CARDIOVASCULAR FUNCTION ASSESSMENT

CARDIOVASCULAR FUNCTION ASSESSMENT

I. INTRODUCTION

Taking stock of your cardiovascular status means exploring the different elements of cardiac function .

These explorations of the heart and vessels range from the simplest to the most complex .

These additional examinations not only allow a cardiac assessment (anatomical and functional) to be carried out but also to make or refine a diagnosis.

II. SIMPLE BALANCE SHEET

It consists of a clinical examination during which the doctor takes the pulse, blood pressure and auscultates the heart .

This examination is usually followed by:

An electrocardiogram .

The latter allows you to assess the general appearance: normal frequency, tachycardia or bradycardia:

Sinus bradycardia: Regular, sinus rhythm of less than 60 beats/min.

Sinus tachycardia: Regular, sinus rhythm of more than 100 beats/min in adults.

CARDIOVASCULAR FUNCTION ASSESSMENT

-The P wave represents the contraction of the atria. It is rounded in shape, often positive and of low amplitude.

-The QRS complex corresponds to the contraction of the ventricles.

-The T wave is the heart’s resting period.

-The ST segment corresponds to the period of excitation of the ventricles until the resting phase. An elevation or depression of more than 1 mm relative to the isoelectric line is abnormal.

III. FURTHER EXAMINATIONS

They are generally part of the continuation of the examination by the cardiologist, but not necessarily at the same time:

echocardiography ,
doppler echo ,
stress test , and Holter , whether it is to monitor heart rate or blood pressure ABPM (Ambulatory Blood Pressure Monitoring)

echocardiography

Ventricles

Their diameters are measured in systole and diastole .

Its volume can be measured, also in systole and diastole: By calculating the ratio (diastolic volume – systolic volume)/diastolic volume, we obtain the ejection fraction , an important indicator of the contractile function of the heart muscle.

We estimate its shape.

Earpieces

The examination allows the volume of each atrium to be calculated and any hypertrophy to be detected.

Septum

Morphological abnormalities or thickening can thus be diagnosed. Septal defect with interatrial communication.

Valves

The four heart valves ( mitral , tricuspid, aortic and pulmonary) are well visualized : the mobility of the leaflets and their thickness are analyzed. Doppler allows the functional surface area (reduced in the event of valve narrowing) to be calculated as well as the presence and extent of a leak.

Heart walls

Thickness: The thickness of each part of the heart muscle can be measured in this way.

Kinetics: we can visualize whether a wall contracts less well than the others (“hypokinesia”) or does not contract at all (“akinesia”), indicating a myocardial infarction .

B. The stress test , or stress test , or stress electrocardiogram or ergometry , is an examination consisting of recording an ECG during the course of a calibrated physical exercise . It helps to diagnose a link to coronary artery disease ( coronary artery disease ). It can be associated with the measurement and analysis of ventilatory volumes and flow rates. It is then useful in the evaluation of certain respiratory or metabolic diseases and also makes it possible to assess the behavior of a subject, whether or not they are sporty , with regard to exercise , which can help to refine sports training or retraining.

IV. COMPLEX EXAMINATIONS

A. Stress echocardiography is a modality of echocardiography that consists of visualizing and analyzing changes in the contraction of the heart muscle during stress caused by exertion or injection of certain medications (Dobutamine ) .

This examination is mainly used to detect myocardial ischemia (lack of oxygenation of the heart muscle), indicating damage to a coronary artery . It also allows its viability to be estimated.

B. Scintigraphy , which allows the contractile function of the heart to be measured or to look for coronary artery disease during exercise.

C. Coronary angiography is a medical imaging technique used to visualize the coronary arteries in cases of suspected coronary artery disease . It is an invasive complementary medical examination that uses the X-ray radiography technique and the injection of an iodinated contrast product . Coronary angiography is the reference examination in cases of suspected coronary artery disease: angina , myocardial infarction or silent myocardial ischemia .

D. The coronary scanner, or coro-CT, is a computed tomography examination allowing the visualization of the coronary arteries , this examination requires the injection of an iodinated contrast product .

E. Cardiac MRI is a medical imaging procedure ( magnetic resonance imaging ) that provides an image of intrathoracic organs without limitations related to tissue composition. Unlike echocardiography, where penetration of the ultrasound beam into tissue is hampered by interposition of ventilated lung tissue, preventing satisfactory cardiac assessment in approximately 10% of patients, cardiac MRI provides diagnostic images in all patients, regardless of their morphology.

CARDIOVASCULAR FUNCTION ASSESSMENT

V. BIOLOGICAL EXAMINATIONS

Transaminases: ASAT – ALAT – TGO – TGP :

ASAT > ALAT elevation: muscular and cardiac causes:

Myocardial infarction.

Myocarditis.

Cardiac arrest (especially if cardiac massage).

Creatine phosphokinase: CPK : Increased CPK-MB in cardiac conditions (enzymes).
Troponin : is a heart-specific protein that is released during myocardial tissue necrosis.
LDH: lactate dehydrogenase A significant increase in the LDH level is a sign of cellular damage to the affected organ. (Enzymes).
Kidney function

Urea , Creatinine , Creatinine clearance