Heart / Cardiac Diseses / Symptons / Syptoms / Diaganosis & Tretments

Positron emission tomography (PET) is a scan that uses information about the energy of certain elements in your body to show whether parts of the heart muscle are alive and working. A PET scan can also show if your heart is getting enough blood to keep the muscle healthy. A PET scan is very accurate because it actually shows your heart at work.

How does it work?

PET scanning uses a radioactive substance, which is injected into your bloodstream. This radioactive substance goes to areas inside your body, where tissue either is damaged or not working properly. These areas usually have what doctors call increased or decreased “metabolic” activity. The PET scan machine then has hundreds of radiation detectors that can find this radioactive substance in your body. The PET scanner measures this radioactivity throughout your body and uses computers to create pictures of your heart or other body tissues.

What should I expect?

No special preparation is needed before a PET scan. If you have diabetes, your blood sugar levels will be monitored during the test, because doctors have found that the test results are not always accurate in patients with diabetes.

The PET scanner is a large machine that has a short, open-ended tube in the middle (like a very short tunnel). The patient lies on a scanning table, which slides through the middle of the PET scanner.

You will be asked to remove all clothes above your waist. A technician will put a ring of detectors around your chest. You will then lie down on a table, which will be moved inside of the PET scan machine. Doctors will take a picture of your heart before the radioactive substance is injected into your bloodstream. This takes about 15 to 30 minutes. You will need to keep your arms above your head during this part of the test. Next, a radioactive substance will be injected with a needle. You will need to wait about 45 minutes for the substance to move through your bloodstream and into your heart. You will be asked to hold your arms above your head as doctors take another picture of your heart.

After the test, you may go about your normal activities.

A nuclear stress test lets doctors see pictures of your heart while you are resting and shortly after you have exercised. The test can give information about the size of the heart’s chambers, how well the heart is pumping blood, and whether the heart has any damaged or dead muscle. Nuclear stress tests can also give doctors information about your arteries and whether they might be narrowed or blocked because of coronary artery disease.
How does it work?

This test is almost the same as the exercise stress test, except doctors will give you a small amount of a radioactive substance just before the end of the exercise part of the test. This radioactive substance is not harmful to your body or your organs.

The results of the nuclear stress test can show doctors if the heart is not working properly while you are resting, exercising, or both. If the test shows that blood flow is normal while you are resting but not normal while you are exercising, then doctors know that your blood flow to your heart is not adequate during times of stress. The heart normally pumps more blood during times of physical exertion. If the test results are not normal during both parts of the test (rest and exercise), part of your heart is permanently deprived of blood or is scarred. If doctors cannot see the radioactive substance in one part of your heart, it probably means that section of heart muscle has died, either because of a previous heart attack or because the coronary arteries supplying blood to that area of the heart are blocked.

What should I expect?

Just like the exercise stress test, you will have small metal disks called electrodes placed on your chest and back. The electrodes are attached to wires called leads, which are attached to an electrocardiogram machine. Doctors will then have you walk on a treadmill.
After your doctors have the information they need from the exercise part of the test, you will step off of the treadmill and go into another room. You will be given an injection of a radioactive substance, and you will be asked to lie on an examination table, which has a gamma-ray camera above it. The camera is used to take pictures of your heart. The camera can pick up traces of the radioactive substance in your body and then send a picture to a television monitor.

After this part of the test is over, you can leave the testing area for 3 or 4 hours. Doctors will ask you not to exercise or drink or eat anything with caffeine, such as coffee, tea, sodas, or chocolate. When you return, doctors will give you another injection of the radioactive substance. You will be asked to lie down on the examination table, and the gamma-ray camera will take pictures of your heart while you are resting. This will give your doctor an idea of how your heart works during both exercise and rest.

After the test is over, you may eat, drink, and go back to your normal activities right away.

Intravascular ultrasound (IVUS) or intravascular echocardiography is a combination of echocardiography and a procedure called cardiac catheterization. IVUS uses sound waves to produce an image of the coronary arteries and to see their condition. The sound waves travel through a tube called a catheter. The catheter is threaded through an artery and into your heart. This test lets doctors look inside your blood vessels.

IVUS is rarely done alone or as a strictly diagnostic procedure. It is usually done at the same time that a percutaneous coronary intervention, such as angioplasty, is being performed.

How does it work?

