Detection Of Heart. By Dr Gary Mo

Transcription

1 Detection Of Heart Disease By Dr Gary Mo

2 Types Of Heart Disease A. Coronary Heart Disease B. Valvular Heart Disease C. Cardiac Arrhythmia ( Rhythm disturbance ) D. Heart Blocks ( Conduction Abnormalities ) E. Cardiomyopathy ( weakening of heart muscles ) F. Congenital Heart Disease ( Born with the defects like Bicuspid Aortic valve etc )

3 Symptoms Of Heart Disease A. Coronary Heart Disease : chest discomfort including chest pain or tightness or burning sensation, dyspnea (shortness of breath, palpitations, light-headedness, fainting syncope, decreased effort tolerance, fatigue etc) B. Valvular Heart Disease : any or all of the above C. Cardiac Arrhythmia : More commonly palpitations, dyspnea, light-headedness D. Cardiomyopathy : More commonly fatigue, dyspnea E. Heart Block : More commonly light-headedness, syncope, exertional dyspnea

4 Signs Of Heart Disease Physical Examination shows : A. Elevated Blood Pressure B. Irregular pulse rate C. Neck vein distention D. Presence of extra heart sound such as S3 and/or S4 gallops, pericardial rub, systolic click etc. E. Presence of Murmur. Helpful blood tests including Lipid panel, Blood sugar, Kidney panel, cardiac enzymes in acute situation.

5 Diagnostic Tests For Heart Disease Electrocardiogram ( EKG ) 1. Any old heart attack or recent heart attack or acute heart attack? 2. Any rhythm disturbance? 3. Any thickening of heart muscles due to hypertension? 4. Any heart block?

6 Holtor Monitor 1. Patient hooked-up to electrodes and tape recorder for 24 hours. 2. Patient keep a diary for symptoms and activities. 3. Patient can do everything including usual activities. 4. No shower during monitoring 5. Monitor will record patient's heart rhythm continuously for 24 hours. 6. Test can detect cardiac arrhythmia, intermittent heart blocks.

7 2-Dimentional Echocardiogram / Color Doppler Test 1. Ultra-sound study 2. Non-invasive and safe 3. Can detect the presence and severity of valvular abnormalities, enlargement of the heart chambers, congestive heart failure ( weakening of heart muscles ). 4. Takes minutes 5. No special preparation required.

8 Treadmill Exercise Stress Test 1. Patient hooked-up to EKG electrodes and walk on the treadmill machine. 2. Patient follows Bruce or Modified Bruce or other protocols 3. Blood pressure taken every 3 minutes. 4. The speed and gradient of the treadmill machine increases incrementally every 3 minutes in standard way. 5. Test stopped when patient is tired / cannot go on, or when patient has significant chest pain, dyspnea, light-headedness, or when EKG shows significant ischemic change, or when target heart rate reached. 6. Accuracy of predicting Coronary Heart Disease about 60-70%.

9 Stress Echocardiogram 1. Most important and effective non-invasive test for detecting Coronary Heart Disease. Secondary benefit of detecting valvular disease / cardiomyopathy. 2. First do a resting 2-Dimentional Echocardiogram. Then patient on treadmill machine. Finally repeat 2-Dimentional Echocardiogram immediately after patient finishes exercise on the treadmill machine. 3. Compare the wall motion of the heart muscles at rest and immediately after exercise, The Hypokinesis ( decreased wall motion ) of heart muscles is suggestive of the presence of significant atherosclerosis ( plaque-formation ) in the coronary arteries.

10 Stress Echocardiogram 4. The test is safe and needs no special preparation 5. Accuracy of predicting Coronary Heart Disease up to 90%. Sensitivity 85-90% Specificity 90% 6. Technical skill of Echo Technician very important for performing accurate test. 7. The test takes 45 minutes to 1 hour.

11 Nuclear Cardiac Test ( Myocardial Stress Perfusion Test ) 1. The test takes 4-6 hours or longer. 2. Needs IV ( intravenous ) line for injection. 3. Unpleasant side effects of some agents used. ( e.g Adenosine, Persantine ) 4. High sensitivity but only modest specificity for detecting Coronary Heart Disease. 5. Cannot detect valvular disease 6. Used for patient who cannot exercise on treadmill machine.

12 Cardiac Catherization / Coronary Angiogram 1. Invasive and higher risk than non-invasive tests 2. Risks including 1-2% heart attacks, strokes, kidney failure, bleeding requiring blood transfusion etc. 3. Gold standard for diagnosing Coronary Heart Disease and Valvular Disease. 4. Only performed in hospitals. 5. Very expensive

13 CAT Scan 1. Ultra-fast CAT scan detects Calcium in coronary arteries. Cannot detect ' soft ' plaques. Limited benefit. 2. CAT Scan Angiogram ( 16 slices; 64 slices ) a. 16 slices not good for distal coronary arteries. b. 64 slices much more promising, needs more data

14 GHC Global Health Clinic A. Multi-purpose clinic with strong Cardiovascular expertise. B. Providing : a. Cardiovascular Consultation b. EKG service c. Holter Monitorong service d. 2-Dimentional Echocardiogram / Color Doppler service e. Stress Echocardiogram service C. Others as described by staff and brochure.

15 The End