Pathological changes in coronary vessels, growth of atypical course of coronary heart disease, post-infarction states with the threat of a repeated event occupy the first places in the statistics of deaths and disability.
And, in connection with this, the standard methods of diagnosing the type of electrocardiogram being carried out at rest in a short period of time, provide little information, especially in cases of atypical "asymptomatic" angina, chronic ischemia of the heart. A detailed diagnostic study of abnormalities in the work of the myocardium and cardiac vessels using highly informative, reliable methods is required, and one of them is scintigraphy of cardiac muscle of the myocardium( radioisotope, stress, stress, dynamic, etc.).
What is myocardial scintigraphy?
Myocardial scintigraphy( or nuclear scanning) is a special study of blood circulation in coronary vessels, which is carried out by injecting into the body radioactive isotopes accumulating in the myocardium. This field performs a scintigram( snapshot) of radionuclide movement along the cardiac vessels, which allows to determine the patency of the blood flow or the degree of insufficiency of the blood supply to the heart tissues. The procedure is performed using a radiological device-a gamma tomograph used in nuclear medicine to diagnose functional changes in organs.
About scintigraphy as a method of diagnosis will tell the following video:
To whom it is prescribed
Scintigraphy for myocardial examination is assigned:
- for the primary diagnosis of patients with cardiovascular pathologies and prevention in patients at risk;
- for the purpose of differentiating the disease in a patient( setting an accurate diagnosis in the case of similar symptoms in various pathologies);
- for the development of the correct tactics of further therapy of the patient and his rehabilitation.
The procedure is prescribed in the following cases:
- if there is a need to evaluate the work of the left ventricle when observing cardiovascular pathologies and with changes in ECG parameters;
- for confirming the diagnosis of coronary heart disease, studying the functioning and determining the viability of the myocardium after a heart attack;
- to identify the causes of cardialgia;
- for the purpose of confirming or excluding angina pectoris;
- for assessing the risks of potential complications;
- , if necessary, evaluate the effectiveness of treatment;
- to determine the appropriateness of using certain therapies: angioplasty, stenting, coronary bypass.
Why go through this procedure
From the results of scintigraphy directly depends on the scheme of therapy and surgical intervention. The procedure is performed only for the purpose of the cardiologist, when it follows:
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- as a whole evaluate the circulation of blood in the coronary vessels of the heart muscle;
- determine the level of blood supply to the tissues of the heart muscle;
- to distinguish the necrosis sites after the infarction transferred from the ischemic zone( with a deficiency of blood supply);
- to detect cicatricial postinfarction and ischemic foci, suffering from a shortage of food and oxygen during exercise.
Types of diagnostics
- Perfusion scintigraphy of the myocardium is the study of blood flow in the myocardium with the use of waist or technetium. This method, which diagnoses ischemic disease, is more informative than the electrocardiography method carried out under physical stress. Using perfusion scintigraphy of the myocardium with high accuracy, localization of the ischemia site is determined where, due to problems with the vessels, there is not enough oxygen and tissue nutrition.
- Scintigraphy of the heart muscle with the use of vasodilating drugs , extending the lumen of the vessels and increasing perfusion( blood flow) in areas where the blood flow is normal. Those areas where a smaller volume of isotopes are detected pass small amounts of blood, indicating that these areas are ischemic( due to narrowed or blocked by blood clots vessels).
About the indications for scintigraphy of the heart muscle, myocardium, read below.
Indications for
Scintigraphy refers to key methods for the detection of coronary artery disease. It allows you to detect and assess the degree of filling of blood vessels in different areas, clearly identify the place where the blood flow is disturbed. The method helps to determine not only an ischemic zone with insufficient blood supply, but also to distinguish it from a site of necrosis of cells after a heart attack. This eliminates the error in developing a treatment regimen, increasing its effectiveness.
Scintigraphy is carried out with the objectives:
- Prophylactic diagnosis of patients with a high probability of developing cardiac problems before surgery, sports activities.
- Confirmation of the diagnosis of coronary artery disease or its exclusion.
- Studies of the contractile function of the cardiac muscle in the post-infarction state.
- Evaluations of the effectiveness of therapeutic or endovascular, surgical techniques - stenting and coronary bypass, balloon angioplasty.
- Clarification of the degree of need for surgery on the coronary artery.
- Finding the reasons for the different nature of chest pain.
Scintigraphy reveals areas of vascular lesions, necrotic zones and develop a treatment program.
Contraindications for
Contraindications for the performance of myocardial scintigraphy:
- period of bearing the child;
- the weight of the patient is more than 120 - 130 kg;
- breastfeeding baby, because after infusion into the blood of radionuclides they enter the female milk for another 2 days, and it is not allowed to use it for feeding. If it is necessary to diagnose this method, it is recommended to express the milk before the test.
Is the
procedure safe? The procedure for myocardial scintigraphy does not cause unpleasant or painful sensations and poses no danger. New technologies radically reduce the negative impact of radioactive radiation. For diagnostic purposes, use extremely small doses of isotopes that are rapidly eliminated from the body.
But any medicine and radionuclides can cause allergic reactions, pressure jumps. Undesirable side effects can cause drugs that are used to stimulate an artificial physical load. Patients with cardiovascular pathologies have chest pains while using the simulator.
Preparation for the examination of myocardial scintigraphy is discussed below.