IVUS uses high-frequency sound waves (also called ultrasound) that can provide a moving picture of your heart. The pictures come from inside the heart rather than through the chest wall. The sound waves are sent with a device called a transducer. The transducer is attached to the end of a catheter, which is threaded through an artery and into your heart. The sound waves bounce off of the walls of the artery and return to the transducer as echoes. The echoes are converted into images on a television monitor to produce a picture of your coronary arteries and other vessels in your body.
What should I expect?

Do not eat or drink anything after midnight the night before your test. Talk to your doctor about any medicines that you are taking, because he or she may want you to stop taking them before the test. Also, it may be helpful if you make a list of the medicines and take it with you to the procedure, so that the doctors and technicians know exactly what you are taking and how much. You will most likely have blood tests, an electrocardiogram, and a chest x-ray taken before the procedure.

Once you are in the catheterization laboratory (also called the cath lab), you will see television monitors, heart monitors, and blood pressure machines. You will lie on an examination table, which is usually near an x-ray camera.

Electrodes will be placed on your chest. These electrodes have wires called leads, which hook up to an electrocardiogram machine. This machine will monitor your heart rhythm during the test.
To prevent infection, you will be shaved and cleansed around the area of your groin or arm where the catheter will be inserted.

A needle with a tube connected to it will be put in your arm. This is called an intravenous line or IV. You will get a mild sedative through the IV to relax you throughout the test.

You will be given an anesthetic medicine with a needle to numb the area around where the catheter will be inserted. You may feel mild discomfort. Next, a small incision will be made in the skin. Once doctors see the vein or artery into which the catheter will go, a special needle is used to poke into it. Doctors then put the catheter into the artery or vein in your groin or arm. You should not feel pain during this part of the test.

The catheter is gently threaded through the artery and into your heart. On the end of the catheter is the transducer, which takes pictures of your heart. Doctors can move the catheter to get pictures of the inside of your heart from different angles.

After the doctors have enough pictures, the catheter and IV line will be removed. You will also be disconnected from the electrocardiogram machine. Firm pressure will be applied to the site where the catheter was inserted to stop any bleeding. You will also be bandaged.

You will be moved to another room where you will need to rest for 5 or 6 hours. You may feel a little sleepy until the sedative has worn off. You will be told to lie still. If the catheter was inserted in your groin, try not to bend your knee. If the catheter was inserted in your arm, try not to bend your elbow. Nurses will watch you to see that your heart rate and blood pressure are normal. After this time of rest, you can go home.

Holter monitoring gives doctors a constant reading of your heart rate and rhythm over a 24-hour period (or longer). The Holter monitor can record heart rate and rhythm when you feel chest pain or symptoms of an irregular heartbeat (called arrhythmia). Your doctor can then look at the time when you noticed your symptoms. Reading this printout will give your doctor an idea about the nature of your heart problem.

How does it work?

The Holter monitor is a recording device. The monitor has a strap that you wear over your shoulder or around your waist. The Holter monitor is battery-powered and holds a regular-sized cassette tape, much like one you would use in an audio tape player. The monitor has 5 to 7 wires called leads. The leads attach to metal disks called electrodes, which you wear on your chest. These electrodes are very sensitive, and they can pick up the electrical impulses of the heart. The impulses are recorded by the Holter monitor and give your doctor a 24-hour record of your heart’s electrical activity.

What should I expect?

Holter monitoring is a painless test. You will need to go into your doctor’s office to be fitted for the monitor. It is a good idea to bathe before you go to the doctor’s office, because once you are fitted with the Holter monitor, you cannot get it wet in the shower or bathtub.

A nurse will clean the areas with alcohol and then place the electrodes on your chest. For men, the nurse may have to shave some small areas of your chest. The electrodes stick to the skin with a gel. Sometimes, an electrode and lead wire will be taped to your chest to prevent them from moving around.

You will wear the Holter monitor for at least 12 to 24 hours. While you are wearing the monitor, you will be asked to keep a log of your daily activities: what you did and at what time. This will help the doctor figure out what you were doing during the times that there were abnormal readings. Otherwise, you can do your typical activities, except those that might get the Holter monitor wet.

After 24 hours (or more), you will go back to your doctor’s office to have the electrodes removed. This may cause some discomfort, similar to having a bandage pulled off.

A gated blood pool scan is a test using radioisotope dye that shows how blood pools in your heart during rest, exercise, or both. The test can tell doctors how well the heart is pumping blood and if it is working harder to make up for one or more blocked arteries. This test is also very useful for finding your “ejection fraction,” which is the percentage of blood that is pumped out of your heart’s lower chambers (called the ventricles) with each heartbeat. This test is also called multi-unit gated analysis or MUGA.

