CARDIOVASCULAR

DIAGNOSTIC TESTS
AND PROCEDURES

Dr. Ramish Saleem , PT

DPT(SMC)
MS-OMPT(RIU)
DIAGNOSTIC TESTS
 Cardiac catheterization
 Cardiac Enzymes Test
 (CAT) Computed Axial Tomography
 Echocardiography
 Electrocardiogram (EKG, ECG)
 Exercise stress testing
 Holter monitoring
 Event monitoring
 Magnetic Resonance Imaging (MRI)
 Positron Emission Tomography (PET)
 Intravascular ultrasound
 Serum lipid
 Thalium scan
 Computed tomography angiography(CTA)
CARDIAC CATHETERIZATION

 Cardiac catheterization
 Diagnostic procedure in which a catheter is
introduced into a large vein or artery, usually
of an arm or a leg, and is then threaded
through the circulatory system to the heart.
 Used to obtain detailed information about
the structure and function of the heart
chambers, valves and the great vessels.
DIAGNOSTIC TESTS & PROCEDURES

 Cardiac Enzymes Test

 Tests performed on samples of blood
obtained by venipuncture to determine the
presence of damage to the myocardial
muscle.
 DIAGNOSTIC TESTS & PROCEDURES
 Cardiac enzyme studies measure the levels of enzymes and
proteins that are linked with injury of the heart muscle. These
include the enzyme creatine kinase (CK), and the proteins
troponin I (TnI) and troponin T (TnT). Low levels of these
enzymes and proteins are normally found in your blood, but if
your heart muscle is injured, such as from a heart attack, the
enzymes and proteins leak out of damaged heart muscle cells,
and their levels in the bloodstream rise.
 Because some of these enzymes and proteins are also found in
other body tissues, their levels in the blood may rise when those
other tissues are damaged. Cardiac enzyme studies must always
be compared with your symptoms, your physical examination
findings, and electrocardiogram (ECG)results.
DIAGNOSTIC TESTS & PROCEDURES

 Computed Axial Tomography(CAT)

 Diagnostic X-ray technique that uses
ionizing radiation to produce a cross-
sectional image of the body.
 Often used to detect aneurysms of the
aorta.
DIAGNOSTIC TESTS & PROCEDURES

 Echocardiography
 Diagnostic procedure for studying the structure
and motion of the heart.
▪ Useful in evaluating structural and functional
changes in a variety of heart disorders.
 Electrocardiogram (EKG, ECG)
 Graphic record of the electrical action of the heart
as reflected from various angles to the surface of
the skin.
DIAGNOSTIC TESTS & PROCEDURES

 Exercise stress testing

 Means of assessing cardiac function, by
subjecting the patient to carefully
controlled amounts of physical stress, for
example, using the treadmill.
DIAGNOSTIC TESTS & PROCEDURES

 Holter monitoring
 Small, portable monitoring device that
makes prolonged electrocardiograph
recordings on a portable tape recorder.
 Continuous EKG (ambulatory EKG) is
recorded on a magnetic tape recording
while the patient conducts normal daily
activities.
DIAGNOSTIC TESTS & PROCEDURES

 Event monitoring
 Similar to the Holter monitor in that it also
records the electrical activity of the heart
while patient goes about usual daily
activities.
 Can be used for a longer period of time
than a Holter monitor.
▪ Usually a month.
DIAGNOSTIC TESTS & PROCEDURES

 Magnetic Resonance Imaging (MRI)

 Use of strong magnetic field and radiofrequency
waves to produce imaging that is valuable in
providing images of the heart, large blood vessels,
brain, and soft tissue.
▪ Used to examine the aorta, to detect masses or
possible tumors, and pericardial disease.
▪ Can also show the flowing of blood and the
beating of the heart.
DIAGNOSTIC TESTS & PROCEDURES

 Positron Emission Tomography (PET)

 Computerized x-ray technique that uses
radioactive substances to examine the blood flow
and the metabolic activity of various body
structures, such as the heart and blood vessels.
▪ Patient is given doses of strong radioactive
tracers by injection or inhalation.
▪ Radiation emitted is measured by the PET
camera.
 DIAGNOSTIC TESTS & PROCEDURES

 Intra vascular ultrasound

 Known as a percutaneous echocardiogram is an
imaging methodology using specially designed,
long, thin, complex manufactured catheters
attached to computerized ultrasound equipment
to visualize the lumen and the interior wall of
blood vessels.
DIAGNOSTIC TESTS & PROCEDURES

 Serum Lipid
 Test that measures the amount of fatty
substances (cholesterol, triglycerides, and
lipoproteins) in a sample of blood obtained
by venipuncture.
 Thallium Stress
 Combination of exercise stress testing with
thallium imaging to assess changes in
coronary blood flow during exercise.
 DIAGNOSTIC TESTS & PROCEDURES
 Computed tomography angiography (CTA), an imaging
methodology using a ring-shaped machine with an X-Ray
source spinning around the circular path so as to bathe the inner
circle with a uniform and known X-Ray density.

 Currently, multi-detector CT, specially the 64 detector-CT are

allowing to make cardiac studies in just a few seconds (less than
10 seconds, depending on the equipment and protocol used).
These images are reconstructed using algorithms and software.

