Roentgen of the heart and blood vessels
Last reviewed: 23.04.2024
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In the last 15-20 years, a technological revolution occurred in diagnostic radiology, connected mainly with the development of fundamentally new ways of studying the heart. In the 1970s, ultrasonic devices were created that operated in real time. With their help, they could look inside the heart cavities, study the movement of valves and various parts of the heart muscle. Dynamic scintigraphy opened the way to assessing myocardial blood flow and measuring the contractility of individual segments of the ventricles of the heart. In the 1980s, computer methods of imaging were introduced into the practice of cardiology: digital coronary and ventriculography, computed tomography synchronized with heart function, magnetic resonance imaging. Moreover, radiologists have received special catheters for vascular plastic and laser devices for evaporation of atherosclerotic plaques. Thus they connected the methods of diagnosis with therapeutic manipulations. So came to radiation cardiology maturity and full recognition.
Radiation anatomy of the heart
Radiation examination of the morphology of the heart and the main vessels can be performed using non-invasive and invasive techniques. Non-invasive methods include: radiography and fluoroscopy; ultrasonic research; CT scan; Magnetic resonance imaging; scintigraphy and emission tomography (one- and two-photon). Invasive procedures are: artificial contrasting of the heart by the venous route - angiocardiography; Artificial contrasting of the left cavities of the heart by the arterial route - ventriculography, coronary arteries - coronary angiography and aorta - aortography.
Normal X-ray anatomy of the heart
Radiation examination of heart function
In a healthy person, about 1 time per second, a wave of excitation spreads through the myocardium - there is a contraction and then a relaxation of the heart. The simplest and most accessible method for their registration is fluoroscopy. It allows you to visually assess the contraction and relaxation of the heart, pulsation of the aorta and pulmonary artery. In this case, changing the position of the patient behind the screen, you can bring to the circuit, i.e. Make the marginal, all parts of the heart and blood vessels. However, in recent years, due to the development of ultrasound diagnostics and its wide introduction into clinical practice, the role of fluoroscopy in the study of the functional activity of the heart has decreased significantly because of the high enough radiation load.
X-ray examination of heart function
Radiation Symptoms of Heart Disease
As can be seen from the above, the cardiologist, thanks to the radiation methods, receives extensive information about the morphology and function of the heart and the main vessels, objective data on the slightest deviations from the norm. Based on the numerous identified symptoms, the final clinical diagnosis of the disease is constructed. It is advisable to consider the signs of the pathology of the heart, which is most often observed by a general practitioner. These are mainly x-ray symptoms of changes in the position, shape, size and contractile function of the heart.
X-ray symptoms of heart failure
Radiation picture of heart lesions
Cardiac ischemia. Myocardial infarction
Coronary heart disease is caused by a violation of coronary blood flow and a gradual decrease in myocardial contractility in ischemic zones. Violations of the contractile function of the myocardium can be detected using various methods of ultrasound diagnosis. The easiest and most accessible of them is echocardiography. In this case, the unevenness of contractions of different sections of the left ventricular wall is determined. In the ischemic zone, a decrease in the amplitude of the motion of the ventricular wall during systole is usually observed. The thickness of the interventricular septum and the systolic thickening of the myocardium are reduced. The left ventricular ejection fraction is reduced with increasing left ventricular contractions (further, the right ventricular ejection fraction decreases). Local violations of contractility are observed at a time when there are still no significant signs of circulatory insufficiency.
Mitral defects
Radiation diagnosis of mitral heart defects is based mainly on ultrasound and radiographic data. If the mitral valve is not sufficient, it does not fully close its valves during systole, which leads to the dropping of blood from the left ventricle into the left atrium. The latter is filled with blood, the pressure in it rises. This is reflected in the pulmonary veins that flow into the left atrium, developing venous plethora of the lungs. The pressure increase in the small circle is transmitted to the right ventricle. Its overload leads to myocardial hypertrophy. The left ventricle also expands, because at each diastole it takes an increased volume of blood.
Aortic defects
If the aortic valve is insufficient, its valves do not provide a seal to the left ventricle: in diastole, part of the blood from the aorta returns to its cavity. There is a diastolic overload of the left ventricle. In the early stages of defect formation, compensation is achieved by increasing the stroke volume. Increased ejection of blood leads to augmentation of the aorta, mainly in its ascending part. Myocardial hypertrophy of the left ventricle develops.
Congenital malformations
The manuals on internal diseases and surgery contain a description of numerous anomalies in the development of the heart and large vessels (congenital malformations). Radiation methods play an important and sometimes decisive role in their recognition. Even with the usual X-ray examination, the position, size and shape of the heart, aorta, pulmonary artery, upper vena cava and the nature of their pulsations are established.
Pericarditis
Dry pericarditis initially does not give symptoms when examining the methods of radiation diagnosis. However, as the thickening and compaction of the pericardial sheets, its image appears on sonograms and computer tomograms. Significant pericardial fusion leads to deformation of the shadow of the heart on the radiographs. Lime deposits in the pericardial shvarts are especially vivid. Sometimes the heart on the roentgenograms as if enclosed in a calcareous shell ("the heart of the heart").
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