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Tools of Diagnosis
Today, the diagnostic arena in cardiology is replete with a wide array of investigative techniques. They range from a simple resting electrocardiogram to its more modern computerized versions-stress test and 24-hour Holter monitoring, nuclear medicine tests employing radionuclide substances, special kinds of camera to view heart's function and muscles, conjuring up images of the heart by echocardiography, threading catheters to the heart to pick up blood samples and pressures from various cardiac chambers, and procuring live pictures of the coronary arteries by injecting special contrast agents. Between them, they can help diagnose virtually all disorders of the heart.
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The Electrocardiogram (ECG)
What is an electrocardiogram? Top
An electrocardiogram is quite simply a graphic description of the heart's electrical activity. This activity is recorded from the body surface by electrodes positioned to reflect it from a variety of spatial perspectives. The source of cardiac electrical activity lies in the cells of heart muscle tissue. Changes occur in them as they pass through different phases of cardiac cycle. Their pattern is well-established and forms the basis of a normal electrocardiogram.
A very basic test, an ECG holds a mine of information on the rate and rhythm of the heart, and also~ about the state of its muscles.
How is an electrocardiogram taken? Top
The electric signals emanating from the heart are picked
up from the body surface through plastic discs (electrodes) suitably placed on the skin surface of the chest, both wrists,
and ankles. They feed these signals through connecting leads
to a highly sensitive galvanometer which forms the heart of an ECG recording device. They are read and converted into a graphic picture which can either be recorded on a graph paper or visualized through a cardiac monitor.
Is recording an ECG of any discomfort to the patient?
Those who have had an ECG would assure you it is the easiest and an entirely painless procedure. It requires no pricks or prods. The cardiac lab technician applies a jelly-like substance on the skin surface where he has to fix the plastic discs, fixes the discs, and switches on the recorder. The recordings are made at the press of buttons and the test is over before you can count a hundred.
In which conditions of the heart is an ECG useful? Top
The ECG is of diagnostic value in a variety of heart disorders. Its usefulness in diagnosis of angina, myocardial ischemia and heart attack is well known. In diagnosis of heart attack, it provides a useful idea of the extent and nature of damage incurred by the heart muscle tissue. At a later stage, it helps keep a vigil on the behaviour and, function of the damaged heart through constant monitoring. In unstable angina too, its constant monitoring can make the physician wise to serious complications in quick time. Irregularities of the heart-beat-missed beats, rapid beats, ectopics and blocks in conduction, can all be picked up on an ECG.
It offers clues to the enlargement of specific cardiac chambers, helps detect the poisoning of heart muscles by disturbances in body electrolyte balance or digitalis toxicity, and suggests the diagnosis of fluid collection in the bag of membrane (pericardium) surrounding the heart.
Does a normal electrocardiogram exclude the diagnosis of ischaemic heart disease? Top
By no means. An ECG recorded at rest and in the absence of pain is normal in approximately one-half of patients with typical angina pectoris and arteriographically demonstrable coronary atherosclerosis.
It is best to have an electrocardiogram taken during an anginal attack. Changes occurring during attacks of pain, which disappear thereafter, are of great diagnostic significance.
But at times an exercise test or a long-term continuous ECG monitoring by a portable device while performing normal activity may be necessary in documenting the association of ECG changes and chest pain. In some patients, even then the diagnosis may remain doubtful and require further investigative tests.
The Exercise (Stress) Test
What is a stress test? Top
It is a test specifically designed to evaluate the capability of coronary arteries to cope with the increased oxygen demand of the heart during conditions of increased workload. Measured exercise is a safe and easily reproducible form of stress employed to generate such a condition and forms the basis of the test. The usefulness of the test lies in diagnosing the presence of ischaemic heart disease, where it results in an easily observable and specific alteration in cardiovascular function and thus, helping establish the diagnosis.
How is the test conducted? Top
The patient is exercised on an apparatus which either has a treadmill, or a calibrated bicycle ergometer. A treadmill is a motor-driven moving belt upon which the patient has to walk keeping pace with it, while a bicycle ergometer is just like an ordinary bicycle fixed to a spot on which the patient has to pedal. The workload of the patient is gradualy increased, according to a predetermined protocol, by gradually increasing speeds and inclinations of the treadmill or asking the patient to pedal at a gradually increasing rate, if a bicycle ergometer is being employed.
