Stories and news about treatment advances that improve your health and quality of life

Heart disease imaging

Knowledge at your cardiologist’s fingertips

November 21, 2014

When you have a heart condition, imaging tests are the best way to ensure you get the right treatment at the right time, and the best possible outcome. Only large heart centers like Duke have the most up to date technology. They also have the credentialed and certified specialists with the expertise to make treatment recommendations based on what they see. Here’s a rundown of the latest imaging advances available today, and how they help your cardiologist diagnose your heart disease.

It starts with the echo

Echocardiograms rely on sound waves to capture high speed, 3-D images of the moving heart. This noninvasive test is the starting point for anyone with a heart condition because it shows the heart’s shape, size, and how it beats.

“We can see if the heart is enlarged, if it is pumping normally, relaxing poorly, how the valves move, and if there is fluid build up,” explains Eric J. Velazquez, MD, director of cardiovascular imaging at Duke. He says echocardiography is a critical technology because it can be applied in any situation: the exam room, hospital room and operating room.

During surgery, for example, transesophageal echocardiogram (TEE) provides continuous monitoring of the heart. It’s used during all heart surgeries at Duke because “it helps your surgeon make moment-by-moment decisions before surgery is completed,” Velazquez explains.

Echocardiograms are a crucial first step in the diagnostic process. However, this procedure can’t tell if tissue is abnormal. And it doesn’t provide information about the arteries or how blood flows. Additional imaging can pinpoint why your heart isn’t functioning, as it should.

Visualizing the heart muscle

Cardiac magnetic resonance imaging (MRI) is a noninvasive test that uses radio waves, magnets and a computer to create still and moving pictures of your heart and major blood vessels.  Cardiac MRI goes beyond echo because it can identify tissue damage that indicates a heart attack. It’s also used to identify congenital defects and heart valve problems, failure, and tumors.

“Cardiac MRI helps us see heart muscle abnormalities related to the soft tissue – is the muscle alive, have the tissues become stiff,” Velazquez says. It can also show whether other diseases are present such as sarcoidosis, which can cause chronic inflammation, or amyloidosis, which can result in abnormal proteins. Both can seriously damage the heart muscle.

Cardiac CT: an emerging technology

Your cardiologist may recommend other non-invasive procedures to complete the picture of your heart condition. The cardiac CT is one of them. Dye is injected through an IV to highlight the coronary arteries, and then picked up by X-ray to show how your blood flows to your heart. It’s used to diagnose coronary artery disease such as narrowed or blocked arteries, and diseased heart areas that may indicate an aneurysm.

“CT is an emerging technology that can complement MRI,“ explains Velazquez. “It’s also used to understand the structure of the heart in a more detailed way than echo can provide.”

Cardiac CT may one day replace cardiac catheterization, an invasive medical procedure used to get a better look at the coronary arteries. Studies are also underway to determine whether cardiac CT should replace the stress test when people come to the emergency room complaining of chest pain.

Hybrid imaging technology: the next frontier

Duke is one of the few medical facilities that can combine the highly advanced positron emission tomography (PET), which evaluates the chemical functions of tissue and organs, with computed tomography (CT), which uses special X-rays to scan and illustrate the heart’s structure. At Duke, this hybrid imaging capability helps cardiologists understand the integrity of the heart muscle and how it responds to stress.

Velazquez describes the process: “When you combine PET with CT, you can clearly see the arteries and whether the heart muscle is at risk for injury because of poor blood flow.” Cardiac PET-CT may more accurately identify the extent of heart disease, and helps guide cardiologists in their treatment recommendations. 

Which test is right for you?

Determining which imaging test you need comes down to what is right for you and your heart condition. At Duke, expert heart imaging specialists help people and their doctors choose the most appropriate series of tests.

“We have access to everything at Duke, “Velazquez says, “but we don’t do the same test on everybody. We get a basic understanding of what we need from the tests that are easily available, then make cost-conscious decisions to obtain further information, if necessary, to provide the best possible care to our patients.”

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