Cardiac Imaging and Diagnostics

It is a term ranges for birth defects that affect the normal functioning of the heart. Congenital heart disease is most common birth defect, which affects ratio of 1 in 100 babies who were born in UK. Causes of congenital heart disease are Genetic conditions genetic health conditions that a baby inherits from 1 or both parents or from anyone of the parent can cause congenital heart disease.  Genetics can direct the risk for heart disease. Genes control the functioning of cardiovascular system, from the functioning of blood vessels to the cells in the heart. Genetic mutations in a single gene influence the cause of heart disease. Congenital heart defects are of: cyanotic heart defects and non-cyanotic heart defects. Defects may include the walls of the heart, heart valves, or cardiac blood vessels that supply blood to the heart.

Cardiac imaging is a diagnostic tool involves radiograph (radiology related to medical images) to diagnose cardiovascular diseases  and to detect the heart defects confined to size and shape of the heart. Image analysis has this processing, an image to fundamental components to take out important information. Image analysis includes tasks such as identifying shapes, removal of noise, counting objects, detecting edges and calculating statistics for texture analysis or image quality.

The main types of cardiac imaging are:

• Echocardiogram (echo).
• Cardiac computed tomography (CT).
• Nuclear cardiac stress test.
• Single-photon emission computed tomography (SPECT).
• Cardiac positron emission tomography (PET).
• Coronary angiogram
• Cardiac MRI.
• Multigated acquisition  (MUGA) scan

Cardiac MRI is the rapid growing diagnostic tools in paediatric cardiology. This technology uses to produce exquisite images of the inside and outside of the heart, allowing many patients to avoid more invasive procedures, and without radiation exposure.Nuclear Cardiology is a non-invasive method of diagnosing heart disease using nuclear imagining technique .This is performed usually done while exercising. Nuclear medicine is the use of small radiation elements which emits radiation and those are referred to as radiotracers and that are injected into the bloodstream, inhaled or swallowed. The radiotracer moves to the test location and empowers the form of gamma rays received by a special camera and computer to create images of your body. Myocardial perfusion imaging is the most widely used in Nuclear Cardiology.

Paediatric heart diseases are various heart conditions observed in children. Paediatric heart disease refers to a problem that effects change in blood flow to the heart in children. Paediatric cardiovascular Disease is the most prevalent birth defect. Diagnostic procedures are echocardiograms, cardiac catheterization, and electrophysiology studies, and for the managing and updating of heart disease, its consequences in infants, children, and adolescents. Various diseases of the heart include myocarditis, Kawasaki disease is cardiac disease which is childhood disease that rarely seen and affects mostly blood vessels. There are many other pericardial diseases that can present clinically as acute pericarditis, pericardial fusion, cardiac tamponade, and constructive pericarditis. Infectious endocarditis is a type of endocarditis which is an inflammation of the heart tissues internally. This is the main inflammatory defect observed in heart of the baby.

• Developmental delay and disorders
• Behavioural problems
• Functional disabilities
• Cocial stresses
• Mental disorders including depression and anxiety disorders

A foetal cardiac scan is a detailed ultrasound of baby's heart before the birth of baby.  The Doctor completely evaluates the baby's heart and this is not quite easy during regular obstetric ultrasound. It is usually performed in second trimester, between 20–24 weeks. Certain Cardiac problems which effect during pregnancies, such include symptoms are fatigue, chest pain, and shortness of breath, fainting, difficulty in breathing while asleep.  And also Fainting occurs due to blood pressure and volume changes in pregnancy.

• Shunt lesions
• Obstructive Lesions
• Complex lesions
• Cyanotic heart disease

Arrhythmia occurs when electrical impulses that inter-relate heart rhythm do not travel casually. It causes the heart beat too fast, too slow, or leads an irregular rhythm. Most arrhythmias are harmless, but some are serious and also life threatening. When a heartbeat is too fast, too slow or irregular, at this condition heart cannot pump sufficient blood and supply to the body.