How does it work?
Gated blood pool scanning makes use of a radioactive substance that is injected into your bloodstream. The radioactive substance “tags” or “labels” the red blood cells in your blood. This substance is safe and will not harm your blood or organs. Doctors will then use a gamma-ray camera to take pictures of your heart as the “tagged” red blood cells circulate.

What should I expect?

No special preparation is needed before you have a resting gated blood pool scan. If your doctor has ordered an exercise gated blood pool scan, do not eat or drink anything (you may only have water) after midnight the night before the test.

If you think you may be pregnant, talk to your doctor before you schedule the test.

A technician will clean certain areas on your chest so that he or she can place small metal disks called electrodes on those areas. The electrodes have wires called leads, which are attached to a nuclear imaging computer. Then the technician will give you 2 injections: the first injection prepares the red blood cells, and the second is used to “label” the red blood cells. The technician will ask you to lie down on a small examination table, which has a special camera around it. Next, the technician will take a number of pictures of your heart with the gamma-ray camera. If your doctor only ordered a resting gated blood pool scan, this would be the end of the test.

If your doctor ordered an exercise gated blood pool test, you will be moved to a different examination table. When you lie down, there will be pedals at the end of the bed. You will put your feet in the pedals and, while still lying down, begin to pedal as if you were riding a bicycle. Using the gamma-ray camera, the technician will take a number of pictures of your heart. Your doctor may also be present to look at the pictures of your heart during the test.

After the test, you may feel tired, but you will be allowed to resume your normal activities as soon as you are done with the test. The harmless radioactive substance will leave the body within 2 or 3 days. Women who are pregnant or breastfeeding should not have a gated blood pool scan.

Exercise Stress Test 

An exercise stress test is a common test that doctors use to diagnose coronary artery disease. The test helps doctors see how the heart performs during exercise. You may also hear exercise stress tests called exercise tolerance tests, stress tests, exercise EKGs, or treadmill tests.

An exercise stress test may also use echocardiography (called a stress echocardiogram) or radioisotope dyes that are injected into the bloodstream (called nuclear stress tests). When these tests are done, doctors can tell more about the structure and blood flow of the heart.

How does it work?
During a stress test, you will wear small metal disks called electrodes. The electrodes are connected to wires called leads, which are connected to a machine with a television monitor that records the electrical activity of your heart (EKG). This screen can also show pictures from a stress echocardiogram and nuclear stress test. By watching this screen, doctors can record your heartbeat while you are exercising.

Sometimes, a patient is too sick to exercise. In these cases, patients are given a drug that has the same effect on the body that exercise does.

What should I expect?

Do not eat or drink for 4 hours before the test, especially items that contain caffeine, which is found in coffee, tea, sodas, chocolate, and some over-the-counter pain relievers. Also, be sure to ask your doctor about any medicines you are taking and whether you should stop taking them before the test.

A technician will use an alcohol swab to clean the areas of your skin where the electrodes will be placed. The alcohol may feel cold. Next, electrodes will be placed on your chest and back. The electrodes are attached to an electrocardiograph machine, which records your heart’s electrical activity. A healthy person’s electrocardiogram has a certain pattern, and changes in that pattern can tell doctors if there is a problem with your heart.

You will also wear a blood pressure cuff around your arm, which will be used to watch your blood pressure during the test.

Before the test, doctors will record your blood pressure and pulse. They will also record your heart’s electrical activity before you start exercising (called a resting EKG). You will also wear the electrodes during exercise and for about 10 minutes after exercise.

During the test, you will be asked to walk on a treadmill or to ride a stationary bike. Every 2 or 3 minutes, your doctor or the technician will increase the speed and slope of the treadmill or stationary bike, which will make you feel like you are walking or pedaling uphill. Your doctor or a technician will look for changes in the electrocardiogram patterns and blood pressure levels, which may tell doctors that your heart is not getting enough oxygen. Other signs of coronary artery disease include chest pain or unusual shortness of breath while you are exercising.

At the end of the test, your doctor will give you a cool-down phase where you may be asked to lie down or sit quietly.

After the test is over, you may eat, drink, and go back to your normal activities.

Electrophysiology (EPS) studies use cardiac catheterization techniques to study patients who have irregular heartbeats (called arrhythmias). EPS shows how the heart reacts to controlled electrical signals. These signals can help doctors find out where in the heart the arrhythmia starts and what medicines will work to stop it. EPS can also help doctors know what other catheter techniques could be used to stop the arrhythmia (see Arrhythmia for more about the catheter techniques used to treat arrhythmia).

