Instrumental methods

for diagnosing heart

disease
Heart
Disease
Introduction:
Heart disease describes a range of conditions that affect the heart.
Diseases under the term heart disease include:
• Cardiovascular disease.
• Heart arrhythmia.
• Congenital heart disease.
• Cardiomyopathy.
• Heart disease caused by heart infections.
• Heart valve disease.
Common
investigations
in
cardiovascular
disease
 Introduction

Diagnostic investigations in cardiology are methods of identifying

heart conditions associated with unhealthy, pathologic, heart
function.
 Full Blood Count
(FBC)
Cardiac troponins (cTn1, cTnT, high sensitivity
troponins)
Diagnosing Methods Electrolytes, urea and creatinine

Liver Function Tests (LFTs)

Thyroid Function Tests (TFTs)

Brain Natriuretic Peptides (BNP or N-terminal pro

BNP) Electrocardiography (ECG)

Chest X-Ray (CXR)

Coronary

angiography

Echocardiography

Myocardial perfusion scan (MPS) (sestamibi scan/ thallium

scan) Cardiac computerised tomography (CT)

Blood Tests
Full Blood Count (FBC)

A full blood count can identify presence of infection, anaemia and other

blood disorders. Mild anaemia is common in heart failure and if left

untreated may contribute to worsening of the condition and to a poorer

prognosis. In cardiac disease, thrombocytopaenia (low platelet count) may

be caused by medications such as diuretics or heparin.

Cardiac troponin (cTn1, cTnT, high sensitivity troponins)

Cardiac troponin is a serum biomarker used for the diagnosis of acute myocardial infarction (MI) and prognosis.
Diagnosis of acute MI is dependent upon rise and fall of the biomarker, in addition to clinical findings or ECG
changes. Serial troponins are frequently done to determine the peak troponin post MI, which has prognostic value.
Cardiac troponins may be elevated in the presence of inflammatory conditions (e.g. acute myocarditis), structural
heart disease, coronary vasospasm and non-cardiac conditions (e.g. sepsis, chronic kidney disease).

Electrolytes, urea and creatinine

Electrolytes, urea and creatinine tests identify electrolyte

disturbances and define renal function.

Electrocardiography
(ECG)
ECG records the electrical activity of the heart. It is a simple
test that identifies heart rate, conduction disturbances,
myocardial ischaemia and possible structural defects.

As changes may be transient, comparison with previous ECGs is

always valuable. ECG aids in the diagnosis of underlying causes
of heart disease such as coronary artery disease or arrhythmias.

ST segment elevation or depression may represent ischaemia or

infarction. Large voltage QRS complexes, downward sloping ST
segments and T wave inversion may represent chamber
hypertrophy.

Rhythm disturbances such as atrial arrhythmias, heart block and

intraventricular septal conduction delays are common in heart
failure secondary to cardiac remodelling and may also
Working

The ECG device detects and amplifies the tiny electrical

changes on the skin that are caused when the heart

muscle depolarizes [ contracts ]during each heartbeat.

This depolarization is detected as tiny rises and falls in

the voltage between two electrodes placed on either side

of the heart which is displayed as a wavy line either on a

screen or on paper.
 Lead system

Consists of electrodes used in pairs

▫ Eg: LA+ and RA-, Active and indifferent

The output from each pair is known as a lead.

Each lead is said to look at the heart from a different angle.

Usually, ECG is recorded

in 12 leads:
▫ Bipolar
▫ Unipolar
 Devices
Devices: Holter monitor, Event monitor, 12 lead electrocardiograph
Coronary angiography

Coronary angiography investigates integrity of

coronary arteries by insertion of a catheter into the
coronary vasculature and the use of dye to
MEDICAL produce the image. The presence, location and
INFOGRAPHICS
extent of vessel narrowing is identified on the
image and likely sources of symptoms ("culprit
lesions") may be identified. The results guide
treatment such as r e v a s c u l a r i s a t i o n ( P C I ,
C A B G ) o r m e d i c a l management.
Echocardiograph An echocardiogram provides an untrasound image of the cardiac anatomy.
Echocardiography may be conducted using a transducer (probe) external to the
y (echo) chest wall as is the case with transthoracic echo (TTE).
A transoesophageal echo (TOL) is more invasive but provides more detailed
information and involves the (ultrasound transducer being passed into the
patient's oesophagus.
Echocardiography can provide information about
chamber size and shape. blood flow velocities systolic and diastolic function,
contractility, wall motion abnormalities and ejection fraction, valve function,
and presence of chamber thrombus.
NB. Echocardiography is the gold standard investigation for diagnosis of heart
failure and should be re-assessed on completion of medication titration and at
least every 2 years thereafter. Echo can identify:
•Type of heart failure. Ejection fraction can determine whether the type of heart
failure, i.e.
Heart Failure with Reduced Ejection
Fraction HFREF (EF < 45%)
 Procedure

Trans-thoracic echocardiogram(TTE):

▫ Echocardiogram of the heart through the thorax external to the body.

