CARDIOVASCULAR

TESTING-IR.MADHURI

PHARM-D II YR ROLL NO:05

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TESTING MODALITIES•CHEST RADIOGRAPHY•CARDIAC CATHETERIZATION•NUCLEAR CARDIOLOGY•INTRAVASCULAR ULTRASOUND

• A chest radiograph, commonly called a chest X-ray (CXR), is a projection radiograph of the chest • used to diagnose conditions affecting the chest, its contents, and nearby structures. • chest radiography employs ionizing radiation in the form of X- rays to generate images of the chest.

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NORMAL

Lung congestion seen here…. SIGN OF CONGESTIVE HEART FAILURE

CHEST RADIOGRAPHY

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Normal cardiovascular anatomy on a chest radiograph

•SVC is superior vena cava•PA are the pulmonary arteries, right and left•RA is right atrium; RV is right ventricle•IVC is the approximate position of the inferior vena cava.

•Ao is the aortic arch, which then continues as the descending aorta, indicated by the dotted line.• LAu is the auricle of the left atrium•PV are the pulmonary veins converging on the left atrium. LV is the left ventricle

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Specific cardiovascular abnormalities on chest radiograph •Cardiac chamber dilation and hypertrophy - Left ventricular hypertrophy - Left atrial enlargement

•Heart failure - Cardiogenic Pulmonary Edema

PLEURAL AND PERICARDIAL EFFUSIONS

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PURPOSE: Chest radiographs are used to diagnose many conditions involving• chest wall, • bones of the thorax,• structures within the thoracic cavity • lungs, heart, and great vessels. • Pneumonia and congestive heart failure are very commonly diagnosed by chest radiograph.The main regions where a chest X-ray may identify problems may be summarized as ABCDEF by their first letters:•Airways•Breast shadows•Bones•Cardiac silhoutte, detecting cardiac enlargement•Costophrenic angles, including pleural effusions

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•Diaphragm, e.g. evidence of free air •Edges, e.g. apices for fibrosis, pleural thickening or plaques Extrathoracic tissues •Fields (lung parenchyma), e.g. alveolar air space disease with prominent vascularity with or without pleural effusionsCONDITIONS COMMONLY IDENTIFIED BY CHEST RADIOGRAPHY

•Pneumonia•Interstitial lung disease•Congestive heart failure•Bone fracture

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• Also called as cardiac cath•An invasive imaging procedure that tests for heart disease to monitor how well our heart is functioning.

CARDIAC CATHETERIZATION

• During the test, a long, narrow tube, called a catheter, is inserted into a blood vessel in your arm or leg and guided to your heart with the aid of a special X-ray machine.

• Contrast dye is injected through the catheter so that X-ray movies of your valves, coronary arteries, and heart chambers can be created.

WHAT IS ACTUALLY DONE:

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PURPOSE•Evaluate or confirm the presence of heart disease (such as coronary artery disease, heart valve disease, or disease of the aorta )•Evaluate heart muscle function. •ATHEROSCLEROSIS

•This test provides the doctor with a picture of the arteries of the heart this shows the presence,• location, •degree of severity of blockages

in the coronary arteries.

•Determine the need for further treatment

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Preparing For A Catheterization•Generally, you should not eat or drink anything for 6-8 hours before the procedure. This will minimize the chance of an upset stomach during the test.

•Bring a list of all medications you are currently taking. Be sure to include the exact names and dosages.

•Mention to the doctor if you are allergic to x-ray dyes.

Several routine tests will be performed before the procedure, including an ECG and blood tests

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Risks Associated With Cardiac Catheterization •Bleeding around the point of puncture•Abnormal heart rhythms•Blood clots•Infection•Allergic reaction to the dye•Stroke•Heart attack•Perforation of a blood vessel•Air embolism (introduction of air into a blood vessel, which can be life-threatening)

Benefits: It provides important information about the heart’s pumping function and the condition of the coronary arteries and heart valves. This information often cannot be obtained by any other means. It helps the doctor to make an accurate diagnosis and begin treatment before irreversible damage to the heart occurs.

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NUCLEAR CARDIOLOGY•Nuclear cardiology tests safely take pictures of the heart•During a nuclear cardiology test, a very small amount of radioactive dye (tracer called radionuclide) is injected into a vein. •A special gamma camera then takes still images and movies of the heart during rest, exercise, or medication-induced stress testing.

•These cardiac images help to identify coronary heart disease, the severity of prior heart attacks, and the risk of future heart attacks

Nuclear cardiology

Technetium Heart Scanning

PURPOSE

•The function of your heart & flow of blood to the heart muscle.

• Whether chest discomfort, shortness of breath, or unusual fatigue is due to heart disease.

• Whether you have silent heart disease

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TECHNETIUM HEART SCANNING• The technetium heart scan is a noninvasive nuclear heart scan as it uses a radioactive isotope technetium which targets the heart to evaluate blood flow after a heart attack • A radionuclide detector traces the absorption of the radioactive isotope.Purpose •To evaluate the heart after a heart attack

•It can confirm that a patient had a heart attack when the symptoms and pain usually associated with a heart attack were not present•Provide information useful in determining the patient's post-heart attack prognosis.

