The document provides an overview of various cardiac diagnostic procedures including echocardiography, cardiac catheterization, and coronary angiography. It details the types of tests, their purposes, contraindications, and potential complications. Additionally, it discusses preparations for these tests and the methodologies used, such as stress tests and imaging techniques.

1. *DIAGNOSTICS
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2. *ECG
*ECHOCARDIOGRAPHY
*CARDIAC CATHETERISATION
*CARDIAC ENZYMES
*NUCLEAR IMAGING
*TMT
*CORONARY ANGIOGRAPHY
*CVP
*DOPPLER STUDIES
*PLETHYSMOGRAPHY
*ARTERIOGRAPHY
*BONE MARROW ANALYSIS

3. *ECHOCARDIOGRAPHY

4. ECHO uses ultrasound waves to record the movement of
the structures of the heart.
It provides information about abnormalities of
*Valvular structure and motion
* cardiac chamber size nand contents
*Ventricular muscle and septal motion and thickness
*The pericardial sac
*Ascending aorta

5. Commonly used modes
*M- mode
*2-D real time cross sectional
Doppler technology and color flow imaging is used in
combination

7. *NUCLEAR IMAGING
Most commonly used methods is the cardiac
blood pool scan.
A small amount of patients blood is removed,
mixed with a radioactive isotope [cardiolite]
and reinjected. Using the ECG and other imaging
technology studies are done.

8. *Types
*Stress echocardiography
*Transesophageal ECHO
*Contrast ECHO
*Real time 3D ultrasound

9. *Types
*Single photon emission computed tomography
[SPECT]
*Positron emission tomography [ PET]
*Stress perfusion imaging

10. *MAGNETIC RESONANCE IMAGING
In magnetic resonance imaging, the client is
placed in a magnetic field and contrast medium
is injected through an IV line and images are
taken to identify any infarction points or
occlusions or even aneurysms.

11. COMPUTED TOMOGRAPHY
In CT scan the patient is placed in a
computerized field and electron beams [EBCT]
are used to take images to identify calcification
in coronary arteries and heart valves.

12. CARDIAC CATHETERIZATION
It is performed by insertion of a Radio opaque
catheter into the right or left side of the heart.
Types:
*Right sided cardiac catheterization [ARTERY ]
*Left sided cardiac catheterization [VEIN]

14. RIGHT HEART CATHERISATION
The catheter is then inserted into the aorta then
to the pulmonary artery and pressures are
recorded. The catheter is then wedged or lodged
in position. [pulmonary artery wedge position]
This obstructs the flow and pressure from the
right side of the heart and looks forward through
the capillary bed to the pressure of the left side
of the heart.

15. LEFT HEART CATHERISATION
In left heart catheterization the catheter is
introduced into a femoral or brachial vein.
Patients frequently feel a temporary hot and
flushed sensation with contrast media injection.

16. Complications – bleeding , hematoma , allergic
reaction to the contrast media, looping kinking
and breaking off the catheter , infection,
thrombus formation, dysrhythmias, stroke,
puncture of cardiac tissues

17. Coronary angiography
Coronary angiography remains the gold standard
for detecting clinically significant
atherosclerotic coronary artery disease
The technique was first performed by Dr. Mason
Sones at the Cleveland Clinic in 1958.

18. INDICATION
*Diagnosis of CAD in clinically suspected patients
* Providing peri-interventional information for
percutaneous coronary intervention
*Coronary anomalies
*To exclude stenoses before non-coronary cardiac
surgery (valve surgery after 40 yrs of age)
*Determine patency of coronary artery bypass grafts

19. CONTRAINDICATIONS
 Coagulopathy
 Decompensate congestive heart failure
 Uncontrolled Hypertension
 CVA
 GI Hemorrhage
 Pregnancy
 Inability for patient cooperation
 Active infection
 Renal Failure
 Contrast medium allergy

20. BEFORE THE PROCEDURE-PATIENT PREP
*• After patient is properly identified, the procedure
must be explained before consent can be signed
*• Baseline vital signs will be done and as long as these
are within the doctor’s interest, can proceed with the
*• Blood tests must be done including BUN, creatnine,
PTT, INR, insulin/sugar levels
* After patient is put on table, the area being puncture
must be free from hair
* • Hair removal done by disposable electric razor and
removed by sticky side of cloth tape
* • Patient must be surgically cleaned with hospital
approved sterile surgical prep solution

21. Arterial Puncture
*Access is easiest from right side of patient due to
aortic bend
*Puncture is generally done via the femoral artery
*Alternative sites include the radial and brachial
arteries of the arm
*Catheter introduction After puncture of femoral,
radial or brachial artery (primarily on right side of
patient), a catheter is advanced into the aorta and
then the coronary arteries
*Contrast medium [Iodine] is introduced and Xray
images are taken
*If any blockage identified, it is removed and stents
are placed.[coronary angioplasty]

22. Complications
*Allergic to dye
*Bleeding
*Damage to the artery and vein
* MI
*Stroke
*Kidney damage
https://www.youtube.com/watch?v=Zuvuwz5snbI

23. TMT- TREAD MILL TEST
Cardiac stress test is used to measure the hearts
ability to respond to external stress in a
clinically controlled status.
It compares the hearts activity during rest and
stress induced [exercise or drug induced]
Exercise is done using a tread mill [slope and
speed is adjusted]or stair climbing and in bed
ridden patients, drugs like Dobutamine,
Adenosine, Dipyridamole is used to increase the
heart rate.
[target heart rate= 220-person’s age]

24. *How to prepare for
the test
• The patient should not eat , smoke or drink beverages
containing caffeine, or alcohol for 3 hours or more before the
test.
• Patient should continue all medications unless instructed
• Wear comfortable shoes and loose clothing to allow you to
exercise.

25. MODIFIED BRUCE PROTOCOL

26. *BRUCE PROTOCOL
*During a Bruce protocol Heart rate and rating of perceived
exertion [slope and speed] are taken every minute,
*BP is taken at the end of each stage. [every 3 minutes]
*In every 3 minutes the speed and angle of treadmill/ slope
gradient si adjusted.

27. *The test is continued
until:
• Reach the target heart rate [220-patients age ]
• Develop complications such as chest pain or a sudden rise or
fall in BP
• ECG evidence of myocardial ischemia
*Patient should be kept under observation for 10-15
minutes after exercising or until your heart rate returns to
baseline.

28. Contraindications
*Acute MI within 48 hrs.
*Unstable angina
*Uncontrolled cardiac arrhythmia
*Severe aortic stenosis, pulmonary embolism,
pericarditis
*Multivessel coronary artery disease