CARDIAC DIAGNOSTIC TESTS

INTRODUCTION

Cardiac diseases are complex in nature. New and advanced diagnostic tests and tools are
constantly being introduced to further understand the complexity of disease, injury, and
congenital or acquired abnormalities. The involves tests used both inside and outside of body
Comprehensive in nature Simplified the diagnosis of complex cardiac diseases The following are
just a few of the diagnostic tests that have been used/are being used to further understand and
identify cardiovascular disease.

TYPES: 
1. NON INVASIVE TESTS
2. INVASIVE/INTERVENTIONAL TESTS

NON INVASIVE TESTS: 

 Blood Tests,
 Carotid & Extremity Vascular Testing,
 CAT (Computed Assisted Tomography) Scans
 Echocardiography
 Electrocardiograms (ECG or EKG)
 Holter and Event (Loop) Monitoring,
 Exercise Stress Tests,
 MRIs Nuclear Cardiology Tests
 VO2 Max Study

BLOOD TESTS: 
 Antistreptolysin-O test ,
 Arterial blood gases,
 Blood fat profile,
 Blood calcium test,
 BNP blood test,
 C-reactive protein test
 Carbon dioxide content.
 Complete blood count
 Electrolyte panel
 Erythrocyte sedimentation rate (ESR)
 Cardiac enzyme tests
 Glucose test.
 INR/prothrombin time tests,
 Serum myoglobin test.
 Total serum protein,
 Waste products test
1. ANTISTREPTOLYSIN - O TEST: Protein produced by streptococcal bacteria. In
response to infection, the body produces streptolysin antibody. Antibodies for
streptolysin, called antistreptolysin-O antibodies High levels indicate the presence of an
infection like Endocarditis or rheumatic fever.
2. BLOOD FAT PROFILE
- Cholesterol HDL (good cholesterol)
- LDL (bad cholesterol)
- Triglycerides Cholesterol
 HDL cholesterol Desirable: Less than 200 mg/dL (5.18 mmol/L) Borderline high: 200-
239 mg/dL (5.18 to 6.18 mmol/L) High: 240 mg/dL (6.22 mmol/L) or higher.
HDL Cholesterol Low risk: Less than 40 mg/dL (1.0 mmol/L) for men and less than 50
mg/dL (1.3 mmol/L) for women Average risk: 40-50 mg/dL (1.0-1.3 mmol/L) for men
and between 50-59 mg/dl (1.3-1.5 mmol/L) for women Less than average risk: 60 mg/dL
(1.55 mmol/L) or higher for both men and women
 LDL Cholesterol Optimal: Less than 100 mg/dL (2.59 mmol/L) Near/above optimal: 100-
129 mg/dL (2.59-3.34 mmol/L) Borderline high: 130-159 mg/dL (3.37-4.12 mmol/L)
High: 160-189 mg/dL (4.15-4.90 mmol/L) Very high: Greater than 190 mg/dL (4.90
mmol/L)
 Triglycerides Desirable: Less than 150 mg/dL (1.70 mmol/L) Borderline high: 150-199
mg/dL(1.7-2.2 mmol/L) High: 200-499 mg/dL (2.3-5.6 mmol/L) Very high: Greater than
500 mg/dL (5.6 mmol/L)
3. BNP BLOOD TEST: Measures the level of hormone called B-type natriuretic peptide
BNP rises in heart failure find out how severe heart failure is?
4. C-REACTIVE PROTEIN TESTS: an inflammatory marker. Provides information about a
patient’s risk of having a Heart attack or Stroke. High levels of CRP in the blood mean
there is inflammation somewhere in the body.
5. CARBON DIOXIDE CONTENT :Used as an investigative and diagnostic tool for
patients with breathing problems.
6. COMPLETE BLOOD COUNT: Information about the types of blood cells present
Condition and number (percentage) in relation to other cells. An elevated WBC may
indicate a heart attack or rheumatoid arthritis.
7. ELECTROLYTE PANEL :Measure the amount of potassium, sodium, chloride and
carbon dioxide levels in the blood. In order to assess how well the heart and
cardiovascular system are functioning.
8. ERYTHROCYTE SEDIMENTATION RATE (ESR): Measures the rate at which red
blood cells separate from plasma.
High levels may occur during a heart attack, rheumatic fever, giant cell arteritis, severe
anemia, cancer relapse or other conditions.
Low levels may be associated with heart failure, sickle cell anemia or other conditions.
9. CARDIAC ENZYME TESTS
 Creatine kinase-MB
 Lactate dehydrogenase
 Troponin
 Myoglobin
 Creatine kinase-MB An elevation in value indicates myocardial damage. An elevation
occurs within 4 to 6 hours and peaks 18 to 24 hours following an acute ischemic attack.
Normal value is 0% to 5% of total; total CK is 26 to 174units/L.
Lactate dehydrogenase Elevations in LDH levels occur 24hours following MI and peak
in 48 to 72hours. Normally LDH 1 is lower than LDH 2. Normal value of LDH in
conventional units is 140 to 280 international units/L.
Troponin Composed of 3 proteins- troponin C, cardiac troponin I, and cardiac troponin
T. Troponin I especially has a high affinity for myocardial injury. Rises within 3hours
and persists for up to 7 days. Normal values are low, with troponin I being lower than
0.6ng/ml and troponin T normally ranging from 0 to 0.2ng/ml. Any rise can indicate
myocardial cell damage.
Myoglobin An oxygen-binding protien found in cardiac and skeletal muscle. Level rises
within 1hour after cell death, peaks in 4 to 6 hours. Returns to normal within 24 to 36
hours.
10. GLUCOSE TEST: Diagnose or monitor patients with diabetes. Following a heart attack
fasting glucose levels may be temporarily high.
11. INR/PROTHROMBIN TIME TESTS: Measures how long it takes blood to clot. People
taking anticoagulants like warfarin may have this test done regularly. Normal Value-12–
15 seconds /0.8–1.2
12. TOTAL SERUM PROTEIN: Blood contains large amounts of protein. Measurement
gives information about a patient’s nutritional state and kidney and liver functions.
Abnormal protein levels may indicate congestive heart failure, hypertension, or kidney or
liver disease.
13. WASTE PRODUCTS TEST: Measure the levels of specific waste products in the blood.
Includes blood urea nitrogen, creatinine and uric acid. Abnormal results could be a sign
of heart failure, heart attack or kidney disease .