How does it work?

EPS uses electrical signals to help doctors find out what kind of arrhythmia you have and what can be done to prevent or control it. Doctors will perform a cardiac catheterization procedure in which a long, thin tube (called a catheter) will be put into an artery in your leg and threaded into your heart. This catheter can be used to send the electrical signals into your heart.

Catheterization laboratory
 
Stimulating the heart will cause an arrhythmia, and doctors can record where in the heart it started. In some cases, you might be given a medicine to cause an arrhythmia. Certain medicines can also be given through the catheter to see which ones will stop the arrhythmia.
What should I expect?

Do not eat or drink anything after midnight the night before your test. If you have diabetes, you should talk to your doctor about your food and insulin intake, because not eating can affect your blood sugar levels.

Talk to your doctor about any medicines that you are taking, because he or she may want you to stop taking them before the test. Also, it may be helpful to make a list of your medicines and bring it with you to the procedure, so that doctors know exactly what you are taking and how much. You will most likely have blood tests, an electrocardiogram, and a chest x-ray taken before the procedure.
Once you are in the catheterization laboratory (also called the cath lab), you will see television monitors, heart monitors, and blood pressure machines. You will be asked to lie down on an examination table.
Electrodes will be placed on your chest. These electrodes have wires called leads, which hook up to an electrocardiogram machine. This machine will monitor your heart rhythm during the test.

To prevent infection, you will be shaved and cleansed around the area of your leg where the catheter will be inserted.

A needle with a tube connected to it will be put in your arm. This is called an intravenous line or IV. You will get a mild sedative through the IV to relax you throughout the test.

You will be given an anesthetic medicine with a needle to numb the area around where the catheter will be inserted. You may feel mild discomfort. Next, a small incision will be made in the skin. Once doctors see the artery into which the catheter will go, a special needle is used to poke into it. Doctors then put the catheter into the artery in your leg. You should not feel pain during this part of the test.

The catheter is gently threaded through the artery and into your heart. Once the catheter is in place, doctors will give your heart small electrical impulses to make it beat at different speeds. You will be able to feel your heartbeat changing speeds, and this may cause some mild discomfort. After the doctors have the information they need, the catheter and IV will be removed. Firm pressure will be applied to the site where the catheter was inserted to stop any bleeding. You will also be bandaged.

You will be moved to another room where you will need to rest for a few hours. You may feel a little sleepy until the sedative has worn off. You should try to lie still and not bend your knee too much. Nurses will watch you to see that your heart rate and blood pressure are normal. After this time of rest, you will be able to go home.

An electrocardiogram (ECG or EKG) is a routine test that is used to look at the electrical activity of the heartbeat. An electrocardiogram can tell your doctor a lot about your heart and how it is working. This test can help your doctor learn more about your heart rhythm, the size and function of the chambers of your heart, and your heart muscle. A healthy person’s electrocardiogram has a certain pattern. When there are changes in that pattern, your doctor can tell that there is a problem with your heart. For example, during a heart attack, the EKG machine records the changing pattern of the heart’s electrical activity.

How does it work?

For your heart to beat, an electrical impulse is sent from the sinoatrial (SA) node, which is located in your heart. The SA node helps your heart keep a steady pace. An electrocardiogram can trace the path of electrical energy that is sent from the SA node and through your heart. This lets your doctor know whether you have a problem that might cause your heart to beat irregularly.

Small metal disks called electrodes are placed on your skin. The electrodes are used to pick up the electrical impulses of the heart. The impulses are recorded, giving doctors a record of your heart’s electrical activity.
What should I expect?

No special preparation is needed before you have an electrocardiogram.

During the test, you will lie on an examination table. A technician will clean the areas on your body where the electrodes will be placed, usually your chest, back, wrists, and ankles. The electrodes have wires called leads, which hook up to the electrocardiogram machine.

Once the electrodes are in place, you will be asked to lie down. The technician will enter some information into the electrocardiogram machine and then tell you to lie still for about a minute while the machine takes its readings. The test is completely safe and painless.

Echocardiography 

Echocardiography uses sound waves to produce an image of the heart and to see how it is functioning. Depending on the type of echocardiography test they use, doctors can learn about the size, shape, and movement of your heart muscle. This test can also show how the heart valves are working and how blood is flowing through your heart. Echocardiography can also give doctors information about your arteries.

