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Cardiac daignostic test

  1. 1. CARDIAC DIAGNOSTIC TESTS Prof.MahendraLamba SandraShroffROFELcollegeof Nursing,VAPI
  2. 2. Introduction • Diagnostic investigations are methods of identifying heart conditions associated with unhealthy, pathologic, heart function.
  3. 3. Types • Invasive • Non invasive ▫ Electrocardiography ▫ Echocardiography/Ultraso und ▫ Cardiac Angiography ▫ Intravascular Ultrasound ▫ Nuclear Heart Scan ▫ Chest X Ray ▫ Sphygmomanometer ▫ CT Scan ▫ MRI
  4. 4. Electrocardiography • The recording produced by this procedure is termed an electrocardiogram (ECG) from the German Elektrokardiogramm). Electrocardiography (ECG) is a transthoracic interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body(electrocardiograph).
  5. 5. • The ECG device detects and amplifies the tiny electrical changes on the skin that are caused when the heart muscle depolarizes [ contracts ]during each heartbeat. • This depolarization is detected as tiny rises and falls in the voltage between two electrodes placed on either side of the heart which is displayed as a wavy line either on a screen or on paper.
  6. 6. Procedure • Patient lies down on his back. • Several areas on skin of arms, legs, and chest are cleaned and shaved, and small patches i.e electrodes are attached to these areas. • The patches are connected by wires to the ECG machine • The heart's electrical signals are printed into wavy lines on paper. • Variations in size and length of the different parts of the tracing may indicate a problem in the part of the heart associated with that particular lead.
  7. 7. Devices: Holter monitor, Event monitor, 12 lead electrocardiograph
  8. 8. Cardiac Stress Test
  9. 9. Normal waves
  10. 10. Feature Description Cause P wave Impulse travels from Atrial depolarization the SA node towards [contraction] the AV node, and spreads from the right atrium to the left atrium QRS complex From beginning of Q wave to end of S wave Ventricular depolarization T wave Relaxation of ventricles Ventricular repolarization
  11. 11. Featur es Descirption Cause PR interval Onset of P wave to onset of Q wave Atrial depolarization and conduction through AV node QT interval Onset of Q wave and end of T wave Electrical activity in ventricles [ depolarization and repolarization] ST segment End Of S wave and onset of T wave Ventricles already depolarized
  12. 12. Indications: To measure: • Any damage to the heart • Heart disease • The effects of drugs[Digitalis] or devices (pacemaker) used to control the heart • The size and position of the heart chambers • Heart rate • Heart rhythm Symptoms like: • Cardiac murmurs • Syncope or collapse • Seizures • Perceived cardiac dysrhythmias • Angina, palpitations, breathlessness.
  13. 13. Abnormal ECG Helpful in diagnosing: • Arrhythmias ▫ Myocardial infarction • Hypertrophy of heart chambers • Coronary Artery Disease • Congenital heart disease • Cardiac Ischemia • Stable and Unstable Angina • Infective endocarditis • Valvular heart disease. ▫ Mitral regurgitation Mitral stenosis ▫ Mitral valve prolapse ▫ Aortic stenosis ▫ Aortic insufficiency ▫ Pulmonary valve stenosis ▫ Tricuspid regurgitation Pericarditis • Aortic dissection • Coarctation of the aorta • Cardiac failure • Hypertensive heart disease • Cardiomyopathy-hypertrophic /alcoholic/dilated/idiopathic/ peripartum • Cardiac Tamponade • Atrial Myxoma • Myocarditis • Primary amyloidosis • Stroke • Myocardial Infarction
  14. 14. Echocardiography • It is the diagnostic procedure which uses ultrasound to produce 2D 0r 3D image slices of the heart muscle. • It determines size, shape, movement of valves and heart chambers and flow of blood through the heart.
