BASIC TOOLS IN ROUTINE

U EVALUATION
V U OF
CARDIAC PATIENTS

MUHAMMAD ALI
 BASIC TOOLS.

1.
1 History Taking
2. Physical Examination
3. ECG
4. Chest R
5. Echocardiography
6 Catheterization
6.
ECG: Routine Interpretation
The following sequence is one of many approaches that
can be used in routine interpretation
p of an ECG.

z Rhythm (sinus or nonsinus) by considering the P axis

z Heart rate (atrial and ventricular rates
rates, if different)
z The QRS axis, the T axis, and the QRSQRS--T angle
z Intervals: PR, QRS, and QT
z Th P wave amplitude
The li d and ddduration
i
z The QRS amplitude and R/S ratio; also abnormal Q
waves
z ST--segment and T
ST T--wave abnormalities
CONDUCTION SYSTEM OF
THE HEART
ATRIAL DEPOLARIZATION
AV NODE DEPOLARIZATION
HIS--PURKINJE OR VENTRICULAR
HIS
DEPOLARIZATION
 VENTRICULAR
REPOLARIZATION
Chest Roentgenography
Echocardiography
Figure 6-6-2 Diagram of important two-two-
dimensional echo views obtained
from the parasternal transducer
position. Parasternal long-
long-axis view
(A) is shown. Parasternal shortshort--axis
views can be obtained at various
levels: semilunar valve and great
artery level (B, C), mitral valve level
(D), and papillary muscle level (E).
AO, aorta; LA, left atrium; LCA, left
coronary artery; LPA, left f pulmonary
artery; LV, left ventricle; MPA, main
pulmonary artery; MV, mitral valve;
PA, pulmonary artery; PM, papillary
muscle;l PV,
PV pulmonary
l valve;
l RA,
RA
right atrium; RCA, right coronary
artery; RPA, right pulmonary artery;
RV, right ventricle; RVOT, right
ventricular
t i l outflow
tfl tract
tract.
t t.
Figure 6-
6-3 Diagram of two-two-dimensional echo views obtained with the transducer at
the apical position. Both the apex-
apex-down and apex-
apex-up images are shown. A, Apical
four--chamber view
four view.. B, Apical four-
four-chamber view with left ventricular outflow tract
(apical five-
five
five-chamber
five- chamber view).
view). C,
C Apical long-
long-axis view.
view AO,
AO aorta; LA,
LA left atrium;
LV, left ventricle; RA, right atrium; RV, right ventricle.
ventricle.
 Figure 6
6--4 Diagram of two-
two-dimensional echo views obtained with the transducer at the
subcostal position. Both the apex
apex--down and apex
apex--up images are shown.
shown. A, Subcostal four
four--
chamber view.
view. B, View showing the left ventricular outflow tract and the proximal aorta
(subcostal five
five--chamber view).
view). C, View that shows the right ventricular outflow tract (RVOT)
and the proximal main pulmonary artery (PA).(PA). D, Subcostal short
short--axis view. AO, aorta; LA, left
atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.
ventricle.
Flow Diagrams
Cardiac Catheterization and
Angiocardiography
Thank You
Y