CARDIAC DIAGNOSTIC TESTS

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It gives a detailed description about various cardiac diagnostic tests used in the current medical mileu especially in cardiology.

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CARDIAC DIAGNOSTIC TESTS : 

CARDIAC DIAGNOSTIC TESTS Suneesh Stephen

OUTLINE : 

OUTLINE Introduction Types Non Invasive Invasive Conclusion

INTRODUCTION : 

INTRODUCTION Cardiac diseases are complex in nature New and advanced diagnostic tests and tools are constantly being introduced Involves tests used both inside and outside of body Comprehensive in nature Simplified the diagnosis of complex cardiac diseases

TYPES : 

TYPES NON INVASIVE TESTS INVASIVE/INTERVENTIONAL TESTS

NON INVASIVE TESTS : 

NON INVASIVE TESTS Blood Tests Carotid & Extremity Vascular Testing CAT Scans Echocardiography Electrocardiograms (EKG)

NON INVASIVE TESTS : 

NON INVASIVE TESTS Holter and Event (Loop) Monitoring Exercise Stress Tests MRIs Nuclear Cardiology Tests VO2 Max Study

BLOOD TESTS : 

BLOOD TESTS Antistreptolysin-O test Arterial blood gases Blood fat profile Blood calcium test BNP blood test C-reactive protein test

BLOOD TESTS : 

BLOOD TESTS Carbon dioxide content. Complete blood count Electrolyte panel Erythrocyte sedimentation rate (ESR) Cardiac enzyme tests Glucose test.

BLOOD TESTS : 

BLOOD TESTS INR/prothrombin time tests Serum myoglobin test. Total serum protein Waste products test

BLOOD TESTS : 

BLOOD TESTS ANTISTREPTOLYSIN - O TEST Protein produced by streptococcal bacteria. In response to infection, the body produces streptolysin antibody. Antibodies for streptolysin, called antistreptolysin-O antibodies High levels indicate the presence of an infection like Endocarditis or rheumatic fever.

BLOOD TESTS : 

BLOOD TESTS BLOOD FAT PROFILE Cholesterol HDL (good cholesterol) LDL (bad cholesterol) Triglycerides

BLOOD TESTS : 

BLOOD TESTS BLOOD FAT PROFILE Cholesterol Desirable: Less than 200 mg/dL (5.18 mmol/L) Borderline high: 200-239 mg/dL (5.18 to 6.18 mmol/L) High: 240 mg/dL (6.22 mmol/L) or higher

BLOOD TESTS : 

BLOOD TESTS BLOOD FAT PROFILE HDL Cholesterol Low risk: Less than 40 mg/dL (1.0 mmol/L) for men and less than 50 mg/dL (1.3 mmol/L) for women Average risk: 40-50 mg/dL (1.0-1.3 mmol/L) for men and between 50-59 mg/dl (1.3-1.5 mmol/L) for women Less than average risk: 60 mg/dL (1.55 mmol/L) or higher for both men and women

BLOOD TESTS : 

BLOOD TESTS BLOOD FAT PROFILE LDL Cholesterol Optimal: Less than 100 mg/dL (2.59 mmol/L) Near/above optimal: 100-129 mg/dL (2.59-3.34 mmol/L) Borderline high: 130-159 mg/dL (3.37-4.12 mmol/L) High: 160-189 mg/dL (4.15-4.90 mmol/L) Very high: Greater than 190 mg/dL (4.90 mmol/L)

BLOOD TESTS : 

BLOOD TESTS BLOOD FAT PROFILE Triglycerides Desirable: Less than 150 mg/dL (1.70 mmol/L) Borderline high: 150-199 mg/dL(1.7-2.2 mmol/L) High: 200-499 mg/dL (2.3-5.6 mmol/L) Very high: Greater than 500 mg/dL (5.6 mmol/L)

BLOOD TESTS : 

BLOOD TESTS BNP BLOOD TEST Measures the level of hormone called B-type natriuretic peptide BNP rises in heart failure Find out how severe heart failure is.

BLOOD TESTS : 

BLOOD TESTS C-REACTIVE PROTEIN TEST An inflammatory marker. Provides information about a patient’s risk of having a Heart attack or Stroke. High levels of CRP in the blood mean there is inflammation somewhere in the body.

