cardiovascular testing part 1

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TESTING MODALITIES
•CHEST RADIOGRAPHY
•CARDIAC CATHETERIZATION
•NUCLEAR CARDIOLOGY
•INTRAVASCULAR ULTRASOUND

3. • A chest radiograph, commonly called a chest X-ray (CXR), is
a projection radiograph of the chest
• used to diagnose conditions affecting the chest, its contents, and
nearby structures.
• chest radiography employs ionizing radiation in the form of
X- rays to generate images of the chest.
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NORMAL
Lung congestion
seen here…. SIGN
OF CONGESTIVE
HEART FAILURE

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Normal cardiovascular anatomy on a chest radiograph
•SVC is superior vena cava
•PA are the pulmonary arteries, right and left
•RA is right atrium; RV is right ventricle
•IVC is the approximate position of the inferior
vena cava.
•Ao is the aortic arch, which then continues as the
descending aorta, indicated by the dotted line.
• LAu is the auricle of the left atrium
•PV are the pulmonary veins converging on the left
atrium. LV is the left ventricle

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Specific cardiovascular abnormalities on chest radiograph
•Cardiac chamber dilation and hypertrophy
- Left ventricular hypertrophy
- Left atrial enlargement
•Heart failure
- Cardiogenic Pulmonary Edema
PLEURAL AND
PERICARDIAL
EFFUSIONS

6. PURPOSE:
Chest radiographs are used to diagnose many conditions involving
• chest wall,
• bones of the thorax,
• structures within the thoracic cavity
• lungs, heart, and great vessels.
• Pneumonia and congestive heart failure are very commonly
diagnosed by chest radiograph.
The main regions where a chest X-ray may identify problems
may be summarized as ABCDEF by their first letters:
•Airways
•Breast shadows
•Bones
•Cardiac silhoutte, detecting cardiac enlargement
•Costophrenic angles, including pleural effusions
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7. •Diaphragm, e.g. evidence of free air
•Edges, e.g. apices for fibrosis, pleural thickening or plaques
Extrathoracic tissues
•Fields (lung parenchyma), e.g. alveolar air space disease with
prominent vascularity with or without pleural effusions
CONDITIONS COMMONLY IDENTIFIED BY CHEST RADIOGRAPHY
•Pneumonia
•Interstitial lung disease
•Congestive heart failure
•Bone fracture
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8. • Also called as cardiac cath
•An invasive imaging procedure that tests for heart disease to
monitor how well our heart is functioning.
• During the test, a long, narrow tube,
called a catheter, is inserted into a
blood vessel in your arm or leg and
guided to your heart with the aid of a
special X-ray machine.
• Contrast dye is injected through the
catheter so that X-ray movies of your
valves, coronary arteries, and heart
chambers can be created.
WHAT IS ACTUALLY DONE:
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9. PURPOSE
•Evaluate or confirm the presence of heart disease (such as coronary
artery disease, heart valve disease, or disease of the aorta )
•Evaluate heart muscle function.
•ATHEROSCLEROSIS
•This test provides the doctor with
a picture of the arteries of the
heart this shows the presence,
• location,
•degree of severity of blockages
in the coronary arteries.
•Determine the need for further
treatment
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10. Preparing For A Catheterization
•Generally, you should not eat or drink anything for 6-8 hours before
the procedure. This will minimize the chance of an upset stomach
during the test.
•Bring a list of all medications you are currently taking. Be sure to
include the exact names and dosages.
•Mention to the doctor if you are allergic to x-ray dyes.
Several routine tests will be performed before the
procedure, including an ECG and blood tests
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11. Risks Associated With Cardiac Catheterization
•Bleeding around the point of puncture
•Abnormal heart rhythms
•Blood clots
•Infection
•Allergic reaction to the dye
•Stroke
•Heart attack
•Perforation of a blood vessel
•Air embolism (introduction of air into a blood vessel, which can
be life-threatening)
Benefits:
It provides important information about the heart’s pumping
function and the condition of the coronary arteries and heart valves.
This information often cannot be obtained by any other means. It
helps the doctor to make an accurate diagnosis and begin treatment
before irreversible damage to the heart occurs. 11

12. •Nuclear cardiology tests safely take pictures of the heart
•During a nuclear cardiology test, a very small amount of radioactive
dye (tracer called radionuclide) is injected into a vein.
•A special gamma camera then takes still images and movies of the
heart during rest, exercise, or medication-induced stress testing.
•These cardiac images help to identify coronary heart disease, the
severity of prior heart attacks, and the risk of future heart attacks
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PURPOSE
•The function of your heart & flow of blood to the heart muscle.
• Whether chest discomfort, shortness
of breath, or unusual fatigue is due to
heart disease.
• Whether you have silent heart disease

13. • The technetium heart scan is a noninvasive nuclear heart scan as it
uses a radioactive isotope technetium which targets the heart to
evaluate blood flow after a heart attack
• A radionuclide detector traces the absorption of the radioactive
isotope.
Purpose
•To evaluate the heart after a heart
attack
•It can confirm that a patient had a heart attack when the symptoms
and pain usually associated with a heart attack were not present
•Provide information useful in determining the patient's post-heart
attack prognosis. 13
•Identify the size and location of the
heart attack.