  15. 15. • A transducer containing crystals converts electrical energy into an ultrasound beam. • This beam is directed towards heart. • The beam is reflected when it strikes the surface between tissues of different densities. • Reflected ultrasound/echo is converted to electrical energy which constructs image based on ▫ Intensity of echos ▫ Time taken for echoes to return
  16. 16. Procedure • Trans-thoracic echocardiogram(TTE): ▫ Echocardiogram of the heart through the thorax external to the body. ▫ Non-invasive, painless, highly accurate and quick.
  17. 17. • Trans-esophageal echocardiogram(TEE) ▫ Echocardiogram of the heart through a catheter placed in the esophagus which is attached to an ultrasound transducer.
  18. 18. ▫ Invasive and must be performed under supervision. • Doppler echocardiography: ▫ Assessment of Cardiac valve areas and function Abnormal communications between the left and right side of the heart Valvular regurgitation Calculation of the cardiac output and ejection fraction. Heart valve defect
  19. 19. Indications Assessment of ▫ Pericardial effusion ▫ Congenital Heart Defects ▫ Valvular heart diseases ▫ Myocardial Infarction ▫ High blood pressure/ Hypertensive heart disease ▫ Hypertrophic cardiomyopathy ▫ Intracardiac tumors and blood clots ▫ Aortic regurgitation/stenosis/aneurysm and dissection ▫ Calcification of valves ▫ Rheumatic mitral valve disease ▫ Cardiac failure VSD
  20. 20. Advantages • No known risks or side effects. • No radiation involved. • Both 2D and 3D images can be viewed.
  21. 21. Cardiac Angiography • Cardiac Angiography or arteriography is a medical imaging technique used to visualize the lumen of the blood vessels [ arteries, veins] and the heart chambers. • This is traditionally done by inserting a catheter followed by injecting a radio-opaque contrast agent[dye which absorbs the x-rays] into the blood vessel and imaging using a camera and X-ray based techniques.
  22. 22. Procedure • Cardiac Catheterization + X ray fluoroscopy • Patient lies on his back on the X-ray table. • A round cylinder or rectangular box that takes the pictures during fluoroscopy will be moved under the patient during the test. • The place where the catheter is inserted is shaved and cleaned. • The doctor numbs the area with a local anesthetic.
  23. 23. • A needle is put into the femoral artery /vein [near groin] or brachial artery/vein[above elbow]. • A guide wire is put through the needle into the blood vessel and the needle is removed. • The thin flexible catheter is placed over the guide wire and moved into the blood vessel. • The catheter is then guided through the blood vessels until it reaches the area to be studied [aorta, coronary arteries, left ventricle and atrium and inferior vena cava , right atrium and ventricles, pulmonary artery etc
  24. 24. • The fluoroscope is used to watch the movement of the catheter in the blood vessels. • When the catheter is in place, Iodine dye is injected through it. • Several X-ray pictures are taken one after another which may either be still images, displayed on a image intensifier or film, or motion images stored digitally on computer. • Duration: 1-3 hrs • The catheter is taken out after the angiogram, and pressure is put on the needle site for 10 to 15 minutes to stop any bleeding.
  25. 25. Side effects: ▫ A tear in a blood vessel (which can cause blockage or internal bleeding) ▫ Haemorrhages ▫ Aneurysms ▫ Stenosis ▫ Pattern of blood flow to a tumor. ▫ Abnormal position of blood vessels ▫ Abnormal branching of blood vessels since birth ▫ Changes in the blood vessels of injured heart. • Presence or absence of atherosclerosis within the walls of the arteries cannot be clearly determined.
  26. 26. Intravascular Ultrasound • Principle: ▫ Coronary catheterization+ Ultrasound • Ultrasound transducer attached at the tip of catheter guided through coronary arteries from femoral/brachial artery. • Proximal end of catheter attached to ultrasound equipment • Evaluates ▫ Coronary plaques—structure and composition [not seen in angiography] ▫ Wall of blood vessel ▫ Connective tissue surrounding vessel
  27. 27. Nuclear Heart Scan • A nuclear heart scan is a type of medical test where a safe, radioactive material called a tracer is injected through a vein into the bloodstream. • The tracer travels to the heart and releases energy, which special cameras outside of the body detect to create pictures of different parts of the heart. • Using computer, the images are made to appear structure of heart.
