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Cardiac Diagnostic Testing

Cardiac Diagnostic Testing. Victor Politi, M.D, FACP Medical Director, SVCMC, School of Allied Health Professions, Physician Assistant Program. Electrocardiographic Tests.

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Cardiac Diagnostic Testing

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  1. Cardiac Diagnostic Testing Victor Politi, M.D, FACP Medical Director, SVCMC, School of Allied Health Professions, Physician Assistant Program

  2. Electrocardiographic Tests • Electrocardiographic tests are noninvasives tests which uses the electrocardiogram to evaluate the electrical activity generated by the heart at rest and with activity

  3. Electrocardiographic Tests • Ambulatory Monitors • EKG/ECG • Exercise Stress Test • Head Upright Tilt Test • Metabolic Exercise Stress Test

  4. Ambulatory Monitors • Ambulatory monitors are small, portable electrocardiograph machines that are able to record the heart’s rhythm. Each type of monitor has unique features related to length of recording time and ability to send the recordings over the phone

  5. Ambulatory Monitors • assess heart rhythm over time • correlate symptoms with heart rhythm • diagnose abnormal heart rhythms: • what kind they are, how long they last, and what may cause them guide treatment for abnormal heart rhythms

  6. Types of Ambulatory Monitors • Holter • Loop Recorder • CardioNet (mobile cardiac outpatient telemetry) • Transtelephonic transmitter

  7. Holter Monitor (also called Ambulatory ECG) • A Holter monitor is a portable ECG recorder that is worn during normal daily activities, including sleeping. It can be worn up to 24 hours.

  8. Holter Monitor • Electrodes are placed on the skin of the chest. Wires are attached from the electrodes to a box about the size of a portable tape player and worn on a belt or shoulder strap. The electrical impulses are continuously recorded and stored in the Holter Monitor

  9. Holter Monitor • The patient is asked to keep a diary of activities and symptoms, such as fluttering feelings in the chest (palpitations), rapid heartbeats, and any episodes of dizziness or faintness.

  10. Loop Recorder (also called an Event Recorder) • This device, similar to a Holter monitor, is worn during normal daily activities including sleeping; however, it is worn for a longer period of time. It can be removed during showers and baths. It is used for arrhythmias that occur less frequently.

  11. Loop Recorder • When the patient feels symptoms, they depress a button and the recorder is activated. The monitor records the event for the 60 seconds prior to pushing the button and up to 40 seconds after the arrhythmia is over. The loop recorder can store up to three events.

  12. Loop Recorder • The rhythm can be sent immediately or saved and transmitted later, over the phone line. The technician will give the recordings to the doctor for review. If the reading indicates an emergency, the technician will instruct the patient to go to the emergency room

  13. Technician instructing on Loop Recorder

  14. CardioNet(Mobile Cardiac Outpatient Telemetry) • CardioNet mobile telemetry allows continuous heartbeat monitoring as the patient goes about daily activities. Most people are on the CardioNet service from 7 to 14 days.

  15. CardioNet(Mobile Cardiac Outpatient Telemetry) • This device consists of a small sensor attached to three electrode pads, worn on a belt clip. The sensor sends each heartbeat to a handheld monitor that can be tucked into a pocket or purse.

  16. CardioNet(Mobile Cardiac Outpatient Telemetry) • When the monitor detects a heart rhythm problem — whether the patient feels it or not — it automatically transmits your ECG to the CardioNet monitoring center. A cardiac technician analyzes each transmission, responds appropriately to each event and transmit diagnostic reports to the doctor.

  17. Patient wearing CardioNet system

  18. Transtelephonic Transmitter • Transtelephonic transmitters are not worn continuously. • They are used only during the phone-monitoring period. In the past, this type of transmitter was used for monitoring pacemaker function. • However, now it is used for patients with arrhythmias to monitor certain events indicated by their doctor.

  19. Transtelephonic Transmitter • The electrode may be a finger electrode, wrist bracelet or chest plate. The patient dials the center and places the telephone into a transmitter. After the transmission is completed, the nurse or technician will ask questions about the patient’s symptoms and current medications.

  20. Patient testing transtelephonic transmitter

  21. Electrocardiogram (ECG or EKG) • The ECG is a device used to record on graph paper the electrical activity of the heart. The picture is drawn by a computer from information supplied by the electrodes

  22. Electrocardiogram (ECG or EKG) • assess your heart rhythm • diagnose poor blood flow to the heart muscle (ischemia) • diagnose a heart attack diagnose abnormalities of your heart, such as: heart chamber enlargement abnormal electrical conduction

  23. EKG

  24. Exercise Stress Test (stress test, exercise electrocardiogram, treadmill test, graded exercise test, stress ECG) • A test used to provide information about how the heart responds to stress. • It usually involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while the electrocardiogram, heart rate and blood pressure are monitored.