CAROTID & EXTREMITY VASCULAR TESTING

Carotid Ultrasound
Venous Duplex - Lower Extremity Doppler
- Upper Extremity Doppler

Carotid Ultrasound: Screening patients for carotid artery disease. Image and record the
appearance of atherosclerotic plaque within the carotid arteries. Technology borrowed from
submarine warfare The type and amount of blockage directly correlates with a patients risk of
stroke. Determine which patients should, or should not undergo carotid endarterectomy.

Venous Duplex: Highly accurate ultrasound test that directly images the inside of veins. When a
patient may have a blood clot in a vein- usually in the arms or legs.This is a Painless procedure
and can be completed in less than hour.

Extremity Doppler Uses a different variety of ultrasound and ultrasound equipment Assess the
amount of circulation in the arms or legs. Does not image the inside of vessels Determine how
much of the circulation is affected by the blockages Help to decide which patients might require
some type of procedure to restore adequate blood flow.
CAT SCANS:  An imaging technique that produces detailed, cross-sectional pictures ("slices")
of internal organs and body parts.Uses multiple x-ray images, taken from different angles, to
create three-dimensional images of body structures. It provides cross-sectional images of the
chest, including the heart and great vessels. In general, cardiac tomography (also called CT scan
and coronary artery scanning) is useful to evaluate aortic disease (such as aortic dissection),
cardiac masses and pericardial disease.

