Role of MDCT in acute chest pain
Cardiovascular causes:
CAD representing as ACS.
Pulmonary embolism.
Acute aortic syndrome.
Other causes of chest pain:
Pneumonia, pleurisy , chest wall (musculoskleteal, osteochondritis) , esophagitis, pericarditis, referred cervical root pain.
MDCT allows assessment of :
Coronary arteries.
Aorta.
PA.
Through a single ECG gated scan.
The goal of TRO CT is to exclude the diagnosis of coronary disease or to define other causes of chest pain.
TRO CT can safely eliminate the need for further diagnostic testing in more than 75% of patients with low to intermediate risk of ACS.
It can provide the additional non-coronary findings that explain the chest pain.
Only 25% of the patients presenting to the ED with symptoms of ACS have a confirmed diagnosis of ACS at the time of discharge .
Patients who are at high risk for ACS, with elevated cardiac biomarkers or acute ECG changes, should be admitted to the hospital and are likely to benefit from direct triage to cardiac catheterization for diagnostic purposes and timely intervention.
Cardiac planes /axes
Axial of the heart = Short Axis (SA).
Sagittal of the heart = Vertical long axis = 2ch view.
Coronal of the heart = Horizontal long axis = 4ch view.
cases
Take Home Message
The TRO CT examination is a powerful tool for evaluation and triage of patients with a low to moderate risk of ACS in whom diagnostic catheterization is not indicated.
TRO CT studies to evaluate the aorta, coronary circulation, pulmonary arteries, and adjacent intrathoracic conditions (other differential diagnoses for chest pain).
Try cardiac axes in assessment of coronary arteries.
28 янв 2022