  25. Exercise Stress Test (stress test, exercise electrocardiogram, treadmill test, graded exercise test, stress ECG) • Used to determine if there is adequate blood flow to your heart during increasing levels of activity • evaluate the effectiveness of cardiac treatment plan • determine the likelihood of having coronary artery disease and the need for future testing

  26. EST • an electrocardiograph (ECG) monitor that charts the heart’s electrical activity during the test. • Blood pressure and ECG recording will be taken before, during and after exercise.

  27. EST • The patient begins to exercise by walking on a treadmill or pedaling a stationary cycle. The degree of difficulty is gradually increased.

  28. EST • It is normal for the heart rate, blood pressure, breathing rate and perspiration to increase during the test. • The lab personnel will watch for any symptoms or changes on the ECG monitor that suggest the test should be stopped.

  29. EST • the appointment lasts about 60 minutes, the actual exercise time is usually between 7 and 12 minutes.

  30. Metabolic Exercise Stress Test (also called metabolic stress test) • A test used to measure the performance of the heart and lungs while they are under physical stress. The test involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while being closely monitored.

  31. Metabolic Exercise Stress Test (also called metabolic stress test) • determine how fit the heart and lungs are • determine if symptoms of shortness of breath or chronic fatigue are due to a medical problem (such as heart or lung disease) or due to poor fitness • measure the heart’s ability to do work (functional capacity) • determine if certain surgical treatments are appropriate • evaluate the effectiveness the cardiac treatment plan • help develop a safe and effective exercise program

  32. Metabolic Exercise Stress Test (also called metabolic stress test)

  33. Laboratory testing • Laboratory tests include a number of blood tests used to diagnose and monitor treatment for heart disease.

  34. Laboratory Testing • CBC • Lipids • electrolytes • BNP (B-type Natriuretic peptide) • Enzymes and Proteins

  35. Laboratory FindingsTroponin I • Earliest increase - 4-6 hours • Peak hours 10-24 • Duration of increase 4-7 days • Specificity 95% • Sensitivity at peak >98%

  36. Laboratory FindingsCK Total • Earliest increase 4-8 hours • Peak hours 24-36 hours • Duration of Increase 36-48 hours • Specificity 57-88% • Sensitivity at peak 93-100%

  37. Laboratory FindingsCK-MB • Earliest increase 3-4 hours • Peak hours 15-24 • Duration of Increase 24-36 hours • Specificity 93-100% • Sensitivity at peak 94-100%

  38. Nuclear Imaging • Nuclear imaging is a method of producing images by detecting radiation from different parts of the body after the administration of a radioactive tracer material.

  39. Nuclear Imaging • Radioactive tracers are not dyes. They have no side effects. • The amount of radiation a patient receives in a typical nuclear imaging scan is very low, similar to the exposure received in a routine chest x-ray. • In most cases the tracers are injected into a vein. In some cases they may be given by mouth.

  40. Nuclear Imaging • Multigated Acquisition Scan (MUGA) • Positron Emission Tomography (PET) • Sestamibi Exercise Stress Test • Thallium Exercise Stress Test

  41. Multigated Acquisition Scan (MUGA scan, nuclear ventriculogram, radionuclide scan) • A nuclear scan that evaluates the pumping function of the ventricles. • An ECG, IV started. • A resting ECG & blood pressure recorded.

  42. Multigated Acquisition Scan (MUGA scan, nuclear ventriculogram, radionuclide scan) • A small amount of blood is withdrawn and mixed with a radioactive tracer. • The radioactive tracer binds to the red blood cells, the mixture is re-injected into the IV. • The tracer stays in the bloodstream for several hours and does not enter tissue cells.

  43. Multigated Acquisition Scan (MUGA scan, nuclear ventriculogram, radionuclide scan) • A MUGA scan analyzes the amount of radio-labeled red blood cells pumped out of the heart with each heartbeat. • This test calculates the amount of blood pumped out of the heart with each heartbeat, called the ejection fraction. • The MUGA scan takes about one to two hours to perform.

  44. Positron Emission Tomography (PET or cardiac viability study) • An imaging procedure that uses radioactive tracers to create three-dimensional pictures of the tissues inside of the body and that can monitor metabolic processes.

  45. PET • PET is used to: • determine if there is adequate blood flow to the heart • assess the amount of damage to the heart after a heart attack • evaluate the effectiveness of your treatment plan • PET is used for patients who are unable to exercise on a treadmill or stationary cycle.

  46. PET • An ECG and IV are started • A resting ECG, and BP reading recorded • A small amount of rubidium injected into the IV. Rubidium is a radioactive tracer that allows the physician to view the blood flow in the heart at rest. It is not a dye.

  47. PET • dipyridamole is injected into the IV for about four minutes. The medication causes the heart to react as if the patient were exercising

  48. PET • After all the medication has entered the bloodstream, a small amount of rubidium will again be injected into the IV. • The rubidium allows the physician to view the blood flow to the heart muscle while it is in stress

  49. PET • The PET takes about three to four hours. The first part of the test will take about one hour. The second part will take about two hours, although the usual exercise time is between 7 and 12 minutes.

  50. PET

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