 Great development and growth seen in the short term, allowing

radiologists to diagnose cardiac artery disease without
anesthesia and in a non-invasive way.
ECG Interpretations
Normal Impulse Conduction
Sinoatrial node

AV node

Bundle of His

Bundle Branches

Purkinje fibers

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Impulse Conduction & the ECG
Sinoatrial node

AV node

Bundle of His

Bundle Branches

Purkinje fibers

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The “PQRST”

 P wave - Atrial
depolarization
• QRS - Ventricular
depolarization
• T wave - Ventricular
repolarization

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 The PR Interval

Atrial depolarization
+
delay in AV junction
(AV node/Bundle of His)

(delay allows time for

the atria to contract
before the ventricles
contract)

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Pacemakers of the Heart
 SA Node - Dominant pacemaker with an
intrinsic rate of 60 - 100 beats/ minute.
 AV Node - Back-up pacemaker with an
intrinsic rate of 40 - 60 beats/minute.
 Ventricular cells - Back-up pacemaker with an
intrinsic rate of 20 - 45 bpm.

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The ECG Paper

 Horizontally
 One small box - 0.04 s
 One large box - 0.20 s
 Vertically
 One large box - 0.5 mV

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The ECG Paper (cont)
3 sec 3 sec

 Every 3 seconds (15 large boxes) is

marked by a vertical line.
 This helps when calculating the heart
rate.
NOTE: the following strips are not
marked but all are 6 seconds long.
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Really Very Easy
How to Analyze a Rhythm

ECG Rhythm Interpretation

Rhythm Analysis

 Step 1: Calculate rate.

 Step 2: Determine regularity.
 Step 3: Assess the P waves.
 Step 4: Determine PR interval.
 Step 5: Determine QRS duration.

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Step 1: Calculate Rate
3 sec 3 sec

 Option 1
 Count the # of R waves in a 6 second rhythm strip,
then multiply by 10.
 Reminder: all rhythm strips in the Modules are 6
seconds in length.
Interpretation?
9 x 10 = 90 bpm
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Step 1: Calculate Rate

R wave

 Option 2
 Find a R wave that lands on a bold line.
 Count the number of large boxes to the next R
wave. If the second R wave is 1 large box away the
rate is 300, 2 boxes - 150, 3 boxes - 100, 4 boxes -
75, etc. (cont)
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Step 1: Calculate Rate
3 1 1
0 5 0 7 6 5
0 0 0 5 0 0

 Option 2 (cont)
 Memorize the sequence:
300 - 150 - 100 - 75 - 60 - 50

Approx. 1 box less than

Interpretation?
100 = 95 bpm
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Step 2: Determine regularity
R R

 Look at the R-R distances (using a caliper or

markings on a pen or paper).
 Regular (are they equidistant apart)? Occasionally
irregular? Regularly irregular? Irregularly irregular?
Interpretation?

Regular

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Step 3: Assess the P waves

 Are there P waves?

 Do the P waves all look alike?
 Do the P waves occur at a regular rate?
 Is there one P wave before each QRS?
Interpretation?
Normal P waves with 1 P
wave for every QRS
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Step 4: Determine PR interval

 Normal: 0.12 - 0.20 seconds.

(3 - 5 boxes)

0.12 seconds
Interpretation?

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Step 5: QRS duration

 Normal: 0.04 - 0.12 seconds.

(1 - 3 boxes)

0.08 seconds
Interpretation?

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Rhythm Summary

 Rate 90-95 bpm

 Regularity regular
 P waves normal
 PR interval 0.12 s
 QRS duration 0.08 s
Interpretation?
Normal Sinus Rhythm

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NSR Parameters

 Rate 60 - 100 bpm

 Regularity regular
 P waves normal
 PR interval 0.12 - 0.20 s
 QRS duration 0.04 - 0.12 s
Any deviation from above is sinus
tachycardia, sinus bradycardia or an
arrhythmia
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Arrhythmia Formation

Arrhythmias can arise from problems in

the:
Sinus node
Atrial cells
AV junction
Ventricular cells

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 SA Node Problems

The SA Node can:

 fire too slow Sinus Bradycardia
 fire too fast Sinus Tachycardia*

*Sinus Tachycardia may be an appropriate response to stress.

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Sinus Rhythms

 Sinus Bradycardia
 Sinus Tachycardia

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Rhythm #1

• Rate? 30 bpm
• Regularity? regular
• P waves? normal
• PR interval? 0.12 s
• QRS duration? 0.10 s
Interpretation? Sinus Bradycardia
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Sinus Bradycardia

 Etiology: SA node is depolarizing slower

than normal, impulse is conducted
normally (i.e. normal PR and QRS
interval).

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Sinus Bradycardia

 Deviation from NSR

- Rate < 60 bpm

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Rhythm #2

• Rate? 130 bpm

• Regularity? regular
• P waves? normal
• PR interval? 0.16 s
• QRS duration? 0.08 s
Interpretation? Sinus Tachycardia
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Sinus Tachycardia

 Deviation from NSR

- Rate > 100 bpm

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Sinus Tachycardia

 Etiology: SA node is depolarizing faster

than normal, impulse is conducted
normally.
 Remember: sinus tachycardia is a
response to physical or psychological
stress, not a primary arrhythmia.

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