This document discusses nuclear cardiac imaging and its indications. It provides an overview of the heart's function and various diagnostic modalities for heart disease, including nuclear imaging techniques. Nuclear imaging can be used to detect ischemia/coronary artery disease via stress tests, assess myocardial viability with FDG uptake, and evaluate left ventricular volumes/ejection fraction before and after chemotherapy. The document outlines stress test options, report interpretation, two types of patients (naive and known cardiac), and provides examples of nuclear imaging indications and cases.

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
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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.
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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
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