Category Archives: Diagnosis

Carotid Ultrasound

Carotid Ultrasound for diagnosing narrowing of the carotid arteries

Diagnosis

Diagnostic tests for heart diseases

Heart Diseases

Carotid ultrasound is a non – invasive diagnostic test used to evaluate the carotid arteries in the neck. It helps to diagnose the narrowing of the carotid arteries (carotid artery stenosis) as this increases the risk of getting a stroke. Assessing atherosclerotic plaques and detecting hematomas are the other reasons for which this test is performed.

Doctors generally recommend this test to patients with transient ischemic attacks, certain types of stroke, or other conditions that increase the risk of stroke. 

How is Carotid Ultrasound performed?

The patient is asked to lie on the examination table with the head slightly turned away from the side being examined. The technician applies clear water-based gel to the area being studied. It is done to help the sound waves reach the arteries and to allow the transducer (probe) to be in close contact with the skin. (Image credit)

The transducer is then moved against different areas on the neck. There is generally no discomfort from pressure as the transducer moves against the area being examined. The patient may be asked to rotate or tilt the head to get the views of the artery from different perspectives.

The sound waves are reflected from the artery walls, and blood cells get detected by the transducer. These waves are then converted into pictures by using a computer. Images of the carotid arteries and the blood flowing through them are then recorded and reviewed by a cardiologist. After completing the imaging, the gel is wiped off from the skin.

Are there any risks involved in it? :

Carotid ultrasound is a safe and painless procedure that has no risks associated with it. 

FAQs: Carotid Ultrasound

What are preparations required from the patient? The patient is advised to wear comfortable clothing to the test. A loose-fitting, open-necked shirt or blouse is generally recommended. He/she is asked to remove all jewelry and metal objects from the area being examined.

How long does it take?  It takes around 30 to 45 minutes to get a Carotid ultrasound done.

Who performs it? It is generally performed by an ultrasound technician or a radiologic technologist in the vascular lab or radiology department. 

How much does it cost? It costs around Rs. 900 to 2K to get a carotid ultrasound done in India.

When can I go home after the procedure? The patient can go home and resume normal activities immediately after the test.

References:

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Abdominal Aortic Ultrasound: How is it peformed?

Diagnosis,

Diagnosing a Heart Problem

Heart Disorders

Abdominal aortic ultrasound is a non – invasive imaging technique used to examine the abdominal aorta. It is generally done to diagnose aortic aneurysms, blood clots, and narrowing of the blood vessels.

High–frequency sound waves are employed to detect any structural abnormalities in the aorta and assess the blood flow through them.

How is Abdominal Aortic Ultrasound performed? :

The patient will be asked to lie face–up with the back on the examination table. He/she is instructed to lift the shirt halfway up the torso to expose the abdomen. (Image credit)

Sometimes, the patient may be asked to change into a hospital gown. The technician applies an ultrasound gel on the patient’s skin to help the transducer slide across the abdomen.

The handheld transducer (probe) is then moved against the abdomen. It is slowly passed along the aortic artery and produces sound waves that bounce off the blood vessels. These echoes are received by the probe and sent to a computer to convert them to pictures.

The technician will finally see the images of the artery and surrounding structures on the screen. The gel is usually water-soluble and can be washed off with soap and water after completing the test.

Are there any risks involved in it?

The abdominal aortic ultrasound is a safe procedure that has no risks associated with it. The patient may feel the transducer’s pressure on the abdomen, but this causes no significant discomfort during the test.

FAQs: Abdominal Aortic Ultrasound

What are preparations required from the patient? The patient is asked to not eat or drink for 6 hours before the test and avoid smoking and eating chewing gums on the day of the test. He/she can eat a low–fat diet such as fruit or juice if they are diabetic or unable to fast. You must also avoid dairy products, carbonated beverages, and caffeinated drinks before the test. The patient is generally advised to empty the bladder before the test.

How long does it take? It takes around 30 to 45 minutes to complete abdominal aortic ultrasound.  

Who performs it?  This ultrasound is performed by a vascular sonographer or ultrasound technician.

