Nuclear Cardiology department – Prince Sultan Cardiac Centre

This Presentation Presented by : Budour Alzahrani Supervised : Mohamed Alshuhri , Saeed Alshuhri Acknowledgment to : Dr. Ahmed Amro

Outlines

Introduction

Nuclear

Cardiology

Case review

Result

Conclusion

and References

Introduction

Nuclear cardiac images help to identify coronary heart disease, and the risk of future heart attacks.

These highly accurate measurements of heart size and function and amount of heart muscle at risk enable cardiologists to better prescribe medications and select further testing.

Nuclear Cardiology In nuclear medicine there are many procedures to evaluate cardiac

function , the most common are :

-1-

-2-

2- MPI (Myocardial Perfusion Imaging)

1- MUGA ( Multi Gated) Scan

MPI – overview

During a nuclear cardiology test, a very small amount of radioactive tracer injected into a vein and is taken up by the heart.

A very sensitive gamma camera takes images

of the heart in the rest and stress part.

Who needs MPI

-Detection of myocardial infarction or ischemia.

-Patients who undergo for kidney transplant.

-Assessment of myocardial viability.

-Chest pain, shortness of breath, family history of

heart disease.

How MPI is performed

MPI divided into 2 parts ( Stress – Rest ).

We can perform it in one day , or 2 day depending on patient weight.

Patient info

43 y\o, male

c\o SOB

Echo EF= 55%

Case study

Patient Preparation

-Patient should be NPO for 6 hours.

-if stress: Caffeine is forbidden 24hrs before study time. (coffee, tea, smoking…etc).

-hold all heart medications until end the test.

Rest Study Injection

one day procedure, with 300Mbq of Tc99m Tetrofosmin.

IV injection with flush , why flush?

After the tracer is injected, the patient should wait 45-60 mins after injection then, we can start scanning.

Stress Study Treadmill

Heart rate should be maximum “depending on patient's age“

Max. HR. = (220 – age) , then x 80%

This case 90% of max. HR.

Injection 800Mbq, 1-2 minutes before stop the treadmill.

ECG monitoring

If : Pharmacologically

Position patient supine. ECG monitoring in both procedures.

Both Pharmacological and exercise , scan begin 15-30 mins after injection.

Stress Study

Pharmacological Persantine : inject 0.56/kg over 4 minutes. Wait 2 minutes more, then inject and flush the radiopharmaceutical dose.

Antidote: Aminophylline, when?

Adenosine : Infuse drug for 6 minutes. Inject at 3 or 4 minutes. Antidote: Aminophylline.

Dobutamine : Used if there are known allergies, asthma, or pulmonary disease.

Scan

-Patient position : Supine with arm up , (the arm may create an artifact), and three-lead ECG.

-The camera will rotate around chest.

gamma camera does not produce radiation; it detects photons and produce raw data of the patient's heart.

Takes approximately 7 mins.

Stress & Rest Study

images

The first MPI on 26-AUG 2015

What you know about ischemia

• condition in which the blood flow is reduced in tissue or a part of the body.

Medical Management After the nuclear scan the doctor sent the patient to the

Cath Lab 27th of AUG 2015

LAD, Diagonal (branch): totally occluded.

2wire, dilated, kissing balloons + stent of diagonal.

Result:

Diagonal look big, with good result.

He came back after 5months to nuclear cardiology for follow up.

images

The second MPI on 27-1-2016

27-1-2016 26-8-2015

26-8-2015 27-1-2016

Conclusion

Angioplasty and stenting have a good result in improve and increase blood flow to the ischemic myocardium.

And it may become normal tissue after treatment.

References

• PSCC

• Urmc.rochester.edu,. (2016). Nuclear Cardiology Tests - Department of Cardiology - Rochester, NY - University of Rochester Medical Center . Retrieved 1 March 2016, from https://www.urmc.rochester.edu/cardiology/patient-care/diagnostic-tests/nuclear-cardiology.aspx

• Heart.org

Thanks for listening