{"id":9650,"date":"2021-12-28T17:56:52","date_gmt":"2021-12-28T15:56:52","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/imaging-techniques-in-cardiology-echocardiography-ct-mri-spect-ecg-exercise-ecg-ecg-holter-abpm-coronarograpy-coronaria-angiography-electrophysiological-examination\/"},"modified":"2022-01-17T17:52:28","modified_gmt":"2022-01-17T15:52:28","slug":"imaging-investigation-techniques-in-cardiology","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/imaging-investigation-techniques-in-cardiology\/","title":{"rendered":"Imaging and investigation techniques in cardiology"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">ECG<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Electrocardiography displays the electrical activity of the heart. It does not provide any information about the mechanical or functional activities of the heart, but valuable information can be collected based on the changes in the various segments and waves.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Steps<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ol class=\"wp-block-list\"><li>Measure heart rate<\/li><li>Check regularity (R-R distance)<\/li><li>Calculate electrical axis (leads I and AVF)<\/li><li>Examine P wave<ol><li>Are they regular? Same polarity? P waves are followed by QRS?<\/li><\/ol><ol><li>Abnormalities:<ol><li>P-mitrale (increased duration)<\/li><li>P-pulmonale (increased amplitude)<\/li><li>P-cardiale (bifid)<\/li><\/ol><\/li><\/ol><\/li><li>PR interval (0.12-0.2s or 3-5 small boxes)<ol><li>&lt;0.12s WPW<\/li><li>&gt;0.2s AV block<\/li><\/ol><\/li><li>QRS complex<ol><li>Narrow (&lt;0.12s, or 3 small boxes)<\/li><li>Broad (&gt;0.12s)<\/li><li>Tall R wave may indicate hypertrophy<\/li><\/ol><\/li><li>ST segment<ol><li>Elevated means STEMI<\/li><li>Depressed means ischemia<\/li><li>&#8220;Boat shaped&#8221; depression in digoxin usage<\/li><\/ol><\/li><li>T-wave (should be upright in all leads except aVR and V1)<ol><li>Inversion means ischemia<\/li><\/ol><\/li><\/ol>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">AV blocks<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>1st degree: prolonged<\/li><li>2nd degree: <ul><li>Mobitz I (progressively prolongs, then stops)<\/li><\/ul><ul><li>Mobitz II (some Ps don\u2019t get through)<\/li><\/ul><\/li><li>3rd degree: P and QRS are not matching<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Bundle branch block<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>RBBB (v1,2,3 RsR)<\/li><li>LBBB (v4,5,6 RsR)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Miscellaneous<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<ul class=\"wp-block-list\"><li>Each large square is 0.2s, each small square is 0.04s<\/li><li>A normal 10-second strip consuists of 50 large squares<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Locations of MI<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li>Anterior: V1-V4 (LAD)<\/li><li>Lateral: I, aVL, V5, V6 (RCx)<\/li><li>Inferior: II, III, aVF (RCA)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Stress ECG<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">Stress ECG is a normal, 12-lead ECG done during exercise. <\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Other form of stress tests are also available (stress echo, stress nuclear imaging), but stress ECG is the cheapest and most widely used one; its disadvantages are lower sensitivity and specificity.<\/li><li>It is used for the detection of possible coronary artery disease, evaluate prognosis after an MI, and assess cardiac performance under stress.<\/li><li>The patient uses a treadmill or a stationary bicycle to elevate thier HR to a target of 85% of their maximal heart rate (220 minus patient&#8217;s age x 0.85).<\/li><li>If the patient is unable to exercise, a pharmaceutical stress test can be done using adenosine, dypiridamole, or dobutamine.<\/li><li><strong>Contraindications <\/strong>include acute coronary syndrome, acute pulmonary embolism, aortic dissection, severe aortic stenosis, severe HTN, severe arrhythmias.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">ECG Holter<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<p class=\"wp-block-paragraph\">A Holter monitor is a wearable, portable ambulatory ECG device used for cardiac monitoring for 24-72 hours or more.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>It is used in case of suspicion of a cardiac irregularity that cannot be captured during a standard ECG.<\/li><li>Indicated in patients with unexplained palpitations, chest pain, and syncope, and monitoring antiarrhythmic and pacemaker therapy.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Echocardiography<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<p class=\"wp-block-paragraph\">Echocardiography uses ultrasound to visualize the cardiac structures. It is non-invasive, uses no ionizing radiation, and is highly safe.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>It can provide valuable information such the size and volume of chambers, wall thickness and motion, calculate cardiac output, ejection fraction, visualize regurgitation, among many other parameters.<\/li><li>It can be done transthoracically (most common and convenient) or transesophagically (more accurate). Other forms include:<ul><li>Stress echocardiography<\/li><li>Intracardiac and intravascular (minimally invasive)<\/li><\/ul><\/li><li>Special techniques include 3D echocardiography, and contrast echo cardiography (the contrast material is microbubbles).<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Computed tomography<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n\n<p class=\"wp-block-paragraph\">CT scans use X-rays to visualize different structures in the body.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>In cardiology, CT is used for visualizing the cardiac anatomy, coronary circulation (most importantly, detection of coronary artery disease) and the great vessles, calcium deposits, with or without contrast material.<\/li><li>Coronary calcium scan provides a score (<strong>Agatston score<\/strong>) regarding the calcification within the coronary arteries (corresponding with advanced atherosclerosis). A score of zero means there is none; a score of 100-300 means moderate risk, and over 300 means high risk for heart disease. <\/li><li>The heart rate should be low enough for accurate imaging (&lt;65\/min). Beta blockers or CCBs can be given, and the patient is asked to hold their breath for 5-10 seconds during the scan.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_11\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">MRI<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_11\">\n\n\n<p class=\"wp-block-paragraph\">MRI uses strong magnetic fields and radio waves to produce high-resolution images. It is a non-invasive, highly safe, but expensive investigation technique.