Lesson Objectives:

• Differentiate between echocardiography, coronary angiography, and MRI.

• Understand when to use each imaging modality.

• Interpret key findings in cardiac imaging.

Echocardiography (Echo) – Bedside and Diagnostic Tool

Types:

• Transthoracic Echocardiography (TTE): First-line for assessing LV function, wall motion abnormalities, and valvular disease.

• Transesophageal Echocardiography (TEE): More detailed; used in endocarditis, atrial thrombus detection, aortic dissection.

Key Echo Findings:

• EF <40%: HFrEF.

• Dilated LV with hypokinesis: Dilated cardiomyopathy.

• Valvular dysfunction: Regurgitation vs. stenosis.

• Vegetations on valves: Endocarditis.

Coronary Angiography – The Gold Standard for CAD

Indications:
✔️ STEMI or high-risk NSTEMI.
✔️ Unstable angina despite medical therapy.
✔️ Suspected severe CAD requiring PCI or CABG.

Findings:
🚩 Single vs. multivessel disease (LAD, RCA, LCx involvement).
🚩 Collateral circulation in chronic ischemia.
🚩 Total occlusion (>99%) → emergency PCI.

Cardiac MRI & Nuclear Imaging – Beyond the Basics

• Cardiac MRI: Superior for myocarditis, infiltrative cardiomyopathies (amyloidosis, sarcoidosis), congenital heart defects.

• Nuclear Stress Testing: Used in intermediate-risk CAD patients; assesses ischemia via perfusion defects.