How much does it cost? It costs around Rs. 700 to 4K to get the abdominal aortic ultrasound done in India.

When can I go home after the procedure? The patient is generally allowed to go home and resume the daily activities immediately after the test.

References:

How does Implantable Loop Recorder monitor heart rhythm?

Diagnosis, ,

Diagnostic tests for heart diseases

Heart Diseases

An implantable loop recorder (ICR) is a small device used to continuously record and monitor cardiac rhythms. It is implanted into the body under the skin on the chest and is used for cardiac monitoring for up to 3 years.

This diagnostic tool helps to determine the cause behind the symptoms experienced by the patient regularly. The signs that prompt ICR implantation is syncope, seizures, recurring palpitations, and dizziness that an external monitor cannot capture. 

How does an implantable loop recorder work?

The patient will be given a medicine to relax, and a local anesthetic will be used to numb the skin. A small incision of about 2 cm will be made in the patient’s left upper chest. A small pocket is made in this area, and the ICR will be implanted in this pocket. (Image credit)

The wound is then closed using dissolvable sutures. The nurse dresses this area and gives instructions on when the dressing can be removed. Antibiotics may be given to the patient to minimize the chances of infection.

The patient is usually instructed to keep the wound clean and dry until it is fully healed. The Implantable Loop Recorder is often programmed to the required settings by the cardiologist before the implantation.

After the procedure, the patient will be instructed on how and when to use the activator. This handheld device must be placed over the implantable loop recorder to record an episode once the symptoms begin. The activator must be pressed as near to the event as possible and store the last three activations only. It generally overwrites the older ones before recording the new events.

The ILR is usually removed after the diagnosis has been made or its battery life has expired. In the case of the latter, a new device is implanted in place of the older one. Once the doctor identifies or rules out the reason behind the symptoms, the device is removed, similar to how it was implanted.

Are there any risks involved in it?

Implanting an ILR involves a minimal risk of bleeding, bruising, infection, damage to the heart and blood vessels, and mild pain at the implantation site.

FAQs: Implantable Loop Recorder

What are preparations required from the patient? The patient is asked not to drink or eat anything after midnight the evening before the test. The patient must notify the doctor about the medications being taken and stop taking them only if instructed.

How long does it take?  It takes about 15 to 20 minutes to complete the procedure.

Who performs it? An electrophysiologist generally implants the Implantable Loop Recorder.

How much does it cost? This device costs around Rs. 11K in India.

When can I go home after the procedure? The patient can leave the hospital and go home after the test. He/she can resume their normal activities but may want to rest for some time.

References:

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Doppler Ultrasound: for detecting abnormal blood flow

Diagnosis, ,

Diagnostic tests for heart diseases

Heart Diseases

A Doppler ultrasound or Doppler echocardiography is an imaging test used to assess the blood flow through the heart and the blood vessels. It is also recommended to detect any abnormalities in the blood flow throughout the body, evaluating cardiac valve functions, and identify leaky valves.

This test is frequently done to examine the children’s hearts for heart disease and see how well blood flows after treatment. Evaluating the blood vessels for narrowed arteries and aneurysms are the other conditions for which this test is done.

How is Doppler Ultrasound performed? :

A Doppler ultrasound test is generally done in the ultrasound or radiology department or a peripheral vascular lab. The patient is asked to lie on a table exposing only the area being examined. The body part could be the arm, leg, neck, or chest.

A special water-soluble gel is applied over the part of the body that is being tested. The gel improves the sound quality. A handheld device called a transducer is then moved over this area. It transmits very high-frequency sound waves into the patient’s body. These waves are bounced off by the heart and blood vessels. They are then recorded and turned into images or graphs on a monitor.

Sometimes, the patient may hear swishing or pulse-like sounds during the procedure. This sound is produced due to changes in the pitch of the sound waves caused by the movement of the blood cells. The technician may also monitor the patient’s blood pressure during the test. The gel is wiped off after the test.

