The following methods of heart imaging (scanning) are available at our clinics in Turkey:
- Stress test
- Echocardiography
- Transoesophageal echocardiography (through the oesophagus)
- Four-dimensional echocardiography
- Stress echocardiography
- Carotid Doppler ultrasonography
- Modern heart screening program "SHAPE"
- Early diagnosis of diseases with asymptomatic cardiac contractions
- Coronary computed tomographic angiography and measurement of calcium accumulation
- Magnetic resonance imaging of heart
Echocardiography
Echocardiography is the examination and analysis of the heart cavities and valves, the structure and function of the large arteries that exit the heart, by sound waves. Since the heart is a moving organ, the technologies used in its measurement are based on the principles of ultrasonography; they are technological devices of the latest generation. Images are obtained of different areas of the heart using a device that allows the transmission of sound waves, called a transducer. In this way, the structure and work of the heart can be examined from different angles. Because it is an ultrasound procedure, there is no risk to the patient; it does not emit radiation and it is painless. The procedure takes 15-30 minutes depending on the case.
Why is Echocardiography performed?
This method is most commonly used to examine symptoms such as heart murmurs, shortness of breath, chest pain, palpitations and faintness to assess the structure and function of the heart. Thus, it allows a detailed assessment and analysis of the size of the heart ventricles, the structure and functionality of the heart valves and the contraction of the heart. It plays an important role in assessing the performance of valve prostheses, as well as in reviewing the performance of the heart and the movement of the heart wall in patients who have a coronary artery bypass graft, balloon or stent placed in their coronary arteries. Echocardiography is used to examine the presence of clots in patients with heart disorders and for the diagnosis of congenital diseases and cardiac tumours. It is also used to determine the amount and significance of any fluid that has accumulated around the heart, for the study and examination of diseases of the great major that originate in the heart.
Transoesophageal echocardiography (TEE)
In cases in which transthoracic echocardiography through the chest wall proved inadequate, an anterior oesophageal echocardiography was performed for a more detailed and accurate examination. This procedure resembles gastro-endoscopy. For greater patient comfort and to perform the examination more efficiently, the patient is gently sedated. This way, the patient does not feel any discomfort during the procedure. If the thoracic wall images have revealed indications of a clot in the heart, a mass or an infection, a TEE will be requested for a closer examination. The technique is also used for detailed examination of valve prostheses, the diagnosis of congenital holes in the heart and other heart diseases, and if enlargement or puncture of the aorta is suspected. TEE is also the preferred method in cases of obesity, pulmonary disease, or diseases of the thoracic structure in which transthoracic echocardiographic imaging has proven inadequate. It is used in cardiac operations for valve repair and/or replacement and also to guide and increase the success rate of catheter-assisted valve replacement procedures.
Preparing for TEE
Ideally, the examination should be performed after a fasting period of 4-12 hours, without intake of any food or fluids. You should inform your doctor if you suffer from allergies, asthma, glaucoma, any type of difficulty swallowing, blocked nose, or any oesophageal discomfort.
How is TEE performed?
TEE is an endoscopic examination. A thin probe is inserted through the mouth to the oesophagus and then reaches an area near the back of the heart, providing very clear and detailed images. Prior to the procedure, a venous access is achieved to insert the necessary medication or dyed/coloured fluids (usually, aerated serum) and the doctor clearly explains to the patient how to swallow the probe, which is lubricated with a special gel for ease of swallowing. It is normal for the patient to feel a temporary sensation of nausea. The patient is hooked up to a monitor to measure their heart rate, respiratory rate and blood oxygen levels, and an anaesthetic spray is used to reduce sensitivity in the patient's mouth and palatal area. Additionally, a mild sedative is placed either intravenously or orally. Your doctor will inform you of the results of the test analysis at the conclusion of the procedure.
On average, the procedure takes about 15-20 minutes. Together with preparation time, the entire duration is usually about 30-60 minutes.
You should not eat or drink anything for up to 2 hours after the exam. The sedative that is used during the course of the procedure will make you feel drowsy and groggy for some time afterwards. You should therefore rest and avoid driving or using machinery. You may have a sore throat or feel numb for a day or two after the procedure. This is temporary and there is no need for treatment.
