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CARDIAC DIAGNOSTIC PROCEDURES 1. 2. 3. 4. 5. 6. 7. 8. Electrocardiography a. Standard (12 leads), Beware of False Negatives Ambulatory ECG a. Useful for arrhythmias when ECG recorded for 24 hrs (Holter monitoring) Stress Test a. Treadmill b. Treadmill/Pharmacological Perfusion Scans or Echocardiography i. Valuable test to induce Myocardial Ischemia with abnormal ECG changes ii. Looking for symptoms and arrhythmias iii. Target Heart Rate = (220 – Age) * 0.85 Cardiac Roentgenalogy (i.e. X-Ray) Four Standard Cardiac Views a. Posterior Anterior (PA) Total Heart Size and Contour b. Right anterior oblique (RAO) Left Atrium c. LAO Aorta, Delineates size of Left Ventricle d. Left Lateral Right Ventricular Wall Echocardiography Valuable Non-invasive tool a. Use Stress Echo for coronary atherosclerosis Radionuclide studies a. Used for Shunt detection b. Imaging for Acute MI c. Nuclear Angiography d. Perfusion Scanning Cardiac Catheterization and Selective Angiography a. Right and Left Heart used for Dx and Assessment of Congenital/Acquired Heart Disease i. Pressure and Oxygen Saturation in heart chambers ii. Selective angiography of chambers iii. Selective coronary cineangiography – motion pictures of contrast through heart/CVS Swan-Ganz Catheterization a. Use a balloon tipped, flow-directed catheter at bedside; Used to evaluate hemodynamics of right and left heart (left is indirect) i. Left Ventricular Filling Pressure ii. Pulmonary Capillary Wedge Pressure iii. Assess cardiac insult (i.e. ruptured IV septum, cardiac tamponade, mitral regurgitation) iv. Monitor IV vasodilator and Ionotropic therapy v. Also used to asses therapy in chronic heart failure