BLOOD TESTS : 

BLOOD TESTS CARBON DIOXIDE CONTENT Used as an investigative and diagnostic tool for patients with breathing problems

BLOOD TESTS : 

BLOOD TESTS COMPLETE BLOOD COUNT Information about the types of blood cells present Condition and number (percentage) in relation to other cells. An elevated WBC may indicate a heart attack or rheumatoid arthritis.

BLOOD TESTS : 

BLOOD TESTS ELECTROLYTE PANEL Measure the amount of potassium, sodium, chloride and carbon dioxide levels in the blood. In order to assess how well the heart and cardiovascular system are functioning.

BLOOD TESTS : 

BLOOD TESTS ERYTHROCYTE SEDIMENTATION RATE Measures the rate at which red blood cells separate from plasma. High levels may occur during a heart attack, rheumatic fever, giant cell arteritis, severe anemia, cancer relapse or other conditions. Low levels may be associated with heart failure, sickle cell anemia or other conditions.

BLOOD TESTS : 

BLOOD TESTS CARDIAC ENZYME TESTS Creatine kinase-MB Lactate dehydrogenase Troponin Myoglobin

BLOOD TESTS : 

BLOOD TESTS Creatine kinase-MB An elevation in value indicates myocardial damage. An elevation occurs within 4 to 6 hours and peaks 18 to 24 hours following an acute ischemic attack. Normal value is 0% to 5% of total; total CK is 26 to 174units/L.

BLOOD TESTS : 

BLOOD TESTS Lactate dehydrogenase Elevations in LDH levels occur 24hours following MI and peak in 48 to 72hours. Normally LDH 1 is lower than LDH 2. Normal value of LDH in conventional units is 140 to 280 international units/L.

BLOOD TESTS : 

BLOOD TESTS Troponin Composed of 3 proteins- troponin C, cardiac troponin I, and cardiac troponin T. Troponin I especially has a high affinity for myocardial injury. Rises within 3hours and persists for up to 7 days. Normal values are low, with troponin I being lower than 0.6ng/ml and troponin T normally ranging from 0 to 0.2ng/ml. Any rise can indicate myocardial cell damage.

BLOOD TESTS : 

BLOOD TESTS Myoglobin An oxygen-binding protien found in cardiac and skeletal muscle. Level rises within 1hour after cell death, peaks in 4 to 6 hours. Returns to normal within 24 to 36 hours.

BLOOD TESTS : 

BLOOD TESTS GLUCOSE TEST Diagnose or monitor patients with diabetes. Following a heart attack fasting glucose levels may be temporarily high.

BLOOD TESTS : 

BLOOD TESTS INR/PROTHROMBIN TIME TESTS Measures how long it takes blood to clot. People taking anticoagulants like warfarin may have this test done regularly. Normal Value-12–15 seconds /0.8–1.2

BLOOD TESTS : 

BLOOD TESTS TOTAL SERUM PROTEIN Blood contains large amounts of protein. Measurement gives information about a patient’s nutritional state and kidney and liver functions. Abnormal protein levels may indicate congestive heart failure, hypertension, or kidney or liver disease.

BLOOD TESTS : 

BLOOD TESTS WASTE PRODUCTS TEST Measure the levels of specific waste products in the blood. Includes blood urea nitrogen, creatinine and uric acid. Abnormal results could be a sign of heart failure, heart attack or kidney disease .

CAROTID & EXTREMITY VASCULAR TESTING : 

CAROTID & EXTREMITY VASCULAR TESTING Carotid Ultrasound Venous Duplex Lower Extremity Doppler Upper Extremity Doppler

Slide 33: 

Carotid Ultrasound

CAROTID & EXTREMITY VASCULAR TESTING : 

CAROTID & EXTREMITY VASCULAR TESTING Carotid Ultrasound Screening patients for carotid artery disease. Image and record the appearance of atherosclerotic plaque within the carotid arteries. Technology borrowed from submarine warfare The type and amount of blockage directly correlates with a patients risk of stroke. Determine which patients should, or should not undergo carotid endarterectomy.

Slide 35: 

Venous Duplex

CAROTID & EXTREMITY VASCULAR TESTING : 

CAROTID & EXTREMITY VASCULAR TESTING Venous Duplex Highly accurate ultrasound test that directly images the inside of veins. When a patient may have a blood clot in a vein- usually in the arms or legs Painless and can be completed in less than hour

Slide 37: 

Venous Duplex

Extremity Doppler : 

Extremity Doppler

CAROTID & EXTREMITY VASCULAR TESTING : 

CAROTID & EXTREMITY VASCULAR TESTING Extremity Doppler Uses a different variety of ultrasound and ultrasound equipment Assess the amount of circulation in the arms or legs. Does not image the inside of vessels Determine how much of the circulation is affected by the blockages Help to decide which patients might require some type of procedure to restore adequate blood flow.