This test can assess blood flow and also detect the direction and velocity of blood flow in the heart. To get this information, the doctor suggests a color Doppler ultrasound instead of the standard one. The blood that flows towards the transducer generally appears red, while that which flows away appears blue.

Are there any risks involved in it? :

This test is a painless, non – invasive procedure that has no risks associated with it. It is considered to be safe for use in pregnant and breastfeeding women.

FAQs: Doppler Ultrasound

What are preparations required from the patient? The patient is asked to remove any jewelry or metal objects from the area being tested. He/she must refrain from smoking for at least 2 hours before the test as nicotine may narrow the blood vessels and produce false results.

How long does it take?  It takes around 30 to 60 minutes to get a Doppler ultrasound done.

Who performs it? It is generally performed by a sonographer or ultrasound technician, or technologist.

How much does it cost? The cost of a standard Doppler ultrasound ranges from Rs. 1500 to 3K while that of a color Doppler ultrasound lies around Rs. 1500 to 7K.

When can I go home after the procedure? The patient can go home and resume normal activities immediately after the test. 

References:

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Tilt table test: Why is this test performed?

Diagnosis,

Diagnostic tests for heart diseases

Heart Diseases

A tilt table test is a simple non – invasive procedure used to diagnose syncope (fainting). It reproduces the symptoms experienced by the patient under controlled conditions. By doing so, the doctor identifies why you keep getting dizzy spells or completely blacks out.  

How is the Tilt table test performed?

Electrodes will be attached to the patient’s chest to monitor the heart rate via the electrocardiogram (ECG). What is ECG, and how is it performed?

It will also measure the patient’s blood pressure, and you are asked to lie down on a special table that tilts. (Image credit)

Straps will be placed across the patient’s chest, abdomen, and knees to prevent a patient from falling if they faint during the test. In the first part of the test, the nurse tilts the table so that the head is slightly higher (30 degrees) than the rest of the body.

The patient’s blood pressure and heart rate are then checked. After this, the table is tilted more to ensure that the patient lies 60 degrees or more for around 45 minutes. The nurse measures the heart rate and blood pressure continuously during this period.

If the blood pressure drops, the nurse stops the test immediately; else, the table is lowered to start the second part of the test. An IV (intravenous) line is put to the patient’s arm, and a medicine (isoproterenol) is administered. This medicine increases the heart rate and makes the patient more sensitive to the test.

The table is then tilted upwards to a 60 degrees angle, and the patient is monitored for symptoms of dizziness, fainting, or low blood pressure. The test is stopped, and the table is lowered to a flat position if the blood pressure drops. If it remains stable, the test ends in around 15 minutes, after which the table is lowered.

The patient’s blood pressure is monitored throughout this time, and all the necessary information is collected.

Are there any risks involved in the Tilt table test?

The possible complications associated with this test are planned episodes of syncope, dizziness, headache, low blood pressure, nausea, and palpitations.

FAQs:

What are preparations required from the patient? The patient must fast and avoid smoking for 2 hours before the test. He/she must notify the doctor about the medicines they are taking for any heart conditions. after the examination, ensure to arrange a ride home or ask someone to accompany you.

How long does it take? It takes around 1 to 2 hours to complete both parts of the test.  

Who performs the Tilt table test? A nurse and a technician with specialized training perform it under the supervision of a cardiac electrophysiologist.

How much does it cost? It costs around Rs. 2500 to get the test done.

When can I go home after the procedure? The patient is generally allowed to go home and resume normal activities after the Tilt table test. Sometimes, he/she may be asked to stay in the recovery area for 30 to 60 minutes to monitor the blood pressure and then leave the hospital. 

References:

How Cardiac MRI help to diagnose heart problems

Diagnosis,

Cardiac MRI is a scan that uses magnetic fields to create a detailed picture of the heart. It allows the doctor to assess the function and structure of the heart non – invasively. Based on this, the doctor decides on the best treatment plan to address the patient’s heart condition. An MRA or magnetic resonance angiography is usually done to diagnose and detect blood vessel diseases. It is also non-invasive and follows the same procedure as MRI. Read about the heart problems that need early diagnosis and treatment.

