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A combined cardiac surgery-cardiology service serves patients undergoing heart surgery. There is an active consultation service providing cardiology input to other services in the hospital.

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Each year, the ECG and Echocardiographic Laboratories perform and interpret more than 36, electrocardiograms, two dimensional and transesophageal echocardiograms, and other non-invasive procedures. The heart station administers multistage exercise testing including radionuclear exercise imaging , Holter monitoring, and M-mode, 2-D, and Doppler Echocardiography.

ECG Rounds

Cardiac nuclear imaging, multi-slice CT, cardiac MR and vascular noninvasive ultrasound studies are read jointly with the Department of Radiology. The Cardiac Catheterization Laboratory performs hemodynamic and angiographic studies. In addition, SPECT images only show relative blood flow, not absolute flow, from the intensities of the regional radioactivity. Therefore, it is possible to miss CAD if all three branches of the coronary arteries are occluded and reduce the flow to a similar extent.

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Therefore physicians should withdraw them slowly and monitor blood pressure to be certain that the patient can complete a stress test. Other anti-hypertensive medications may be continued to avoid excess hypertension at the time of the test. Anti-anginal agents may be continued with the referring physicians approval. If physicians want to establish the effectiveness of medication, they may continue the medication to evaluate the symptoms and ischemic territory and size with stress test MPI SPECT.

Patients should not consume any caffeine or chocolate 24 hours prior to the test and should not eat, drink, or smoke for 12 hours prior to the test.

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Therefore, diabetics, in consultation with their PCP or endocrinologist, should adjust their insulin and other anti-diabetic medication accordingly. Test Procedure The procedure begins with an intravenous injection of radionuclide contrast agent with the patient at rest. Twenty to thirty minutes later, when the radionuclide is distributed throughout the body, the patient is imaged with a gamma camera for a period of minutes to obtain baseline cardiac images.

If an exercise stress test is to be done, the patient will be taken to a treadmill and asked to exercise while their ECG is monitored.

ECG Rounds : Thomas S. Metkus :

After another 30 minute wait for the radionuclide to equilibrate, the patient is imaged for a second time to obtain stress myocardial images. At the basic and translational science level our faculty are interested in thrombosis, angiogenesis, exercise and many other relevant topics. Our faculty regularly present at national meetings and are considered opinion leaders in a number of areas including the management of myocardial infarction, cardiac arrhythmias, obesity and the heart and cardiomyopathies.

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Emory Cardiology Grand Rounds 05-07-2018

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