nuclear cardiology

1. Dr Ihab Suliman
MBBS ECFMG MRCP (UK) ABcv MRCP Spec
(endo and DM) CBNC rece 2016 FESC
ihab.suliman@gmail.com
Indications For Nuclear
Cardiac Imaging
Interactive Session
2019

2. What does the heart do ?
• The heart is a powerful muscle
consisting of two pumps side
by side.
• Its steady beating maintains
flow of blood to all parts of the
body throughout life.
ECG/ Treadmill
Radiography
Echocardiography
CT scan
MRI
Angiography
Radionuclide
imaging
Diagnostic modalities in heart disease

3. History of nuclear cardiology
 Blumgard and Weiss (1927) :
the first use of radioactivity in the study of the
cardiovascular system
 Wilson : measurement of the circulation times
 Tl-201 (1971)
 The development and improvement of SPECT
 The development and established Tc-labeled agents
 Alternative stress than physical exercise
 Gate-spect allows simultaneous assessment both of
myocardial perfusion, function and assessment of
myocardial viability
 Gamma camera coincidence imaging system
 Myocardial metabolic imaging

4. Nuclear cardiology Report interpretation
I. Defects
 Location
 Extent
 Severity
 Reversible or fixed
 Quantitative or semi quantitative analysis
II. Other information
 Transient ischemic dilation
 Lung uptake
Other Un related Findings like masses

5. Two types of patients
 1- Naïve Patients, Not Known cardiac.
 2- Known Patients, labelled as Cardiac
3/8/20195
Indications
Who are They (Our Dear Patients)

6. 1- Ischemia or CAD (Nuclear stress
test)
2- Viability. FDG uptake
3- Assess LV volumes or EF before or
after chemotherapy.
3/8/20196
To Detect

7. Cardiac stress test
Physical exercises
Exercise has to be adequate to produced the
heterogenity in blood flow to achieve high detection
sensitivity
 Treadmil
 Ergocycle
Pharmacological
 Pharmacological stress test become important, since
many patients are unable to exercise
 Pharmacological stress agents largely remove the
need for patient cooperation and motivation, and
enable a confident assessment of cardiac function in
virtually all cases
 Dipyridamole
 Dobutamine
 Adenosine

8. 1- Patients visited ER and ACS was
Ruled out.
2- Pre Operative Or Pre Transplant
3- Pre or post cardiac cath , PCI or
CABG.
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Examples

9.  61 yrs. old male who is k/c of type II DM.
 He has sustained acute Anterior wall
myocardial infarction was admitted in
Affif hospital, where given thrombolytic
therapy.
 came here for further management.

10. Case 1

11. Echo EF 35-40%, Akinetic LAD area,
No significant Valvular pathology

16.  56 years old male with DM, HTN, CVA
Recovered .
 Had occasional Exertional CP, ACS
Ruled Out in ER, Given appointment for
PET /CT Stress as OP
Second Case

22. 67 years old male with Recent
anterior MI from another
hospital.
Third Case

25.  In MCICU he had Multiple and Recurrent
VF/VT.
 EP labelled him as ischemic VF/VT
 Cardiac surgery insisted on Viability Before
CABG

27.  60 years old lady with Recurrent CP.
 Had Persantin Technitium after initial workup
was OK.
 Stress ECG was Negative
The PRONE IMAGE

28. 4 th Case

30.  Eventually Had Cardiac Angiogram due
to on and off chest pain.
 Coronaries were Normal.

31. Thank You very
Much
3/8/201931