CARDIAC DIAGNOSTIC TESTS : CARDIAC DIAGNOSTIC TESTS Suneesh Stephen OUTLINE : OUTLINE Introduction
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
Electrocardiograms (EKG) NON INVASIVE TESTS : NON INVASIVE TESTS Holter and Event (Loop) Monitoring
Exercise Stress Tests
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
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
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
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
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
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
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
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
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 ?
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?
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
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
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
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
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
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’