Concept of cardiac function test

1. CARDIAC FUNCTION TESTS
CLINICAL PHARMACY
By- Ranjeet Kumar
(Pharmacy Practice)

3. Circulates blood
through the
body to meet the
nutritive
requirements.
Circulation
Short circuit starts from
right ventricle & carries
impure blood to the
lungs for purification.
Again the oxygenated
blood goes to the left
atrium.
FUNCTIONS OF HEART

4. Circulates blood
through the body
to meet the
nutritive
requirements
Pumped from the left
ventricle through blood
vessel & reaches the
tissue
Exchange of various
substances between
blood & tissue.
Then enters to the
venous system &returns
to the right atrium .
Systemic Circulation

5. WHY CARDIAC FUNCTION TEST ?
For the understanding of the disease , injury ,
and congenital or acquired abnormalities of
the heart.

6. CARDIAC FUNCTION TEST
Non Invasive
Process
Chest X
Ray
Echocardi
ography
MRI
Scans
ECG
Invasive
Process
High Speed
Computed axial
Tomography

7. CHEST X – RAYS
• It is used for the diagnosis of the heart enlargement and about its size
& shape.
• It is a second routine test often used initially after the medical history
& physical examination .
• There are no risks involved in X- rays ; they are painless, fast &
relatively inexpensive.
• Can be done when a person’s symptoms include a persistent cough,
coughing up blood, chest pain, chest injury, or difficulty in breathing.
• The main advantages of this is differentiating primary lung diseases
from heart diseases & provides a clear view of anatomical
abnormalities .

9. ELECTROCARDIOGRAPHY
(EKG/ ECG)
• This test records the electrical activity of the heart .
• Detects abnormal cardiac rhythm(arrhythmias) & myocardium
damage (heart muscle damage).
• Graphical record of electrical changes occurring during the
cardiac cycle of the heart is known as ECG / EKG .
• Is the simplest and most used routine test.
• Risks associated with this procedure are minimal & rare.
• This is preferred procedure for valvular dysfunction, wall motion
& congenital abnormalities .

11. EKG /ECG PROCEDURE
• In this procedure , patients lays still on bed.
• Small pads are placed on arms, legs & chest to help
with the conduction of electrical impulses.
• Several electrodes are attached to the small pads.
• The electrodes are hooked to the machine which traces
the patient’s heart activity onto a paper.
• Any deviation towards the lower side & upper side
indicates the abnormal function of the heart.

12. EKG / ECG RESULTS
NORMAL ABNORMAL
The heart beats in a normal rhythm
for usually 60 and 100 beats
/minute.
The heart beat is too slow ( less
than 60 / minute)
The heart beat is too fast (> than
100 beats /minute)
The heart rhythm is regular. The heart rhythm is not regular.
The tracing looks normal. The tracing does not look normal.

13. WHY ECG/EKG ?
• To look for the cause of chest pain.
• To evaluate problems which may be heart-related, such as severe
tiredness, shortness of breath, dizziness/ fainting .
• To identify irregular heartbeats.
• To help determine the overall health of the heart prior to
procedures such as surgery, &/ or after treatment for conditions
such as a heart attack (myocardial infarction/ MI), endocarditis(
inflammation / infection of one /more of the heart valves ;&/ after
heart surgery / cardiac catheterization.
• To see how an implanted pacemaker is working.
• To determine how well certain heart medications are working.

14. FACTORS AFFECTING RESULTS
OF EKG/ECG
• Obesity
• Pregnancy
• Ascites(fluid build-up in the abdomen (belly)
• Anatomical considerations
• Movement during the procedure
• Exercise /smoking prior to the procedure
• Certain medications
• Electrolyte imbalances, such as too much/ too little K+ , Mg2+
,& Ca2+ in the blood.

15. MRI SCANS
• This procedure uses a combination of large magnets,
radiofrequencies & a computer to make detailed images of
organs & structures in your body.
• Provides detailed picture of heart & blood vessels.
• Used to evaluate the heart valves & major vessels, detect
coronary artery diseases & the extent of damage it has
caused, evaluate congenital defects,& detect the presence of
tumors or other abnormalities.

