Eric T. Kimura-Hayama MD, Presenter: Nothing to Disclose

The aims of the presentation are: 1) Identify the broad spectrum of cardiovascular disorders that may present in the acute setting according to their pathophysiology and anatomic location: a) Traumatic vs non-traumatic (ischemic, tumoral, inflammatory or infectious), b) Cardiac vs vascular emergencies. 2) Recognize imaging findings useful in the differential diagnosis. 3) Analyze the role of non-invasive imaging methods in the acute setting.

Acute cardiovascular disorders include a broad spectrum of diseases either within the heart chambers, valves and coronary arteries and in vascular structures (i.e. aorta and pulmonary arteries). Cardiac disorders that may present in the acute setting include ischemic and non-ischemic complications. Ischemic heart disease may be accompanied of related complications different from the obstructive flow within the coronary lumen, such as: cardiac perforation, pseudoaneurysms, secondary septal defects, acute mitral insufficiency and pericardial disorders, among others.   However, other than myocardial or coronary disorders may present in the acute setting such as endocarditis with valvular abscess or pseudoaneurysms, valvular perforation, prosthetic dysfunction, tumors or cardiac masses with obstructive hemodynamics, and acute intracardiac shunts (e.g. sinus of Valsalva rupture). Pericardial effusion with tamponade and constrictive pericarditis  may also present as a cardiac emergency, and should be distinguished from restrictive cardiomyopathies since treatment is different. In regard vascular complications, acute aortic syndromes (i.e. intramural hematoma, penetrating ulcer, complicated aneurysms and dissection) and pulmonary embolism account for most of the emergencies.  Complications may be related to trauma (e.g. pseudoaneurysms of the aorta), but most are non-traumatic disorders.  Nowadays, non-invasive imaging, Multidetector Computed Tomography and Magnetic Resonance, plays a growing role in diagnostic evaluation of these patients, not only in vascular assessement but also in cardiac imaging itself. The high availability of MDCT and its short acquisition times makes it suitable for several clinical scenarios.

Kimura-Hayama, E, Urgencias Cardiovascularers/Acute Cardiovascular Imaging.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12038478.html