Transcript Cardiac Diagnostic Testing

Cardiac Diagnostic Testing
Victor Politi, M.D, FACP
Medical Director, SVCMC, School of Allied
Health Professions, Physician Assistant Program
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
Electrocardiographic Tests
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Ambulatory Monitors
EKG/ECG
Exercise Stress Test
Head Upright Tilt Test
Metabolic Exercise Stress Test
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
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
Types of Ambulatory Monitors
• Holter
• Loop Recorder
• CardioNet (mobile cardiac outpatient
telemetry)
• Transtelephonic transmitter
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.
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
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.
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.
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.
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
Technician instructing on Loop
Recorder
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.
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.
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.
Patient wearing CardioNet
system
Transtelephonic Transmitter
• Transtelephonic transmitters are not worn
continuously.
• They are used only during the phonemonitoring 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.
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.
Patient testing transtelephonic
transmitter
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
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
EKG
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.
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
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.
EST
• The patient begins to exercise by
walking on a treadmill or pedaling a
stationary cycle. The degree of difficulty
is gradually increased.
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.
EST
• the appointment lasts about 60 minutes,
the actual exercise time is usually
between 7 and 12 minutes.
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.
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
Metabolic Exercise Stress Test
(also called metabolic stress test)
Laboratory testing
• Laboratory tests include a number of
blood tests used to diagnose and
monitor treatment for heart disease.
Laboratory Testing
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CBC
Lipids
electrolytes
BNP (B-type Natriuretic peptide)
Enzymes and Proteins
Laboratory Findings
Troponin I
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Earliest increase - 4-6 hours
Peak hours 10-24
Duration of increase 4-7 days
Specificity 95%
Sensitivity at peak >98%
Laboratory Findings
CK Total
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Earliest increase 4-8 hours
Peak hours 24-36 hours
Duration of Increase 36-48 hours
Specificity 57-88%
Sensitivity at peak 93-100%
Laboratory Findings
CK-MB
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Earliest increase 3-4 hours
Peak hours 15-24
Duration of Increase 24-36 hours
Specificity 93-100%
Sensitivity at peak 94-100%
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.
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.
Nuclear Imaging
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Multigated Acquisition Scan (MUGA)
Positron Emission Tomography (PET)
Sestamibi Exercise Stress Test
Thallium Exercise Stress Test
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.
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.
Multigated Acquisition Scan
(MUGA scan, nuclear ventriculogram, radionuclide
scan)
 A MUGA scan analyzes the amount of radiolabeled 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.
Positron Emission Tomography (PET or
cardiac viability study)
• An imaging procedure that uses
radioactive tracers to create threedimensional pictures of the tissues
inside of the body and that can monitor
metabolic processes.
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.
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.
PET
• dipyridamole is injected into the IV for
about four minutes. The medication causes
the heart to react as if the patient were
exercising
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
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.
PET
Sestamibi Exercise Stress Test
(sestamibi stress test, stress perfusion scan, stress
sestamibi)
• A diagnostic study, that uses a small amount
of radioactive tracer, injected into the
body,and a special camera, that detects the
radiation released by the substance to
produce a computer image of the heart.
• Combined with exercise, the study can help
determine if there is adequate blood flow to
the heart at rest, as compared with activity.
Sestamibi Exercise Stress Test
(sestamibi stress test, stress perfusion scan, stress
sestamibi)
 Used to:
 determine if there is adequate blood flow to your
heart during increasing levels of activity
 evaluate the effectiveness of your cardiac treatment
plan
 determine the likelihood of having coronary artery
disease and the need for future testing
Sestamibi Exercise Stress Test
(sestamibi stress test, stress perfusion scan, stress sestamibi)
• a small amount of thallium is injected into a vein.
• Thallium is a radioactive tracer that allows the
physician to assess heart function. Thallium is not
a dye.
• The patient lies under a camera with their arms
over their head for about 15 to 20 minutes.
• The camera records images that show the blood
flow to each area of the heart muscle at rest.
Sestamibi Exercise Stress Test
(sestamibi stress test, stress perfusion scan, stress sestamibi)
• Next the patient goes to the Stress Lab. A
resting ECG, and BP rate recorded. An IV
will be started.
• The patient will begin to exercise by
walking on a treadmill or pedaling a
stationary cycle. The degree of difficulty
will gradually increase.
Sestamibi Exercise Stress Test
(sestamibi stress test, stress perfusion scan, stress sestamibi)
• One minute before stopping exercise, a
small amount of sestamibi (a different type
of radioactive tracer) will be injected in the
IV. Once the sestamibi is administered, the
IV will be removed. The patient may be
asked to drink milk, which enhances the
quality of the images.