▫ Non-invasive, painless, highly accurate and quick

 Intravascular ultrasound
Principle:
▫ Coronary catheterization+ Ultrasound

Ultrasound transducer attached at the tip of catheter guided through coronary arteries from
femoral/brachial artery.
Proximal end of catheter attached to
ultrasound equipment
Evaluates
▫ Coronary plaques—structure and composition
▫ Wall of blood vessel
▫ Connective tissue surrounding vessel

Prescribed for
▫ Coronary angioplasty
▫ Stenting
 Nuclear scan
A nuclear heart scan is a type of medical test where a safe, radioactive material called a tracer is
injected through a vein into the bloodstream.

The tracer travels to the heart and releases energy, which special cameras outside of the body
detect to create pictures of different parts of the heart.

Using computer software, the images are made to appear as if the heart is
moving.

Two main types:

• Single positron emission

computed tomography
(SPECT)

• Cardiac positron emission

tomography (PET)
 Chest X-Ray
(CXR)
A chest x-ray aides in the differentiation between respiratory
and cardiac causes of dyspnoea. In those with heart failure,
common findings include cardiomegaly, interstitial oedema,
pulmonary oedema and pleural effusions. Evidence of surgery
(eg CABG, valve repair, ICD implantation) is also detected on
CXR.
Procedure

Patient has to remove all clothes and metallic jewelry from the waist up and put on a hospital
gown for the test.

Patient then stands very still with his chest against the cassette that contains the film.

The X-ray machine sends a beam of ionizing radiation through an X-ray tube.

This energy passes through the chest and is absorbed on film to create a picture.

Bones and other dense areas show up as lighter shades of

gray
Areas that don’t absorb the radiation appear as dark gray.
 Views
PA or postero-anterior view:
Patient stands with his chest against the container of the
film.

The X-ray beam from the machine comes from the

posterior/back and moves through the chest to the
anterior/front.

Lateral view:
Patient stands sideways in front of the film with arms raised
up.
The X rays penetrate the chest from the sides.
Stress echocardiography

Stress echo assesses patients with suspected

or known
mvocardial ischaemia. Exercise or medication
is used
to stress the heart. Cardiac function is then
evaluated using echocardiography pre and
immediately post stress. Myocardial response may
be described as hypokinetic (decreased), dyskinetic
(impaired) or akinetic (absent).
This test is valuable in assessment of viable
ischaemic myocardium in known CVD
being considered for
revescularisarion
Myocardial perfusion scan
(MPS) (sestamibi scan/ thallium
scan)
MPS is a non invasive nuclear medicine scan that examines
myocardial perfusion both at rest and under stress using a small
amount of a radioactive substance, called a radionuclide
(radiopharmaceutical or radioactive tracer). Stress scanning may be
conducted after exercise (treadmill or stationary bicycle) or using
medication (adenosine, dipyridamole, dobutamine) to increase the
blood flow to the heart. The study identifies severity of coronary
artery disease as well as providing information regarding
management such as the need for angiography or coronary artery
revascularisation.

MPS may also be used to identify patients with recurrent

ischaemia following revascularisation with either percutaneous
coronary intervention(PCI) or coronary artery bypass graft
 Cardiac Computerised
Tomography (CT)

Cardiac CT uses CT technology to provide detailed images of 70%

the heart. This may include identification of anatomical
abnormalities such as aneurysms or valve dysfunction, as
well as providing information about pulmonary vein anatomy
which may be implicated in AF. Cardiac CT also provides 20%
information about patency of grafts following CABG.

CT angiography uses the addition of a contrast dye to prove

more detailed information about CAD. 10%
Calcium scoring may be undertaken with CT to investigate the
presence, location and extent of calcified plaque in the
coronary vasculature. The test has prognostic value and may
guide further investigations and management.
Cardiac Magnetic Resonance
Imaging (MRI)
Cardiac MRI uses high intensity magnetic fields and radiofrequency to produce 3D images with high
resolution. The image provides accurate information about cardiac volumes, muscle mass, contractility,
tissue scarring and ejection fraction. Location and size of myocardial infarction can be described with
precision and may provide useful information regarding patency of bypass grafts.

The image can identify regional wall motion abnormalities (RWMA) and wall dyssynchrony, valve sclerosis,
stenosis or regurgitation and provide information regarding myocardial fibrosis and assists in the diagnosis
of amyloid cardiomyopathy, myocarditis and cardiac sarcoid.

Stress MRI

A stress myocardial MRI is a MRI scan that uses an intravenous infusion of a drug (adenosine,
dipyridamole or dobutamine) to increase the work load of the heart. A gadolinium dye or contrast agent is
injected and provides images as it passes through the myocardium. The stress MRI identifies
myocardial scarring or defects and myocardial perfusion and is valuable in assessment of ischaemic
myocardium for possible revascularisation or treatment.
T H A N
K Y O
U
Made by-
Areesha Turk
Farhan shoeib