The document discusses various cardiac tests that can be used to answer clinical questions about a patient's condition. It describes tests such as physical exams, echocardiograms, nuclear medicine tests, cardiac CT, and cardiac MRI that provide information on risk factors, existing diseases, signs and symptoms, and the progression of cardiac disease. Examples of specific views and images from these tests are also shown to illustrate what details they can reveal about the heart and blood vessels.

1. Robert E. Henson II, MD RM Cardiovascular Associates, PC Feb, 2009

2. Questions to be Answered What does the future hold? What is bothering me now? How is the course of my disease progressing?

3. Types of Cardiac Tests Consultation/Interview Physical Exam ECG Blood Testing Exercise Tests Echocardiogram Pictures Nuclear Medicine/Perfusion Pictures Cardiac CT Pictures Cardiac MRI Pictures

4. Characteristics of Testing True Positives / False Positives True Negatives / False Negatives

5. Specific Clinical Questions What does my future hold ? Identifying Risk Factors by Interview & Exam Family history, hypertension, smoking, obesity and inactivity Identifying existing diseases Diabetes, high cholesterol Established vascular disease : Coronary disease by Cardiac CT Carotid Atherosclerosis by Carotid Ultrasound

6. Specific Clinical Questions What is bothering me ? Stress Testing to screen for Obstructive Coronary Disease Chest pain/ shortness of breath Echo/Cardiac MR to evaluate for structural Heart Disease Shortness of breath, palpitations, murmurs ECG monitoring to look for arrythmias Palpitations, lightheadedness, fainting spells

7. Specific Imaging Tests

8. Echocardiographic Views

9. Echocardiographic Views

10. Nuclear Medicine Tests

12. Cardiac CT

13. Diseased vs Normal

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

15. 3D Reconstruction of the Heart

16. Severe LAD Calcification

17. CABG

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)

19. 3D Reconstruction: s/p CABG

20. Cardiac MRI

21. Cardiac MR Comparable Views * SAX: 1 echo, 9 CMR views * “ Parasternal Long Axis” Short Axis 4 Chamber 2 Chamber

22. CE-CMR vs SPECT for Viability Wagner, et al. Lancet 2003

23. CE-CMR vs SPECT for Viability Wagner, et al. Lancet 2003

24. Where to go for Information Heart Hub for Patients : www.hearthub.org CardioSmart for Patients: www.cardiosmart.org

25. Questions

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