CARDIOVASCULAR TESING-II R.MADHURI

PHARM-D II YR

ROLL NO:05

•ECHOCARDIOGRAM•ANGIOGRAM•ANGIOPLASTY•PHARMACOLOGICAL STRESS TESTING

TESTING MODALITIES

3

ECHOCARDIOGRAM•Test that uses sound waves to create a moving picture of the heart. •During this test, high-frequency sound waves, called ultrasound, provide pictures of the heart's valves and chambers.

• This allows the technician, called a sonographer, to evaluate the pumping action of the heart.•Echo is often combined with Doppler ultrasound and color Doppler to evaluate blood flow across the heart's valves.

PURPOSE•Valve problems•Size of the heart•Pumping strength

4

An echocardiogram allows doctors to monitor:•Abnormal heart valves•The pumping function of the heart for people with heart failure •Damage to the heart muscle in patients who have had heart attacks•pericarditis•The source of a blood clot or emboli after a stroke•Congenital heart disease •Atrial fibrillation •Pulmonary hypertension •An instrument that transmits high-frequency sound waves called a transducer is placed on the ribs near the breast bone and directed toward the heart.•The transducer picks up the echoes of the sound waves and transmits them as electrical impulses. The echocardiography machine converts these impulses into moving pictures of the heart.

WORKING:

5

TYPES OF ECHOCARDIOGRAM DESCRIPTION

•Transthoracic echocardiogram

•Painless test similar to X-ray, but without the radiation•Transducer is placed on the chest and transmits high frequency sound waves (ultrasound). These sound waves bounce off the heart structures, producing images and sounds that can be used to detect heart damage and disease. •Transesophageal

echocardiogram (TEE)•Transducer to be inserted down the throat into the esophagus•Because the esophagus is located close to the heart, clear images of the heart structures can be obtained without the interference of the lungs and chest.

7

•Stress echocardiogram

•Performed while the person exercises on a treadmill or stationary bicycle.• Used to visualize the motion of the heart's walls and pumping action when the heart is stressed•Is performed just prior and just after the exercise. •Reveals a lack of blood flow conditions….

BENIFITS: •Gives information about the heart's structures and blood flow•The major limitation is that it is often difficult to obtain good quality images in patients who have broad chests, are obese, or are suffering from chronic lung disease (such as emphysema)

SAFETY: The echo test is very safe. There are no known risks from the ultrasound waves.

8

ANGIOGRAM

•Is “radiographic visualization of coronary vessels after injection of radiopaque contrast medium.”

TYPES

•Heart (coronary angiogram)•Lungs ( pulmonary angiogram)•Brain (cerebral angiogram)

PURPOSE •Commonly used to check the condition of blood vessels.

•An Angiogram uses x-rays and a special dye (contrast) to take pictures of the arteries in heart

•Can be used to show blockages in your arteries.

PURPOSE OF

•Shows a clear picture of the blood vessels. Useful in considering surgery

•Reveals aneurysms (a bulge on an artery caused by a blood vessel wall becoming weaker).

ANGIOGRAM

•Gives good view of the carotid artery and its branches in the neck and head.

•The test is used to show if the arteries of the heart have narrowed.

PROCEDURE•Before taking an X-ray, a liquid dye is injected into the blood vessels. The catheter is inserted into the groin, or occasionally the arm. •Before inserting into an artery, the surrounding area is numbed with a local anaesthetic.•A short, thin wire with a rounded tip is then carefully inserted into the artery using a needle.

10

•It is guided with the help of fluoroscopy (X-ray images) to the spot where the dye is needed. •The needle is then removed and a vascular sheath inserted around the wire. A catheter may then be inserted along the guide wire. •When the catheter is in the correct position, the wire is pulled out and dye is inserted through the catheter.

•Now the blood vessels can be checked on a screen, or on a series of rapidly recorded X-rays.

11

RISK FACTORS•Cardiac catheterization carries a slightly increased risk when compared with other heart tests. •Safe when performed by an experienced team.•Generally the risk of serious complications ranges from 1 in 1,000 to 1 in 500. •Risks of the procedure include the following:•Cardiac arrhythmias •Trauma to the artery causing a hematoma •Low blood pressure•Allergic reaction to contrast medium•Hemorrhage•Stroke •Heart attack

•Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel

Alternative NamesCarotid angioplasty & stenting; CAS

ANGIOPLASTY

•The inflated balloon crushes the fatty deposits, opening up the blood vessel for improved flow, and the balloon is then deflated and withdrawn.