Four-dimensional echocardiography
Most echocardiographic devices in modern times are two-dimensional systems. Recent advances have led to the introduction of three- and four-dimensional systems. It is not easy to visualize the heart, an organ that is in constant motion, using basic ultrasonographic equipment. Three-dimensional imaging gives picture quality, colour, and tissue quality as if a surgeon had opened the heart and viewed it from different angles. The goal of this imaging method is to achieve better image quality, to help provide a better view, and to reveal specific structural diseases that are not picked up on two-dimensional echocardiography.
This method conveys much more detailed data and information than two-dimensional echocardiography, especially in the evaluation of cardiac tumours, clots, holes, and other structural diseases. It is important in the process of deciding whether natural but diseased valves should be reconstructed or whether replacement with valve prostheses is necessary; once again, three-dimensional imaging is superior to two-dimensional imaging and helps when deciding whether to surgically repair holes in the heart or close them with a catheter. Our centre offers real-time three-dimensional imaging and has the ability to use four-dimensional echocardiography during the procedure. Four-dimensional echocardiography equipment allows for safe imaging of the heart through the chest wall or through the oesophagus.
Stress echocardiography
Stress echocardiography is an echocardiographic method that is combined with exercise or medication to speed up heart activity. The physical exercise is performed on a treadmill or bicycle. The necessary cardiac images are taken after the patient has done the prescribed exercise from the relevant protocols and these images are compared with those taken with the patient at rest. In cases where exercise is not feasible (peripheral arterial disease of the legs, muscular or bone structural limitations), drugs such as dobutamine or adenosine are administered intravenously to accelerate cardiac activity and contractions and thus stress echocardiography is performed.
In which cases is it performed?
This is the preferred method for cases of permanent pacemakers, when a left femoral block is revealed on ECG, when the left ventricle is thickened, and in some specific cases of ECG findings (before arousal). Stress echocardiography is mostly used to determine the presence and severity of myocardial blood supply disease and the risks that exist in the follow-up of acute myocardial infarctions and interventional coronary-artery procedures; with the exception of cardiac surgery, stress echocardiography is used to assess risk before surgery.
Preparation for the procedure
Fasting is required for 4-6 hours before the stress test. During this 6-hour period, the patient should not smoke or consume caffeinated products (tea, coffee, chocolate, cola, etc.) or take any medications (some pain relievers contain caffeine). The patient may need to discontinue specific medications that impair the blood supply to the heart for a period of 24 hours prior to the test. This will be decided by the doctor who is conducting the test. Medications that the doctor has allowed can be taken with water 3-4 hours before the procedure. As with all tests that require fasting beforehand, diabetics should not take medications or food that regulate sugar until the doctor has given permission. Food may be taken, immediately after the stress test.
Carotid Doppler testing
Strokes share the same risk factors as myocardial infarctions and can lead to life-threatening conditions that lower a patient's quality of life by causing loss of speech ability and motor function. It is therefore important to assess the carotid and vertebral arterial system, which is responsible for the cerebral blood supply, while examining patients with cardiovascular disease.
Just as with echocardiography, carotid Doppler imaging is based on ultrasonography and is aided by ultrasound equipment. It is a simple imaging technique that is harmless to the patient. There is no risk of radiation exposure. Findings of vessels in the neck (increased vessel wall thickness or atheroma plaque, stenosis, etc.) may be indicative from the perspective of the cardiac arteries. In practice, it is inevitable that in a patient diagnosed with carotid artery hardening there will be no association with hardening of the coronary vessels that supply the heart, whose diameter is much smaller than that of the carotid artery.
Modern heart screening program "SHAPE"
Cardiovascular diseases are the deadliest ones worldwide, causing 13% of deaths. Therefore, screening and prevention of risk factors such as smoking, high cholesterol levels, hypertension and diabetes are of utmost importance. However, risk calculations made on the basis of individual factors can be misleading, especially in young men and women. Liv Hospital introduces SHAPE (a US-based Society for the Prevention and Elimination of Myocardial Infarction approved program), which is led by certified specialists, to obtain information and data about your potential risk of myocardial infarction and then provide preventive and protective treatment according to your individual condition.
What is the purpose of the modern heart screening program SHAPE?