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• Radionuclides such as technetium-pyrophosphate (99mTc-PYP) are
used
Uptake of 99mTc-PYP into infarcted tissue depends
•on regional blood flow,
•myocardial calcium concentration,
•the degree of irreversible myocardial injury,
•and time after infarction.
• 99mTc-PYP attaches to calcium deposited in the infarcted area, so
the approach is known as hot-spot scanning.
• False hot spots may occur where there is necrotic myocardial tissue,
as in myocarditis, old infarctions, and myocardial trauma.
• In infarcted tissue, 99mTc- PYP levels are as high as 18 to 20 times
that of normal myocardium, which gives rise to very distinct borders
between the infarcted and normal myocardium.
UPTAKE OF TECHNETIUM

15. •The scan is most useful when the electrocardiogram and cardiac
enzyme studies do not provide definitive results after heart surgery.
•It is also used to evaluate the heart before and after heart surgery.
Precautions
Pregnant women and those who are breastfeeding should not be
exposed to technetium.
Preparation
Two to three hours before the scan, technetium
is injected into a vein in the patient's forearm.
Normal results
If the heart scan is normal, no technetium will
shown up in the heart.
Abnormal results
If heart scan abnormal, hot spots reveal
damage to the heart. The larger the hot
spots, the poorer the patient's prognosis. 15

16. • A thallium scan is a test that uses a
radioactive substance (known as a tracer)
to produce images of the heart muscle.
• When combined with an exercise
test, the thallium scan helps determine if
areas of the heart do not receive enough
blood.
•The exercise thallium scan is especially
useful in diagnosing coronary artery
disease, the presence of blockages in the
coronary arteries
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17. •The tracer via bloodstream, is carried to the coronary arteries, and is
picked up by the heart muscle cells.
•Areas of the heart muscle that have an adequate blood supply pick
up the tracer almost immediately. Areas that do not have an
adequate blood supply pick up the tracer very slowly or not at all.
This will show up as a lighter area, called a "defect".
•A second set of images is taken several hours later, while at rest.
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WHAT IS DONE:
•During the test, a tiny amount of thallium tracer is injected into a
vein in your arm while you walk on a treadmill.
•For patients who cannot exercise, the test may be done after the
injection of a drug (DIPIRIDAMOLE) that produces a stress on the
heart similar to exercise.

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What does the thallium stress test show?
•It checks whether the blood flow through the coronary arteries is
normal during exercise and while at rest.
•If the test shows that blood flow is normal during rest but not during
exercise (a perfusion defect), then the heart isn't getting enough
blood when it must work harder than normal. This may be due to a
blockage in one or more coronary arteries
•If the test is abnormal during both exercise and rest, there's limited
blood flow to that part of the heart at all times
•If no thallium is seen in some part of the heart muscle, the cells in
this part of the heart are dead from a prior heart attack. (They
have become scar tissue.)

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Benefits:
•The exercise thallium scan is generally more accurate and
provides more information than an exercise ECG test.
•The radiation exposure during a thallium scan is extremely
small, and the doses used are safe. Thallium is excreted rapidly by
the kidneys. Not advisable during pregnancy and lactation .
•These images help differentiate between areas that temporarily
do not receive enough blood (the defect returns to normal) and
areas that are permanently damaged from a previous heart
attack (the defect persists).

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21. Alternative Names: IVUS; Ultrasound - coronary artery;
Endovascular ultrasound
•Ultrasound uses sound waves to
create moving images of organs
and systems within the body.
•IVUS is a combination of a heart
ultrasound (ECG) and cardiac
catheterization.
•A tiny ultrasound wand is attached
to the top of a tiny, hollow tube
called a catheter.
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23. •IVUS provides quantitative information from within the vessel on
diameter
•circumference
•plaque volume
•percent stenosis.
• Another new development in imaging the inner wall of the coronary
is the recently developed, intravascular optical coherence
tomography providing high-resolution, cross-sectional images of
tissues.
• IVUS images highlight the artery walls and can show if there are
cholesterol and fat deposits (plaques). Build up of such plaque leads
to hardening of the arteries (atherosclerosis).
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•This gives the visualization of arteries from the inside-out.
•During the IVUS procedure, the ultrasound catheter is inserted into
an artery in your groin area and moved up to the heart.

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REFERENCES:
•Pharmacotheraphy,A pathophysiological approach;T.Dipiro;7th
Edition
•www.ucsfhealth.org/adult/adam/data/003876.html
•www.texasheart.org/HIC/Topics/Diag/diangio.cfm
•www.medterms.com
•www.heartsite.com/html/chemical_stress
•www.heartsite.com/html/chestradiography
•www.nlm.nih.gov/medlineplus/ency/article
The goal of cardiac testing is to help stratify patients thought to be
at risk for symptomatic coronary artery disease, specifically for
short-term complications such as myocardial infarction (MI) or
sudden cardiac death.
CONCLUSION:
THANK YOU……