How is Cardiac MRI performed? :

The test is done in a medical imaging facility or a hospital in an MRI or MRA machine. The equipment has a table that slides in and out of a donut-shaped machine. The patient is asked to lie on the table, and a contrast dye may be injected into the vein in the arm. It is done to highlight the heart and the blood vessels. The table then slides along with the patient into the machine. 

Inside the MRA machine, the patient is surrounded by a magnetic field. This field reacts with the hydrogen atoms in the body as these atoms are magnetic. Finally, a faint radio signal gets created, and the computer reads this. This signal gets converted to an image that is seen on the computer’s monitor. Claustrophobic patients are either given a calming medication before the test or recommended an open MRI or MRA. During the test, the patient can communicate with the technician to follow his instructions and voice his discomfort. MRI cannot be done if the patient has a pacemaker or other metallic devices like valves, clips, etc., in his body.

Are there any risks involved in it? :

 Cardiac MRI and MRA are harmless and painless procedures. Few patients might find it uncomfortable to remain still or be bothered by the scanner’s noise during the test. The body might also feel slightly warm while the images the being taken.

Apart from Cardiac MRI, there are other diagnostic tests that are performed to detect heart problems.

Cardiac MRI : FAQs

What are preparations required from the patient? 

The patient will be asked to remove all metallic or magnetic items and jewelry before the test. He/She must inform the doctor about his history of claustrophobia and the presence of metallic implants in the body. Women must notify the doctor if they are pregnant or breastfeeding before scheduling the MRI.  

How long does it take?

An MRI scan lasts for approximately 60 to 90 minutes, while an MRA takes over 30 to 90 minutes.

Who performs it?

A radiologist or a radiology technologist usually does the MRI and MRA.

How much does Cardiac MRI cost?

The average cost of an MRI is around Rs. 1500 to 25K, and that of MRA is around Rs. 2500 to 10K.

When can I go home after the procedure?

The patient is allowed to go home and resume regular activity immediately after the test.

Transesophageal Echocardiography

Diagnosis,

Transesophageal echocardiography (TEE) is an invasive test that creates high–quality, moving images of the heart. The transducer is passed down the esophagus to get detailed pictures of the heart structures, valves, and blood vessels. TEE guides the positioning of catheters for diagnosis and provides information during surgery to repair the valves. Regurgitation of blood through the valves and valve stenosis can also be diagnosed by it. 

TEE is performed to diagnose infective endocarditis, valve disease, pericardial disease, myocardial disease, cardiac masses, and congenital heart disease.

Read: Heart Diseases

How is Transesophageal Echocardiography performed? :

The back of the mouth and the throat are sprayed with an anesthetic to numb the region and suppress the gag reflex. The nurse then puts an intravenous line (IV) in the patient’s arm. A patient is asked to lie down on a table, and a mild sedative is administered to calm him.

Generally, the patient lies down on his left side. Electrodes are then attached to his chest to monitor his heart rate throughout the procedure. Following this, a thin, flexible tube is gently guided down his throat through the mouth. This tube is called a probe and has a transducer in its end. The patient may be asked to swallow the probe to propel it easily into the throat. Once the probe reaches the desired position, it sends sound waves to the heart. These waves are bounced back to the probe and get captured as images. [1]

The doctor views the pictures of the heart through the video screen. After getting the necessary images, the probe, IV, and electrodes are removed from the patient’s body. Occasionally, oxygen is administered through nasal tubes, but this depends on the patient’s condition. The room is often darkened to let the doctor see the images clearly on the echocardiogram monitor. 

Know about other diagnostic tests to detect heart diseases.

Are there any risks involved in it? :

There are a few problems associated with Transesophageal Echocardiography. This includes having a sore throat for a day or two, nausea, and bad reactions to the medicine. These usually resolve on their own within a day.

FAQs: Transesophageal Echocardiography

What are preparations required from the patient? 

The patient should refrain from consuming alcoholic drinks for a few days before the test. He is also asked to not eat or drink anything for 4 to 6 hours before the TEE. Dentures, oral prostheses, and other objects that interfere with the test must be removed before inserting the probe. He must also arrange for a ride home after the test as he may feel drowsy after the test.

