Doppler Doppler UltrasoundUltrasound

Percutaneous Percutaneous Transluminal Transluminal

Coronary Coronary Angioplasty Angioplasty

(PTCA)(PTCA)

Cardiac Cardiac Enzyme Enzyme StudiesStudies

By Hana JakubickovaBy Hana Jakubickova

Doppler UltrasoundDoppler Ultrasound

A form of ultrasound that can detect A form of ultrasound that can detect and measure blood flow and measure blood flow

Depends on the Doppler effect, a Depends on the Doppler effect, a change in frequency of a wave change in frequency of a wave resulting here from the motion of a resulting here from the motion of a reflector, the red blood cell reflector, the red blood cell

Named after Austrian physicist Christian Doppler Named after Austrian physicist Christian Doppler who proposed Doppler effect in 1842who proposed Doppler effect in 1842

Doppler UltrasoundDoppler Ultrasound

Doppler Ultrasound Doppler Ultrasound DescriptionDescription

During Doppler ultrasound, a handheld During Doppler ultrasound, a handheld instrument (transducer) is passed instrument (transducer) is passed lightly over the skin above a blood lightly over the skin above a blood vessel. vessel.

The transducer sends and receives The transducer sends and receives sound waves that are amplified sound waves that are amplified through a microphone.through a microphone.

The sound waves bounce off solid The sound waves bounce off solid objects, including blood cells.objects, including blood cells.

Doppler Ultrasound Doppler Ultrasound Description (cont.)Description (cont.)

The movement of blood cells causes a The movement of blood cells causes a change in pitch of the reflected sound change in pitch of the reflected sound waves (Doppler effect). If there is no waves (Doppler effect). If there is no blood flow, the pitch does not change. blood flow, the pitch does not change.

Information from the reflected sound Information from the reflected sound waves can be processed by a waves can be processed by a computer to provide graphs or computer to provide graphs or pictures that represent the flow of pictures that represent the flow of blood through the blood vessels.blood through the blood vessels.

Doppler UltrasoundDoppler UltrasoundUseUse

Blood clots Blood clots

Poorly functioning Poorly functioning

valves in the leg veins,valves in the leg veins,

which can cause blood or other fluids which can cause blood or other fluids to pool in the legs (venous to pool in the legs (venous insufficiency)insufficiency)

Doppler UltrasoundDoppler UltrasoundUse (cont.)Use (cont.)

Heart valve defects and congenital Heart valve defects and congenital heart disease heart disease

A blocked artery (arterial occlusion)A blocked artery (arterial occlusion) Decreased blood circulation into the Decreased blood circulation into the

legs (peripheral artery disease)legs (peripheral artery disease) Bulging arteries (aneurysms)Bulging arteries (aneurysms) Narrowing (stenosis) of an arteryNarrowing (stenosis) of an artery

Doppler Ultrasound of an Doppler Ultrasound of an ArteryArtery

Doppler UltrasoundDoppler UltrasoundTypesTypes

Color DopplerColor Doppler - estimates the - estimates the average velocity of flow within a average velocity of flow within a vessel by color coding the vessel by color coding the information. The direction of blood information. The direction of blood flow is asigned by the color red or flow is asigned by the color red or blue, indicating flow toward or away blue, indicating flow toward or away from the ultrasound transducerfrom the ultrasound transducer

Doppler UltrasoundDoppler UltrasoundTypes (cont.)Types (cont.)

Duplex DopplerDuplex Doppler – uses standard – uses standard ultrasound methods, and also a ultrasound methods, and also a computer that converts the Doppler computer that converts the Doppler sounds into a graph. This graph gives sounds into a graph. This graph gives information about the speed and information about the speed and direction of blood flow through the direction of blood flow through the blood vessel being evaluated. blood vessel being evaluated.

Doppler UltrasoundDoppler UltrasoundTypes (cont.)Types (cont.)

Pulsed DopplerPulsed Doppler – this method allows a – this method allows a sampling volume or “gate” to be sampling volume or “gate” to be positioned in a vessel visualized on positioned in a vessel visualized on the gray-scale image, and displays a the gray-scale image, and displays a graph of the full range of blood graph of the full range of blood velocities within the gate versus time. velocities within the gate versus time. The amplitude of the signal is The amplitude of the signal is approximately proportional to the approximately proportional to the number of red blood cells and is number of red blood cells and is indicated as a shade of grayindicated as a shade of gray

Doppler UltrasoundDoppler UltrasoundTypes (cont.)Types (cont.)

