Heart and vascular x-rays

In the last 15-20 years, diagnostic radiology has undergone a technological revolution, mainly related to the development of fundamentally new methods for studying the heart. In the 1970s, ultrasound devices operating in real time were created. They made it possible to look inside the cavities of the heart, study the movement of the valves and various parts of the heart muscle. Dynamic scintigraphy paved the way for assessing myocardial blood flow and measuring the contractility of individual segments of the ventricles of the heart. In the 1980s, computer methods for obtaining images entered the practice of cardiology: digital coronary and ventriculography, computed tomography synchronized with the work of the heart, magnetic resonance imaging. Moreover, radiologists received special catheters for vascular plastic surgery and laser devices for evaporating atherosclerotic plaques. Thus, they combined diagnostic methods with therapeutic manipulations. Thus, radiation cardiology came to maturity and full recognition.

Radial anatomy of the heart

Radiological examination of the morphology of the heart and great vessels can be performed using non-invasive and invasive techniques. Non-invasive methods include: radiography and fluoroscopy; ultrasound examinations; computed tomography; magnetic resonance imaging; scintigraphy and emission tomography (single- and dual-photon). Invasive procedures include: artificial contrasting of the heart by venous means - angiocardiography; artificial contrasting of the left cavities of the heart by arterial means - ventriculography, coronary arteries - coronary angiography and aorta - aortography.

Normal x-ray anatomy of the heart

Radiological examination of cardiac function

In a healthy person, an excitation wave spreads through the myocardium approximately once per second - the heart contracts and then relaxes. The simplest and most accessible method of recording them is fluoroscopy. It allows visually assessing the contractions and relaxation of the heart, the pulsation of the aorta and pulmonary artery. At the same time, by changing the patient's position behind the screen, it is possible to bring out on the contour, i.e. make all sections of the heart and blood vessels edge-forming. However, recently, due to the development of ultrasound diagnostics and its widespread introduction into clinical practice, the role of fluoroscopy in studying the functional activity of the heart has noticeably decreased due to the fairly high radiation load that exists with it.

X-ray examination of cardiac function

Radiation symptoms of heart damage

As can be seen from the above, the cardiologist, thanks to radiation methods, receives extensive information about the morphology and function of the heart and main vessels, objective data on the slightest deviations from the norm. Based on the numerous symptoms identified, the final clinical diagnosis of the disease is made. It is advisable to consider the signs of heart pathology that are most often observed by a general practitioner. These are mainly radiological symptoms of changes in the position, shape, size and contractile function of the heart.

X-ray symptoms of heart damage

Radiation picture of cardiac lesions

Ischemic heart disease. Myocardial infarction

Ischemic heart disease is caused by impaired coronary blood flow and a gradual decrease in myocardial contractility in ischemic zones. Impaired myocardial contractility can be detected using various ultrasound diagnostic methods. The simplest and most accessible of these is echocardiography. It determines the uneven contractions of various sections of the left ventricular wall. In the ischemic zone, a decrease in the amplitude of ventricular wall movement during systole is usually observed. The thickness of the interventricular septum and systolic thickening of the myocardium are reduced. The ejection fraction of the left ventricle is reduced with increased contractions of the left ventricle (later, the ejection fraction of the right ventricle also decreases). Local contractility disorders are observed in the period when there are no pronounced signs of circulatory failure.

Mitral valve defects

Radiation diagnostics of mitral heart defects is based mainly on ultrasound and X-ray data. In case of mitral valve insufficiency, its flaps do not close completely during systole, which leads to blood being thrown from the left ventricle into the left atrium. The latter is overfilled with blood, and the pressure in it increases. This affects the pulmonary veins, which flow into the left atrium - venous plethora of the lungs develops. The increase in pressure in the pulmonary circulation is transmitted to the right ventricle. Its overload leads to myocardial hypertrophy. The left ventricle also expands, since with each diastole it receives an increased volume of blood.

Aortic defects

In case of aortic valve insufficiency, its cusps do not ensure the tightness of the left ventricle: in diastole, some of the blood from the aorta returns to its cavity. Diastolic overload of the left ventricle occurs. In the early stages of the defect formation, compensation is achieved by increasing the stroke volume. Increased blood ejection leads to expansion of the aorta, mainly in its ascending part. Hypertrophy of the left ventricular myocardium develops.

Congenital defects

Manuals on internal medicine and surgery contain descriptions of numerous anomalies in the development of the heart and large vessels (congenital defects). Radiation methods play an important, and sometimes decisive, role in their recognition. Even with a regular X-ray examination, the position, size and shape of the heart, aorta, pulmonary artery, superior vena cava and the nature of their pulsation are established.

Pericarditis

Dry pericarditis initially does not produce symptoms when examined by radiological diagnostic methods. However, as the pericardial layers thicken and harden, its image appears on sonograms and CT scans. Significant pericardial adhesions lead to deformation of the heart shadow on radiographs. Calcium deposits in pericardial adhesions are especially clearly visible. Sometimes the heart on radiographs seems to be enclosed in a calcareous shell ("armored heart").

X-ray picture of heart damage

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