  28. 28. Procedure Pretest • The radioactive tracer is injected into the bloodstream through the intravenous line. • ECG are attached to the body to check the heart's electrical activity during the test. • An exercise stress test maybe done as a part of nuclear heart scan • If Patient is unable to exercise, medicine is used to make the heart beat faster. This is called a chemical stress test.
  29. 29. • Before the exercise or the chemical stress test stops, the tracer is again injected through the IV line. • The patient then lies very still on a table. • The nuclear heart scan camera, called a gamma camera, which is put in several positions around the body. • The computer collects the pictures of the heart nearby or in another room. • Two sets of pictures is taken. One is taken right after exercise /chemical stress test and the other is taken after a period of rest. • Each set of pictures takes about 15 to 30 minutes.
  30. 30. Types Two main types: • Single positron emission computed tomography (SPECT) • Cardiac positron emission tomography (PET)
  31. 31. Uses Detects : • The flow of blood throughout the heart muscle --myocardial perfusion scanning. • To look for damaged heart muscle due to a previous heart attack, injury, infection, or medicine---myocardial viability testing. • Pumping action of heart to the body-- ventricular function scanning.
  32. 32. Uses Also evaluates: ▫ Coronary Artery Disease ▫ Heart valve diseases ▫ Past heart attack (myocardial infarction) ▫ Poor pumping function and heart failure • Decides whether coronary angiography or cardiac catheterization will be helpful. • Decides whether angioplasty or coronary artery bypass grafting (CABG) will be needed • Monitors procedures or surgeries, such as CABG or a heart transplant
  33. 33. Indications Conditions under which the test may be performed: ▫ Atrial septal defect ▫ cardiomyopathy ▫ Heart failure
  34. 34. Chest X ray A chest X-ray uses a very small amount of radiation to produce an image of the heart, lungs, and chest bones on film.
  35. 35. Procedure • Patient has to remove all clothes and metallic jewelry from the waist up and put on a hospital gown for the test. • Patient then stands very still with his chest against the cassette that contains the film. • The X-ray machine sends a beam of ionizing radiation through an X-ray tube. • This energy passes through the chest and is absorbed on film to create a picture. • Bones and other dense areas show up as lighter shades of gray • Areas that don't absorb the radiation appear as dark gray. • The entire test takes no more than 10 to 15 minutes.
  36. 36. Views PA or postero-anterior view: • Patient stands with his chest against the container of the film • The X-ray beam from the machine comes from the posterior/back and moves through the chest to the anterior/front. Lateral view: • Patient stands sideways in front of the film with arms raised up. • The X rays penetrate the chest from the sides.
  37. 37. Uses • Helps to diagnose heart diseases such as ▫ Cardiomegaly ▫ Aneurysm of aorta ▫ Acute Myocardial Infarction ▫ Heart failure ▫ Pericardial effusion with Tamponade • Evaluates placement of devices (pacemakers, defibrillators) or catheters, chest tubes placed during hospitalization.
  38. 38. Cardiomegaly Heart failure
  39. 39. Cardiac CT Scan (CCT) • Computerised Tomography (CT) is a medical imaging method employing tomography, created by computer processing. • Tomography refers to imaging by sections or sectioning, through the use of any kind of penetrating wave [radiation]. • A three-dimensional image of the inside of the heart is generated from a large series of two-dimensional X-ray picture taken around a single axis of rotation. • In simpler terms, it is an imaging method that uses x-rays to create cross-sectional pictures of the heart.
  40. 40. Procedure • The patient will be asked to lie on a narrow table that slides into the center of the CT scanner. • Once he is inside the scanner, the machine's x-ray beam rotates around him. • A computer creates separate images of the body area, called slices. • Three-dimensional models of the body area can be created by stacking the slices together. • Sometimes an iodine-based dye (contrast dye) is injected intravenously during the scan. The contrast dye travels through the blood vessels, which helps highlight them on the x-ray pictures.