Sestamibi Exercise Stress Test
(sestamibi stress test, stress perfusion scan, stress sestamibi)
• About 30 minutes after exercise is
complete, the patient returns to nuclear
medicine - images are again taken (for
about 20 minutes). The camera will now
record images that show how well blood
flows through the coronary arteries to each
area of the heart muscle during exercise
Sestamibi Exercise Stress Test
(sestamibi stress test, stress perfusion scan, stress sestamibi)
• The appointment lasts about three to four
hours, the actual exercise time is usually
between 7 and 12 minutes.
Thallium Exercise Stress Test (stress thallium test,
perfusion scan)
• A type of nuclear scanning technique
that uses the radioactive substance
thallium.
• A thallium stress test combines nuclear
scanning with exercise on a treadmill or
stationary bicycle to assess heart
function and determine if there is
adequate blood flow to the myocardium.
Thallium Exercise Stress Test (stress thallium test,
perfusion scan)
• A thallium stress test is used to– determine if there is adequate blood flow to
the heart during increasing levels of activity
– evaluate the effectiveness of a cardiac
treatment plan
– determine the likelihood of having coronary
artery disease and the need for future
testing
Thallium Exercise Stress Test (stress thallium test,
perfusion scan)
• BP and ECG recording will be taken before,
during and after exercise.
• The patient will begin to exercise by
walking on a treadmill or pedaling a
stationary cycle.
• The degree of difficulty will gradually
increase.
Thallium Exercise Stress Test (stress thallium test,
perfusion scan)
• At the maximum level of exercise, a small
amount of thallium is injected into a vein.
• The thallium travels through the
bloodstream, reaching the coronary arteries
and then the cells of the heart muscle.
• A camera detects the distribution of
thallium in the myocardium.
Thallium Exercise Stress Test (stress thallium test,
perfusion scan)
• Because the thallium works as a tracer to
indicate the areas of the myocardium that
blood is reaching, regions that show less
thallium have a loss of perfusion, or blood
flow
• the appointment lasts about 60 minutes,
the actual exercise time is usually
between 7 and 12 minutes.
Ultrasound
• Ultrasound tests are noninvasive
tests which use ultrasound, or high
frequency sound wave, to create
graphic images of the heart's
structures, pumping action, and
direction of blood flow.
Ultrasound Studies
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Echocardiogram
Dobutamine Stress Echo
Transesophageal Echocardiogram (TEE)
Exercise Stress Echo
Echocardiogram
• An echocardiogram (often called
"echo") is a graphic outline of the heart's
movement.
Echocardiogram
• During an echocardiogram test,
ultrasound ( high-frequency sound
waves) that come from a hand-held
wand placed on the chest, is used to
provide pictures of the heart's valves
and chambers and help the
sonographer evaluate the pumping
action of the heart.
Echocardiogram
• Echo is often combined with Doppler
ultrasound and color Doppler to
evaluate blood flow across the heart’s
valves.
Dobutamine Stress Echocardiogram (dobutamine echo,
pharmacological echocardiogram)
• An echocardiogram is used to
– assess the heart’s function
– determine the presence of disease of the heart
muscle, valves and pericardium, heart tumors,
and congenital heart disease
– evaluate the effectiveness of medical or surgical
treatments
– follow the progress of valve disease
Dobutamine Stress Echocardiogram (dobutamine echo,
pharmacological echocardiogram)
• The dobutamine stress echo test
involves infusing a medication through
an intravenous (IV) line, called
dobutamine.
• The dobutamine stimulates the heart
and makes it "think" it is exercising.
• The test is used to evaluate the heart
and valve function when the patient is
unable to exercise on a treadmill or
stationary cycle
Dobutamine Stress Echocardiogram (dobutamine echo,
pharmacological echocardiogram)
 A dobutamine stress echo is used to:
 Determine how well the heart tolerates stress or exertion
 Evaluate the function of your heart and valves
 Evaluate the effectiveness of your cardiac treatment plan
 Determine the likelihood of having coronary artery disease
and the need for further testing
Dobutamine Stress Echocardiogram (dobutamine echo,
pharmacological echocardiogram)
• A resting ECG and BP are recorded
• A resting sonogram is done
• The dobutamine is administered via IV as
the sonogram continues
• The dobutamine causes the heart to react as
it would under exercise
• The dobutamine stress echo takes about 60
minutes. The actual infusion time is usually
15 minutes.
TEE- Transesophageal
echocardiogram
• During the transesophageal
echocardiogram (TEE) test, an
ultrasound transducer (which produces
high frequency sound waves) provides
pictures of the heart's valves and
chambers and helps evaluate the
pumping action of the heart.
TEE- Transesophageal
echocardiogram
• The ultrasound transducer is positioned
on an endoscope. The endoscope is
placed into the mouth and passed into
the esophagus to provide a close look
at the heart's valves and chambers
without interference from the ribs or
lungs.