Before beginning the test, adhesive electrodes are fixed to the chest of the patient, which help to record a continuous cardiogram during the test. As the patient exercises, a cardiologist and a nurse stay in attendance. The cardiologist keeps a careful watch on his electrocardiogram tracing and heart rate; takes his
blood pressure every now and then and keeps a tab on how he feels. The test is discontinued at a lower level of work if the patient develops chest pain, feels giddy, has a drop in blood pressure, or has significant electrocardiographic changes. Otherwise, the test is allowed to continue until he achieves his target heart rate, which is computed beforehand.
What preparation is required by the patient for the test? Top
The patient is required not to eat or drink anything, except water for two hours before going for the test. He has also to abstain from smoking. If the test is scheduled for the morning, the breakfast should not contain any heavy or fatty foods
and he must not have any tea, coffee, or alcohol. If the test is in . the afternoon, the same rules have to be followed for lunch.
Before reporting for the test, men should shave off the hair on the chest. They should carry with them gym shorts or loose
fitting trousers which would enable them to jog and run on the treadmill comfortably. For the same purpose, they must wear comfortable shoes. Sneakers or rubber-soled shoes are the best. Bedroom slippers and high-heeled shoes are not permitted.
For women patients, a loose-fitting shirt and a pyjama pant
is an ideal dress, along with sneakers.
The patient is also required to bring his latest cardiogram and treatment card, and a responsible adult attendant along with him.
What about medication? Are any drugs required before taking on the test?
No. Rather, some may have to be stopped a day or two previous to the test. Necessary instructions as regards this would be given by the physician.
What precautions are required after completion of the test? Top
Normal activity can be resumed immediately after the test. The only precaution to be followed is not to take a hot shower immediately after. A lukewarm bath is, however, permissible.
Does the test carry any risk?
The risk is very small-almost negligible, estimated at about 1 in 10,000.
It is, however, unusually hazardous and hence not done to patients with unstable angina and patients who have suffered a heart attack during the preceding few weeks. In the latter class of patients, modified exercise tests are employed with negligible risk.
How reliable is the test? Top
A positive stress test has a high, 90%, overall reliability
in correctly indicating the presence of coronary artery disease.
This reliability rises to 98% in patients with typical angina,
dips marginally to 88% in patients with a typical pain, is down
to 44% in patients with nonanginal chest pain, and is only 33% in asymptomatic persons.
Thus, the results have to be considered keeping the clinical picture in view.
Can the test be falsely negative?
This likelihood is only about 15%. The Holter Test
What is a Holter test? Top
A Holter test is a record of ECG on a continuous basis for 24 hours or more, while the patients carrying out his normal routine activities. The test is of specific value in diagnosing patients who experience attacks of angina at rest, or who develop waywardness of heart rhythm at odd times when an immediate electrocardiogram may not otherwise be possible. It is a good measure of what happens to the heart while a person is engaged in diverse activities, such as climbing stairs, eating a meal, watching a movie, playing a game of tennis, working at his office, sleeping, or making love.
How is the test done? Top
The patient is fitted with a small portable Holter recorder, the size of a pocket transistor, which records the ECG in a compressed form. The recorder is connected through fine leads to electrodes placed on the chest wall of the patient. The patient is given a diary for maintaining the record of his daily activities and symptoms, if any, during the test period. The patient has to wear the recorder and the electrodes on his person until it is taken off the next day.
During the test the patient is expected to perform all normal daily activities. This may include light exercise, if advised by
the physician. He has to maintain a record of the time and duration of all his activities like eating, playing, chatting, smoking, and even sleeping.
After 24 hours or more, as decided by the physician, the recorder is received back and the leads gently removed.
The ECG record is fed to an analyser, a sort of computer, which has the capacity to recognize cardiac rhythm disturbances and electrocardiographic changes of ischaemic heart disease by quickly miming through the recorded cardiogram. These rhythm and other ECG changes are verified by a physician and correlated with the patient's activity diary before a final report is prepared.
Does the patient require to take any precautions during the test?
He should not take a bath as the electrodes may fall off. Otherwise, he should be entirely his normal self.
In which conditions of the heart is the test useful? Top
The Holter test is useful in:
(i) diagnosis of angina at rest caused possibly by coronary arterial spasm; (ii) diagnosis of , any waywardness in heart's rhythm or rate, or conduction disturbances. In patients who experience sudden attacks of unconsciousness, this may help establish the cause; and (iii) at other times, the test can serve as a useful guide to test the usefulness of a medication and in adjusting its dosage and timing.
Radio-Nuclear Tests:
Thallium-201 Myocardial Scintigraphy
What is Thallium-201 myocardial scintigraphy? Top
It is an important radio-nuclear technique for the noninvasive detection and evaluation of both acute and chronic coronary artery diseases. Thallium-201 is a radiopharmaceutical which has a special affinity for myocardium, or in other words, the muscle tissue of the heart. The degree of uptake of this substance depends upon the coronary artery blood flow and the physical state of the myocardium. In case either is adversely affected, the tissue is unable to pick up the radioactive substance and can be visualized clearly as a cold spot on the scan images taken by a special kind of camera-the Gamma Camera, after an injection ofThallium-201. By following up the scans, the two conditions-myocardial ischaemia from CAD, and acute infarcts or chronic scars in the heart muscle tissue from a recent or old heart attack can be identified.
What preparation is required by the patient prior to the test? Top
The patient is not to eat or drink anything except water for at least four hours prior to the study. If he is on medication, for example, propranolol, it has to be discontinued approximately 48 hours before the scheduled study. Necessary advice regarding this is given by the treating physician. He must be dressed in clothes in which he can comfortably exercise. .A
responsible adult attendant must accompany him for the test.
How is the test done? Top
On the patient's arrival at the test laboratory, the technician applies adhesive electrodes to the patient's chest to provide a cardiogram during the test. The attending doctor ex
plains the procedure and tells the patient how to exercise on the bicycle ergometer coupled with the Gamma Camera. While the patient is exercising, the doctor at the right moment injects the necessary radioisotope intravenously. The patient is asked to continue exercising for another 60 seconds. Myocardial scans are then performed in different projections under the Gamma Camera. Images are read on the scope as well as fed into the computer. After this first set of studies the patient is asked to rest.
If required, repeat scans are taken with the patient at rest
after four to six hours.
After completion of the test, the patient can return home or
back to his bed if he is admitted to hospital. The results of the test are available by the next day.
Radionuclide Ventricular Performance Test (MUGA )
What is a MUGA test? Top
This radioisotopic investigation is an important diagnostic tool for assessing left and right ventricular function at rest and during exercise. It is a non-invasive, painless test, which provides reliable information on heart function prior to surgery and in the post-operative phase, as also to check the damage suffered by a heart attack. Thus, it serves as a very useful guide for planning and follow-up of treatment and for assessment of the outcome.
MUGA stands for multiple-gated acquisition-the method used to obtain scintigraphic information during the course of the study.
How does the patient prepare himself for the test?
The patient must not eat or drink anything except water for two hours prior to the test. He must also restrict his medications as advised by his physician.
How is the test conducted? Top
The patient is given two intravenous injections at an interval of about 30-45 minutes in the radionuclide laboratory.
The second of the injections is of radioisotope, usually technetium 99m. Once the radioisotope is properly distributed in the body, the patient is taken to the Gamma Camera table, connected to a bicycle ergometer. Records of various parameters related to the heart are made while at rest, as well as during exercise. Scintigraphic scans are taken with the assistance of the Camera and the Computer. The study is over in an hour or so, and the patient can go back home or to the ward soon after.
Echocardiography.
What is echocardiography? Top
It is a simple, safe and non-invasive technique which is based on ultrasound and helps the doctor determine the structure and function of the heart.
The machine has a microphone-like device called a, transducer, which is placed on/the chest wall. This gives off
ultrasound waves (sound waves of very high frequency, inaudible to the human ear). They strike the structures of the heart and are echoed back, to be picked up by the transducer, which doubles up as a receiver as well.
The machine translates these echoes into a dynamic picture of the structures of the heart and displays it on the screen from where it can be recorded.
Two-dimensional echocardiography is the technique currently in vogue and it provides detailed information on the structure of all parts of the heart and their function.
Doppler echocardiography and colour. flow imaging are additional techniques that record the blood flow within the heart.
Is any special preparation needed for the test? Top
No. The patient can just walk in for the test without any
restriction on food or usual medication. The test may take up
to one hour.
How is the test gone through? Top
The patient has to change into a gown and lie down on an examination table. The cardiologist applies some kind of a jelly on the chest wall and places the transducer. This does not cause any discomfort or pain. He rotates the transducer around and procures the images of the heart which are recorded on a video tape or on paper. The study is over as soon as he is satisfied with the number of images he has procured.
In which conditions of the heart is the test useful?
The test is of special significance in diagnosing disease of the heart-valves, presence of vegetations as a result of bacterial endocarditis, assessment of left ventricular size, wall thickness and function, identifying aneurysms (a complication of heart attack) of the left ventricle, evaluating fluid collection in the bag of membrane enveloping the heart (pericardial effusion), and establishing the diagnosis in a variety of birth heart defects.
Is echocardiography safe? Top
Yes, so much so that it can be performed without ill effects even on a pregnant woman.
