Cardiology, cardiac diagnostic tests

1. CARDIAC DIAGNOSTIC TESTS
Copyright and Owner:
POKHREL,BHARAT M.D
DOCTOR OF MEDICINE

2. 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

3. Chest Roentgenogram
lFrontal view is generally Posterior-anterior
l→ For assessing size of:
lLeft ventricle
lLeft atrial appendages
lPulmonary artery
lAorta
lSuperior venacava

4. 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

5. 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

6. 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

7. 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%

9. Pharmacological Stress Test
lAgents commonly used:
l→ Adenosine, Dobutamine or Dipyridamole

10. 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

11. Tilt Table Test
lProcedure often used to diagnose dysautonomia
or syncope
lWorks with the change in posture of the body
from lying to standing

12. 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

13. 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.

14. 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

15. 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

16. Types of Electrocardiographic
studies
lM-Mod
lTwo dimensional (2D)
lDoppler imaging
lContrast
lTransthoracic (Cardiac ultrasound)
lTransesophageal (TEE)

17. 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

19. 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.

20. 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.

21. PET Cardiology Viability Imaging
lAlso calledF-18-FDG PET Viability Imaging,
Cardiac PET FDG viability test

22. 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.

23. Electrophysiology study (EPS)
lHelps doctors understand the nature of abnormal
heart rhythms.

24. 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.

25. 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.

26. 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

27. 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.

29. References
lDr. Dennis James Torres,Lecture
notes
lhttp://www.lorvenheart.com/proIVU.
html
lhttps://www.nlm.nih.gov/medlineplus
/ency/article/003827.htm