It should be noted that before any tests, a good medical evaluation is needed to decide which tests will be most useful for that particular person. Otherwise it may be a wastage of resources and the needed result may not be obtained. In general, tests are most useful when there is an intermediate probability of disease. When there is a low probability, a positive result could be false positive. Similarly, when the probability is high, a negative result may be a false negative. So we have to know the pretest probability of the disease before proceeding with a test, which is what we plan to achieve by a good medical evaluation.
One of the first tests to be done when heart disease is suspected, is an ECG, which records the electrical activity of the heart. Though it was started over a century back, it is still one of the best tests to diagnose a heart attack at the bedside. It does have its limitations – a normal ECG does not rule out heart disease. X-ray of the chest is useful to document the size of the heart and to look for enlargement of various chambers and blood vessels. It is also a simple and old test, with certain advantages and disadvantages.
Blood tests used in the emergency department to detect heart disease are Troponin estimation to detect heart attack and BNP estimation to look for evidence of heart failure.
Next come the imaging tests. Ultrasound study of the heart is known as echocardiography, which can detect the function of the heart and structural abnormalities of the heart, major blood vessels and heart valves. It is now available in portable mode at the bedside. Cardiac computerized tomography or cardiac CT is the next imaging test, which can be done at the radiology suite.
An advanced form of cardiac CT is CT coronary angiography. Magnetic resonance imaging (MRI or CMR – cardiac magnetic resonance imaging) is yet another advanced mode of cardiac imaging. Nuclear scans of the heart include imaging the blood pool with radioactive tracers, imaging the blood flow to the heart with tracers and assessing the metabolic function of the heart with PET scan (positron emission tomography).
Holter monitoring and treadmill tests are different forms of ECG evaluations in different settings. Holter is continuous ambulatory monitoring done for 24-48 hours. Treadmill test is exercise ECG, done with a computerized treadmill which monitors and records the ECG during gradual, stage wise increasing speeds of the treadmill.
Electrophysiological study is an invasive form of ECG in which leads are introduced into the heart through blood vessels and recording of the electrical activity from various sites of the heart done from inside.
Gold standard for diagnosing coronary artery disease is coronary angiography. Allied tests to coronary angiography are coronary intravascular ultrasound (IVUS), fractional flow reserve (FFR) and optical coherence tomography (OCT). All these are invasive tests, requiring the introduction of small tubes known as catheters into the blood vessels and the procedure of introducing catheters into the heart is known as cardiac catheterization. Cardiac catheterization is done in a cardiac catheterization laboratory equipped with cine X-ray equipment.
Content
0 -> it should be noted that before any tests
2.58 -> a good medical evaluation is needed to
5.64 -> decide which tests will be most useful
8.58 -> for that particular person
10.5 -> otherwise it may be a wastage of
12.66 -> resources and the needed result may not
15.599 -> be obtained
17.16 -> in general tests are most useful when
20.64 -> there is an intermediate probability of
22.5 -> disease
23.76 -> when there is a low probability a
26.46 -> positive result could be false positive
29.4 -> similarly when the probability is high a
32.94 -> negative result may be a false negative
35.7 -> so we have to know the pre-test
38.16 -> probability of the disease before
40.26 -> proceeding with the test
42.12 -> which is what we plan to achieve by a
45.36 -> good medical evaluation one of the first
48.3 -> tests to be done when heart disease is
50.399 -> suspected is an ECG which records the
53.7 -> electrical activity of the heart
55.62 -> though it was started over a century
57.84 -> back it is still one of the best tests
60.6 -> to diagnose a heart attack at the
62.579 -> bedside
63.6 -> it does have its limitations a normal
66.6 -> ECG does not roll out our disease x-ray
69.78 -> of chest is useful to document the size
72.06 -> of the heart and to look for enlargement
74.7 -> of various Chambers and blood vessels
77.4 -> it is also a simple and old test with
80.64 -> certain advantages and disadvantages
83.34 -> blood tests used in the emergency
85.32 -> department to detect heart disease are
88.28 -> troponin estimation to detect heart
90.659 -> attack and BNP estimation to look for
94.68 -> evidence of heart failure next comes the
97.439 -> imaging test
99 -> ultrasound study of the heart is known
101.04 -> as echocardiography which can detect the
103.799 -> function of the heart and structural
105.659 -> abnormalities of the heart major blood
107.939 -> vessels and heart walls it is now
110.82 -> available in portable mode at bedside
113.759 -> cardiac computed tomography or cardiac
117.119 -> CT is the next imaging test which can be
120.42 -> done at the Radiology issue
122.88 -> an advanced form of cardiac cities CT
125.939 -> coronary angiography
127.86 -> magnetic resonance imaging MRI or CMR
131.4 -> cardiac magnetic resonance imaging is
134.52 -> yet another advanced mode of cardiac
136.44 -> imaging
137.64 -> nuclear scans of the heart include
139.8 -> Imaging the blood pole with radioactive
142.44 -> traces imagine the blood flow to the
144.959 -> heart with traces and assessing the
147.3 -> metabolic function of the heart with pet
149.52 -> scan positron emission tomography
153.06 -> hold the monitoring and treadmill tests
155.58 -> are different forms of ECG evaluations
158.16 -> in different settings
160.68 -> Holter is continuous ambulatory
162.84 -> monitoring done for 24 to 48 hours
166.5 -> treadmill test is exercise ECG done with
169.86 -> a computerized treadmill which monitors
172.379 -> and Records the ECG during gradual stage
175.56 -> wise increasing speeds of the treadmill
178.519 -> electrophysiology study is an invasive
180.9 -> form of ECG in which leads are
183.42 -> introduced into the heart through blood
185.16 -> vessels and recording of the electrical
187.62 -> activity from various sites of the heart
189.42 -> done from inside
191.28 -> gold standard for diagnosing coronary
193.62 -> artery disease is coronary angiography
195.98 -> Allied tests to coronary angiography are
199.08 -> coronary intravascular ultrasound iOS
202.62 -> fractional fluores of ffr and Optical
206.22 -> coherence tomography OCT
208.8 -> all these are invasive tests requiring
212.22 -> the introduction of small tubes known as
214.379 -> catheters into the blood vessels and the
