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Imaging the cardiovascular system in the ICU 

Imaging the cardiovascular system in the ICU
Chapter:
Imaging the cardiovascular system in the ICU
Author(s):

Richard Paul

and Susanna Price

DOI:
10.1093/med/9780199600830.003.0143
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date: 30 November 2020

Cardiac imaging in the critically ill can be challenging. Interpretation requires a broad knowledge of cardiovascular pathophysiology, the range of available investigations, and their sensitivity and specificity in diagnosing individual conditions. Applying first principles and interpreting findings in the clinical context are mandatory. Useful non-invasive investigations include simple chest X-ray, thoracic ultrasound, and computed tomography (CT) to detect pulmonary and extrapulmonary pathology, whilst CT coronary angiography can evaluate stent and graft patency, and identify extramural plaques, undiagnosed with conventional angiography. Invasive left heart cardiac catheterization may be indicated in patients with cardiovascular instability and particularly in patients where cardiac surgery has involved manipulation of the coronary arteries, whilst right heart catheterization remains the gold standard for haemodynamic assessment of pulmonary hypertension. Echocardiography has many applications in the ICU, ranging from haemodynamic monitoring to aiding diagnosis of complex pathology and rapid diagnosis in cardiac arrest. Other investigation modalities less frequently used in the critical care population are also discussed within this chapter.

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