Recognizing What to Order - Cardiac Imaging

Question 1

Chest pain, suggestive of acute coronary syndrome?

Answer 1

Coronary arteriography or SPECT myocardial perfusion imaging rest/stress.

Question 2

Acute chest pain, suspicion of aortic dissection?

Answer 2

CXR only if time permits - CTA.
CTA = definitive test for dissection.
MRA if patient allergic to contrast.

Question 3

Acute chest pain, suspect PE?

Answer 3

CXR to exclude other causes of acute chest pain - CTPA.

V/Q scan if CXR is negative with HIGH index of suspicion + CTPA UNAVAILABLE.

Question 4

Chronic chest pain, high probability of CAD?

Answer 4

CXR to exclude other causes - SPECT scan.

Question 5

Chronic chest pain - Lower probability of CAD?

Answer 5

CXR to exclude other causes - Echocardiography - CTA of the coronary arteries.

Question 6

CHF, new or worse or currently stable?

Answer 6

CXR.

Question 7

SOB, cardiac origin?

Answer 7

CXR - Echo, SPECT scan.

Question 8

Suspected congenital heart disease in an adult?

Answer 8

CXR and US transthoracic echo with Doppler - Done in combination.

Question 9

Acute chest pain, low probability of CAD?

Answer 9

CXR - SPECT scan if cardiac etiology is suspected.