Ali shakhatreh MD

OUTLINE

IntroductionTypesNon Invasive Invasive

INTRODUCTIONCardiac diseases are complex in natureNew and advanced diagnostic tests and tools

are constantly being introduced Involves tests used both inside and outside of

bodyComprehensive in natureSimplified the diagnosis of complex cardiac

diseases

TYPES

NON INVASIVE TESTS

INVASIVE/INTERVENTIONAL TESTS

NON INVASIVE TESTS

Blood TestsCarotid & Extremity Vascular TestingCAT ScansEchocardiographyElectrocardiograms (EKG)

NON INVASIVE TESTS

Holter and Event (Loop) Monitoring Exercise Stress TestsMRIsNuclear Cardiology Tests

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

BLOOD TESTSComplete blood count Electrolyte panel Erythrocyte sedimentation rate (ESR)Cardiac enzyme tests Glucose test.

BLOOD TESTS

INR/prothrombin time tests Serum myoglobin test. Total serum protein

BLOOD TESTSBLOOD FAT PROFILE

Cholesterol HDL (good cholesterol)

LDL (bad cholesterol)

Triglycerides

BLOOD TESTSBLOOD FAT PROFILECholesterol

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 TESTSBLOOD FAT PROFILEHDL CholesterolLow 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 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 TESTSBLOOD FAT PROFILETriglycerides

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 TESTSELECTROLYTE PANEL

Measure the amount of potassium, sodium, chloride and magnesium.

In order to assess how well the heart and cardiovascular system are functioning.

BLOOD TESTSCARDIAC ENZYME TESTS

Creatine kinase-MB Lactate dehydrogenaseTroponin Myoglobin

Tests Normal values Begins rise peak Values

return Total CK 38–174 units/L for men

96–140 units/L for women within four to six hours 24 hours

within three to four days.

CK-MB: 10–13 units/L within three to four hours 10–24 hours two to four days.

Troponin T: less than0.4ng/mL. within two to four hours 10–24 hours within five to 14 days

Troponin I less than 0.4 ng/mL. within two to four hours 10–24 hours. within five to 14 days.

Myoglobin less than 110 ng/mL. within one to two hours four to eight hours

within 12–24 hours.

BLOOD TESTSINR/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

CAROTID & EXTREMITY VASCULAR TESTING

Carotid Ultrasound Lower Extremity Doppler Upper Extremity Doppler

Carotid Ultrasound

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.

Extremity Doppler

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

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

Helical CT

CAT SCANS

MultiSlice CT

CAT SCANSGenerally 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

A test that uses sound waves to create a moving picture of theheart. The picture is much more detailed than X-ray image and involves no radiation exposure. .

Provides information about the size and shape of the heart and how well the heart's chambers and valves are working

Echocardiography can detect possible blood clots inside the heart, fluid buildup in the sac around the heart (pericardium), and problems with the aorta

ECHOCARDIOGRAPHYTYPESColor-Flow Doppler EchocardiogramsStress Echocardiogram (exercise and

pharmacological)Transesophageal Echocardiogram

ECHOCARDIOGRAPHY

ELECTROCARDIOGRAMSPainless 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

ELECTROCARDIOGRAMSEXERCISE 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

TREADMILL

ELECTROCARDIOGRAMSEXERCISE TOLERANCE TESTIndications Coronary artery diseaseGauge 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.

ELECTROCARDIOGRAMSEXERCISE TOLERANCE TESTHooked 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.

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

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 MONITORINGUSESto 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

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

MAGNETIC RESONANCE IMAGING

MAGNETIC RESONANCE IMAGINGAn 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 IMAGINGWHY MRI ?Non invasiveProvides much greater contrast between the different soft

tissues of the body than CTconsidered generally safer than contrast-enhanced x-ray

tests in unstable patients.

MAGNETIC RESONANCE IMAGING

MAGNETIC RESONANCE IMAGINGANY 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 IMAGINGANY 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 IMAGINGANY 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

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 TESTTYPESMyocardial Perfusion Scans Pharmacologic Stress Tests Technetium-99m gated SPECT imaging Ventricular Function StudiesPeripheral Vascular Studies Tilt table testing

NUCLEAR CARDIOLOGY TESTMyocardial Perfusion Scans

NUCLEAR CARDIOLOGY TESTMYOCARDIAL PERFUSION SCANS

common test is done in two partsfirst 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 TESTMYOCARDIAL PERFUSION SCANS

NUCLEAR CARDIOLOGY TESTMYOCARDIAL PERFUSION SCANSUSES 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 TESTPHARMACOLOGIC STRESS TESTS

ThalliumDobutamine Persantine

INVASIVE TESTS

Cardiac CatheterizationCardiac BiopsyElectrophysiology Studies (cardiac mappingLower limb angiography

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 CATHETERIZATIONCharacteristics

Performed in cardiac laboratory and special examination table.

Local anesthesia is given ,and catheter is inserted into blood vessels.

CARDIAC CATHETERIZATIONSITES OF INSERTION

Groin Inner bend of the elbowWrist (palm side)Neck

CARDIAC CATHETERIZATION

CARDIAC CATHETERIZATIONGOALS

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 CATHETERIZATIONRISKS

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 BIOPSYINDICATIONS

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

ELECTROPHYSIOLOGY

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

ELECTROPHYSIOLOGYCardiac mapping

ELECTROPHYSIOLOGYIndicationsHeart 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

CONCLUSIONBlood 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.

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