Diagnostic Preparation
Before the Scintigraphy:
- Do not eat solid foods for 2 to 3 hours. The day before the study excludes products with caffeine: tea, coffee, cola, chocolate.
- It should be ensured that there is no pregnancy.
- Breastfeeding mothers need to express milk.
- Viagra, Levitra and similar preparations should be discontinued. With physical exertion during the scintigraphy, the onset of an angina attack can not be ruled out, which is stopped by nitrates incompatible with medications from erectile dysfunction.
- Patients suffering from asthma, necessarily inform the doctor who is carrying out the procedure.
- It is not excluded that some medications are stopped, which is necessary for consultation with the attending physician.
- For the results to be accurate, it is necessary that during the procedure the liver be cleaned from radiopharmaceuticals. Therefore, it is inadmissible to take a tomography scan 2 to 3 hours before the scintigram, because the liver does not have time to purify itself from previous medicines.
- Before the procedure, radionuclides do not enter the stomach and small intestine. Therefore, it is performed on an empty stomach so that no medication of this group in the body is present.
How the procedure is performed
The procedure is performed by the patient when he is at rest, then - giving a certain amount of physical activity to see how the heart works under voltage. Duration about 2 - 4 hours. Scintigraphy is not an invasive( ie, without tissue excision) study of the function and condition of the heart muscle. The procedure takes place in two stages - at rest and under load.
During physical activity to pump blood, the heart requires more oxygen, and more blood flows into the myocardium. With pathology of the circulation, all disturbances during exercise are much more pronounced. Comparison of scintigrams made in a state of tension and at rest gives a broad clinical picture for the analysis and detection of ischemia sites.
The drug moves along with the bloodstream along the vascular network and, getting into the heart, is absorbed by its intact cells. The specialist analyzes the distribution of radionuclides in the myocardium using a gamma camera that captures radiation, captures and transforms them into statistical, dynamic and synchronized images with an electrocardiogram.
- Observing the concentration of isotopes, reveal the level of blood supply of different sites. If the radiopharmacological substance is actively absorbed, it means that the blood supply in this zone is normal.
- In ischemic areas, radionuclides are slightly absorbed. Half an hour after the infusion of the radio indicator using a gamma camera, several images are taken, in which all the zones are viewed very well.
Next - the heart is examined under physical exertion, but the procedure is done after partial decay of radionuclides.
- For the creation of physical tension, the patient is engaged in simulators( treadmill, bicycle).
- The medication option is used if the patient is not exposed to physical stress. Then, in order to imitate active activity, he is injected with medications that stimulate the increase and acceleration of cardiac contractions, as a rule - adenosine, dipyridamole, Dobutamine.
Simultaneously monitor the pulse rate, pressure, make an electrocardiogram. The repeated infusion of isotopes is done at the maximum physical load, and after 30 minutes the heart is scanned in three axial projections. When feeling pressure, chest pain, spasms in the legs, difficulty breathing, dizziness should be reported immediately to the doctor during the procedure.
Decoding of the results of
It is important that images obtained during scintigraphy make it possible to distinguish between areas of necrosis of cells from areas with insufficient blood supply.
For accurate detection and subsequent examination of the areas of defects use software products and "polar maps" of the axes of the heart.
Begin the analysis from the upper region of the heart, progressing gradually from the short axis to the base. Deviations are assessed as permanent or transient defects. Compare the pictures taken at rest and under load. Transient defects reflect emotional stresses, and are not found at rest. And permanent defects do not change in any condition, which indicates the signs of an infarction.
The difference in the accumulation of a radiopharmaceutical in different areas is determined by quantitative analysis on a scale of 0 to 3 points. This system allows you to accurately assess the complexity of the changes that have occurred. The radioactive substance accumulates well only in those areas of the heart muscle, where there is an active metabolism - that is, in healthy tissues that are not damaged by ischemia.
The analysis of scintigraphy results is carried out according to the scheme:
- visual examination of images and analysis of myocardial images in three axes;
- Quantitative analysis conducted to determine the difference between the concentration of radionuclides in different segments of the myocardium( using digital technologies);
- location of defects relative to the heart walls;
- assessment of the viability and extent of lesions of the myocardium.
Positive sample:
- multiple accumulation defect or a large number of sites with low isotope uptake - ischemia regions;
- detection of a small concentration of isotopes outside the range of changes in the tissues of the heart after a heart attack;
- detection of a defect in the accumulation of isotopes in the outbreak of a heart attack;
- detection of accumulation defect under low load( pulse 120 bpm = J 6.5);
- increased indices of isotope accumulation in the lungs.
Factors that can lead to distortion of the result of the scintigram( "false positive test"):
- increased tendency of tissues to absorb radionuclides;
- large volume of mammary glands;
- a large number of heart-sapping subcutaneous fatty tissue;
- high congenital diaphragm position.
About the prices for myocardial scintigraphy with a load and without read at last.
Average cost of
Myocardial scintigraphy is not a cheap procedure, but it is quite comparable with the treatment of pulpitis in dental clinics. About where to make a scintigraphy of the myocardium in your city, it is better to find out from your doctor.
The price differs depending on the region of Russia, the level of the medical institution. In Moscow centers, the study at rest will cost about 7,000 rubles, scintigraphy is two-stage - at rest and under load - 15,000 rubles.
Even more useful information about myocardial scintigraphy is contained in the video below: