Non-Invasive Diagnostic Methods in Cardiovascular Diseases

  1. Electrocardiography
  2. Echocardiography
  3. Exercises stress tests -Treadmill
  4. Myocardial perfusion scintigraphy
  5. Positron Emission Tomography-PET
  6. Coronary angiography CT (Multislice CT Angiography)
  7. Cardiac MR

Electrocardiography (ECG)

  • Basal rhythm
  • Cardiac maximum heart rate
  • Axe changes
  • Branch blocks
  • Expansion of spaces, symptoms of hypertrophy
  • Changes in ST-T


Sinusal rhythm: Heartbeats are normally controlled by sinoatrial node (basic=basal rhythm is sinusal.)

  • P waves appear.
  • Heartbeats are regular.
  • Heart rate of an adult ranges 60 to 100 per minute.

Nodal rhythm: Heart rate ranges 40 to 60 per minute.
Ventricular rhythm: Heart rate is 40 per minute.

Ambulatory ECG Display

  • Holter Monitorization (24-72 hours)
  • Event-Loop Recorder (1week-1month)

Etiology of heart-throb or syncope

  • Arrhythmia
  • Change in ST-T

Echocardiography (ECHO)

  • Ejection fraction (EF)
  • Local wall movements
  • Expansion of spaces
  • Wall thicknesses
  • Evaluation of heart valves
  • Pulmonary artery pressure
  • Evaluation of diastolic functions

Exercise stress teats-Treadmill

For diagnostic and prognostic purposes.
Depression of J point with exercise or depression of rapid up-sloping ST occurs also in normal persons.
Depression of slow up-slopping ST greater than 1.5 mm or horizontal down-sloping greater than 1 mm or over for longer than 0,08 seconds after J point is considered pathological.
Graded Walking tests (Maximal or submaximal)

  • Maximum speed, time and slope of the exercise is determined.
  • Heart rate at which the symptoms appear is determined.
  • Ischemic bone ECG changes are determined.
  • TA and pulse response to effort and whether there are any arrhythmias are determined.

220-Age=Predicted Maximum Heart Rate (PMHR) is the target heart rate.

Generally, Bruce or modified Bruce protocol is followed.

Indications

  • Evaluation of recurrent chest pain in patients known to have Ischemic Heart Disease (IHD) known, or in patients with previous stabile angina
  • Elimination of IHD in those presented with atypical chest pain
  • Those that come for cardiac check up, and athletes
  • Evaluation of arrhythmias induced by exercises
  • For routine follow up in those who have suffered from PCI and ACBG
  • Preoperative evaluation in those with IHD
  • Detection of FK in patients with valve disease, preoperative evaluation

Contraindications

After AMI, within 5 days

  • High risk unstable angina
  • Uncontrolled arrhythmias leading to symptoms or hemodynamic insufficiency
  • Symptomatic severe aortic stenosis
  • Symptomatic uncontrolled heart failure
  • Acute pulmonary embolism or pulmonary infarction
  • Acute myocarditis or pericarditis
  • Acute aortic dissection
  • Left main coronary artery stenosis
  • Uncontrolled hypertension
  • Physical or mental retardation preventing exercising

Causes of Cessation of Exercises

  • Drop in systolic blood pressure more than 10 mmHg of basal value despite increased effort with evidence of ischemia
  • Moderate to severe angina< /p> •ST elevation greater than 1mmden
  • Poor symptoms of perfusion (cyanosis, paleness)
  • Increased symptoms of nervous system (dizziness or presyncope)
  • Ventricular tachycardia
  • Patient’s urge for durdurma
  • Technical problems with displaying ECG or blood pressure

Myocardial perfusion scintigraphy

Provides information about myocardial perfusion.

Usually examined with Thallium 201.

Exercise, dipyridamole, adenosine, or dobutamine is used as a stimulant for ischemia.

Imaging is either planar or SPECT imaging (tomographic images).

Positron Emission Tomography-PET

Records photons from breaking up positron and provides information about myocardial perfusion and metabolic activity.

It is the best method to show myocardial ischemia.

Coronary Angio CT (Multislice CT Angiography) (Multislice Cardiac CT))

  • Multislice (16, 32, 40, 64, 125.... slices) computerized method provides information on calcium score and plagues in coroners.
  • Exposure time is as short as 10 minutes.
  • Information on values of urea, bun, and creatinine, and renal functions should be available.
  • Cardiac MR
  • Pericardial thickness (particularly tbc pericarditis)
  • Evaluation of left and right ventricles (left ventricular hypertrophy, arrhythmogenic right ventricular dysplasia)
  • Aortic dissection
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