•An empty and collapsed balloon on a guide wire, known as a balloon catheter is passed into the narrowed locations & then inflated to a fixed size

•Surgical cut in groin•A catheter is inserted through the cut into an artery •Catheter is guided up to the blockage in your carotid artery.•Live x-ray pictures are used to see artery. This kind of x-ray is called fluoroscopy.•A guide wire is passed through the catheter to the blockage. •Another catheter with a very small balloon on the end is pushed over the guide wire and into the blockage.• Then the balloon is blown up. The balloon presses against the inside wall of artery. •This opens the artery and restores proper blood flow.•A stent (a wire mesh tube) may also be placed in the blocked area. It expands when the balloon is blown up.•The stent is left in place to help keep the artery open.• The balloon is then removed.

PROCEDURE

PURPOSE•Useful in condition of atherosclerosis

Angioplasty with or without stenting may be used to treat:• Persistent chest pain (angina) that medicines do not control•Clears blockage in a coronary artery during or after a heart attack

•Some patients who have many blockages or blockages in certain locations may need a coronary bypass (heart surgery).

Risks•Breathing problems•Bleeding•Infection•Heart attack•Seizures (this is rare)•Stroke (this is rare)

angioplasty stenting.htm

PHARMACOLOGICAL STRESS TESTING

•Stress causes normal coronary arteries to dilate, while the blood flow in a blocked coronary artery is reduced. This reduced blood flow may decrease the movement of the affected wall (as seen by echo), or have reduced isotope uptake in a nuclear scan•Agents that are commonly used in pharmacologic stress testing include dipyridamole, dobutamine

•A chemical or pharmacological stress test combines an intravenous medication with an imaging technique (isotope imaging or echocardiography) to evaluate the LV.•Medication serves the purpose of increasing the heart load instead of using exercise

PRINCIPLE

17

•notify your physician if you have a history of asthma, bronchitis or emphysema.

•Diabetics, particularly those who use insulin, will need special instructions •Caution about asthma: The use of dipyridamole (Phosphodiesterase Inhibitor) is generally avoided in patients with asthma.

PURPOSE•Gives an idea about the patient's exercise tolerance •pharmacologic or chemical stress test is performed in situations of severe arthritis, prior injury, reduced exercise tolerance or in patients who are unable to increase the heart rate SPECIAL INSTRUCTIONS

PROCEDURE•The imaging portion of the test is identical to that used during Stress Echocardiography

•An intravenous line is started in the arm, the blood pressure is checked and an EKG recorded. The EKG is also constantly monitored on the screen.

•If Stress Echo is being performed, an echocardiogram is obtained before and immediately after administration of the stress producing medication.

• In cases of stress isotope testing, the resting images may be obtained before or approximately two hours after the stress

•The stress-producing medication is given intravenously, as per protocol.

•In cases of dipyridamole, the medication is usually given over four minutes, through the IV line. A drop in the diastolic (lower number) blood pressure is generally awaited before administration of the isotope.

•If a patient is able to perform mild exercise, he or she may be asked to walk on a treadmill for a minute or so after the injection of dipyridamole.

•In cases of dobutamine, drug is given as a continuous drip with a gradual increase in the rate (at three minute intervals). The patient's heart rate accelerates and the isotope is given when 85% of the target heart rate is achieved.

•The patient is exposed to a very small amount of radiation and the risk is minimal.

•Also, the stress medicine like Dobutamine can be immediately stopped if there are problems

•The effects of dipyridamole (which can occasionally cause nausea or a headache can be reversed by aminophylline (an anti-asthma medication).

RISK AND SAFETY

•Technical problems can occur when a patient is markedly overweight. Some men may demonstrate an inferior wall abnormality because of a prominent diaphragm

• Patients who have a left bundle branch block on their EKG may also have a false abnormal test.

REFERENCESPharmacotheraphy,A pathophysiological approach;T.Dipiro;Edition 7http://www.ucsfhealth.org/adult/adam/data/003876.htmlhttp://www.texasheart.org/HIC/Topics/Diag/diangio.cfmhttp://www.medterms.com/script/main/art.asp?articlekey=10287http://www.heartsite.com/html/chemical_stress.htmlhttp://www.medicinenet.com/echocardiogram/article.htmhttp://www.heartsite.com/html/echocardiogram.html#http://www.nlm.nih.gov/medlineplus/ency/article/003869.htm

CONCLUSION: The goal of cardiac testing is to help stratify patients thought to be at risk for symptomatic coronary artery disease, specifically for short-term complications such at myocardial infarction (MI) or sudden cardiac death.

THANK YOU……