16. ECHOCARDIOGRAPHY
• An Echocardiography is a test that uses high frequency sound
waves (ultrasound) to make pictures /images of heart.
• This test is also known as echocardiogram /diagnostic cardiac
ultrasound.
• Can evaluate the structures of the heart, as well as the direction of
blood flow within it.
• Produces the images & videos , often using a special probe /
transducer that is placed in various places on the chest wall, to
view heart from different directions.
• It is the most common heart tracing done.

18. TYPES OF ECHOCARDIOGRAPHY
• Transthoracic Echocardiography
• Transesophageal Echocardiography
• Doppler Echocardiography
• Stress Echocardiography
• M- mode Echocardiography
• Color Doppler
• 2-D Echocardiography
• 3-D Echocardiography

19. WHAT IS AN ECHO USED TO DIAGNOSE ?
• Regarding structure, the test can assess the general size of the
heart, the size of the four heart chambers, and the appearance
and function of the four heart valves.
• It can look at the two septa of the heart; the atrial septum
separates the right and left atrium and the ventricular septum
separates the right and left ventricles.
• It can also assess the pericardium (the sac that lines the
heart) and the aorta.

20. • Regarding function, the echocardiogram can determine how the heart
valves open and close.
• It can evaluate whether the heart muscle squeezes appropriately and
how efficiently.
• Cardiac output measures how much blood the heart pumps.
• Ejection fraction measures what percent of blood within the heart is
pumped out to the body with each heartbeat.
• It can also measure how well the heart relaxes in between beats,
when the heart fills for the next pump.
• Some heart issues that the echocardiogram can help evaluate include
the following:
• Heart valve disorders: Stenosis (narrowed), insufficiency or
regurgitation (leaking), and endocarditis (infection of the valves)

21. • Abnormalities of the septum: Atrial septal defect, ventricular
septal defect, and patent foramen ovale
• Wall motion abnormalities: Cardiomyopathy, atherosclerotic
heart disease (also known as coronary artery disease), and
trauma
• Diseases of the pericardium (the sac that lines the heart): This
includes pericardial effusion (assessment of fluid in the
pericardial sac)

22. CARDIAC CATHETERIZATION
• It is also called as coronary angiogram .
• It is an invasive procedure.
• Checks the blood flow in the coronary arteries , blood
flow , and blood pressure in the chambers of the heart.

24. PROCEDURE
• For this test, doctor guides a small catheter (hollow tube)
through the large artery in your upper leg, or sometimes your
wrist or arm, into your heart.
• Dye is given through the catheter, and moving X-ray pictures
are made as the dye travels through your heart.
• This comprehensive test shows: narrowing in the arteries,
heart chamber size, how well your heart pumps, and how well
the valves open and close, as well as a measurement of the
pressures within the heart chambers and arteries.

25. HIGH SPEED COMPUTED AXIAL
TOMOGRAPHY
• By this test , we can detect cardiac function and
cardiac structure .
• Provides precise visualization of cardiac structure
from the inner endocardial wall to surface of the
pericardium .

26. CARDIAC ENZYME TESTS
• CREATININE KINASE
• Creatinine phosphokinase isoenzymes play a key role in the
intracellular energy transport fro mitochondria to myofibrils and
other sites of energy utilization
• CK – CK-MB , CK-MM, CK-BB
• CK-MB is the substance that rises if the heart muscle is damaged
• CPK-MB mostly found in the heart .
• Normal Range : 5- 25 IU/L

27. • CARDIAC TROPONIN
• Are of two types :
• Troponin T and Troponin I
• These protein controls the interactions of two other substances
(actin and myosin ) that causes the heart muscle to contract or
squeeze.
• Normal levels in the blood are very low. But they rise sharply and
quickly in response to a heart muscle injury , usually within 2 or
3 hrs. after the beginning of the heart attack.
• It will also rise in response to angina .