diagnostic studies in cardiology

1. DIAGNOSTIC MEASURES IN
CARDIOLOGY
Sudeshna Banerjee
HFCON

2. • The procedures are used to diagnose and treat a variety of
cardiovascular abnormalities and diseases.
• Cardiovascular diagnostics explore the function and the
current health of the cardiovascular system (i.e. the heart,
arteries, veins and capillaries).

3. Stress test
• Tread mill test/ exercise tolerance test
• The test helps to see how the heart
performs during exercise
• The test can show if the blood supply
is reduced in the arteries that supply
the heart
• Test may also use echocardiography
(called a stress echocardiogram)

4. Echocardiography
• Transthoracic interpretation of the contractile activity and
morphology of the heart overtime captured and externally
recorded by skin electrodes
• Size, shape, and movement of heart muscle can be
known
• This test can also show how the heart valves are
working and how blood is flowing through heart

6. How does it work ??
• One-dimensional or M-mode echocardiography is one
beam of ultrasound directed toward the heart.
• M-mode echocardiography to see just the left side (or main
pumping chamber) of heart.
• 2 D echo produces a broader moving picture of heart & is
one of the most important diagnostic tools.
• Doppler echocardiography measures blood flowing through
the arteries and shows the pattern of flow through the
heart.

7. RADIOGRAPHIC TESTS

8. CHEST X-RAY
• A radiology test that involves exposing the chest briefly to radiation
to produce an image of the chest and the internal organs of the
chest.
• An X-ray film is positioned against the body opposite the camera,
which sends out a very small
dose of a radiation beam.
• As the radiation penetrates the body,
it is absorbed in varying amounts by
different body tissues depending on
the tissue's composition of air, water,
blood, bone, or muscle.

9. CT ANGIORAPHY
• Noninvasive way to evaluate the coronary arteries, great vessels,
aorta, renal arteries, and lower extremity arteries through two-or
three dimensional images
• An x-ray technique that uses a computer to create cross-sectional (or
slice-like) pictures of the heart

10. MRA
• Similar to MRI, but it uses gadolinium as intravenous
contrast medium to evaluate arterial disease.
USES:
 Not nephrotoxic;thus clients with renal insufficiency can
safely undergo this procedure along with coronary MRA,
pulmonary, renal, and peripheral arteries can also be
studied.

11. PET SCAN
PET scanning uses a radioactive substance, which is injected into
bloodstream. This radioactive substance goes to areas inside body,
where tissue either is damaged or not working properly.
PET scan machine has hundreds of radiation detectors that can find
this radioactive substance in body
The PET scanner measures this radioactivity throughout body and
uses computers to create pictures of heart or other body tissues.

12. ELECTROCARDIOGRAPHIC TESTS

13. ELECTROCARDIOGRAM
• It is transthoracic interpretation of the electrical activity of the heart
overtime captured and externally recorded by skin electrodes for
diagnostic purposes on human hearts

14. ELECTRODES PLACEMENTS

15. Uses OF ECG
• Diagnosing and determining the severity of valvular disease.
• Assessment of ventricular function during systole and diastole.
• Diagnosis and assessment of congenital heart disease.
• Identify the source of embolism.
• Detection of infective endocarditis .
• Diagnosis and assessment of coronary artery disease.
• Assessment of cardiomyopathies

16. Holter monitoring
 A Holter monitor is about the size of a large deck of cards
 Wires connect the device to sensors (called electrodes) that
are stuck to patient’s chest using sticky patches
 Sensors detect heart's electrical signals, and the monitor
records heart rhythm

17. Uses of holter
Diagnose problems with the heart's rate or rhythm
Diagnose arrhythmias
Detect silent myocardial ischemia
Diagnose whether a heart rhythm problem is
harmless or requires treatment

18. INVASIVE TESTS

19. TRANSESOPHAGEAL ECHO
Especially useful for clients who have thickened lung tissue
or thick chest walls or who are obese
It eliminates the interference of the thoracic structures and
provides an excellent image of the heart and great vessels
from a posterior view
Because the probe is placed behind the heart.

21. CARDIAC CATHETERIZATION
 Insertion of a catheter into the heart, coronary arteries, and
surrounding vessels to obtain detailed information about the
structure and performance of the heart
RIGHT HEART CATHETERIZATION
• Passage of a catheter from an antecubital or femoral vein into the
right atrium, right ventricle, pulmonary artery, and pulmonary
arterioles. Pressures and oxygen saturation levels from each of these
areas are obtained and recorded
LEFT HEART CATHETERIZATION
• Done to evaluate the patency of coronary arteries and the function of left ventricle
and the mitral and aortic valves

23. Electro physiologic studies
A specialized electrode catheter designed for EP studies lets them
send electrical signals to the heart and record its electrical activity
Uses:
1. Where an arrhythmia is coming from.
2. How well certain medicines work to treat your arrhythmia.
3. If at risk for heart problems such as fainting or sudden cardiac death
due to cardiac arrest
4. During an EPS, about 3 to 5 electrically sensitive catheters are
placed inside the heart to record electrical activity.

25. LABORATORY TESTS
• Diagnose a variety of cardiovascular ailments(MI)
• Screen people at risk for CVD
• Identify concurrent disorders(anemia, diabetes, electrolyte
imbalance, renal or liver abnormalities)

26. Central venous pressure
 CVP reflects the amount of blood returning to the heart
and the ability of the heart to pump the blood into the
arterial system
 CVP range from 5-12cm
 Serve as a guide to detect whether the heart can handle its
fluid load and whether hypovolemia or hypervolemia is
present
 Normal CVP is 2-6 mm Hg.

28.  CVP is elevated by :
– overhydration which increases venous return
– Heart failure which limit venous outflow and lead to venous
congestion
 CVP decreases with:
ˉ Hypovolemic shock from hemorrhage, fluid shift, dehydration
ˉ Negative pressure breathing which occurs when the patient
demonstrates retractions or mechanical negative pressure which is
sometimes used for high spinal cord injuries.

29. PULMONARY CAPILLARY WEDGE PRESSURE
 The pressure measured in by wedging a pulmonary catheter with a
deflated balloon into a small pulmonary arterial branch
 To diagnose the severity of left ventricular failure and to quantify the
degree of mitral valve stenosis
 Development of the balloon-tipped flow directed catheter has
enabled continuous direct monitoring of PA pressure. Pulmonary
artery catheter otherwise known as “swan- ganz catheter”
 A balloon-tipped, flow-directed catheter be inserted into a large vein
(usually the subclavian, jugular, or femoral vein); the catheter is then
passed into the vena cava and right atrium

30. After the catheter is correctly positioned, the following
pressures can be measured:
• CVP or right atrial pressure
• Pulmonary artery systolic pressure
• Diastolic pressures
• Mean pulmonary artery pressure
• Normal pulmonary artery pressure is 25/9 mm Hg, with a
mean pressure of 15 mm Hg
• Pulmonary capillary wedge pressure is a mean pressure and
is normally 4.5 to 13 mm Hg

32. INTRA-ARTERIAL BLOOD PRESSURE
• It is a technique in which an intra-arterial catheter (A-line: a very
small plastic tube called catheter) is placed in one of blood vessels
(an artery) by highly trained personnel. This is usually done during or
before certain types of surgery or in the ICU
REASONS FOR PLACING A-LINE
• To watch blood pressure very closely
• To draw frequent blood samples for lab tests
• To test for the oxygen saturation in the blood (check how much
oxygen is in the blood)