Download Gammagraphy of the myocardial perfusion

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S A N I T A T
Gammagraphy of the myocardial perfusion
(Myocardial SPECT, stress test with isotopes, isotope ergometry)
1. Identification and description of the procedure
The myocardial perfusion gammagraphy is an imaging diagnostic method hat permits the study of the
blood flow in the myocardium and the integrity of the cells after the intravenous administration of a
radioactive tracer (Talium-201, isonitriles or tetrophosmins marked with Technecium-99m).
The state of the myocardial perfusion can be studied in resting conditions, during a controlled physical
effort or after the administration of different pharmaceuticals.
The habitual exploration consists of a stress test with rolling tape or ergometric bicycle, administering
the tracer at the moment of maximum effort, obtaining posterior images that reflect the state of the
myocardial perfusion at the time of most effort. If the result is not absolutely normal, another exploration
will be performed afterwards while resting, being able to be completed on the same or different days,
depending on the type of tracer and protocol used.
If the patient presents physical impossibility to perform the stress test, the exploration will be performed
after the administration of a pharmaceutical equivalent to the effect of the effort.
The studies are usually obtained through tomography technique (SPECT), meaning, making multiple images
around the heart, always when possible, with a synchronized electrocardiogram, so as to be able to identify
the start of each heart beat. These images are then submitted to a careful computer process, by which
the existence of perfusion defects is studied and its localization in any myocardial segment, its severity
and extension is quantified, it is compared to the stress test and rest period of the same patient, you can
also obtain, if the synchronized study has been performed, the evaluation of the ventricular function, that
is to say, the contraction capacity of the heart, both globally as well as regionally and both while resting
as well as after the effort.
It may be necessary to withdraw some of the patient’s normal medications one or various days before
the exploration, as well as only having a light meal between the injection of the tracer and the image
collection to favour the elimination of the tracer part and so that the image quality is optimal.
Previously, upon carrying out the exploration, the corresponding Nuclear Medicine Service personnel will
inform you of the procedure and will answer your questions regarding it.
2. Purpose of the procedure and benefits that are expected to be achieved
Diagnosis of the coronary illness, acute or chronic, determining he existence, localization, extension and
severity of the myocardial ischemia and myocardial infarction.
Prognostic evaluation of the possible evolution of the coronary disease.
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Evaluation of the existence of viable myocardia, that is to say with possibility of recuperation if an operation
is performed on it by angioplasty or by-pass.
Evaluation of the results and posterior evaluation of the treatments both medicational as well as different
operation on the heart.
It is the only procedure to be able to directly study the myocardial perfusion during physical effort,
obtaining rigorous and detailed information regarding the myocardial blood flow as well as the cardiac
functionality, as well as being a simple technique to perform for the patient, that it has low radiation dose
very inferior to other radiological techniques.
3. Reasonable alternatives to this procedure
Through a cardiac PET we can also directly study the myocardial perfusion but it is performed after the
pharmaceutical stimulation as well as the myocardial viability, even though currently it is a scarcely
available exploration.
Other explorations such as the echocardiography or MRI allow an indirect study of the status of the
myocardial perfusion through the alteration of the heart contractions; generally after pharmaceutical
stimulation, currently other more direct studies are still under the initial phases.
The contrast coronariography studies the anatomic lesions of the heart while the perfusion gammagraphy
allows us to get to know the real functional significance of these lesions, so they are considered
complementary methods in the evaluation of coronary patients. However, the contrast coronariography
is performed through cardiac catheters that require hospitalization and the administration or radioactive
contrast that can represent a severe risk in determined patients.
Gammagraphy of the myocardial perfusion
(Myocardial SPECT, stress test with isotopes, isotope ergometry)
4. Foreseeable consequences of its performance
To contribute to the diagnosis and adequate treatment of the patient as well to the posterior follow-ups.
To contribute to the prognostic evaluation of the cardiac patient, as well as the correct recomendation
of a revascularization operation.
5. Foreseeable consequences of its non performance
To contribute to the diagnosis and treatment of the patient.
Incorrect diagnosis or prognosis.
Inadequate recommendation for a revascularization operation.
6. Frequent risks
Not described.
7. Infrequent risks.
The scarce risks that a physical effort test can carry or a pharmaceutical under medical control.
8. Risks depending on the patient's clinical situation
The exploration is not advised for pregnant women, even though in exceptional circumstances the
risk/benefit will be evaluated.
In case of performing the exploration on a woman during lactation, she must interrupt it during a short
time period.
During the day of the exploration close contact with small children and pregnant women must be avoided.
9. Declaration of consent
Mr./Mrs./Miss.
aged
, with home address at
, National Identity No.
Mr./Mrs./Miss.
and SIP number
aged
, with home address at
acting in the capacity of (the patient's legal representative, relative or close
, with National Identity No.
friend)
HEREBY DECLARE:
That the Doctor
situation to perform
In
has explained to me that it is advisable/necessary in my
on
,2
With National Identity Card No
Signed: Dr.
With National Identity Card No
Associate number
10. Revocation of the consent
I hereby revoke the consent granted on the date of
to carry on with the treatment that I hereby terminate on this date.
In
Signed: The Doctor
Associate number:
on
,2
Signed: The patient
,2
and I do not wish
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Signed: Mr./Mrs./Miss.