 CAT SCANS Helical CT

 CAT SCANS MultiSlice CT

Helical CAT scan, which uses special slip-ring technology to create a continuously moving x-ray
tube. Multislice CAT scan, which creates up to 64 images and allows physicians to look more
closely at intricate heart structures.

CAT SCANS : Generally advised not to eat or drink for four to six hours before the test ,if the
test requires an injection of a special dye or a sedative. A CAT scan may take less than one
minute.
COMPUTED TOMOGRAPHY: Cardiac computed tomography (CCT) can measure the
density and extent of calcifications in coronary artery walls. The technique of CCT was
established with electron beam scanners, but it has been refined and made more widely available
with the introduction of multidetector scanners. The technique relies on ECG "gating" to
compensate for cardiac motion. No contrast is used. The coronary lumen itself is not visualized.
A related technique is cardiac CT angiography (CCTA). CCTA uses intravenous contrast
material to provide direct visualization of the coronary lumen. Gating is also used to decrease
motion artifact. CCTA has been shown to have good correlation with the criterion standard of
conventional coronary angiography.

Electron-Beam Computed Tomography (EBCT or EBT)

EBCT is an especially fast form of X-ray imaging technology. It's particularly useful to

 Evaluate bypass graft patency, intra- and congenital cardiac lesions, and

 Quantify right and left ventricular muscle mass, chamber volumes, and systolic and
diastolic function (such as cardiac output and ejection fraction).

Electron-beam CT can also measure calcium deposits in the coronary arteries. The amount of
calcium detected by EBCT is related to the amount of underlying coronary atherosclerosis. The
coronary calcium score, derived from EBCT scans of the coronary arteries, is known to predict
the occurrence of cardiac events, such as fatal and nonfatal heart attacks or the need for coronary
bypass surgery or coronary (balloon) angioplasty over the next one or two years. A negative
calcium score implies a very low risk for obstructing coronary lesions and has a high negative
predictive value for coronary events.
EBCT isn't a substitute for cardiac catheterization. EBCT measurement of coronary calcium is of
no known value in patients who've already had a heart attack or undergone coronary bypass
surgery or coronary angioplasty because their risk is known.

ECHOCARDIOGRAPHY (also known as echo): A noninvasive test that uses sound waves to
produce a study of the motion of the heart's chambers and valves. The echo sound waves create
an image on the monitor as an ultrasound transducer is passed over the heart.
Echocardiography uses the technology to bounce sound waves off the heart's chambers and
valves, creating still and moving images of the heart.
TYPES :
 Color-Flow Doppler Echocardiograms
 Signal averaged ECG
 Stress Echocardiogram (exercise and pharmacological)
 Transesophageal Echocardiogram (TEE) - A test in which a small transducer is passed
down the esophagus to provide a clearer image of heart structures.

ELECTROCARDIOGRAMS (ECG or EKG): A test that records the electrical activity of the
heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
Painless test in which electrodes are put on the chest, arms and legs to monitor and record the
heart’s electrical activity. The record appears as a graph or series of wave lines on a monitor or a
long strip of paper. An EKG gives information about the heart’s rate and rhythm. Suggest the
presence of a past or current heart attack.
A signal averaged EKG Uses a computer to amplify and enhance very small electrical impulses
in the heart Helps cardiologists predict who may suffer dangerous ventricular (lower chamber)
arrhythmias.  
ELECTROCARDIOGRAMS EXERCISE TOLERANCE TEST an EKG done while you are
exercising on a treadmill or stationary bicycle. Results are compared with those from when
you’re at rest. To show how your heart reacts to exercise and exertion.
Signal Average Electrocardiogram (SAE) : A test that is much like an ECG, but takes longer
because it records more information related to abnormal electrical activity.
Stress Test (usually with ECG; also called treadmill or exercise ECG): A test that is given
while a patient walks on a treadmill or pedals a stationary bike to monitor the heart during
exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to
detect coronary artery disease, and/or to determine safe levels of exercise following a heart
attack or heart surgery.

ST depression seen in ECG during stress test.

