Scans & Tests Overview

Question 1

List 3 types of angiography

Answer 1

• MRI angiography
• CT angiography
• Catheter angiography

Question 2

Describe MRI angiography

What it images?
What it looks for?
Indications for its use?

Answer 2

Injected with dye, get and MRI scan

Looks for:

• stenosis
• occlusions
• aneurysms
• other abnormalities

Indcations:

• Ischaemic heart disease
• Stroke

Question 3

Describe CT angiography

Answer 3

Injected with dye, get and CT scan

Very good anatomical detail

Less resolution than angiograms

Can cause contrast allergy and nephropathy

Looks for:

• stenosis
• occlusions
• aneurysms
• other abnormalities

Indcations:

• Ischaemic heart disease with non-typical presentation
• Stroke (cerebral and carotid scans)

Question 4

Describe catheter angiography

Answer 4

Cateter goes to correct area via your arteries, injects dye, xray is taken

Question 5

Describe Duplex Ultrasound

Answer 5

Ultrasound scan that scan tell movement relative to the scanner

Indcations:

• Peripheral arterial disease
• Peripheral venous disease

Question 6

Describe ultrasound scanning

Answer 6

Indcations:

- Abdominal aortic aneurysm (but can’t detect rupture)

Question 7

Describe perfusion scanning

Answer 7

Nuclear medicine test

Shows vessel occlusion

Indicated for non-acute ischaemic heart disease if:

• exercise ECG not possible
• exercise ECG negative despite classic presentation
• exercise ECG is ambiguous

Question 8

List relevant blood tests

Answer 8

• Glucose
• LDL
• HDL
• Triglyceride
• Thrombophilia screen
• Creatine kinase
• Troponin I and T

Question 9

List different types of ECG

Answer 9

• Standard 12 lead ECG
• Exercise (stress test) ECG
• 24 hour monitoring ECG

Question 10

Describe the ABPI and its use in diagnosing peripheral vascular disease

Answer 10

ABPI = Ankle-Brachial Pressure Index

ABPI = (Ankle pressure)/(brachial pressure)

Normal		= 0.9 - 1.2
Claudication	= 0.4 - 0.85 
Severe		= 0 – 0.4

Question 11

What is the required level of troponin I and T to diagnose an MI?

Answer 11

99th percentile

Question 12

Why are troponin I and T blood tests good for MI diagnosis?

Answer 12

• Specific to heart muscle
• Their amount indicates the extent of damage
• The increase lasts from 4-6 hours after infarct to ~7 days after, thus they can be used to detect a previous MI

Question 13

Does a troponin T and I increase = an MI

Why?

Answer 13

No, as other things can cause an troponin rise

Question 14

List things that can lead to an increase of T and I troponins

Answer 14

STEMI
NSTEMI

Chronic heart failure
Massive PE
Hypertensive crisis
Sepsis
Stroke/TIA
Pericarditis and Myocarditis
Post Arrhythmia

Question 15

What are BNP and NT-pro-BNP?

What are they used to diagnose?

Answer 15

BNP = Brain Natriuretic Peptide

NT-pro-BNP = the precursor to BNP

used to diagnose heart failure

Question 16

Describe an echocardiogram

Indications?

Looks for?

Answer 16

Ultrasound of the heart

Indcations:

• Cardiac thrombus
• Heart valve deformities
• Heart deformities
• Hemopericardium (or other excess pericardial fluid)

Looks for:

• Chamber size
• ventricle function
• ejection fraction
• valve disease
• pericardial disease
• impaired filling
• wall abnormalities (e.g. post MI)

Question 17

Describe cardiac MRI

Answer 17

Used in heart failure

To see:

• left ventricle wall thickness
• the amount of scarring (viable myocardium)

Question 18

What are the 2 types of echocardiogram?

When would you use each type?

Answer 18

Transthoracic echocardiogram (TTE):

• non-invasive
• like a regular ultrasound
• doesn’t work well with some lung diseases (e.g. COPD)

Transoesophageal echocardiogram (TEE):

• via a probe that goes down the oesophagus
• used if TTE won’t give good results

Question 19

Describe an electrophysiological study

Answer 19

An arrhythmia is deliberately triggered in the heart so that its mechanism and pathway can be studied

Is an invasive procedure

You can treat the arrhythmia, via ablation of accessory pathways, as part of the same procedure