Extremity Doppler : 

Extremity Doppler

CAT SCANS : 

CAT SCANS

CAT SCANS : 

CAT SCANS An imaging technique that produces detailed, cross-sectional pictures ("slices") of internal organs and body parts. Uses multiple x-ray images, taken from different angles, to create three-dimensional images of body structures

CAT SCANS : 

CAT SCANS

CAT SCANS : 

CAT SCANS Helical CAT scan, which uses special slip-ring technology to create a continuously moving x-ray tube. Multislice CAT scan, which creates up to 64 images and allows physicians to look more closely at intricate heart structures.

CAT SCANS : 

CAT SCANS Helical CT

CAT SCANS : 

CAT SCANS MultiSlice CT

CAT SCANS : 

CAT SCANS Generally advised not to eat or drink for four to six hours before the test ,if the test requires an injection of a special dye or a sedative. A CAT scan may take less than one minute.

ECHOCARDIOGRAPHY : 

ECHOCARDIOGRAPHY Echocardiography uses the technology to bounce sound waves off the heart's chambers and valves, creating still and moving images of the heart.

ECHOCARDIOGRAPHY : 

ECHOCARDIOGRAPHY

ECHOCARDIOGRAPHY : 

ECHOCARDIOGRAPHY TYPES Color-Flow Doppler Echocardiograms Signal averaged ECG Stress Echocardiogram (exercise and pharmacological) Transesophageal Echocardiogram

ELECTROCARDIOGRAMS : 

ELECTROCARDIOGRAMS Painless test in which electrodes are put on the chest, arms and legs to monitor and record the heart’s electrical activity. The record appears as a graph or series of wave lines on a monitor or a long strip of paper. An EKG gives information about the heart’s rate and rhythm. Suggest the presence of a past or current heart attack.

ELECTROCARDIOGRAMS : 

ELECTROCARDIOGRAMS

ELECTROCARDIOGRAMS : 

ELECTROCARDIOGRAMS

ELECTROCARDIOGRAMS : 

ELECTROCARDIOGRAMS A signal averaged EKG Uses a computer to amplify and enhance very small electrical impulses in the heart Helps cardiologists predict who may suffer dangerous ventricular (lower chamber) arrhythmias.

ELECTROCARDIOGRAMS : 

ELECTROCARDIOGRAMS A signal averaged EKG

ELECTROCARDIOGRAMS : 

ELECTROCARDIOGRAMS A signal averaged EKG

ELECTROCARDIOGRAMS : 

ELECTROCARDIOGRAMS EXERCISE TOLERANCE TEST An EKG done while you are exercising on a treadmill or stationary bicycle. Results are compared with those from when you’re at rest. To show how your heart reacts to exercise and exertion.

ELECTROCARDIOGRAMS : 

ELECTROCARDIOGRAMS TREADMILL

ELECTROCARDIOGRAMS : 

ELECTROCARDIOGRAMS EXERCISE TOLERANCE TEST Indications Coronary artery disease Gauge exercise capacity in heart failure patients To diagnose heart-related causes of symptoms such as chest pain, shortness of breath or lightheadedness. Predict risk of dangerous heart-related conditions such as a heart attack.

ELECTROCARDIOGRAMS : 

ELECTROCARDIOGRAMS EXERCISE TOLERANCE TEST Hooked up to equipment to monitor the heart. Walks slowly in place on a treadmill. Then the speed is increased for a faster pace and the treadmill is tilted to produce the effect of going up a small hill. May be asked to breathe into a tube for a couple of minutes. Can stop the test at any time if needed. Afterwards will sit or lie down to have their heart and blood pressure checked

HOLTER MONITORING : 

HOLTER MONITORING

HOLTER MONITORING : 

HOLTER MONITORING Also known as continuous EKG or Ambulatory EKG monitoring. Wearing a small, portable, battery operated EKG recorder, called a Holter monitor. Monitors the electrical activity of an ambulatory patient’s heart while the person goes about daily activities Records continuous EKG information, for one to five days, on a tape. This recorded data is then analyzed by doctors.