ELECTROCARDIOGRAMS TREADMILL/ ELECTROCARDIOGRAMS EXERCISE

TOLERANCE TEST
Indications
 Coronary artery disease
 Gauge exercise capacity in heart failure patients
 To diagnose heart-related causes of symptoms such as chest pain, shortness of breath or
lightheadedness.
 Predict risk of dangerous heart-related conditions such as a heart attack.
Procedure: Hooked up to equipment to monitor the heart. Walks slowly in place on a treadmill.
Then the speed is increased for a faster pace and the treadmill is tilted to produce the effect of
going up a small hill. May be asked to breathe into a tube for a couple of minutes. Can stop the
test at any time if needed. Afterwards will sit or lie down to have their heart and blood pressure
checked

HOLTER MONITORING : Also known as continuous EKG or Ambulatory EKG monitoring.

A small, portable, battery-powered ECG machine worn by a patient to record heartbeats on tape
over a period of 24 to 48 hours - during normal activities. At the end of the time period, the
monitor is returned to the physician's office so the tape can be read and evaluated.
Wearing a small, portable, battery operated EKG recorder, called a Holter monitor. Monitors the
electrical activity of an ambulatory patient’s heart while the person goes about daily activities
Records continuous EKG information, for one to five days, on a tape. This recorded data is then
analyzed by doctors.
USES
 to detect abnormal heart rhythms (arrhythmias) as well as cardiac ischemia 
 to detect transient and short cardiac arrhythmias that might not be present during in-office
EKG monitoring.
  to monitor pacemakers or evaluate how well medications are working especially
antiarrhythmics
 Diagnose and treat premature ventricular contractions,or PVCs
 Design effective antiarrhythmic treatment programs, usually using various antiarrhythmic
medications.
 Monitor existing pacemakers,
 diagnose a lack of oxygen-rich blood flowing to the heart (cardiac ischemia) and
measuring variability in the heart rate.
 Commonly using in heart attack and cardio myopathy patients

EVENT (LOOP) MONITORING:  A small, portable, battery-powered machine used by a

patient to record ECG over a long period of time. Patients may keep the recorder for several
weeks. Each time symptoms are experienced, the patient presses a button on the recorder to
record the ECG sample. As soon as possible, this sample is transmitted to the physician's office
by telephone hookup for evaluation.
Wearing a very small, portable, EKG recorder for months An event monitor is activated when
patient have "an event," that is, when he feels the symptoms of heart problem (an arrhythmia, for
example ) Several types of event recorders, from wristwatch size devices to those that can be
implanted for up to 18 months.

Why these are known as transtelephonic pace makers….??? : 

In recent years, technology has advanced and, in some cases, the devices are capable of
transmitting their results over a telephone to the physician's office. Once transmitted, the results
can be printed out as a standard EKG and interpreted.

MAGNETIC RESONANCE IMAGING: An imaging technique that produces detailed,

accurate, cross-sectional pictures ("slices") of internal organs and body parts . But it doesn’t use
ionizing radiation and has no known biological risks.
 Magnetic Resonance Imaging (MRI) of the Heart A diagnostic procedure that uses a
combination of large magnets, radiofrequencies, and a computer to produce detailed
images of organs and structures within the body.
 Magnetic Resonance angiography (MRA) of the Heart A specialized type of MRI
procedure used to evaluate blood vessels in the heart.
MRI: A Non invasive procedure Provides much greater contrast between the different soft
tissues of the body than CT considered generally safer than contrast-enhanced x-ray tests in
unstable patients. Magnetic resonance imaging (MRI) is also called nuclear magnetic resonance
(NMR) imaging. It uses powerful magnets to look inside the body. Computer-generated pictures
can show the heart muscle, identify damage from a heart attack, diagnose certain congenital
cardiovascular defects and evaluate disease of larger blood vessels such as the aorta. It can
outline the affected part of the brain and help define the problems created by stroke. Unlike
radiographic imaging methods,

 It's non-ionizing and has no known biological hazards.