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Cardiac MRI can be used for accurately visualizing ventricular volume and mass, detection of cardiomyopathy, valvular disease, pericardial disease, tumors, tissue changes, inflammation, and fibrosis.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_12\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">SPECT<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_12\">\n\n\n<p class=\"wp-block-paragraph\">Single-photon emission computed tomography is a functional imaging technique that uses a radiological tracer that emits gamma rays, and a gamma camera to capture them, visualizing biological activities.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>In cardiology, the most common investigation is <strong>myocardial perfusion scintigraphy<\/strong> (MPS). <ul><li>It visualizes the absorption of the radioactive tracer in the myocardium, with well-perfused myocardial tissue readily absorbing it, while areas with poor absorption (underperfused, damaged) having poor absorption (known as &#8220;cold spots&#8221; or &#8220;defects&#8221;).<\/li><li>It can be done during stress (physical activity, or pharmaceutical using adenosine or dipyridamole).<\/li><\/ul><\/li><li>Other, less commonly used investigations include <strong>radionucleotide ventriculography <\/strong>for the assessment of left ventricle functionality, largely repalced by echocardiography. <\/li><li>Nuclear imaging can be combined with anatomical imaging (CT, MRI) to produce functional-anatomical imaging.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_13\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">ABPM<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_13\">\n\n\n<p class=\"wp-block-paragraph\">Ambulatory blood pressure measurement is used for periodically measuring a patient&#8217;s blood pressure over a period of time (24hrs), outside of hospital settings. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is useful for the diagnosis and follow-up of hypertension, in cases of &#8220;whitecoat hypertension&#8221;, and measuring night-time dip in blood pressure (a desirable quality).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ABPM measurement usually displays ~5mmHg lower than normal blood pressure measurement.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_14\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Coronarography and coronary angiography<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_14\">\n\n\n<p class=\"wp-block-paragraph\">Coronarography describes the insertion of a catheter through the skin and the femoral\/radial\/brachial artery into the coronaries. Once the catheter is placed in the coronary artery, the vasculature is visualized using a radio-opaque dye and visualized using fluoroscopy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Coronary angiography is a term often used interchangeably with coronarography. CCTA (coronary CT angiography) is a contrast CT visualizing the coronary arteries.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_15\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">EP study<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_15\">\n\n\n<p class=\"wp-block-paragraph\">Electrophysiological study is used for examining the conduction system of the heart and detecting arrhythmias (especially tachyarrhythmias).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The procedure is done under fluoroscopy; a catheter is placed through a vein and into the right atrium.<\/li><li>Electrodes are inserted, and the electrical signals of the heart are measured at different areas.<\/li><li>The electrodes can also stimulate the heard and elevate\/reduce the heartrate, or perform cardiac mapping (finding the best location for cardiac ablation), and also perform a cardiac ablation.<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"pure-table\"><tbody><tr><td>Echocardiography<\/td><td>Wall motion<br>Ventricle volume and size<br>CO and ejection fraction<br>Regurgitation<\/td><\/tr><tr><td>CT<\/td><td>Anatomy<br>Coronaries and great vessels<br>Calcium deposits<\/td><\/tr><tr><td>MRI<\/td><td>Anatomy<br>Coronaries and great vessels<br>Ventricular mass and volume<br>Valvular disease and endocarditis<br>Cardiomyopathy<br>Pericarditis<br>Tumors, fibrosis, inflammation and changes<\/td><\/tr><tr><td>SPECT<\/td><td>Biological activity<br>-Myocardial perfusion scintigraphy<br>-Radionucleotide ventriculography <\/td><\/tr><\/tbody><\/table><figcaption>Imaging techniques and what do they visualize.<\/figcaption><\/figure>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">ECG<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Steps<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">AV blocks<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Bundle branch block<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Miscellaneous<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Locations of MI<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Stress ECG<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">ECG Holter<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Echocardiography<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Computed tomography<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">MRI<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">SPECT<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">ABPM<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Coronarography and coronary angiography<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">EP study<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>ECG Electrocardiography displays the electrical activity of the heart. It does not provide any information about the mechanical or functional activities of the heart, but valuable information can be collected based on the changes in the various segments and waves. Steps Measure heart rate Check regularity (R-R distance) Calculate electrical axis (leads I and AVF) [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9650","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Imaging and investigation techniques in cardiology &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/imaging-investigation-techniques-in-cardiology\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/imaging-investigation-techniques-in-cardiology\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/imaging-investigation-techniques-in-cardiology\\\/\",\"name\":\"Imaging and investigation techniques in cardiology &#8211; 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