Spect

Thallum and technetium are similar to potassium

Cells absorb them

Halflife of a few hours

Radionuclei ventriculography / lv wall studies

Image the motion of the left ventricle

To determine areas of the ventricle that are not contracting properly

Analyze the....

Echocardiography

Trans thoracic 2d, 3d

The us device is placed on top of the chest

1st us test that was done

2d - limited to 30 degrees

3d - 1980's

Trying to image the coronary arteries

You get a long axis view - imaging the heart diagonally

Imagi g the rv, lv, some portions of the aorta

You can see the heart beating (contraction of ventricles)

When you rotate the transuceer to 90 degrees - you get a short acid view of the hesrt

Rv, chamber, septum, postrior wall of the left ventricle

Lateral wall

Analyze wall motion - seprum, posterior wall, lateral wall

Calculate ejection fraction - amount of blood ejected from the heart in one single minute

Measure the size of the left atrium

Turn the patient to left side --> transducer to pmi --> imaging the heart from the apex to the
back

Apical four chamber view

60 degrees angle view of the heart

See the herat upside down

See all the four chambers of the heart

See the chambers contracting

You can sample the blood flow of the ventricle at dierent points

If blood is flowing toward - positive the transducer

If blood is away -

Color doppler sampling volume

Toward - red color

Away - blue color

Determine if there is regurgitant blood flow or not

Transesophageal

1990's

Some patients cannot be imaged properly with transthoracic mode

Patients with chronic lung disease (emphysema), hyperinflated lungs

Putting the us down into the esophagus

Invasive type of procedure

Image the heart from the back

Better pictures

Disadvantage: invasive

Not done in pediatrics patients: brcause you can use transthoracic

Intravascular

1980

Image inside of the arteries esp the coronary arteries

 Doc morante developed this!!! Wtf!

MRI

Using the priciples of magnetism

You cant do mri on patients with pacemakers, artifical headt valves, metallic objects

Done if you have trouble getting a good image of the heart with us

Expensive

Ct scan

Okay for patients with pacemakers

Exercise testing

Subject the patient to physical activity --> monitor ekg

Treadmill

Sensitivity: 50-60%

Spec: 85-90%

Mostp opular: bruce protocol

Determine if there is presence of myocardial is hemia

Patients qith severe coronary artery disease: greater than 3 ( diagnose them easily)

As screening procudre 50-60% sensitivity

Bicycle ergometer

Youcan calibrate the amount of stress

You can do it in stages

Patients who cannot walk properly : trouble with balance

Arm ergometer

Patients who cannot exercise?

Determine evidence of ischemia

Myocardial perfusion scan

Thallium - 1st isotope used

Technetium - better pictures

Less radiation

Combined with stress test to ger better sensitivity

Take patient to treadmill --> exercise --> peak exercise --> inject isotope --> stop exercise -> nuclear scan

Myocardium absorbs isotope for few hears

Image the myocardium --> determine areas not getting enough blood flow

Combined with pharmacologic stress trst

Contraindicated ang exercise

Patients eho are at risk of heart attack, unstable angina, having a heart attack

Image the perfusion at rest with radioisotope --> few hours later inject persantine --> inject
another dose of isotope --> imGe the heart again

Drugs used are vasodilators --> inc blood fow to the normal portion of the heart -->
increased absorption

Areas with less blood flow --> less radioisotope ( absent to very little isotope absorbed)

Accentuates the abnormality

Cardiac Arrythmia Evaluation

**Arrythmias - may manifest with syncopal episodes (common symptoms)

EKG

Holter montioring

24 hour recording of ekgHooked up to ekg electrode connected to a recorder

Patient carries the recorder for 24 hours

Good for eval of rhythm disorders

Outpatient procedure

Patient carries a diary --> records symptoms (palpitations, syncope)

2 lead system

HRV

A way of determining the activity of the sympathetic and para of the heart

Use holter monitor

Normally, there is a variation of the heart rate becase of the sympa and para activity

Trans-telephonic recorders

Evaluating the heart rate

Like a cellphone (size)

Patient attached to the lead system

If patient feel palpitations --> plug to the device --> transmits to hospital to get actual ekg
recording

Evaluating the cause of palpitations

Signal average ECG

Ekg but it samples the heart for 100 or 200 heart beats

Heart beats are merged into 2 waveform or trace

Analyze any abnormalities

Determine any conduction or activation abnormalities which are usually a source of arrythmias

Detect delayed electrical activity of the heart

Electrophysiology test

Intracardiac electrocardiography

Put electrode inside the heart then record the conduction

Determine more accurately the conduction inside the heart

Frequently combined with stimulation testing

Deliver electrical impulse through the catheter --> trigger abnormal heart beats

Last resort

Coronary Angiography
Visualization of the coronary arteries using a radiocontrast dyes

Iodine dyes

You can premedicate the patient to prevent allergic reactions

Steroids

...

Relative contraindication : patients with renal dysfunction

Possible toxicity with contrast dye

Invasive procedure --> injected directly to ....

Transbrachial

Transfemoral

Easier

Intorduce cath to femoral artery

Radial approach

Noninavsive

Ultrafast ct

Dye is injected in the peripheral vein

If there areas areas of stenosis --> it will show up on the angiography

Do acrual measure,ent of the arteries to eetermine degree of stenosis