CARDIAC DIAGNOSTIC TESTS

Copyright and Owner: POKHREL,BHARAT M.D

DOCTOR OF MEDICINE

ELECTROCARDIOGRAM

(ECG/EKG)

lTo measure:

lAny damage to the heart lHow fast the heart is beating and whether it is

normal or not lThe effect of the drugs or deivices to control the heart (pacemakers)

lThe size and position of the heart chambers

Chest Roentgenogram

lFrontal view is generally Posterior-anterior

l→ For assessing size of: lLeft ventricle

lLeft atrial appendages lPulmonary artery lAorta

lSuperior venacava

Lateral view

lLeft side of the body against the film plate and the

x-rays through the body from right to left lFor evaluating:

l→ Right ventricular size l→ Posterior border of the left atrium and ventricle lPA diameter of the thorax

Stress Test

lStress is induced by Exercise or drug stimulation.

lMeasure the heart's ability to respond to the external stress and is performed in controlled

clinical environment unless you want to kill the patient with cardiac arrest :) lYou certainly know how it works, if not that's not

quite my problem

Types of stress test

lECG exercise stress testing

l→ a) Treadmill excersie test l→ b) Bicycle exercise test l→ c) Pharmacologic stress test lEchocardiogram exercise stress testing lNuclear stress testing

Nuclear stress testing Treadmill Test

lRadioactive tracer is injected into the veins and small camera called gamma camera detects

the radiation released by tracer to produce computer images of the heart.

lSensitivity: 81%

lSpecificity: 85-95%

lYou challenge the heart with the stress produced by making patient walk in the treadmill and

observe the change in the heart rhythm.

lSensitivity: 73-90%%

lSpecificity: 50-74%

Pharmacological Stress Test

lAgents commonly used:

l→ Adenosine, Dobutamine or Dipyridamole

Ambulatory BP Monitoring (ABPM)

lClinical Applications:

lEvaluation of drugs lowering BP lHigh normal BP with target organ involvement

lResistant Hypertension lEpisodic hypertension lEvaluation of hypotensive symptoms

l“Office” hypertension lPatient with myocardial disease

Tilt Table Test

lProcedure often used to diagnose dysautonomia

or syncope lWorks with the change in posture of the body

from lying to standing

Holter Monitor

lPortable recording device worn by the patient

under clothing and attached to the chest via electrode leads and patches to the cord an ECG

continuously. lCLINICAL APPLICATIONS lDiagnosis of cardiac arrythmias

lDiagnosis of suspected ischemia lEvaluation of anti-arrythmic therapy

Arrythmia Event Recorder

lLooping memory monitor is an ECG recording

device about the size of a pager and is attached to the chest with two electrodes with an adhesive

backing that sticks to the skin over a long period of time. lPost Event Monitors are small ECG recording

devices that can be carried in purse or pockets. ECG monitor is held up to the level of chest to make a recording at the time of occurrence of the

symptoms.

Echocardiogram

lUses sound waves to create images of the heart.

lCLINICAL APPLICATIONS: lEstimation of intra-cardiac pressure

lEstimation of intra-cardiac shunts lAssessment of LV function

USES

lMeasure heart size,functions and thickness of

heart muscle lWith doppler technique can measure the blood

flow through the different chambers and measure the pressure gradients across the valves and can actually diagnose stenosis ,regurgitation or

calcification. lVery reliable, non-invasive, no pain or risk

Types of Electrocardiographic

studies

lM-Mod

lTwo dimensional (2D) lDoppler imaging

lContrast

lTransthoracic (Cardiac ultrasound) lTransesophageal (TEE)

Thallium Stress Testing

lAgent: Thallium radioisotope, gamma camera

lCLINICAL APLLICATIONS lDiagnosis of coronary disease

lDetermine extent of diagnosed coronary disease lAssess effectiveness of angioplasty lEvaluates patients with abnormal ECG

Positron emission tomography

(PET) scan

lAdvances noninvasive method, uses tracer drugs

that emit positively charged particles called positron

lUses gamma camera lProvides information on metabolic functioning rather than the structure of the heart and other

organs.

TYPES

lOne which makes use of tracer called Rubidium-

82 (Rb-82), that measures circulation in the arteries of the heart

lSecond, using sugar like substance called F-18 FDG, distinguish healthy cardiac tissues from damaged ones such as in heart attack.

PET Cardiology Viability Imaging

lAlso calledF-18-FDG PET Viability Imaging,

Cardiac PET FDG viability test

MUGS scans. Radionuclide

angiography (RNA) scans

lPerformed by labelling patient's red blood pool

with radioactive tracer, technetium-99m-petechnetate (Tc-99m) and measuring

radioactivity over anterior part as the radioactive blood flows through the blood vessels and the heart chambers.

Electrophysiology study (EPS)

lHelps doctors understand the nature of abnormal

heart rhythms.

Cardiac Catherization(coronary

angiogram)

lSmall cathether is advanced into and around the

heart through an artery or vein in the groin or arm which helps to measure pressure within heart and

produce angiograms of the coronary arteries, LV and other cardiac structures.

Cardiac MRI

lIt's used to diagnose and assess many diseases

and conditions, including: Coronary heart disease. Damage caused by a heart attack. Heart failure.

Computed Tomography

lUses X rays to produce planar image of the heart

lAssess pericardial and aortic diseases lSpeed of image acquisition limits use due to

cardiac motion

Intravascular Ultrasound (IVUS)

lIntravascular ultrasound (IVUS) is a medical

imaging methodology using a specially designed catheter with a miniaturized ultrasound probe

attached to the distal end of the catheter. The proximal end of the catheter is attached to computerized ultrasound equipment.

References

lDr. Dennis James Torres,Lecture notes

lhttp://www.lorvenheart.com/proIVU.html

lhttps://www.nlm.nih.gov/medlineplus/ency/article/003827.htm