  41. 41. • These images can be stored/ viewed on a monitor, or printed on film. • Patient must be still during the exam, because movement causes blurred images.
  42. 42. Uses: Helps in evaluating: • Calcium buildup in the walls of the coronary arteries- coronary calcium scan • Coronary Artery Disease • Problems with heart function and heart valves. • Aneurysm and Dissection of Aorta • Atrial Fibrillation • Pericardial Disease • Wall motion and Ejection fraction • Cardiac masses and post- operative abnormalities • Congenital Heart Diseases
  43. 43. Indications: If Patient is Asymptomatic • Family history of coronary artery disease • Persistent high triglyceride levels • Other high risk factors such as smoking, diabetes, etc. • ECG abnormalities • Abnormalities on a routine stress test • Moderate to severe hypertension
  44. 44. Indications If Patient is Symptomatic : • Atypical chest pain (right side, shoulder tip, etc.) • Suspected dilated cardiomyopathy • Coronary arteries disease and aneurysms Other: • Post-bypass: assessing the status of bypass grafts. • Post-stent: for assessing in-stent lumen. • Tumors and cardiac neoplasms
  45. 45. Cardiac Magnetic Resonance Imaging • Cardiovascular magnetic resonance imaging (CMR) / cardiac MRI, is a medical imaging technology that uses powerful magnets and radio waves to create pictures of the body. • Single MRI images produced are called slices. • One exam produces dozens or sometimes hundreds of images which can be combined to produce 3D models. • The images can be stored on a computer or printed on film.
  46. 46. Principle • The single proton of the nucleus of a hydrogen atom vibrates , or "resonates," when exposed to bursts of magnetic energy. • When many hydrogen nuclei resonate in response to changes in a magnetic field, they emit radiofrequency energy. • The MRI machine detects this emitted energy, and converts it to an image. • Hydrogen nuclei are used because hydrogen atoms are present in water molecules (H2O), and therefore are present in every tissue in the body. • Differences in the hydrogen atoms between various parts of a tissue - emit different amounts of energy. • These energy differences show up as different shades of gray on the MRI which is helpful in detecting areas of cardiac tissue that have poor blood flow (coronary artery disease) or that has been damaged (heart attack).
  47. 47. Procedure • Patient is asked to wear a hospital gown or clothing without metal items or ornaments • Patient will lie on a narrow table, which slides into a large tunnel-shaped scanner. • Sometimes a dye is usually injected before the test intravenously in the hand or forearm to see images more clearly • During the MRI, the person who operates the machine will watch you from another room. • An intercom in the room allows patient to speak to the monitoring person at any time. • The test most often lasts 30-60 minutes, but may take longer.
  48. 48. Closed MRI Open MRI
  49. 49. Uses • Helps in visualising ▫ Heart muscle scar or fat without using a contrast agent ▫ Heart function ▫ Infarct imaging using contrast ▫ Perfusion defects ▫ Congenital Heart Defects ▫ Aortic Dissection ▫ Cardiac tumor ▫ Cardiomyopathies ▫ Thrombus ▫ Pericarditis ▫ Stenosis of valves
  50. 50. ▫ Assessing Volume of blood flow and Ejection fraction Damage caused by Heart attack Heart Failure Coronary Artery Disease ▫ Distinguishing between "stable atherosclerotic plaques and "vulnerable" plaques. ▫ Visualising blood vessels and the flow of blood.
  51. 51. Advantages • Safe, non-invasive test • MRI uses radio waves, without ionizing radiation or X rays • Unlike CT does not carry any risk of causing cancer. • The images generated remarkably complete, detailed and precise • MRI has the potential of replacing other cardiac tests like: ▫ Echocardiogram, ▫ Thallium scan ▫ Diagnostic cardiac catheterization.