Treatments for heart arrhythmia which include are:

• Electrophysiology procedures (EP study, mapping, ablation)
• Cardioversion
• Implantable Cardio Verter Defibrillator (ICD)
• Medical management
• Pacemaker implantation
• Trans oesophageal echocardiogram
• Heart surgery

Electrophysiology:  Cardiac Electrophysiology is the physiological study, which that obtains broadly flow of ions to the biological tissues and, in particular, to electrical recording techniques which allows the tracking of measurement of this flow. Classical electrophysiology techniques is a technique which includes placing of electrodes into various preparations of biological tissue.

Cardiac nursing   refers to cares for patients who suffers from various conditions of  the cardiovascular system. Cardiac nurses play a vital role in the diagnosing, and providing treatment, and prevention of cardiovascular conditions by working with patients, involved in experiencing heart attacks, angina, coronary artery disease, arrhythmias, and several heart conditions.

• Acute cardiac care
• Chronic cardiac care

Cardio-oncology is a new term describes and puts complete efforts to treat patients who face heart problems which causes by cancer treatments. Although certain cancer patients have health conditions which are related to lung disease, infections or kidney disease, the rise of cardiac diseases in these patients has led the pathway to the development of this new field. Cardio-Oncology associate mainly with cancer doctors (Oncologists), Cardiologists and researchers. New therapies are serving patients to live longer, but that means they also require on-going cancer treatments which may show damage effect on their hearts. Many of these survivors are chance to risk for heart disease and now will live long period after the cancer treatments to expand their heart disease. In   general addition, to this some cancer medications also may effect and damage the heart.

Geriatric cardiology refers to as the offering of cardio vascular care to the geriatric population which are taken into consideration principles of geriatric medicine along with into the daily routine care of ageing population who are having cardiovascular diseases. Geriatric cardiology is a sub division of cardiology and geriatric medicine that acts upon the cardiovascular disorders in most elderly people. Cardiac disorders such commonly are coronary heart disease, along with myocardial infarction, heart failure, cardiomyopathy, and arrhythmias such as atrial fibrillation, are seen and it is a major cause of mortality in elderly people. Vascular disorders includes like atherosclerosis and peripheral arterial disease which causes expressing morbidity and mortality in aged persons

Cardiovascular pharmacotherapy plays a truly major role in managing of cardiovascular diseases with in its whole spectrum.  Drug therapy results in life-prolonging inference, in many cardiovascular conditions and raises the life expectancy level, as a result of its role in increase of other undermining symptoms. Many types of cardiovascular agents are available to treat different cardiovascular conditions.  There are nearly around 6 associations and societies are of 50 universities that work on cardiac medications .Among them the main association for cardiology medical agents are in US. There are various cardiovascular drugs which are available in the market that includes cardiac glycosides, anticoagulants, antiarrhythmic agents, anti anginal agents and antihypertensive agents.  

• Renin-Angiotensin-Aldosterone system
• Neural Control of the cardiovascular system
• Platelet/Clotting system
• Pharmacokinetics

The study of molecular mechanisms and cellular interactions in cardiovascular biology is known as Molecular and Cellular Cardiology. It aims in highlighting the research and identifying novel pathways which regulate cardiac hypertrophy, ageing, and metabolic disorders, with a main focus on translating bench discoveries into new aiming treatments and techniques. It incorporates techniques such as genomics, stem cell biology, molecular biology, gene therapy, transgenic models, and parabiosis, as well to approach cardiovascular problems which are pertinent to human diseases and to generate solutions that are validated upon in vivo investigations.

Echocardiography: An echocardiography is a test that involves the use of high frequency of sound waves to produce live images of heart to observe the structure of heart and to evaluate its heart functions. The image so obtained is called an echocardiogram which has no side effects. Echocardiography helps the doctor to trace out:

The size and shape of the heart, thickness.