TEE- Transesophageal
echocardiogram
• TEE is often combined with Doppler
ultrasound and color Doppler to
evaluate blood flow across the heart’s
valves. TEE is often used when the
results from standard echo studies were
not sufficient
TEE- Transesophageal
echocardiogram
• TEE is used to:
– Assess the overall function of the heart's
chambers and valves
– Determine the presence of many types of
heart disease (I.e. valvular/myocardial
heart disease, pericardial disease, cardiac
masses and congenital heart disease)
– Evaluate the effectiveness of medical or
surgical treatments Evaluate abnormalities
of the left atrium
Exercise Stress Echo
• The exercise stress echo test involves
exercising on a treadmill or stationary cycle.
• The test is used to evaluate heart and valve
function at rest and with exertion
Exercise Stress Echo
• An exercise stress echo is used to  Determine how well the heart tolerates activity
 Evaluate the function of the heart and valves
 Determine the likelihood of coronary artery disease
 Evaluate the effectiveness of a cardiac treatment plan
Exercise Stress Echo
• A resting ECG, resting heart rate and BP
will be recorded before exercise
• A resting echo will also be performed.
• The patient will exercise either on a
treadmill or stationary bicycle - gradually
increasing the rate of exercise
Exercise Stress Echo
• if the patient was exercising on a bike, the
echo test may be performed while the
patient is still pedaling. Another
echocardiogram after exercising may also
be performed
• If exercise was on a treadmill, the patient
will return to the table to lie down for
another echo.
Exercise Stress Echo
• The appointment takes about 60 minutes.
The actual exercise time is usually between
7 and 12 minutes.
Radiographic Tests
• Radiographic tests are noninvasive
tests which use x-ray machines or
specialized equipment with computer
technology to create pictures of the
internal structures of the chest
Radiographic Studies
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Calcium-Score Screening
Cardiac CT
Chest x-ray
MRI
Radiographic Test- Calcium
Score Screening Heart Scan
• A test used to detect calcium deposits found
in atherosclerotic plaque in the coronary
arteries.
• CT methods, such as this one, are the most
sensitive approaches to detecting coronary
calcification from atherosclerosis, before
symptoms develop.
Radiographic Test- Calcium
Score Screening Heart Scan
• More coronary calcium means more
coronary atherosclerosis, suggesting a
greater likelihood of significant narrowing
somewhere in the coronary system and a
higher risk of future cardiovascular events
Radiographic Test- Calcium
Score Screening Heart Scan
• Those at increased risk include
individuals with the following traits:
 family or personal history of coronary artery disease
 male over 45 years of age, female over 55 years of age
 past or present smoker
 history of high cholesterol, diabetes or high blood pressure
 overweight
 inactive lifestyle
Radiographic Test- Calcium
Score Screening Heart Scan
• there are certain forms of coronary disease - such as "soft plaque" atherosclerosis – that
escape detection during this CT scan, it is
important to remember that this test is not
absolute in predicting risk for a lifethreatening event, such as a heart attack.
Radiographic Test- Calcium
Score Screening Heart Scan
• CT scan captures multiple images,
synchronized with the heartbeat. A
computer program, guided by the
cardiovascular radiologist, then analyzes the
images for presence of calcification within
the coronary arteries
Radiographic Test- Calcium
Score Screening Heart Scan
 Absence of calcium is considered a
"negative" exam. It does not exclude
the presence of "soft" noncalcified
plaque.
 If calcium is present, the computer
will create a calcium score that
estimates the extent of coronary
artery disease.
Cardiac Computed Tomography
(CT, cardiac CT or cardiac CAT scan)
• A traditional CT scan is an x-ray procedure
that combines many x-ray images with the aid
of a computer to generate cross-sectional
views of the body.
• Cardiac CT uses the advanced CT
technology with intravenous (IV) contrast
(dye) to visualize your cardiac anatomy,
coronary circulation and great vessels.
Cardiac Computed Tomography
(CT, cardiac CT or cardiac CAT scan)
• the cardiac CT is used to evaluate:
 the heart muscle
 the coronary arteries
 the pulmonary veins
 the thoracic aorta
 the sac around the heart (pericardium)
Chest X-Ray (CXR, chest film)
• an image of the structures of the chest
(heart, lungs and bones) on film
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used to:
 look at the structures of the chest (bones, heart,
lungs)
 evaluate placement of devices (pacemakers,
defibrillators) or tubes placed during hospitalization
for treatment and monitoring (catheters, chest tubes)
 diagnose lung and cardiac diseases
Magnetic Resonance Imaging (MRI)
• A test that produces high-quality still
and moving pictures of the heart and
great vessels.