HOLTER MONITORING : 

HOLTER MONITORING

HOLTER MONITORING : 

HOLTER MONITORING USES to detect abnormal heart rhythms (arrhythmias) as well as cardiac ischemia  to detect transient and short cardiac arrhythmias that might not be present during in-office EKG monitoring. to monitor pacemakers or evaluate how well medications are working especially antiarrhythmics

Slide 65: 

Diagnose and treat premature ventricular contractions,or PVCs Design effective antiarrhythmic treatment programs, usually using various antiarrhythmic medications. Monitor existing pacemakers, diagnose a lack of oxygen-rich blood flowing to the heart (cardiac ischemia) and measuring variability in the heart rate. Commonly using in heart attack and cardio myopathy patients HOLTER MONITORING

EVENT (LOOP) MONITORING : 

EVENT (LOOP) MONITORING

EVENT (LOOP) MONITORING : 

EVENT (LOOP) MONITORING Wearing a very small, portable, EKG recorder for months An event monitor is activated when patient have "an event," that is, when he feels the symptoms of heart problem (an arrhythmia, for example ) Several types of event recorders, from wristwatch size devices to those that can be implanted for up to 18 months.

Why these are known as transtelephonic pace makers….??? : 

Why these are known as transtelephonic pace makers….??? In recent years, technology has advanced and, in some cases, the devices are capable of transmitting their results over a telephone to the physician's office. Once transmitted, the results can be printed out as a standard EKG and interpreted.

MAGNETIC RESONANCE IMAGING : 

MAGNETIC RESONANCE IMAGING

MAGNETIC RESONANCE IMAGING : 

MAGNETIC RESONANCE IMAGING An imaging technique that produces detailed, accurate, cross-sectional pictures ("slices") of internal organs and body parts . But it doesn’t use ionizing radiation and has no known biological risks.

MAGNETIC RESONANCE IMAGING : 

MAGNETIC RESONANCE IMAGING WHY MRI ? Non invasive Provides much greater contrast between the different soft tissues of the body than CT considered generally safer than contrast-enhanced x-ray tests in unstable patients.

MAGNETIC RESONANCE IMAGING : 

MAGNETIC RESONANCE IMAGING

MAGNETIC RESONANCE IMAGING : 

MAGNETIC RESONANCE IMAGING ANY USE IN CARDIOLOGY? Aortic disease Blockages within the coronary arteries (which supply oxygen-rich blood to the heart) A weakened heart muscle (cardiomyopathy)

MAGNETIC RESONANCE IMAGING : 

MAGNETIC RESONANCE IMAGING ANY USE IN CARDIOLOGY? The severity of a heart attack Heart valve disease Disease in the arteries outside the heart, or peripheral arterial disease Heart defects present at birth (congenital)

MAGNETIC RESONANCE IMAGING : 

MAGNETIC RESONANCE IMAGING ANY USE IN CARDIOLOGY? To assess patients’ progress after a heart attack To evaluate blockages in the coronary arteries (which could rupture and cause a heart attack) To detect an atrial myxoma (heart tumor)

NUCLEAR CARDIOLOGY TEST : 

NUCLEAR CARDIOLOGY TEST Produce images of the heart at work (during exercise) and at rest. Reveal problems in heart muscle and blood vessels, especially when the images of the heart at work and at rest are compared.

NUCLEAR CARDIOLOGY TEST : 

NUCLEAR CARDIOLOGY TEST TYPES Myocardial Perfusion Scans Pharmacologic Stress Tests Technetium-99m gated SPECT imaging Ventricular Function Studies Peripheral Vascular Studies Tilt table testing

NUCLEAR CARDIOLOGY TEST : 

Myocardial Perfusion Scans NUCLEAR CARDIOLOGY TEST

NUCLEAR CARDIOLOGY TEST : 

NUCLEAR CARDIOLOGY TEST MYOCARDIAL PERFUSION SCANS common test is done in two parts first part shows the heart during normal functioning, called "rest.“ During the second part, called "stress," the coronary arteries are dilated through exercise. You may walk on a treadmill or ride a stationary bicycle.

