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Cardiac PET Scan

 - Hyderabad

Cardiologist

Hyderabad   |   10 Aug 2023

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Cardiac PET Scan

What is a Cardiac PET scan?

A cardiac PET scan is a diagnostic imaging procedure that uses radioactive substances to visualize the blood flow to the heart and the functioning of the heart muscles. A cardiac PET scan stress test is more accurate in assessing blood flow (perfusion) defects and evaluating the functioning of the left ventricle.

Alternate names

  • Myocardial perfusion imaging
  • Cardiac stress test
  • Myocardial perfusion scanning
  • Cardiac positron emission tomography scan

Is this procedure an elective or an emergency procedure?

A cardiac PET scan is an elective procedure.

Indications of cardiac PET scan

Some of the common indications for a cardiac pet scan include:

  • Detection of suspected coronary artery disease
  • Evaluation of individuals with known coronary artery disease to assess the severity of the blood vessel involvement
  • Assessment of damage and heart muscle viability after a myocardial infarction
  • Assessment of damage and heart muscle viability in left ventricular dysfunction
  • Assessment of response to treatment in coronary artery disease and myocardial infarction

Myocardial perfusion imaging is recommended for the following conditions:

  • It is to use if any conditions are causing ECG abnormalities that could interfere with stress ECG testing, such as left ventricular hypertrophy, bundle branch blocks, or if on digoxin therapy
  • It is also recommended as a support procedure when cardiac stress testing is done with a pharmacological agent (drug-induced) instead of normal exercise or physical activity
  • It is also recommended for those who are at a higher risk for cardiovascular adverse events, such as individuals with diabetes mellitus

Contraindications and risk factors of cardiac PET scan

  • Some of the contraindications for a cardiac PET scan include:
    • Pregnant women or nursing mothers
    • A history of an allergic response to dyes is a risk factor
    • Severe claustrophobia
  • Contraindications for cardiac PET stress test include:ECG abnormalities at rest, such as left bundle branch block, pre-excitation syndromes, inability to exercise (better suited to pharmacologic testing)
    • Acute Myocardial Infarction (MI)
    • Sustained ventricular arrhythmias
    • High-grade heart block
    • Aortic stenosis is severe and causes significant blood flow obstruction
    • Severely raised blood pressure
    • Serious medical conditions such as pneumonia
    • Severe and uncontrolled diabetes with diabetic ketoacidosis
    • Severe congestive heart failure, which is symptomatic
    • Deep venous thrombosis
    • Pulmonary embolism
    • Pericarditis
    • Myocarditis
    • Endocarditis

Investigations before the procedure

A cardiac pet scan is usually done after an echocardiogram or a cardiac stress test, especially if the results from these tests are inconclusive or need further evaluation.

Pre-operative advice

Before performing a cardiac PET stress test, the following may be done

  • The risks and benefits of the procedure are explained
  • Avoid caffeine or caffeinated drinks 24 hours before the procedure
  • Avoid smoking on the day of the test
  • Nothing by mouth from 4 hours before the procedure
  • Medications with caffeine are to be stopped 24 hours before the test
  • Medications with theophylline are to be stopped 48-72 hours before the test
  • Medications that are being taken for indications related to cardiac disease should be stopped only as advised by the attending specialist

Intra-operative details

  • Duration: A cardiac PET stress test can last between 1-4 hours
  • Anesthesia: No anesthesia is required for a cardiac PET scan

Description of the procedure

Before the start of the procedure, an ECG is performed, an IV line is inserted, and a radiotracer is injected through it. The radiotracer may be thallium (TI-201) or technetium (Tc-99). After 20-45 minutes, the individual is moved to the PET scan machine room, allowing the radiotracer to be absorbed and circulate in the body. The individual then lies on a table that slides into the cardiac PET scan machine. The machine has a rotating gamma camera that captures images of the coronary arteries and heart muscle. A vasodilator may be administered to study the heart's response to the drug, and additional images are taken. ECG recordings are also taken during the procedure. Once the images are captured, and the testing is complete, the table is moved out of the PET scan machine, and the ECG leads and IV line are removed.

Cardiac PET scan stress test

As physical activity and exercise place additional stress on the heart muscle, increase the heart rate and blood pressure, and increase the requirement of blood flow to it, a stress test is a procedure that can induce ischemia (absence of blood flow) in the heart muscle if there is a presence of coronary artery disease. A cardiac PET scan stress test may be done by making the individual perform physical activity (such as cycling or walking on a treadmill) to increase the heart activity while monitoring the ECG and the blood pressure and then injecting the radiotracer to capture images of the blood flow and the heart muscle. The radiotracer is injected at the peak of exercise or shortly after a drug to simulate physical activity is injected. Images are taken immediately after the radiotracer injection and again after a gap of 3-4 hours (called delayed imaging). Areas of the heart muscle at risk of damage are filled with the radiotracer in the delayed imaging, while dead heart tissue does not take up any radiotracer (called a fixed defect). This helps to differentiate between the areas of the heart that are damaged beyond repair due to a previous myocardial infarction (heart attack) and those at risk of damage due to a future myocardial infarction.

Post-operative details

A cardiac PET scan is an outpatient procedure, individual can leave after the test is completed. Soreness at the IV line insertion site and in the back muscles may be noticed. The reports of a cardiac PET stress test are typically available for interpretation by attending specialists within a day or two after the procedure.

Complications of cardiac PET scan

There are no complications after a cardiac PET scan which is a very safe procedure.

Prognosis

Cardiac PET scans are safe procedures, and no complications are seen. They are useful in detecting the severity and extent of known or suspected coronary artery disease and the after-effects of a heart attack.

Indications for hospitalization if required

Hospitalization is not required for a cardiac PET scan.

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