How long does it take?

  The test gets over in about 30 to 60 minutes.

Who performs it?

 It is done by cardiologists, cardiac anesthesiologists, or physicians as it is an invasive procedure.

How much does Transesophageal Echocardiography cost?

The cost of TEE is around Rs. 800 to Rs. 3 K.  

When can I go home after the procedure?

The patient is allowed to go home once his vital signs stabilize and gag reflex returns. He can resume his normal activities and usual diet unless advised by the doctor. 

Stress Echocardiography or stress echo or stress test

Diagnosis,

A Stress Echocardiography (stress echocardiogram) is a diagnostic procedure used to assess the working of the heart muscle under stress. It is also called a stress echo or echocardiography stress test. Either exercise or medicines can trigger this stress. Exercising on a treadmill or using a supine bicycle provides the stress (pressure) needed for this test. If this is not possible, then a drug called dobutamine is given to mimic the effects of exercise on the heart. A stress echo is performed if a patient complains about chest pain. It also helps in the diagnosis of Myocardial infarction or coronary artery disease.

How is Stress Echocardiography performed? :

The patient will be asked to change to the hospital gown and lie down on his left side on the examination table. Electrodes are then attached to the chest to monitor the heart’s electrical activity via the electrocardiogram (ECG) monitor. Other vital signs such as oxygen level, breathing rate, and blood pressure are also recorded while the patient is resting.

An IV (intravenous) line is inserted into the patient’s arm, and a contrast dye is given if needed. This helps to improve the image quality. Following this, a lubricating gel is applied to the patient’s chest and a transducer a placed over this. It is then moved to capture several resting images of the heart. After this, the patient is asked to either exercise on a treadmill or injected with dobutamine. Once the target heart workload is reached, the activity is stopped, and the patient is asked to lie down.

The technologist monitors the patient continuously and stops the test immediately in case of any problem. Echo images of the heart are captured at different intervals during the exercise. If dobutamine is used, it is administered till the target heart rate is reached. The infusion rate is increased every few minutes, and the vital signs are monitored after each time. These vitals are also monitored for 3 to 6 minutes after the exercise or 10 to 15 minutes after the medicine is stopped. Once the images are captured, the electrodes and IV line are removed.  1

Are there any risks involved in it? :

The risks associated with Stress Echocardiography are chest pain, high blood pressure, nausea, dizziness, and extreme tiredness.

FAQs: Stress Echocardiography

What are preparations required from the patient? 

The patient must not eat, drink or smoke for 2 hours before the test. He is asked to refrain from caffeinated drinks for 6 hours before the test. Jewelry and other objects that interfere with the test must be removed beforehand.

How long does Stress Echocardiography take?

  It generally takes 45 minutes to complete stress echo, but a dobutamine stress echo takes about 1 to 2 hours.

Who performs it?

It is done by a cardiac sonographer or an echo technician.

How much does it cost?

  The cost of a stress echo lies around Rs. 3K to 5K.

When can I go home after the procedure?

The patient is allowed to go home and resume his daily routine immediately after the test.

Cardiac PET Scan: Positron Emission Tomography

Diagnosis,

Diagnostic tests for heart diseases

Heart Diseases

A cardiac positron emission tomography (PET) scan is an imaging technique that uses radioactive tracers to evaluate the blood flow to the heart. The scan provides information about the working of the heart and its tissues at the cellular level. It is also used to assess the extent of heart damage due to heart attack and diagnose coronary artery disease.

How is Cardiac PET Scan performed? :

Image credit

An IV (intravenous) line is connected to the patient’s arm, and a radioactive tracer is injected via this. Natural body compounds like glucose or water labeled with a small amount of radioactive material (rubidium-82) are commonly used as tracers for PET scans.

The patient is then asked to wait for an hour to ensure that the tracer gets absorbed by the organs and tissues. During this time, electrodes are attached to the patient’s chest to record the electrocardiogram (ECG). After this period, the patient will lie on a narrow table that slides into the tunnel-shaped PET scanner.