NUCLEAR CARDIOLOGY TEST : 

NUCLEAR CARDIOLOGY TEST MYOCARDIAL PERFUSION SCANS

NUCLEAR CARDIOLOGY TEST : 

NUCLEAR CARDIOLOGY TEST MYOCARDIAL PERFUSION SCANS USES Identify areas of the heart muscle that have an inadequate blood supply Quantify the extent of the heart muscle with a limited blood flow Provide information about the heart’s pumping function Ascertain the amount of scarring from a heart attack Evaluate the success of coronary bypass surgery or angioplasty

NUCLEAR CARDIOLOGY TEST : 

NUCLEAR CARDIOLOGY TEST PHARMACOLOGIC STRESS TESTS Thallium Dobutamine Persantine

NUCLEAR CARDIOLOGY TEST : 

NUCLEAR CARDIOLOGY TEST VENTRICULAR FUNCTION STUDIES Two types of tests MUGA (Multi-Gated Acquisition) study (also known as Equilibrium Gated Blood Pool Study Angiography First Pass Study

NUCLEAR CARDIOLOGY TEST : 

NUCLEAR CARDIOLOGY TEST VENTRICULAR FUNCTION STUDIES USES Visualize the integrity of the cardiac chambers and valves Monitor the effect of different drugs on the heart muscle (such as chemotherapy drugs)

VO2 MAX STUDY : 

VO2 MAX STUDY Metabolic study Measures how effectively the body uses oxygen Determine whether symptoms are respiratory or cardiac in origin Help to set appropriate limits for exercise programs.

INVASIVE TESTS : 

INVASIVE TESTS Cardiac Catheterization Cardiac Biopsy Electrophysiology Studies (cardiac mapping

CARDIAC CATHETERIZATION : 

CARDIAC CATHETERIZATION

CARDIAC CATHETERIZATION : 

CARDIAC CATHETERIZATION Test in which catheters (hollow tubes) are placed into the heart in order to evaluate the anatomy and function of the heart and surrounding blood vessel.

CARDIAC CATHETERIZATION : 

Characteristics Performed in cardiac laboratory and special examination table. Local anesthesia is given ,and catheter is inserted into blood vessels. CARDIAC CATHETERIZATION

CARDIAC CATHETERIZATION : 

SITES OF INSERTION Groin Inner bend of the elbow Wrist (palm side) Neck CARDIAC CATHETERIZATION

CARDIAC CATHETERIZATION : 

CARDIAC CATHETERIZATION

CARDIAC CATHETERIZATION : 

GOALS Confirm the presence of a suspected heart ailment eg.stenosis,congenital heart failure etc. Quantify the severity of the disease and its effect on the heart Seek out the cause of a symptom such as shortness of breath or signs of cardiac insufficiency Make a patient assessment prior to heart surgery. CARDIAC CATHETERIZATION

CARDIAC CATHETERIZATION : 

CARDIAC CATHETERIZATION RISKS Minor bleeding at the site of catheter insertion. Temporary heart rhythm disturbances caused by the catheter irritating the heart muscle. Temporary changes in the blood pressure. Cardiac tamponade, sudden blockage of a coronary artery. Stroke .

CARDIAC BIOPSY : 

A cardiac biopsy is a procedure to take samples of heart tissue for evaluation. It is a outpatient procedure. CARDIAC BIOPSY

CARDIAC BIOPSY : 

CARDIAC BIOPSY

CARDIAC BIOPSY : 

INDICATIONS After a heart transplant, to check for rejection of your new heart. If a patient has a cardio-myopathy,it is done to find the cause CARDIAC BIOPSY

ELECTROPHYSIOLOGY : 

ELECTROPHYSIOLOGY The term “electrophysiology study” or “EP study” applies to any procedure that requires the insertion of an electrode catheter into the heart .

ELECTROPHYSIOLOGY : 

ELECTROPHYSIOLOGY Cardiac mapping

ELECTROPHYSIOLOGY : 

ELECTROPHYSIOLOGY Indications Heart rhythm disorders. Patient at a risk of sudden cardiac death. Evaluate the effectiveness of certain medications. Predict the risk of a future cardiac event. Assess the need for an implantable device (pacemakers) or treatment procedures

CONCLUSION : 

CONCLUSION Blood Chemistry and Physiology provides vital clues regarding actual or potential cardiac problems. Scans,USGs and MRIs are painless in nature. ECG provides clues regarding rhythm and pattern of heart beat. Cardiac Catherisation can be both diagnostic as well as therapeutic in nature. Electophysiology helps to predict the future events.

’DANKE SCHÖN’ : 

’DANKE SCHÖN’