•Identify the size and location of the heart attack

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• Radionuclides such as technetium-pyrophosphate (99mTc-PYP) are usedUptake of 99mTc-PYP into infarcted tissue depends •on regional blood flow, •myocardial calcium concentration, •the degree of irreversible myocardial injury, •and time after infarction.

• 99mTc-PYP attaches to calcium deposited in the infarcted area, so the approach is known as hot-spot scanning.

• False hot spots may occur where there is necrotic myocardial tissue, as in myocarditis, old infarctions, and myocardial trauma. • In infarcted tissue, 99mTc- PYP levels are as high as 18 to 20 times that of normal myocardium, which gives rise to very distinct borders between the infarcted and normal myocardium.

UPTAKE OF TECHNETIUM

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•The scan is most useful when the electrocardiogram and cardiac enzyme studies do not provide definitive results after heart surgery.•It is also used to evaluate the heart before and after heart surgery. Precautions

Pregnant women and those who are breastfeeding should not be exposed to technetium.

Preparation

Two to three hours before the scan, technetium is injected into a vein in the patient's forearm. Normal results If the heart scan is normal, no technetium will shown up in the heart. Abnormal results If heart scan abnormal, hot spots reveal damage to the heart. The larger the hot spots, the poorer the patient's prognosis.

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THALLIUM SCANNING• A thallium scan is a test that uses a radioactive substance (known as a tracer) to produce images of the heart muscle.• When combined with an exercise test, the thallium scan helps determine if areas of the heart do not receive enough blood.

•The exercise thallium scan is especially useful in diagnosing coronary artery disease, the presence of blockages in the coronary arteries

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•The tracer via bloodstream, is carried to the coronary arteries, and is picked up by the heart muscle cells.

•Areas of the heart muscle that have an adequate blood supply pick up the tracer almost immediately. Areas that do not have an adequate blood supply pick up the tracer very slowly or not at all. This will show up as a lighter area, called a "defect".

•A second set of images is taken several hours later, while at rest.

WHAT IS DONE:•During the test, a tiny amount of thallium tracer is injected into a vein in your arm while you walk on a treadmill. •For patients who cannot exercise, the test may be done after the injection of a drug (DIPIRIDAMOLE) that produces a stress on the heart similar to exercise.

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What does the thallium stress test show?•It checks whether the blood flow through the coronary arteries is normal during exercise and while at rest.

•If the test shows that blood flow is normal during rest but not during exercise (a perfusion defect), then the heart isn't getting enough blood when it must work harder than normal. This may be due to a blockage in one or more coronary arteries

•If the test is abnormal during both exercise and rest, there's limited blood flow to that part of the heart at all times

•If no thallium is seen in some part of the heart muscle, the cells in this part of the heart are dead from a prior heart attack. (They have become scar tissue.)

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Benefits:•The exercise thallium scan is generally more accurate and provides more information than an exercise ECG test. •The radiation exposure during a thallium scan is extremely small, and the doses used are safe. Thallium is excreted rapidly by the kidneys. Not advisable during pregnancy and lactation .

•These images help differentiate between areas that temporarily do not receive enough blood (the defect returns to normal) and areas that are permanently damaged from a previous heart attack (the defect persists).

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INTRAVASCULAR ULTRASOUNDAlternative Names: IVUS; Ultrasound - coronary artery; Endovascular ultrasound

•Ultrasound uses sound waves to create moving images of organs and systems within the body. •IVUS is a combination of a heart ultrasound (ECG) and cardiac catheterization.

•A tiny ultrasound wand is attached to the top of a tiny, hollow tube called a catheter.

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•IVUS provides quantitative information from within the vessel on diameter •circumference•plaque volume•percent stenosis. • Another new development in imaging the inner wall of the coronary is the recently developed, intravascular optical coherence tomography providing high-resolution, cross-sectional images of tissues.

• IVUS images highlight the artery walls and can show if there are cholesterol and fat deposits (plaques). Build up of such plaque leads to hardening of the arteries (atherosclerosis).

•This gives the visualization of arteries from the inside-out.

IVUS animation.htm

•During the IVUS procedure, the ultrasound catheter is inserted into an artery in your groin area and moved up to the heart.

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REFERENCES:

•Pharmacotheraphy,A pathophysiological approach;T.Dipiro;7th Edition•www.ucsfhealth.org/adult/adam/data/003876.html•www.texasheart.org/HIC/Topics/Diag/diangio.cfm•www.medterms.com•www.heartsite.com/html/chemical_stress•www.heartsite.com/html/chestradiography•www.nlm.nih.gov/medlineplus/ency/article

The goal of cardiac testing is to help stratify patients thought to be at risk for symptomatic coronary artery disease, specifically for short-term complications such as myocardial infarction (MI) or sudden cardiac death.

CONCLUSION:

THANK YOU……