Power DopplerPower Doppler – this device depicts – this device depicts the amplitude, or power, of Doppler the amplitude, or power, of Doppler signals rather than frequency shift. signals rather than frequency shift. This allows detection of a larger range This allows detection of a larger range of Doppler shifts and thus better of Doppler shifts and thus better visualization (up to five times) of small visualization (up to five times) of small vessels, but at the expense of vessels, but at the expense of directional and velocity informationdirectional and velocity information

Doppler UltrasoundDoppler UltrasoundTestTest

Non-invasiveNon-invasive Safe - no known risk, will not harm a Safe - no known risk, will not harm a

fetusfetus Little or no discomfort during the test Little or no discomfort during the test

(you may feel pressure of the inflated (you may feel pressure of the inflated blood pressure cuff, if used; and, the blood pressure cuff, if used; and, the gel may feel cold) gel may feel cold)

Percutaneous Transluminal Percutaneous Transluminal Coronary Angioplasty Coronary Angioplasty

(PTCA)(PTCA) Is performed to open blocked or Is performed to open blocked or

narrowed narrowed

coronary arteries caused by coronary coronary arteries caused by coronary artery disease (CAD) artery disease (CAD)

and to restore arterial and to restore arterial

blood flow to the heart blood flow to the heart

tissue without open tissue without open

heart surgeryheart surgery

PTCA PTCA ProcedureProcedure

A special catheter (long hollow tube) is A special catheter (long hollow tube) is inserted into the coronary artery to be inserted into the coronary artery to be treated.treated.

This catheter has a tiny balloon as its tip.This catheter has a tiny balloon as its tip.

The balloon is inflated once the catheter The balloon is inflated once the catheter has been placed into the narrowed area has been placed into the narrowed area of the coronary artery.of the coronary artery.

PTCA PTCA Procedure (cont.)Procedure (cont.)

The inflation of the The inflation of the

balloon compressesballoon compresses

the fatty tissue in the fatty tissue in

the artery and the artery and

makes a larger makes a larger

opening inside theopening inside the

artery for improved blood flow. artery for improved blood flow.

PTCA PTCA Procedure (cont.)Procedure (cont.)

The use of fluoroscopy (a special type The use of fluoroscopy (a special type of x-ray that obtains real- time of x-ray that obtains real- time

moving images) assists themoving images) assists the

physician in the location of physician in the location of

blockages in the coronaryblockages in the coronary

arteries as the contrast dye arteries as the contrast dye

moves through the arteries. moves through the arteries.

PTCA PTCA Procedure – Stent PlacementProcedure – Stent Placement

Is a procedure used in PTCAIs a procedure used in PTCA A tiny, expandable A tiny, expandable

metal coil (stent) is metal coil (stent) is

inserted into the newlyinserted into the newly

opened area of the opened area of the

artery to help keep theartery to help keep the

artery from narrowing or closing artery from narrowing or closing again.again.

PTCAPTCARisks of the ProcedureRisks of the Procedure

Bleeding at the catheter insertion Bleeding at the catheter insertion site (usually groin)site (usually groin)

Blood clots or damage to the blood Blood clots or damage to the blood vessels at the insertion sitevessels at the insertion site

Blood clot within the vessel treated Blood clot within the vessel treated by PTCA/stentby PTCA/stent

PTCAPTCARisks of the Procedure (cont.)Risks of the Procedure (cont.)