 It can produce high-resolution images of the heart's chambers and large vessels without
the need for contrast agents.
 It's intrinsically three-dimensional.
  It produces images of cardiovascular structures without interference from adjacent bone
or air.
 It has high tissue contrast.

MRI is an acceptable technique for evaluating diseases of the aorta such as dissection,
aneurysm and coarctation; diseases of the pericardium such as constrictive pericarditis or
hematoma; congenital cardiac lesions before or after surgical repair; heart muscle diseases,
including those affecting the right ventricle such as dysplasia; and cardiac masses such as
intracardiac tumor or invasive lung malignancy.

USES:

 MRI of the heart may be used to evaluate the heart valves and major vessels, detect
coronary artery disease and the extent of damage it has caused,
 detect the presence of plaque causing blockages of the coronary arteries,
 evaluate congenital defects, and
 detect the presence of tumors or other abnormalities.
 The cardiac MRI may be used prior to other cardiac procedures such as angioplasty or
stenting of the coronary arteries and cardiac or vascular surgery.
 Aortic disease Blockages within the coronary arteries (which supply oxygen-rich blood to
the heart)
 A weakened heart muscle (cardiomyopathy).
 The severity of a heart attack Heart valve disease.
 Disease in the arteries outside the heart, or peripheral arterial disease
 Heart defects present at birth (congenital)
 To assess patients’ progress after a heart attack
 To evaluate blockages in the coronary arteries (which could rupture and cause a heart
attack)
 To detect an atrial myxoma (heart tumor)

Magnetic Resonance Imaging of Heart

 Figure A shows the heart's position in the body and the location and angle of the MRI
pictures shown in figure C. Figure B is an MRI angiogram, which is sometimes used instead
of a standard angiogram. Figure C shows MRI pictures of a normal left ventricle (left
image), a left ventricle damaged from a heart attack (middle image), and a left ventricle that
isn't getting enough blood from the coronary arteries (right image).

NUCLEAR CARDIOLOGY TEST: Produce images of the heart at work (during exercise) and
at rest. Reveal problems in heart muscle and blood vessels, especially when the images of the
heart at work and at rest are compared.
 Myocardial Perfusion Scans
 Pharmacologic Stress Tests
 Technetium-99m gated SPECT imaging
 Ventricular Function Studies
 Peripheral Vascular Studies
 Tilt table testing
Myocardial perfusion scans common test is done in two parts first part shows the heart during
normal functioning, called "rest.“ During the second part, called "stress," the coronary arteries
are dilated through exercise. You may walk on a treadmill or ride a stationary bicycle.
USES Identify areas of the heart muscle that have an inadequate blood supply Quantify the
extent of the heart muscle with a limited blood flow Provide information about the heart’s
pumping function Ascertain the amount of scarring from a heart attack Evaluate the success of
coronary bypass surgery or angioplasty

Pharmacologic stress tests: Pharmacologic stress testing differs from exercise testing in that it
does not rely on the patient's own ability to increase cardiac oxygen demand. The most widely
available pharmacologic agents for stress testing are dipyridamole (Persantine), adenosine, and
dobutamine, Thallium Dobutamine Persantine. Dipyridamole, adenosine and regadenoson are
cardiac vasodilators and rely on a unique mechanism of action to demonstrate coronary stenosis.
By dilating coronary vessels, they lead to an increased blood velocity and flow rate in normal
coronary vessels Pharmacologic stress testing is indicated for patients who would be unable to
adequately perform an exercise stress test. An exercise test is considered inadequate when a
patient cannot reach 85% of predicted maximum heart rate, or reach a workload of 5 metabolic
equivalents of task (METs) for 3 minutes.
A pharmacologic test is preferred over an exercise test in patients with aortic stenosis, left bundle
branch block, a paced rhythm, recent MI, and severe hypertension even if they were able to
exercise adequately

