk menilai ventrikel kiri dan atrium ventrikel kiri dan atrium kiri juga untuk menilai kiri juga untuk menilai aorta keseluruhan.aorta keseluruhan.
Cor analisaCor analisaPemeriksaan Pemeriksaan jantung dengan foto jantung dengan foto radiografi.radiografi.
Caranya dengan Caranya dengan bantuan barium bantuan barium meal.meal.
Barium yang ada di Barium yang ada di esofagus membantu esofagus membantu menilai pembesaran menilai pembesaran bagian jantung.bagian jantung.
ECHOCARDIOGRAPHYECHOCARDIOGRAPHYEchocardiography, which uses sound waves to Echocardiography, which uses sound waves to create moving pictures of the heart, is one of the create moving pictures of the heart, is one of the most widely used diagnostic tests for heart most widely used diagnostic tests for heart disease. Without exposing patients to radiation, disease. Without exposing patients to radiation, echocardiograms provide detailed images that echocardiograms provide detailed images that can provide a wealth of helpful information — can provide a wealth of helpful information — including the size and shape of the heart, its including the size and shape of the heart, its pumping strength, and the location and extent of pumping strength, and the location and extent of any damage to its tissues. The new 3D any damage to its tissues. The new 3D technology can help doctors make better technology can help doctors make better diagnostic decisions because they can view the diagnostic decisions because they can view the data from any angle and see views not obtainable data from any angle and see views not obtainable from conventional two dimensional echo.from conventional two dimensional echo.
Echocardiography including Echocardiography including DopplerDoppler
One – Dimensional or M-Mode One – Dimensional or M-Mode echocardiography (sudah ditinggalkan)echocardiography (sudah ditinggalkan)Two – Dimensional echocardiography Two – Dimensional echocardiography
( Standard )( Standard )Three – dimensional echocardiography Three – dimensional echocardiography
( reconstruction of 2D images)( reconstruction of 2D images)Doppler echocardiography ( display blood Doppler echocardiography ( display blood velocity information)velocity information)Contrast echocardiography ( dengan Contrast echocardiography ( dengan microbuble contrast)microbuble contrast)
MITRAL VALVEMITRAL VALVE
Contrast dan 3D EchocardiogramContrast dan 3D Echocardiogram
Computerized Tomography of Computerized Tomography of cardiovascular systemcardiovascular system
Dengan Multislice Dengan Multislice CT Scan dapat CT Scan dapat menilai sistim menilai sistim pembuluh coroner pembuluh coroner
Dengan Dengan rekonstruksirekonstruksi
Menggunakan Menggunakan contrast media IVcontrast media IV
CT Scan multisliceCT Scan multislicedual, 4, 6 16 dan dual, 4, 6 16 dan 64 slice.64 slice.Merekam gambar Merekam gambar dalam waktu yang dalam waktu yang lebih cepat.lebih cepat.Rekostruksi lebih Rekostruksi lebih baik.baik.Angio CT coroner ( 16 Angio CT coroner ( 16 dan 64 slice) saat ini dan 64 slice) saat ini sudah ada yang 128 sudah ada yang 128 slice bahkan 526 sliceslice bahkan 526 slice
MULTISLICE CTMULTISLICE CT
Rekonstruksi lebih baik.Rekonstruksi lebih baik.
Angio CT Coroner Angio CT Coroner
Magnetic Resonance Magnetic Resonance ImagingImaging
MRIMRIMenggunakan Menggunakan medan magnet.medan magnet.Kekuatan medan Kekuatan medan magnit ( Tesla : saat magnit ( Tesla : saat ini yang banyak ini yang banyak dipakai 1,5 dan 3)dipakai 1,5 dan 3)Terbaik untuk otak Terbaik untuk otak dan medula spinalis, dan medula spinalis, serta serta muskuloskeletal.muskuloskeletal.Multiplanar.Multiplanar.Perfusi sel.Perfusi sel.
Using MRI, physicians can obtain images of the Using MRI, physicians can obtain images of the heart and blood vessels from different angles and heart and blood vessels from different angles and create moving images of the heart throughout its create moving images of the heart throughout its beating cycle. This allows for better assessment beating cycle. This allows for better assessment of complex cardiovascular anatomy compared to of complex cardiovascular anatomy compared to other imaging techniques. Cardiac MRI provides other imaging techniques. Cardiac MRI provides accurate assessment of ventricular function, accurate assessment of ventricular function, cardiac masses, valvular function, congenital cardiac masses, valvular function, congenital heart disease, coronary artery disease, heart disease, coronary artery disease, characterization of aorta and other blood vessels characterization of aorta and other blood vessels and is becoming recognized as the "gold and is becoming recognized as the "gold standard" for myocardial viability.standard" for myocardial viability.Cardiac MRI can help in the diagnosis and Cardiac MRI can help in the diagnosis and treatment of patients with following conditions:treatment of patients with following conditions: Coronary artery disease , Congestive heart Coronary artery disease , Congestive heart failure and cardiomyopathy, Congenital heart failure and cardiomyopathy, Congenital heart disease , Pericardial disease Cardiac masses and disease , Pericardial disease Cardiac masses and thrombi Arrhythmia , Aortic disease, Peripheral thrombi Arrhythmia , Aortic disease, Peripheral vascular disease, Valve diseasevascular disease, Valve disease
MR Cardiac anatomy MR Cardiac anatomy
Magnetic Resonance ImagingMagnetic Resonance Imaging
Perfusion cardiac MR
Magnetic Resonance Magnetic Resonance ImagingImaging
MRI OPEN GANTRYMRI OPEN GANTRY
Interventional Interventional radiologyradiology
Invasive.Invasive.