The SHAPE screening program aims to uncover hidden arterial diseases and thus prevent - and ultimately eliminate - sudden deaths associated with myocardial infarction. The SHAPE system is a step ahead of conventional approaches to cardiovascular diseases because it adopts the principle of recognizing and treating atherosclerosis as part of the process of identifying risk factors and treatment. In this way, just as in the early diagnosis and treatment of cancer, hardening of the arteries is detected early and treated before any clinical signs appear and so the incidence of deaths caused by myocardial infarctions or strokes will be reduced.
What blood vessel imaging tests are used?
As an adjunct to standard tests to determine hardening of the arteries, vascular imaging provides significant information about the stage of hardening of the heart arteries, even when the patient is healthy or at low risk for heart disease. To this end, the SHAPE screening program is based on two methods that have been internationally proven in clinical studies to be reliable in screening for hardening of the arteries. The first is the non-invasive carotid Doppler ultrasound, which carries no risk to the patient and has no side effects. This study allows imaging of plaques that can lead to thickening of the walls, as well as any hardening of the arteries that is already present. The other method is computed tomographic examination of the calcification of the coronary arteries. Although this means exposure to a small amount of radiation, the use of modern equipment reduces this exposure to a minimum.
Facts you need to know about the beginning of myocardial infarction
Myocardial infarctions are a leading cause of death worldwide. The first indication for 50% of patients with cardiovascular disease is a myocardial infarction or sudden death. It is not enough to simply calculate the extent of risk factors for cardiovascular disease, such as hypertension, diabetes, obesity, or high cholesterol levels prior to myocardial infarction. Normal cholesterol levels are important for a healthy life. But that does not mean people with normal cholesterol levels won't suffer a myocardial infarction. Research shows that 77% of patients who suffer a myocardial infarction have normal cholesterol levels.
What is hardening of the arteries?
Atherosclerosis is the main cause of myocardial infarctions, strokes, and peripheral vascular disease. The cardiovascular system of our bodies has an arterial system that is responsible for supplying oxygen to our organs and tissues. Arteries also regulate blood flow, pressure and regional repair mechanisms that are activated by infection or injury. When the wall structure is thin and elastic, arteries do their job adequately. Genetic or external factors, however, can lead to inflammation that causes the thickening and hardening in arterial walls that we know as "hardening of the arteries."
Why should imaging tests (scans) be performed?
Myocardial infarction cannot be easily predicted. It can occur suddenly, without warning. It can catch the patient unaware and defenceless.
Who is at risk of myocardial infarction?
50-70% of myocardial infarction victims are unaware of the risks. For this reason, safe and reliable assessment of myocardial infarction risk is of the utmost importance.
Testing for early diagnosis of cardiovascular disease and atherosclerotic imaging is performed in our clinics by experienced specialists certified by SHAPE (Society for the Prevention and Elimination of Myocardial Infarction, based in the USA). Detailed clinical examination and imaging of your blood vessels provides more reliable information about your risk of myocardial infarction, allowing you to take individual preventive measures and treatment as needed.
Early diagnosis of diseases with asymptomatic cardiac contractions
Some non-cardiac diseases, medications, infections, or events, such as radiation therapy, can damage the heart and lead to contraction disorders even though the patient is perfectly healthy and has no symptoms. Most of these cases will not be detected by conventional two-dimensional echocardiography. High-tech equipment, advanced technology and software are required to diagnose diseases with asymptomatic cardiac contractions. Liv Hospital uses four-dimensional echocardiographic equipment with image enhancement capabilities to allow early diagnosis.
For whom is this important?
It is of priority importance for the assessment of patients who have had, or are planning chemotherapy for cancer. Unfortunately, most cancer medications damage cells in the heart as well as kill cancer cells. Accordingly, a detailed echocardiographic study performed by both oncologists and cardiologists is highly recommended before cancer treatment and repeated periodically thereafter. This is vitally important in terms of diagnosis and treatment at an early stage of any potentially permanent damage on the heart muscle, as well as the prevention of potentially permanent heart muscle damage and heart failure. Another advantage of these studies is that detailed cardiac monitoring makes it easier for the patient to take the required dose of cancer medicine regularly and without interruption. Radiation therapy is another technique that can damage the heart muscle.
In addition, certain rheumatic and neurological diseases, hypertension, diabetes, and various lung diseases can lead to defects in the contractions of the heart muscle.