Infection at the catheter insertion Infection at the catheter insertion sitesite

Cardiac arrhythmia (abnormal heart Cardiac arrhythmia (abnormal heart rhythm) rhythm)

Myocardial infarctionMyocardial infarction Chest pain or discomfortChest pain or discomfort Rupture of the coronary arteryRupture of the coronary artery

Cardiac Enzyme StudiesCardiac Enzyme Studies

Blood tests that measure the level of Blood tests that measure the level of the enzyme creatine phosphokinase the enzyme creatine phosphokinase (CPK, CK) and the protein troponin (CPK, CK) and the protein troponin (TnI, TnT) in the blood(TnI, TnT) in the blood

Sometimes include the levels of Sometimes include the levels of lactate dehydrogenase (LDH) lactate dehydrogenase (LDH)

and glutamic oxaloacetic and glutamic oxaloacetic transaminase (GOT)transaminase (GOT)

Cardiac Enzyme Studies Cardiac Enzyme Studies (cont.)(cont.)

Low levels of these enzymes and Low levels of these enzymes and proteins are normally found in the proteins are normally found in the blood blood

If the heart muscle is injured (for If the heart muscle is injured (for example from heart attack), the example from heart attack), the enzymes and proteins leak out of enzymes and proteins leak out of damaged heart muscle cells, and damaged heart muscle cells, and their levels in the bloodstream risetheir levels in the bloodstream rise

Cardiac Enzyme Studies Cardiac Enzyme Studies Purpose of the TestPurpose of the Test

To determine whether a person is To determine whether a person is having a heart attack or is having a heart attack or is threatened by a heart attack threatened by a heart attack (unstable angina)(unstable angina)

To check for injury to the heart after To check for injury to the heart after bypass surgerybypass surgery

To determine if a procedure (such as To determine if a procedure (such as PTCA) has successfully restored PTCA) has successfully restored blood flow through a blocked arteryblood flow through a blocked artery

Cardiac Enzyme Studies Cardiac Enzyme Studies ResultsResults

Cardiac Enzyme Studies Cardiac Enzyme Studies Results – General GuideResults – General Guide

Troponin (TnI and TnT)Troponin (TnI and TnT)

Normal Normal - - TnI TnI less than 0.3 less than 0.3 micrograms/litermicrograms/liter

TnT TnT less than 0.1 less than 0.1 micrograms/litermicrograms/liter

AbnormalAbnormal - typically rise within 4 to 6 - typically rise within 4 to 6 hours after a heart attack, reach their hours after a heart attack, reach their highest levels within 10 to 24 hours highest levels within 10 to 24 hours

Falls to normal levels within 10 daysFalls to normal levels within 10 days

Cardiac Enzyme Studies Cardiac Enzyme Studies Results – General Guide (cont.)Results – General Guide (cont.) Total Creatine phosphokinase (CPK)Total Creatine phosphokinase (CPK)

NormalNormal - -

MenMen: 55 – 170 international units/liter: 55 – 170 international units/liter

WomenWomen : 30 – 135 international units/liter : 30 – 135 international units/liter

AbnormalAbnormal – rise within 4 to 8 hours after a – rise within 4 to 8 hours after a heart attack, reach their highest levels heart attack, reach their highest levels within 12 to 24 hourswithin 12 to 24 hours

Returns to normal within 3 to 4 daysReturns to normal within 3 to 4 days

SourcesSources

Wikipedia, the free encyclopedia (Last modified on June 19, Wikipedia, the free encyclopedia (Last modified on June 19, 2009).2009). Doppler Effect. Doppler Effect. Retrieved June 22, 2009, from Retrieved June 22, 2009, from http://en.wikipedia.org/wiki/Doppler_effecthttp://en.wikipedia.org/wiki/Doppler_effect

MedicineNet.com. MedicineNet.com. Definition of Doppler Ultrasound.Definition of Doppler Ultrasound. Retrieved Retrieved June 22, 2009, from June 22, 2009, from http://www.medterms.com/script/main/art.asp?articlekey=181http://www.medterms.com/script/main/art.asp?articlekey=1818080

Stanford Medicine. Stanford Medicine. Percutaneous Transluminal Coronary Percutaneous Transluminal Coronary

Angioplasty/Stent Placement. Angioplasty/Stent Placement. Retrieved June 22, 2009, fromRetrieved June 22, 2009, from http://stanfordhospital.org/healthLib/greystone/heartCenter/http://stanfordhospital.org/healthLib/greystone/heartCenter/heartProcedures/heartProcedures/percutaneousTransluminalCoronaryAngioplastyStentPlacemenpercutaneousTransluminalCoronaryAngioplastyStentPlacement.htmlt.html