Single Photon Emission Computed Tomography (SPECT): SPECT of the heart is a well-
established nuclear imaging technique. It involves taking a series of pictures around the chest
after injecting a radioactive tracer into the blood. Then computer graphics are used to create
images of slices through the heart. This technique has been applied to the heart for myocardial
perfusion (blood flow) imaging with agents like thallium-201 and the technetium-based
myocardial perfusion tracers. These agents are injected either at rest or with exercise or
pharmacologic stress. Cardiac SPECT was introduced for myocardial perfusion imaging to
overcome some of the limitations of planar imaging and to improve the localization and
quantification of perfusion defects. Cardiac SPECT has been shown to make it easier to detect
and localize myocardial perfusion defects at rest and during stress. The ability of SPECT to
localize coronary artery disease and assess the extent and severity of perfusion abnormalities is
enhanced compared to planar imaging. Several large, published studies have demonstrated the
quantitative methods of interpretation.

Ventricular function studies Two types of tests MUGA (Multi-Gated Acquisition) study (also
known as Equilibrium Gated Blood Pool Study Angiography First Pass Study

USES Visualize the integrity of the cardiac chambers and valves Monitor the effect of different
drugs on the heart muscle (such as chemotherapy drugs)

Tilt Table Test A test performed while the patient is connected to ECG and blood pressure
monitors and strapped to a table that tilts the patient from a lying to standing position. This test is
to determine if the patient is prone to sudden drops in blood pressure or slow pulse rates with
position changes.
Positron Emission Tomography (PET) Scan: A nuclear scan that gives information about the
flow of blood through the coronary arteries to the heart muscle.
Cardiac Positron Emission Tomography (PET): Positron emission tomography of the heart
allows the study and quantification of various aspects of heart tissue function. Its use in research
has provided novel observations in cardiac physiology and pathophysiology. PET combines

1. Tomographic imaging with radionuclide tracers of blood flow metabolism and receptors
and
2. Tracer kinetic principles for noninvasively quantifying regional myocardial blood flow,
substrate fluxes, biochemical reaction rates and neural control.

Clinical studies suggest an important role for PET in diagnosing patients, describing disease and
developing treatment strategy. Two areas of clinical application have emerged:

 PET, which is noninvasive, is highly accurate for detecting, localizing and describing
coronary artery disease that impairs blood flow to the myocardium (heart muscle).
 PET accurately identifies injured but viable myocardium (heart muscle), such as
reversible ventricular dysfunction.

PET F-18 FDG (Fluorodeoxyglucose) Scan

A specialized PET scan which uses a form of glucose to help determine which heart tissue, if
any, has permanent damage due to decreased blood flow. It may be used after a heart attack to
determine which procedure, such as angioplasty or stenting of the coronary arteries or bypass
surgery, may be beneficial.
Thallium Scans or Myocardial Perfusion Scans
 Resting SPECT Thallium Scan or Myocardial Perfusion Scan
A nuclear scan given while the patient is at rest that may reveal areas of the heart muscle
that are not getting enough blood.
 Exercise Thallium Scan or Myocardial Perfusion Scan
A nuclear scan given while the patient is exercising that may reveal areas of the heart
muscle that are not getting enough blood.
 Adenosine or Persantine Thallium Scan or Myocardial Perfusion Scan
A nuclear scan given to a patient who is unable to exercise to reveal areas of the heart
muscle that are not getting enough blood. Special medications which stress the heart, like
exercise, may be given.
MUGA Scans/Radionuclide Angiography (RNA) Scans
 Resting Gated Blood Pool Scan (RGBPS), Resting MUGA, or Resting Radionuclide
Angiography
A nuclear scan to see how the heart wall moves and how much blood is expelled with
each heartbeat, while the patient is at rest.
  Exercise Gated Blood Pool Scan, Exercise MUGA, or Exercise Radionuclide
Angiography
A nuclear scan to see how the heart wall moves and how much blood is expelled with
each heartbeat, just after the patient has walked on a treadmill or ridden on a stationary
bike.
VO2 MAX STUDY: Metabolic study Measures how effectively the body uses oxygen
Determine whether symptoms are respiratory or cardiac in origin Help to set appropriate limits
for exercise programs.