• MRI uses large magnets and radiofrequency waves to produce pictures of
the body’s internal structures; no x-ray
exposure is involved.
MRI
• MRI acquires information about the
heart as it is beating; creating moving
images of the heart throughout its
pumping cycle.
MRI
• MRI to evaluate:
 The anatomy and function of the structures of the
chest: heart, lungs, great vessels and pericardium
 Presence of disease: ischemic heart disease,
thoracic aortic disease, pericardial disease, right
ventricular abnormalities, cardiac tumors, valve
disease, heart muscle disease (cardiomyopathy),
pulmonary artery disease and complex congenital
heart disease
Invasive Tests
• Invasive tests involve inserting
catheters into the blood vessels of the
heart in order to get a closer look at the
coronary arteries or to stimulate and
test the electrical system of the heart.
Invasive Tests
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Carotid Angiography
Cardiac Catheterization
Electrophysiology Study
Intravascular Ultrasound
Myocardial Biopsy
Carotid Angiography
• An invasive imaging procedure that
involves inserting a catheter into a blood
vessel in the arm or leg, and guiding it to
the carotid arteries with the aid of a special
x-ray machine.
• Contrast dye is injected through the catheter
so that x-ray movies of the carotid arteries
are taken.
Carotid Angiography
Carotid angiography
• carotid angiography is used to:
 evaluate or confirm the presence of narrowing or
blockage in carotid arteries
 determine risk for future stroke
 determine the need for further treatment (angioplasty
or surgery)
Carotid angiography
• A plastic introducer sheath (a short, hollow
tube through which the catheter is placed) is
inserted a blood vessel in the arm or groin.
A catheter is inserted through the sheath and
threaded to the arteries of the neck (right
and left carotid artery).
• When the catheter is in place, contrast
material will be injected. The contrast
material outlines the vessels.
Cardiac Catheterization
• An invasive imaging procedure that
involves inserting a catheter into a blood
vessel in the arm or leg, and guiding it
to the heart with the aid of a special xray machine.
• Contrast dye is injected through the
catheter so that the valves, coronary
arteries and heart chambers are can be
visualized.
Cardiac Catheterization
• cardiac cath is used to:
 evaluate or confirm the presence of heart disease
(such as coronary artery disease, valve disease or
disease of the aorta)
 evaluate heart muscle function
 determine the need for further treatment (angioplasty
or bypass surgery)
Intravascular Ultrasound (IVUS)
• An invasive procedure, performed along
with cardiac catheterization; a miniature
sound probe (transducer) on the tip of a
coronary catheter is threaded through
the coronary arteries and, using highfrequency sound waves, produces
detailed images of the interior walls of
the arteries.
Intravascular Ultrasound (IVUS)
• IVUS is used to:
 assess the inside of the vessel walls, making it
possible to evaluate the size of fatty matter; how it is
distributed, and in some cases, what it is made of
 determine the need for further treatment (angioplasty
or bypass surgery)
 determine the need for aggressive management of
risk factors prior to onset of symptoms and advanced
disease
 determine the predictors of transplant coronary artery
disease
Intravascular Ultrasound (IVUS)
• A plastic introducer sheath is inserted in
the groin. A catheter will be inserted
through the sheath and threaded to the
arteries of the heart. Through the
catheter, a wire with an ultrasound tip
will be passed into the coronary
arteries.
Intravascular Ultrasound (IVUS)
• Once the catheter is within the coronary
artery, a series of cross-sectional
pictures of the artery are produced
Myocardial Biopsy
• An invasive procedure that involves using a
bioptome (a small catheter with a grasping
device on the end) to obtain a small piece of
heart muscle tissue that is sent to a
laboratory for analysis.
Myocardial Biopsy
• myocardial biopsy is used to:
 evaluate or confirm the presence of rejection after
heart transplant
 diagnose myocarditis (inflammation of the heart
muscle)
Electrophysiology Study (EP)
• An EP Study is a recording of the electrical
activity of the heart. This test is used to help
determine the cause of rhythm disturbances
and the best treatment.
• During the test, arrhythmia can be
reproduced and various medications given
to see which one controls it best.
Electrophysiology Study (EP)
• the EP study is used to:
 determine the cause of an abnormal heart rhythm
 locate the site of origin of an abnormal heart rhythm
 decide the best treatment for an abnormal heart
rhythm
Electrophysiology Study (EP)
• Several catheters are inserted into the vein in the
groin
• Guided by the fluoroscopy machine, the catheters
are threaded to the heart.
• The catheters sense the electrical activity in the
heart and are used to evaluate the heart’s
conduction system.
• A pacemaker is used to give the heart electrical
impulses through one of the catheters to increase
heart rate.
Questions ??