Diagnostic Procedures for Angina Pectoris

8/6/2019 Diagnostic Procedures for Angina Pectoris

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Diagnostic ProceduresFor Angina Pectoris

Ammar Sarwar(Pharm-D)

Diagnostics Tests For AnginaPectoris

1- Signs & Symptoms

2-Chest X-Rays

3- Electrocardiography (ECG)

4- Holter

5- Exercise Tolerance Test (ETT)

6- Thalium Test ( TI-201 Scintigraphy )

7- Echocardiography (Echo)

8- Angiography

9- Blood Tests


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1- Signs & Symptoms

Typical: Crushing", "tight", "gripping" typechest pain

Pain radiating down left arm, to jaw, neckor shoulder (Referred Pain).

Atypical: Sweating, Breathlessness,Apprehension, Anxiety.

Sometimes "autonomic symptoms" suchas nausea, vomiting and pallor.

2-Chest X-Rays

A chest x-ray may be performed to rule outlung disease or other chest abnormalitiesthat may be causing pain. In addition, a

chest x-ray will reveal enlargement of theheart, which may be associated with heartmuscle damage due to heart attack.


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3- Electrocardiography (ECG)

Electrocardiography (EKG, ECG)measures the electrical activity of theheart.

Normal ECG:


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Waves & Intervals Of NormalECG

P Wave: Depolarization Of Atria

PR Interval: reflects the time the electrical

impulse takes to travel from the sinus nodethrough the AV node and entering theventricles.

QRS Complex: The QRS complex reflectsthe rapid depolarization of the right and leftventricles.

Waves & Intervals Of NormalECG

The ST Interval: represents the periodwhen the ventricles are depolarized.

T wave:

The T wave represents the repolarization(or recovery) of the ventricles. The intervalfrom the beginning of the QRS complex tothe apex of the T wave is referred to as theabsolute refractory period.

QT Interval: A prolonged QT interval is arisk factor for ventricular tachyarrhythmiasand sudden death. It varies with heart rate.


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ECG in Angina Pectoris

It can reveal previous damage of the heartmuscle, such as a mild heart attack that aperson may have had without evenknowing it.

Unfortunately, the EKG does not reliablydetect narrowing of the coronary arteries.

The EKG often is normal in people withangina when they are at rest, although itusually changes during an anginal attack.

4- Exercise Tolerance Test,

During this procedure, the individual isasked to ride a stationary bicycle or walkon a treadmill while a physician takes

an electrocardiogram.


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Thalium Test

In addition to ECG during ETT, the personmay receive an injection of a radioisotope(a radioactive material) such as thallium,which makes the heart and its vesselsvisible to a special, computer-linkedcamera.

ETT


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Abnormal ECG in Angina Pectoris

Abnormal ECG in Angina Pectoris


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Diagnostic Value of ETT

The common approach for ETT by ACC

and AHA indicates the following: Treadmill test: sensitivity 67%, specificity

70%

Thalium test: sensitivity 81%, specificity85-95%

(Sensitivity is the percentage of sickpeople who are correctly identified ashaving the condition. Specificity indicatesthe percentage of healthy people who arecorrectly identified as not having thecondition.)

5- Echocardiography

ECHO, is a sonogram of the heart, Alsoknown as a cardiac ultrasound.

2D Imaging of the Heart.

The latest ultrasound systems now employ3D imaging.

Doppler ultrasound:is an Echocardiogramwhich produce accurate assessment of thevelocity of blood and cardiac tissue at anyarbitrary point using pulsed or continuouswave.


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Types of Echocardiography

1- Transthoracic echocardiogram:

In this case, the echocardiography

transducer (or probe) is placed on thechest wall (or thorax) of the subject, andimages are taken through the chest wall.This is a non-invasive, highly accurate andquick assessment of the overall health ofthe heart.

Types of Echocardiography

2- Transesophageal echocardiogram

A specialized probe containing anultrasound transducer at its tip is passed

into the patient's esophagus. This allowsimage and Doppler evaluation which canbe recorded.


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3D echocardiogram of a heart viewed from theapex

6- Angiography

Can pinpoint narrowing, obstruction, andother abnormalities of the coronaryarteries.

Takes about 30 minutes to perform, and itis quite safe.

Performed under Local Anaesthesia.

Most individuals are given antianxietymedication.


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Procedure of Angiography

A catheter (fine tube) is inserted into anartery in the forearm or groin, and it issnaked through the blood vessels until itreaches the coronary arteries.

Then, dye is pumped through the catheter,so that the heart itself and the coronaryarteries are visible on a special videoscreen.

Ergonovine test

Also Known as a "provocation test"

The procedure is conducted duringcoronary angiography.

The artery-narrowing drug ergonovine (or,alternatively, acetylcholine) is injected toprovoke coronary artery spasm.

If the individual experiences severe arterialspasm, probably has variant angina.


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7- Other Tests

Holter

Blood Test:

Lipid Profile

ESR

CRP

Documents

Diagnostic Procedures for Angina Pectoris