CONCLUSION

Noninvasive cardiac testing is used as part of a broader scheme of risk stratification for patients
with possible acute coronary syndromes. Noninvasive cardiac tests are improving as new
diagnostic technologies and methods are being developed. As future studies reveal the true
diagnostic characteristics and capabilities of these tests. Blood Chemistry and Physiology
provides vital clues regarding actual or potential cardiac problems. Scans, USGs and MRIs are
painless in nature. ECG provides clues regarding rhythm and pattern of heart beat. Cardiac
Catherisation can be both diagnostic as well as therapeutic in nature. Electophysiology helps to
predict the future events.

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2. Lippincott manual of nursing. 2003
3. Brunner’s Medical-surgical nursing. 2004
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120. [Medline].
5. Patel RN, Arteaga RB, Mandawat MK, et al. Pharmacologic stress myocardial perfusion
imaging. South Med J. Oct 2007;100(10):1006-14; quiz 1004. [Medline].
6. [Guideline] Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003
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9. http://www.americanheart.org/presenter.jhtml?identifier=4554
10. Cardiac Stress, Expect after the test - Retrieved on 2010-01-26
 NON-INVASIVE
CARDIAC DIAGNOSTIC
PROCEDURES
SUBMITTED TO: Mr. P. JEBADEV SINGH
M.SC. (N)
LECTURER
CIMS CON

SUBMITTED BY: MS. REETA KHURESHA

M.SC (MSN)
CIMS CON

DATE: 02-04-11

INVASIVE TESTS :
INVASIVE TESTS
 Cardiac Catheterization
  Cardiac Biopsy
 Electrophysiology Studies (cardiac mapping)

CARDIAC CATHETERIZATION (also called CORONARY ANGIOGRAM): A test in

which a small catheter (hollow tube) is guided through a vein or artery into the heart. Dye is
given through the catheter, and moving x-ray pictures are made as the dye travels through the
heart. This comprehensive test shows: narrowings in the arteries, outside heart size, inside
chamber size, pumping ability of the heart, ability of the valves to open and close, as well as a
measurement of the pressures within the heart chambers and arteries.
Test in which catheters (hollow tubes) are placed into the heart in order to evaluate the anatomy
and function of the heart and surrounding blood vessel.
Characteristics Performed in cardiac laboratory and special examination table. Local anesthesia
is given, and catheter is inserted into blood vessels.
SITES OF INSERTION Groin Inner bend of the elbow, Wrist (palm side), Neck
GOALS Confirm the presence of a suspected heart ailment e.g. stenosis, congenital heart failure
etc. Quantify the severity of the disease and its effect on the heart Seek out the cause of a
symptom such as shortness of breath or signs of cardiac insufficiency. Make a patient assessment
prior to heart surgery.
RISKS Minor bleeding at the site of catheter insertion. Temporary heart rhythm disturbances
caused by the catheter irritating the heart muscle. Temporary changes in the blood pressure.
Cardiac tamponade, sudden blockage of a coronary artery. Stroke .

CARDIAC BIOPSY : 
A cardiac biopsy is a procedure to take samples of heart tissue for evaluation. It is a outpatient
procedure.
INDICATIONS
 After a heart transplant,
 to check for rejection of your new heart.
 If a patient has a cardio-myopathy,it is done to find the cause.

ELECTROPHYSIOLOGY : 
The term “electrophysiology study” or “EP study” applies to any procedure that requires the
insertion of an electrode catheter into the heart .
A test in which insulated electric catheters are placed inside the heart to study the heart's
electrical system/Cardiac mapping.
INDICATIONS
 Heart rhythm disorders.
 Patient at a risk of sudden cardiac death.
 Evaluate the effectiveness of certain medications.
 Predict the risk of a future cardiac event.
 Assess the need for an implantable device (pacemakers) or treatment procedures.