The Cardiac Catheterization Technique and Coronary Angiography
What is cardiac catheterization? What is coronary angiography? Top
Cardiac catheterization is a highly specialized, invasive kind of diagnostic technique which provides precise and detailed information on the dynamic functioning and anatomy of all parts of the heart in the normal state and a variety of cardiac disorders. It employs a fine, flexible, tube-the catheter, which can be pushed through either an artery or a vein of any of the four limbs to reach the left and right side of the heart respectively. During the test, pressures can be measured and blood samples procured from different chambers of the heart. By injecting radio-opaque contrasts, various structures of the heart can be studied with the help of high speed X-ray motion
pictures.
By the same technique, a selective study of the coronary arterial tree can be made through injection of a contrast medium directly into each coronary artery orifice and taking motion pictures. This technique is called coronary angiography. Its great value lies in diagnosis and exact estimation of the coronary artery disease, a prerequisite for bypass surgery.
What preparation is required for the test? Top
Cardiac catheterization and angiography is essentially an indoor procedure. The patient has to be admitted to hospital at least a day in advance. A thorough physical examination and a variety of laboratory tests-blood tests, urine analysis, a chest X-ray and an ECG-are conducted on the patient the previous evening. The area that will be used to puncture the vessel to thread in the catheter is shaved before the patient goes to bed. Generally this is the right groin area in the upper thigh. The patient has to stay fasting after midnight. Medications, if any, would be continued as usual, except anti-coagulants and diabetic medications, which would have to be rescheduled.
On the morning of the test, the patient is asked to empty the bladder and given sedation for relaxation. Dentures are removed, but glasses may be worn. If the patient is on nitroglycerine for chest pain, a supply of fresh tablets is kept with him. The patient is then wheeled. into the Cathie on a stretcher trolley.
What is done during the test? Is the patient put under general anaesthesia? Top
During the procedure, no general anaesthetic is used.
The patient is awake and in his full sense.
All through the procedure, he or she has to lie on the X-ray table. His blood pressure, pulse, and cardiogram are constantly monitored.
The doctor begins the procedure by injecting a local anaesthetic to numb the area where the puncture for inserting the catheter will be made. Usually the blood vessel in the right groin is selected for the purpose. After the area is anaesthetized, the doctor makes a small nick or puncture and inserts the
catheter and gradually advances it to the heart. When the catheter reaches the required site, a contrast medium is injected and motion pictures are taken. At the same time, if necessary, blood samples and pressure readings can be obtained from the chambers of the heart. On completion of the procedure, the catheter is withdrawn and the puncture site dressed.
The patient is wheeled out and taken to an observation unit, where a close watch is kept on him for at least four hours.
Is the procedure painful? Top
No, but it does cause some discomfort. A stinging sensation may be felt where the local anaesthetic has been injected. Similarly, a sense of heat may flood the patient at the time the contrast medium is injected. Some patients may experience headache, nausea, chest pain, or palpitations. These sensations are temporary, and usually not severe, though they must be reported to the attending doctor.
What precautions and care are required after the procedure? Top
The patient has to stay in bed for at least four hours after the procedure. He must keep the limb used for catheter insertion absolutely straight during this time. After about four hours, he can sit in a propped-up position. He may resume his meals immediately on return from the cath-Iab and should take a lot of fluids. If he feels any discomfort or sees any discoloration at the insertion site, he must inform the physician or the urse. By the evening he can be up and about, and ready for discharge from the hospital. But he must take care of the insertion site for another day or two and limit the movement of the limb.
What is the potential risk of the procedure? Can it cause any complications? Top
The risk of the procedure is very small, but real, with an overall reported mortality of 1 in 500.
Complications are rare, with a reported incidence of 1 in 4000 for a heart attack, less than 1 in 1000 for an ambolus breaking away and blocking a vital artery, and about 0.74% for an injury to a blood vessel.
| Herbal Cure for Heart - Complete Pack |
| Total Heart Support |
Arjuna |
Arjun Tea |
Arjun Saar |
Kumari Saar |
|
|
|
|
|
|
Free Shipping and Handling
Worldwide!
No Side Effects! |
2 Bottles |
1 Bottle |
1 Pack |
4 Bottles |
4 Bottles |
$47.90 |
$ 31.00 |
$ 14.95 |
$ 75.80 |
$ 75.80 |
$ 274.55
|
| Price after Discount 20% |
$ 220.00 |
| Buy This Pack for Just $ 220.00 |
| Free Shipping and Handling Worldwide! No Side Effects! |
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