Very good presentation on cardiac failure.CF.pptx

Very good presentation on cardiac failure. Experiences and cases shared.

1. CARDIAC FAILURE: RADIOLOGICAL FEATURES Dr BISHIKWABO Frank,Radiology Resident Supervised by Dr OKELLO Ambroise, Senoir Radiologist

2. OUT LINE 1. Introduction 2. Cardiac Failure Overview 3. Imaging modalities used in Cardiac Failure. 4 .Summary 5 .References

3. INTRODUCTION Definition: CF is a condition where the heart can't supply enough blood to meet your body's needs.

4. Epidemiology Heart failure remains a health challenge in Africa, associated with significant rates of hospitalization, morbidity and mortality . The prevalence of heart failure (HF) in East Africa is high but difficult to quantify due to a lack of population-based studies. However , studies indicate that hospital admissions due to HF can range from 9.4% to 42.5% of all medical admissions.

5. epidem Cardiovascular disease (CVD) is a noncommunicable disease (NCD) that accounts for 10 per cent of all deaths in Uganda . 2 Heart failure (HF) is a structural and hemodynamic complication of CVD, responsible for 30 per cent of all NCD-related deaths and 7 per cent of hospital admissions in the region of Sub-Saharan AfricaThe common causes of HF vary by country, with hypertensive heart disease (HHD) being prevalent in Uganda and rheumatic heart disease (RHD) being a significant cause of HF in countries like Uganda and Sudan

6. Radiology's Roles in Heart Failure : 1.Diagnosis 2.Monitoring 3.Identifying Symptoms

7. CARDIAC FAILURE OVERVIEW • Definition : Inability of the heart to pump sufficient blood to meet metabolic demands . • Types: Left-sided vs Right-sided Systolic ( HFrEF ) vs Diastolic ( HFpEF ) Common causes : • Ischemic heart disease • Hypertension • Valvular diseases • Cardiomyopathies

8. Signs and symptoms Symptoms may develop slowly. Sometimes, heart failure symptoms start suddenly. Heart failure symptoms may include: Shortness of breath with activity or when lying down. Fatigue and weakness. Swelling in the legs, ankles and feet. Rapid or irregular heartbeat. Reduced ability to exercise. Wheezing.

9. C ont… A cough that doesn't go away or a cough that brings up white or pink mucus with spots of blood. Swelling of the belly area. Very rapid weight gain from fluid buildup. Nausea and lack of appetite. Difficulty concentrating or decreased alertness. Chest pain if heart failure is caused by a heart attack.

10. Radiological signs • Pulmonary edema → visible on chest X-ray • Pleural effusion • Cardiomegaly • Kerley B lines

11. IMAGING MODALITIES IN CARDIAC FAILURE 1. X RAY First-line tool for suspected heart failure CXR is a rapid, non-invasive, and cost-effective initial test for assessing heart size and shape and checking for signs of fluid in the lungs (pulmonary congestion). Disadvantages Limited Sensitivity : it’s not sensitive enough to definitively rule out heart failure, as a normal chest X-ray doesn't exclude the condition. Lack of Detail: It provides a general view of the chest but does not show detailed images of the heart's internal structures or its ability to pump blood.

12. Chest radiograph /x ray signs of CF Alveolar oedema : Bat- wing pattern Interstitial oedema : Kerley B lines Cardiomegaly Heart size: Cardiothoracic ratio > 0.5 Dilated Upper lobe vessels:cephalisation Pleural effusions The ABCDE is a useful mnemonic approach to remember these xrays signs

13. Cardiomegaly a medical condition where the heart becomes abnormally large or thick, not a disease itself, but a sign of an underlying issue that makes the heart work too hard.

14. Interstitial edema: Kerley B lines fluid leakage into the interlobular and peribronchial interstitium as a result of the increased pressure in the capillaries. When fluid leaks into the peripheral interlobular septa it is seen as Kerley B or septal lines. Kerley -B lines are seen as peripheral short 1-2 cm horizontal lines near the costophrenic angles.

15. Inter edema When fluid leaks into the peribronchovascular interstitium it is seen as thickening of the bronchial walls and as loss of definition of these vessels ( perihilar haze). There is an increase in the caliber of the pulmonary vessels and they have lost their definition because they are surrounded by edema.

16. Both sided and diffused interstitial edema

17. Alveolar edema This is a fluffy;patchy or confluent opacity appearing as Butterfly or Batwing pattern. Alveolar edema is typically perihilar and caused by fluid in the alveolar space due.

18. PLEURAL EFFUSION Pleural effusion is bilateral in 70% of cases of CHF. When unilateral, it is slightly more often on the right side than on the left side. There has to be at least 175 ml of pleural fluid, before it will be visible on a PA image as a meniscus in the costophrenic angle. On a lateral image effusion of > 75 ml can be visible. If pleural effusion is seen on a supine chest film, it means that there is at least 500 ml present.

19. On the left images of a patient who has bilateral pleural effusions. Notice that it is more evident on the lateral view.

20. Pleural effusion The frontal view shows a meniscus in the left costophrenic angle.

21. 2. CARDIAC CT / CTA In case of CF computed tomography is Used for: • Coronary anatomy (CTCA) • Structural heart disease • Assessing aorta (e.g., for dissection) • Evaluation of pericardium CT scan stills also Important in assessment of the heart size and the pleural effusion which are commonest features of a congestive heart failure

22. CT Contrast-enhanced CT shows bilateral pleural effusions; the right is greater than the left. Both have low attenuation and form sickle-shaped opacities posteriorly

23. CT in HF In the left patient There is a large cardiac silhouette, which could be the result of cardiomegaly.

24. Ultra Sound vs Echo Sonographic signs of RV failure : Dilatation of the inferior vena cava (IVC) and hepatic veins Hepatomegaly Ascites and pleural effusion The indication for ultrasound examination in many of these patients is abnormal liver function tests . Echocardiography Usually performed by cardiologists but radiologists may do in some systems. Role:1. EF measurement 2.Valve assessment 3.Pericardial effusion 4.Wall motion abnormalities

25. US studies of liver with features DIVC

26. US pleural effusion Anechoic pleural fluid collection. The sonogram shows a collapsed right lower lobe surrounded by a large pleural effusion

27. OTHER MODALITIES Cardiac MRI Gold standard for tissue , MRI helps distinguish viable myocardium from scar;impacts treatment decisions Indications: 1.Myocarditis 2.Cardiomyopathies (HCM, DCM, ARVC) 3.Ischemic vs non- ischemic fibrosis E. Nuclear Medicine 1.MUGA scan for EF 2.PET for sarcoidosis or viability

28. SUMMARY Key Takeaways: •Radiology is critical in both diagnosis and follow-up of cardiac failure • Understand the strengths and limitations of each modality • Communicate effectively: What clinicians need vs what radiologists report • Collaborate for best patient outcomes

29. REFENCES 1. Grainger and Allisons .Diagnostic Radiology,A medical imaging text book 3th Edition. 2. Chest radiology; A resident’s . manual . Johannes K 3. American Journal of Roentgenology , Vol 144, Issue 5, 879-894 4. The vascular pedicle of the heart and the vena azygos. Part II: Acquired heart disease . by M Pistolesi , E N Milne , M Miniati and C Giuntini July 1984 Radiology, 152, 9-17 . 5. Radiological detection of clinically occult cardiac failure following myocardial infarction.Harrison M.O., Conte P.J., Heitzman E.

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