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Cardiac Imaging
Aka: Cardiac Imaging, Stress Imaging, Cardiac Stress Imaging, Stress EKG with Cardiac Imaging, Stress Electrocardiogram with Imaging
- See Also
- Acute Coronary Syndrome
- Exercise Stress Test
- Pharmacologic Stress Test
- Stress Echocardiogram
- Stress Myocardial Perfusion Imaging
- Cardiac Stress Imaging Indications
- Preparation: Stress Testing
- Hold all Beta Blockers 24 hours before test
- Hold nitrates (Nitroglycerin) on day of the test
- Efficacy
- Exercise Stress Test
- Test Sensitivity: 55-68%
- Test Specificity: 70-77%
- Stress Echocardiogram
- Test Sensitivity: 79-90%
- Test Specificity: 80-87%
- Stress Myocardial Perfusion Scan (Thallium Scan, SPECT)
- Test Sensitivity: 85-90%
- Test Specificity: 80-90%
- Cardiac CT
- Test Sensitivity: 93-97%
- Test Specificity: 80-90%
- Cardiac Catheterization
- Test Sensitivity: 98%
- Test Specificity: 82%
- References
- Garner (2017) Am Fam Physician 96(5): 293-9 [PubMed]
- Metz (2007) J Am Coll Cardiol 49(2): 227-37 [PubMed]
- Mark (1991) N Engl J Med 325(12): 849-53 [PubMed]
- Tests: Screening
- Indications
- Intermediate CAD risk asymptomatic patients
- Tests
- CT Coronary Calcium
- Consider other markers of subclinical disease
- Ankle-Brachial Index
- Carotid intimal-medial thickness
- Retinography
- Tests: Stress Test
- Indications
- Symptomatic patients with intermediate CAD risk
- Asymptomatic patients with high CAD risk
- Tests:
- Exercise Stress Test (no imaging)
- Indicated as cost effective first-line test
- See Cardiac Stress Imaging Indications
- Consider imaging if nondiagnostic EKG is likely (uninterpretable EKG)
- Resting ST depression >1mm
- Left Bundle Branch Block
- Paced rhythm
- Digoxin
- WPW Syndrome
- Avoid non-imaging stress test if prior coronary revascularization (low sensitivity)
- Stress Tests with Imaging and Exercise as stressor
- Indications
- See Cardiac Stress Imaging Indications
- Stress Echocardiogram
- Most cost-effective, versatile Cardiac Imaging
- Large body habitus interferes with echo windows
- Consider Optison contrast to increase accuracy
- May be better study post-revascularization
- Lower sensitivity than myocardial perfusion imaging, but much better Specificity
- Stress Echo is less likely to result in False Positive tests post-revascularization
- Stress Myocardial Perfusion Imaging
- Diaphragm and Breast interferes with images
- Stress Imaging with Pharmacologic Provocation
- Indicated if patient unable to Exercise 5 mets (~5 minutes on bruce protocol)
- Dobutamine Echocardiogram
- No Beta Blockers for 24 hours before test
- Myocardial Perfusion Imaging with Adenosine
- Avoid in severe COPD, Asthma, Carotid Stenosis
- No nitrates on day of test
- No Methylxanthines (e.g. Caffeine) for 24 hours
- Myocardial Perfusion Imaging with Dipyridamole
- Tests: Angiography
- Indications
- Significantly abnormal stress test (see above)
- Symptomatic patient and high Cardiac Risk
- Tests
- See Coronary Angiography
- CT Coronary Angiography
- MR Coronary Angiography
- Tests: Adjunctive
- Transthoracic Echocardiogram
- See Echocardiogram in Myocardial Infarction
- Transesophageal Echocardiogram
- Evaluates for non-ischemic intracardiac lesions
- Aortic Dissection
- Valvular dysfunction (including vegetations)
- Intracardiac thrombi
- Intracardiac shunts
- References
- Garner (2017) Am Fam Physician 96(5): 293-9 [PubMed]
- Mieres (2007) Am Fam Physician 75:1219-28 [PubMed]
- Shaw (2006) J Am Coll Cardiol 47:S15 [PubMed]