ABCs OF THE

HEART DISEASE
SYSTEM
NASRAH N. MUSA
 ASSESSMENT

• Cardiac size (cardiothoracic ratio)

• Determination that the heart is enlarged.

• Heart is not enlarged?

ABCs
 Is the Left Atrium Enlarged? A

Is the Main Pulmonary Artery Big or Bulbous? B

Is the Main Pulmonary Artery Segment Concave? C

Is the Heart a Dilated or Delta-Shaped Heart? D

 Is the Left Atrium Enlarged? A

Double density Straightening

• It is more common for straightening to be present
with an enlarged left atrium than for the double
density to be apparent.

size of the right descending pulmonary artery

distribution of flow in the lungs from apex to base

and then from hilum to periphery.

A B
Is the left atrium enlarged?
 Is the Main Pulmonary Artery Big or Bulbous? B

• Draw the imaginary tangent line from the apex of the left
ventricle to the aortic knob to determine if the main pulmonary
artery protrudes beyond the tangent line.

size of the right descending pulmonary artery

distribution of flow in the lungs from the hilum to the periphery.

 prominent main
pulmonary artery
 Is the Main Pulmonary Artery Segment Concave? C

o see if the main pulmonary artery is more than 15 mm

medial to the tangent line.

o “Away from the tangent line”

 >15mm medial
 >15mm to the patient’s right of the tangent.
 Is the Main Pulmonary Artery Segment Concave? C

Aortic knob
• C is yes, thenAortic
we areknob
not going to look at the
Aortic knob
pulmonary
Ascending
Aorta
vasculature; we are going to look at
the configuration of the thoracic
Ascending
aorta.
Aorta Ascending
Aorta
* Configuration of the thoracic aorta
Descending
> ascendingDescending
aorta, Descending aorta
> aortic knob,aorta
and aorta

> descending thoracic aorta

Right heart
border
main pulmonary artery
segment
 Is the Heart a Dilated or Delta-Shaped Heart? D

• >65% of the cardiothoracic ratio (a really big heart)

• smooth contours such that almost as much of the heart projects to both the
right and the left of the spine

Differential Diagnosis:

• cardiomyopathy and pericardial effusion.

a dilated cardiac silhouette
 Facts
• The ventricles respond to obstruction to their outflow by first
undergoing hypertrophy rather than dilatation.

• Therefore the heart may not be enlarged with lesions like

 aortic stenosis,
 coarctation of the aorta,
 pulmonic stenosis, or systemic hypertension.

• Cardiomegaly, is primarily produced by ventricular enlargement,

not isolated enlargement of the atria.

 Therefore the heart is classically normal in size in early mitral stenosis.

 Facts
• Most marked chamber enlargement will occur from volume
overload

• Therefore the heart will usually be larger with aortic

regurgitation rather than aortic stenosis
THANK YOU