New cardiac imaging methods such as Coronary CTA and Cardiac MRI are allowing physicians to take a closer look at the heart and blood vessels at little risk to the patient.
The following describes several diagnostic tests and procedures that are used to determine if a person has cardiovascular disease as well as the type and the severity of the disease.
A non-invasive imaging examination is performed to determine if fatty or calcium deposits have built up in coronary arteries. Arteries are evaluated for narrowing, blockage, enlargement, or anomalies. CTA provides valuable information about the nature of blockages (soft plaque vs. hard calcified plaque) and the wall of the vessel. In the past, this information could only be obtained by invasive Cardiac Catheterization which shows only if an artery is narrowed. CTA identifies soft plaque. Artery narrowing with as little as 30% of soft plaque can rupture and result in a heart attack within seconds. Coronary CTA enables patients to know if they have coronary artery disease before it’s too late. With newer CT scanners such as those at SJRA this information can be obtained at a fraction of the dose of cardiac cath or stress perfusion imaging.
The most advanced CT scanner in the world
SJRA is proud to announce that we are among the first in the world to have the latest, revolutionary CT scanner. The Definition Scanner integrates two X-ray sources and two sets of 64 detectors for the most detailed clinical images available. The Definition is also one of the fastest CT systems on the market. It can capture cardiac images in a few seconds.
Who should have a Coronary CTA?
- Patients who require evaluation for chest pain syndrome / angina.
- Patients who have at least one or two risk factors for coronary artery disease and who are symptomatic.
- Patients who have known cardiac disease and require reevaluation of their coronary vessels but who may not want or cannot have invasive catheterization.
- Patients who are symptomatic for aortic dissection or pulmonary emboli.
Why is a Coronary CTA better than other cardiac tests?
- Coronary CTA is low risk and high yield. This study provides unprecedented information about the coronary arteries as well as surrounding tissue and organs. In other words, the radiologists at SJRA expertly evaluate all visualized structures identified including the lungs.
Who should interpret a coronary CTA?
- Although interventional cardiologists and Cardiac imaging radiologists both specialize in coronary anatomy, the images obtained during coronary CTA are digital and require expert post processing to enable high quality, highly detailed interpretation using extensive 3D and 4 D multiformating. Only radiologists have over five years of training in the use of workstation interpretation.
- Incidental findings such as lung disease, cancer, cysts, and hiatal hernias have been identified by Radiologist in patients who have this study performed at SJRA. These findings are frequently missed or even purposefully not included in processing when studies are not interpreted by a radiologist.
Why Choose SJRA?
- We have one of the most sophisticated scanners available with two tubes and 128 detectors.
- We have the largest and best trained group of cardiac imagers in the Delaware Valley, including Philadelphia.
What preparation is required for a Coronary CTA?
In preparation for the study, patients should:
- Avoid caffeine products for 12 hours prior to this study
- Not eat for three hours prior to this study
- Arrive 20 minutes prior to your scheduled study so that your vital signs can be obtained and an IV can be placed in your arm.
How long does the scan take?
- Approximately 10 minutes on the CT table. The actual CTA acquisition ranges from 10 to 20 seconds.
What is a Cardiac MRI?
A test that produces high-quality still and moving pictures of the heart and great vessels. MRI acquires information about the heart as it is beating; creating moving images of the heart throughout its pumping cycle. This is used for analyzing heart function and anatomy.
MRI uses large magnets and radio-frequency waves to produce pictures of the body’s internal structures; no x-ray exposure is involved.
What preparation is required for a Cardiac MRI?
Preparation for most MRI exams is minimal. You may be asked not to eat or drink before the exam depending upon the body area to be examined. Please wear little or no jewelry. Watches, coins and any other metallic objects will be removed before you enter the scanner. Most importantly, you must inform the staff of any metal in your body such as pacemakers, heart valves, aneurysm clips, metal fragments in your eyes, or other sources of metal. This will be reviewed in detail when you schedule your exam.
What is a Cardiac stress test?
This procedure is performed with treadmill exercise, monitoring the heart rate and blood pressure as the patient exercises. A cardiologist is present during a cardiac stress test to monitor the EKG.
In addition to treadmill stress your doctor may want either an isotope stress test or an Echo stress test. SJRA offers both of these forms of stress testing.
All stress tests are designed to see if the heart muscle is getting enough blood during exercise. Narrowings in arteries that supply blood to the heart can be detected this way. This is an indirect way to look for the same pathology seen directly with Coronary CTA. In some cases there are changes in the EKG during exercise indicating the underlying lack of blood.
In a Nuclear Stress test a small dose of a radiopharmaceutical that binds to heart muscle is injected after the stress. Images are then made of the heart muscle to look for areas that do not receive adequate blood supply.
In an ECHO stress an echocardiogram (see below) is performed during stress to look for regions of the heart muscle that do not contract (pump) properly during stress.
Both nuclear stress and stress ECHO increase the accuracy of the exam.
What kind of preparation do I need for a stress test?
You may be asked to fast or withhold certain medications prior to the procedure. Be sure to ask your doctor for any special instructions. If you can’t fast, are diabetic or are on medication, ask your physician or call our office for instructions. Please be sure to let us know about any medications you may be taking.
On the day of the examination, wear loose, comfortable clothing, as well as sneakers or rubber-soled shoes, since you will be exercising as part of the examination.
What is an echocardiogram?
An echocardiogram, or echo test is a safe, noninvasive test that uses ultrasound (sound waves) to evaluate the structures, function, and blood flow of the heart. This test is ordinarily done to look for evidence of previous heart muscle damage and to find out if there are areas of the heart muscle which have impaired blood supply.
How is the procedure done?
You will lie on a table on your left side to enhance viewing of the heart. Pads called electrodes for obtaining the heart’s electrical pattern are placed on your chest. An instrument called a transducer is placed on the left side of your chest and tilted at different places with gel. The gel may be slightly cool and slight pressure may be felt from the transducer. You may be asked to hold your breath at times so that the technologist can obtain clearer views of the heart.
How will I prepare for my echocardiogram?
There is no special pre-test preparation.
How long does the test take?
The echo takes 20 minutes.