• Heart moves
• About heart’s pumping strength.
• Check if the heart values are working correctly.
• Severe conditions if blood is leaking backwards through heart values.
• Find out whether the heart values are too narrow
• To check out if there is a tumour or infectious growth around heart values

Hypertension: Hypertension is a major condition that significantly increases the risks of organs like heart, brain, kidney and other diseases. Blood pressure is determined by both the amount of blood pumps by the heart and the amount of resistance to which blood flow in your arteries.

The walls of Blood vessel can be damaged due to high blood pressure, which can lead to stroke. High blood pressure can be managed by maintaining good lifestyle behaviours like exercising and the DASH diet, as well as the use of medications if necessary. People with hypertension are four to six times more likely to have a stroke because blood supply to one part of the brain is being cut off.

According to  the term Translational research, in Cardiology, it is the using advanced  method  of using  procedures to promote their significance  in fields of cardiovascular disease, diagnosis and treatment  and also to speed up scientific discovery into patient and  for future community benefit. It addresses the critical medical needs. In applied sciences, it is specially designed to improve the health outcomes.  Certain types of Translational Research:

• T1 research
• T2 research
• T3 research
• T4 research

Stem cell therapy is best emerging treatment of cardiovascular diseases. Although it is feasible and clinically safe, the in vivo behaviour and integration of stem cell transplants still remain largely not known. This leads into the development of innovative non-invasive imaging techniques capable of effectively tracking such therapy in vivo is vital for the most in-depth investigation into the clinical applications in future. Such imaging modalities will not only generate further insight into the mechanisms behind stem cell-based therapy, but also address some major concerns associated with translational cardiovascular stem cell therapy. In the present review, we summarize the principles underlying three major stem cell tracking methods: (1) radioactive labelling for positron emission tomography (PET) and single photon emission computed tomography SPECT) imaging

There are several types and combinations of medications, can be used to treat coronary artery disease (CAD), and physician will choose the optimal one for patient. Cardiac devices can restore or maintain an adequate rhythm and rate to meet metabolic needs. Implantable cardiac devices play a key role in the treatment and prevention of heart disorders and also sudden cardiac death. Pacemakers (PMs), implanted cardioverter defibrillators (ICDs), and cardiac resynchronization treatment (CRT) are some examples of devices. Some medications can cause these devices to malfunction, while others can protect them from delivering unwanted shocks.

Resuscitation: Resuscitation is defined as the process of improving the physiological disorders (such as lack of breathing or heartbeat) in a patient. It is a key part of intensive care medicine, trauma surgery and emergency medicine. Examples such as cardiopulmonary resuscitation  and mouth-to-mouth resuscitation . CPR Techniques;

• High-Frequency chest compressions.
• Open-Chest CPR.
• Interposed Abdominal Compression-CPR
• “Cough” CPR
• Prone CPR
• Precordial thump
• Percussion pacing

Emergency infusions: Emergency infusion is the process which involves in injecting directly into the bone marrow which produces a non-collapsible entry point into the systemic venous system. This technique is used to allow fluids and medication when intravenous access is not available

Infusion Drugs & Types of Infusions:

• Antibiotics
• Biologics
• Chemotherapy
• Fluids
• Heart pumps medication
• Haemophilia factor therapy
• Intravenous gamma globulin (IVIG)
• Pain management

Diagnostic cardiology is special term used as tests that are performed to check the heart condition. If a person suffers from cardiovascular disease, it is used to check the severity of the disease. They perform several diagnostic tests for cardiovascular diseases which includes electrocardiograph test, invasive test, laboratory test, autoimmune reflex test etc.

Multimodal imaging or multiplexed imaging refers to the production of signals simultaneously involving in more than one image technique. For example, it could be used by combining optical, magnetic and radioactivity reporters to be recognising by SPECT, MRI and PET. The multimodal or multiplexed imaging aim is to achieve and improve early detection and localization of cancer. Furthermore, multimodal imaging enables to find out more than one molecule at a time, so this progression of these events can be followed in real-time.

• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)