How does it work?
Echocardiography uses high-frequency sound waves (also called ultrasound) that can provide a moving picture of your heart. The sound waves are sent through the body with a device called a transducer. The sound waves bounce off of the heart and return to the transducer as echoes. The echoes are converted into images on a television monitor to produce pictures of your heart.

One-dimensional or M-mode echocardiography is one beam of ultrasound directed toward the heart. Doctors most often use M-mode echocardiography to see just the left side (or main pumping chamber) of your heart.
 
Two-dimensional echocardiography produces a broader moving picture of your heart. Two-dimensional echocardiography is one of the most important diagnostic tools for doctors.
 
Doppler echocardiography measures blood flowing through the arteries and shows the pattern of flow through the heart.

What should I expect?

No special preparation is needed before you have an echocardiogram.
During the test, you will lie on an examination table. A technician will place small metal disks called electrodes on your chest. These electrodes have wires called leads, which hook up to an electrocardiogram machine. This machine will monitor your heart rhythm during the test.

Next, the technician will put a thick gel on your chest. The gel may feel cold, but it does not harm your skin. Then, the technician will use the transducer to send and receive the sound waves.

The transducer will be placed directly on the left side of your chest, above your heart. The technician will press firmly as he or she moves the transducer across your chest. You may be asked to breathe in or out or to briefly hold your breath during the test. But, for most of the test, you will lie still.

An echocardiogram may take up to 45 minutes to perform. You should not have any pain or discomfort during the test

Computed Tomography (CT) Scan 

A CT scan (”cat scan”) is an x-ray technique that uses a computer to create cross-sectional (or slice-like) pictures of the heart.

How does it work?

The CT scanner is a large X-ray machine that has a short, open-ended tube in the middle (like a very short tunnel). The patient lies on a scanning table, which slides through the middle of the CT scanner. The CT scanner takes many x-ray pictures of thin slices of your heart. A computer then puts these images together to make one detailed picture. In some cases, a contrast dye is injected into the bloodstream to help doctors get a clearer picture.

What should I expect?

If a contrast dye is not going to be used during your CT scan, you should not eat for about 2 hours before the test. If a contrast dye is going to be used, you should not eat for about 4 hours before the test. The contrast dye may cause hot flushing in some patients.

You will be asked to undress and put on a hospital gown. Then, you will lie down on a table, which will be slowly moved through the hollow center of the CT scanner. You will be asked to lie still and to hold your breath briefly as each picture is taken.
After the test, you may go about your normal activities. Some people find that they have a bad reaction to the contrast dye, but this is rare. If this happens, you will be treated at the hospital after your test.

CT scanning is a safe test. Although your exposure to radiation is small, you should not have a CT scan if you are pregnant.

A CT scan does not get a moving picture of the heart. Instead, CT scans are used to see if part of the heart has calcified. This patient has had a heart attack that scarred the heart’s main pumping chamber (the left ventricle). The red arrows point to the scarred part of the heart that has since formed a thick, calcified wall at the tip of the left ventricle.

Electron Beam Computed Tomography (EBCT or Ultrafast® CT)
 
An electron beam CT scan is faster than a regular CT scan. The technician can “freeze” an image while the heart is in motion. This lets doctors get a better look at the coronary arteries. The red arrow is pointing to calcification in the left coronary artery.

EBCT is a faster type of CT scanning, which takes an x-ray of the heart in about one-tenth of a second. Ordinary CT scanning can take anywhere from 1 to 10 seconds. EBCT takes pictures so quickly that it can avoid blurred pictures caused by the beating of the heart, a problem with a regular CT scan. This type of scanning can also detect calcium buildup in the arteries of the heart (the coronary arteries). The amount of calcium in the coronary arteries has been found to be a marker for the presence of coronary artery disease.

Multi-Detector Computed Tomography (MDCT)

Ordinary CT scanning can take anywhere from 1 to 10 seconds per slice (or picture), but the faster MDCT scanners have many rows of detectors (up to 64!) that can take multiple X-rays of the heart at the same time. These scanners can also obtain pictures of the entire heart in about 1 ten-second breathhold.

The new MDCT scanners are used routinely to measure the amount of calcium in the coronary arteries—similar to EBCT—but are also now able to take images of the coronary arteries that are nearly comparable to those taken during a cardiac catheterization. For many patients, an MDCT scan of the heart is enough for doctors to determine whether coronary artery disease is present, and patients may not need to have a cardiac catheterization.