Diagnotik dan Diagnotik dan therapi.therapi.
Menggunakan Menggunakan catheter dan catheter dan kontras media kontras media IVIV
Kesiapan SDM <Kesiapan SDM <
Arteri coroner Arteri coroner
The Left main coronary artery or Left Main Trunk (LMT)The Left main coronary artery or Left Main Trunk (LMT) originates from the left coronary cusp and bifurcates to give rise to originates from the left coronary cusp and bifurcates to give rise to the Left anterior descending (LAD) and Left Circumflex (LCx) the Left anterior descending (LAD) and Left Circumflex (LCx) coronary arteries. Occasionally, a third branch vessel, the Ramus coronary arteries. Occasionally, a third branch vessel, the Ramus Intermedius (RI) arises from the LMT. Intermedius (RI) arises from the LMT.
The Left anterior descending coronary artery (LAD)The Left anterior descending coronary artery (LAD) provides provides blood supply to the anterior wall of the left ventricle. As it courses blood supply to the anterior wall of the left ventricle. As it courses through the anterior intraventricular groove it provides multiple through the anterior intraventricular groove it provides multiple septal branches to the interventricular septum and diagonal septal branches to the interventricular septum and diagonal branches to the anterior lateral wall. branches to the anterior lateral wall.
The Left Circumflex coronary artery (LCx)The Left Circumflex coronary artery (LCx) courses around the courses around the lateral or left atrio-ventricular groove and gives rise to multiple lateral or left atrio-ventricular groove and gives rise to multiple marginal or lateral branches. The branches are termed obtuse marginal or lateral branches. The branches are termed obtuse marginal (OM) or lateral branches depending on institutional marginal (OM) or lateral branches depending on institutional preference. preference.
The Right Coronary artery (RCA)The Right Coronary artery (RCA) arises from the right coronary arises from the right coronary cusp. This vessel follows the right AV groove and provides branches cusp. This vessel follows the right AV groove and provides branches to the right ventricle. The most proximal branches of the RCA are to the right ventricle. The most proximal branches of the RCA are the conus-branch which supplies the Right ventricular outflow tract the conus-branch which supplies the Right ventricular outflow tract and a branch that supplies the sino-atrial (SA) node (60% of and a branch that supplies the sino-atrial (SA) node (60% of patients). patients).
MSCT : AngiografiMSCT : Angiografi
Nuclear medicineNuclear medicineImaging :Imaging :
1. Planar imaging1. Planar imaging
2. SPECT imaging 2. SPECT imaging
( single Positron Emition CT)( single Positron Emition CT)
3. Analysis of perfusion 3. Analysis of perfusion imagesimages
Menggunakan isotoop:Menggunakan isotoop:
- Thalium-201- Thalium-201
- Technetium-99m - Technetium-99m myocardial perfusion myocardial perfusion agents.agents.
STRESS NUCLEAR PERFUSION STRESS NUCLEAR PERFUSION IMAGINGIMAGING
Also called a nuclear stress test, this Also called a nuclear stress test, this procedure is an imaging test that measures procedure is an imaging test that measures the extent of blood flow to the heart (i.e., the extent of blood flow to the heart (i.e., myocardial perfusion). myocardial perfusion). Doctor use this in conjunction with a Doctor use this in conjunction with a patient’s stress test, and it can be conducted patient’s stress test, and it can be conducted on a tread-mill, a stationary bicycle or by on a tread-mill, a stationary bicycle or by means of infusion of intravenous drugs to means of infusion of intravenous drugs to accelerate the heart rate. After the patient accelerate the heart rate. After the patient receives a small dose of radioactive tracer receives a small dose of radioactive tracer (thallium or technetium), physicians use a (thallium or technetium), physicians use a gamma camera to visualize the distribution gamma camera to visualize the distribution of blood in the myocardium.of blood in the myocardium.
SPECT IMAGINGSPECT IMAGING
CARDIAC PET SCANCARDIAC PET SCANPositron Emission Positron Emission Tomography (PET) Tomography (PET) scans show the scans show the chemical functioning of chemical functioning of organs and tissues, organs and tissues, while other imaging while other imaging techniques — such as X-techniques — such as X-ray, MRI and CT scans ray, MRI and CT scans — show structure. That — show structure. That makes PET technology makes PET technology particularly useful for particularly useful for the detection of the detection of coronary artery disease.coronary artery disease.
The innovative, integrated The innovative, integrated equipment combines the best equipment combines the best of these two imaging of these two imaging technologies. PET permits technologies. PET permits assessment of myocardial assessment of myocardial perfusion and metabolism perfusion and metabolism with superior accuracy. The with superior accuracy. The results help physicians results help physicians identify the extent of heart identify the extent of heart disease and know when to disease and know when to suggest revascularization to suggest revascularization to the patient. CT helps to the patient. CT helps to further increase the accuracy further increase the accuracy of PET by allowing perfect of PET by allowing perfect alignment of the cardiac alignment of the cardiac silhouette and chest cage.silhouette and chest cage.