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Cardiac Testing for the Layman


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Lecture to the General Public about the different aspects and modalities of Cardiac Testing

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Cardiac Testing for the Layman

  1. 1. Robert E. Henson II, MD RM Cardiovascular Associates, PC Feb, 2009
  2. 2. Questions to be Answered <ul><li>What does the future hold? </li></ul><ul><li>What is bothering me now? </li></ul><ul><li>How is the course of my disease progressing? </li></ul>
  3. 3. Types of Cardiac Tests <ul><li>Consultation/Interview </li></ul><ul><li>Physical Exam </li></ul><ul><li>ECG </li></ul><ul><li>Blood Testing </li></ul><ul><li>Exercise Tests </li></ul><ul><li>Echocardiogram Pictures </li></ul><ul><li>Nuclear Medicine/Perfusion Pictures </li></ul><ul><li>Cardiac CT Pictures </li></ul><ul><li>Cardiac MRI Pictures </li></ul>
  4. 4. Characteristics of Testing <ul><li>True Positives / False Positives </li></ul><ul><li>True Negatives / False Negatives </li></ul>
  5. 5. Specific Clinical Questions <ul><li>What does my future hold ? </li></ul><ul><ul><li>Identifying Risk Factors by Interview & Exam </li></ul></ul><ul><ul><ul><li>Family history, hypertension, smoking, obesity and inactivity </li></ul></ul></ul><ul><ul><li>Identifying existing diseases </li></ul></ul><ul><ul><ul><li>Diabetes, high cholesterol </li></ul></ul></ul><ul><ul><ul><li>Established vascular disease : </li></ul></ul></ul><ul><ul><ul><ul><li>Coronary disease by Cardiac CT </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Carotid Atherosclerosis by Carotid Ultrasound </li></ul></ul></ul></ul>
  6. 6. Specific Clinical Questions <ul><li>What is bothering me ? </li></ul><ul><ul><li>Stress Testing to screen for Obstructive Coronary Disease </li></ul></ul><ul><ul><ul><li>Chest pain/ shortness of breath </li></ul></ul></ul><ul><ul><li>Echo/Cardiac MR to evaluate for structural Heart Disease </li></ul></ul><ul><ul><ul><li>Shortness of breath, palpitations, murmurs </li></ul></ul></ul><ul><ul><li>ECG monitoring to look for arrythmias </li></ul></ul><ul><ul><ul><li>Palpitations, lightheadedness, fainting spells </li></ul></ul></ul>
  7. 7. Specific Imaging Tests
  8. 8. Echocardiographic Views
  9. 9. Echocardiographic Views
  10. 10. Nuclear Medicine Tests
  11. 12. Cardiac CT
  12. 13. Diseased vs Normal
  13. 14. Mollet, N. R. et al. J Am Coll Cardiol 2004;43:2265-2270 Volume-rendered multislice spiral computed tomography images (left) and corresponding conventional angiography images (right) of the left anterior descending (LAD) (A), circumflex (C), and right coronary artery (D) in a 69-year-old woman with stable angina and a positive bicycle test
  14. 15. 3D Reconstruction of the Heart
  15. 16. Severe LAD Calcification
  16. 17. CABG
  17. 18. Raff, G. L. et al. J Am Coll Cardiol 2005;46:552-557 Visualization of soft and hard coronary atherosclerotic plaques by 64-slice multislice computed tomography (MSCT)
  18. 19. 3D Reconstruction: s/p CABG
  19. 20. Cardiac MRI
  20. 21. Cardiac MR Comparable Views * SAX: 1 echo, 9 CMR views * “ Parasternal Long Axis” Short Axis 4 Chamber 2 Chamber
  21. 22. CE-CMR vs SPECT for Viability Wagner, et al. Lancet 2003
  22. 23. CE-CMR vs SPECT for Viability Wagner, et al. Lancet 2003
  23. 24. Where to go for Information <ul><li>Heart Hub for Patients : </li></ul><ul><ul><li> </li></ul></ul><ul><li>CardioSmart for Patients: </li></ul><ul><li> </li></ul>
  24. 25. Questions
  25. 26. Mollet, N. R. et al. J Am Coll Cardiol 2004;43:2265-2270 Colored image = volume rendered multislice spiral computed tomography (MSCT) image providing an overview of the anatomy of the main coronary arteries