The patient is instructed to be completely still during the scan. A gamma-ray camera that detects the gamma rays emitted by the tracer is used to produce images of the heart from all directions and angles. The 3 – dimensional (3D) images of the heart are then created by a computer and viewed by the doctor. The technician generally takes a baseline picture of the heart before injecting the tracer.

This scan can also be done in conjugation with a nuclear chemical stress test. In such cases, the images of the heart are captured both before and after the test to examine how well the heart takes up the tracer.  

Single Photon Emission Computed Tomography (SPECT):

 A SPECT scan of the heart is also a nuclear imaging test that follows the same procedure as a PET scan. The radioactive tracer used in this scan is Technetium-99m. SPECT scans are generally less popular than PET scans; as they produce low-resolution images that do not provide a quantifiable estimate of blood flow.

Are there any risks involved in it? :

  It is a relatively safe test as a small amount of radioactive tracer is only used. Women- pregnant or breastfeeding should consult with the doctor beforehand as the radiations may harm the baby.

FAQs: Cardiac PET Scan

What are preparations required from the patient? The patient must fast for 4 to 6 hours before the test. All caffeinated products must be avoided for 24 hours before the test. The patient must notify the doctor if he/she is diabetic and takes insulin.  

How long does it take?  It takes 1 to 3 hours to complete this test.

Who performs it? This scan is performed by a PET/CT technologist.

How much does it cost? The cost of a PET scan ranges from Rs. 15K to 27K.

When can I go home after the procedure? The patient can resume his normal activities and go home immediately after the test.

References:

Nuclear Ventriculography: imaging technique for the Heart Chambers

Diagnosis, , , ,

Diagnostic tests for heart diseases

Heart Diseases

Nuclear ventriculography is an imaging technique that is primarily used to scan the chambers of the heart. It is often done to measure the heart’s ejection fraction and identify any abnormalities of the blood pumping function. This test is also known as MUGA (multiple–gated acquisition) scan or radionuclide ventriculography. 

How is Nuclear ventriculography performed?

The patient is asked to remove his clothing from the waist up and wear the hospital gown. Small sticky metal discs called electrodes are then attached to his chest. These are connected to the electrocardiograph machine by the leads. Through this machine, the doctor monitors the patient’s ECG to track his heartbeat during the test.

An IV (intravenous) line is then started on his arm, and the radionuclide tracer is injected via this. Technetium is commonly used as the radioactive tracer in this test. It “tags” or “labels” the red blood cells and can be detected via a particular camera. The “tagged” red blood cells circulate in the body and show how well blood flows through the heart. (Image credit)

After this, the patient lies down on the examination table, and a gamma-ray camera is placed over his chest. It captures pictures of the patient’s heart while resting, thus called the “resting” scan. Sometimes, the doctor may order an “exercise” scan in addition to the resting scan. For this, the patient will be asked to walk on a treadmill or pedal an exercise bike. On reaching the peak activity level, the technician stops him and instructs him to lie on the examination table.

The gamma-ray camera then hovers over him to take pictures of his heart. The patient will be moved to a different examination table and pedal a specifically mounted bicycle in some cases. This allows the technician to capture several images of the heart while the patient is exercising. 

Are there any risks involved in it?

It is a relatively safe test as minimal amounts of radionuclide is only used. The harmless radioisotope will generally leave the patient’s body within 2 to 3 days. This test is, however, contraindicated in pregnant and breastfeeding women as it may harm the baby. 

FAQs: Nuclear ventriculography

What are preparations required from the patient? The patient must fast for 4 to 6 hours before the test. He should also avoid smoking and taking caffeinated drinks for 24 hours before the test. It is generally advised to wear comfortable clothing and shoes for the test. 

How long does it take? It takes about 1 to 2 hours to get the test done.

Who performs it? This test is performed by a nuclear medicine technologist.

How much does it cost? It costs over Rs. 5K to 7K to get a MUGA scan done in India.

When can I go home after the procedure? The patient can go home and resume his normal activities immediately after the test.

References:

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