1. By Dr/ Dina Metwaly

2.  Consists of two atria and two ventricles, with a partition (the septum) separating the right and left sides of the heart A. Atrio-ventricular valves:  Between each atrium and its associated ventricle, permits blood flow in only one direction  Consist of flaps (cusps) of endocardium that are anchored to the papillary muscles of the ventricles by cordlike structures called chordae tendoneae

3. 1. Mitral Valve : Between the left atrium and left ventricle has two cusps 2. Tricuspid Valve : Between the right atrium and the right ventricle has three cusps B. Semi-lunar valves: Separates the ventricles from the great vessels leaving the heart 1. Pulmonary valve: Lies between the right ventricle and the pulmonary artery 2. Aortic valve: Separates the aorta from the left ventricle

4.  Myocardium: Striated muscle which composes the walls of the heart  Endocardium: A smooth delicate membrane that lines the heart  Pericardium: A double membranous sac surrounding the heart  Sinoatrial (SA) node: Normal cardiac impulse that stimulates mechanical contraction of the heart arises, which is located in the right atrial wall near the opening of the superior vena cava ; pacemaker of the heart  Atrioventricular (AV) node: Impulse slowly passes through, located in the right atrium along the lower portion of the interatrial septum

5. 1. Aneurysm (example: Abdominal Aortic Aneurysm (AAA) ) 2. Coronary artery disease 3. Congestive Heart Failure 4. Congenital heart diseases 5. Pulmonary embolism

6.  An aneurysm is a weakening of an arterial wall that results in a bulge or balloon-like appearance.  A rupture of this bulge is potentially fatal.  They are most commonly associated with cerebral arteries and the abdominal aorta.  Aortic Abdominal Aneurysm (AAA):  Aortic abdominal aneurysms often form with minimal symptoms and are easily diagnosed with an ultrasound.  The risk of rupture begins at 5 cm and they can swell to over 15 cm in diameter.

7. The arrows are pointing to a very large, calcified AAA. Although they are usually diagnosed with ultrasound, this particular case was discovered on a routine KUB.

8.  Definition: Narrowing of the coronary arteries causes oxygen deprivation of the myocardium and ischemic heart disease  Angina Pectoris: Temporary oxygen insufficiency cause a feeling of severe chest pain that may radiate to the neck, jaw, and left arm (sometimes both arms) and that is often associated with the sensation of chest tightness  CAD: Occlusion of a coronary artery deprives an area of myocardium of its blood supply and leads to the death of muscle cells (myocardial infarction) in the area of vascular distribution

9.  Coronary Angiography is the definitive test i. 30% of significant stenosis involve a single vessel, most commonly the anterior descending artery ii. 30% involve 2 vessels, and significant stenosis of the three main vessels can be demonstrated in the remaining 40% iii. 50% occurs in the left coronary artery, 35% in the right coronary artery, and 15% in the left circumflex artery

11. Before and after treatment of CAD

12.  Definition: Refers to the inability of the heart to propel blood at a rate and volume sufficient to provide an adequate supply to the tissues  Causes: e.g. hypertension, and any obstructive process that abnormally increases the peripheral resistance to blood flow  A chest X-ray may demonstrate cardiomegaly, pulmonary edema, or a pleural effusion.

13.  There are multiple conditions that can cause CHF. A. Conditions affecting the left side of the heart include: 1. Hypertension 2. Aortic Coarctation (narrowing of the aorta) 3. Aortic and Mitral Valve Disease B. Conditions affecting the right side of the heart include: 1. Pulmonary Hypertension 2. Pulmonary or Tricuspid Valve Disease C. Both side of the heart are affected by: 1. Ischemic Heart Disease 2. Acute Myocardial Infarction (heart attack) 3. Cardiomyopathy 4. Chronic Arrhythmia

14. Congestive Heart Failure (CHF): This patient is suffering from congestive heart failure. The congested radiographic appearance of this image is the result of pulmonary edema. L

15.  Blood pressure: A function of cardiac output (the amount of blood pumped per minute by the heart) and the total peripheral resistance, which reflects the condition of the walls of the blood vessels throughout the body  Systolic pressure: The highest pressure in the peripheral arteries that occurs when the left ventricle contracts  Diastolic pressure: The pressure in the peripheral arteries when the left ventricle is relaxing and filling with blood from the left atrium

16.  High blood pressure: Defined as elevation of the systolic pressure above 140 mmHg and of the diastolic pressure above 90 mmHg  Arteriography is the most accurate screening examination a. Bilateral renal artery stenosis are noted in up to one third of patients b. the left ventricular hypertrophy (double thickness of normal wall)

17.  MOST COMMON CONGENITAL ANOMALIES 1. Ventricular septal defect (VSD) 30% 2. Atrial septal defect (ASD) 10% 3. Tetralogyof Fallot 10% 4. Patent ductus arteriosus (PDA) 10% 5. Coarctation of aorta 7% 6. Transposition of great arteries (TGA)

18.  Tetralogy of Fallot is a very rare congenital heart defect that presents at birth.  As the name indicates, it consists of the following 4 defects: 1. Pulmonary Stenosis 2. Right Ventricular Hypertrophy: it enlarges due to the pulmonary stenosis. 3. Ventricular Septal Defect:This is a hole that is located between the ventricles. 4. An Overriding Aorta: A defective aorta causes deoxygenated blood to flow directly into the aorta and bypass the lungs.

19.  The combination of these four heart defects causes the heart to have a very distinctive “boot-shaped” radiographic appearance.

20.  Situs inversus is a very rare congenital condition where all of the organs in the body are transposed to the opposite side.  Dextrocardia is also a congenital defect where the heart is transposed to the opposite side of the body within the thorax.  Dextrocardia can occur independently of situs inversus and is somewhat more common.

21. This patient has situs inversus and her PA chest radiograph is a good example of the radiographic appearance of dextrocardia.

22.  Pulmonary emboli are often caused by blood clots that break off from veins in the legs(DVT).  These clots form emboli that can obstruct the lumen of the pulmonary arteries.  A PE is most often seen in elderly, bedridden patients, and in postoperative patients.  A chest X-ray may demonstrate an area of consolidation that is commonly referred to as “Hampton’s Hump.”

23.  Diagnostic tests for this condition are as follows: 1. Arterial Blood Gas 2. Routine Chest X-ray 3. Ventilation/Perfusion Scan in Nuclear Medicine 4. Pulmonary Arteriogram 5. CT Angiogram of the Chest 6. Doppler Ultrasound to Detect DVT

24. Thispulmonary arteriogramdemonstrates how a pulmonary embolus(arrows) can obstruct the flow of contrast material (and blood) from the pulmonary arteries. This is a normal pulmonary arteriogramthat demonstrates how the iodinated contrast material should evenly disperse throughout the pulmonary arteries.