Cardiac Imaging
From the baseline images provided by echocardiograph to the CT-angiography, a cutting edge technology that provides surgeons with a three-dimensional picture of the arteries running along the surface of the heart, cardiac imaging makes non-invasive diagnosis of a range of heart problems possible.
With 20,000 echocardiograms performed at Montefiore each year, Montefiore-Einstein Heart Center is the largest echo lab in New York City. As a premiere urban cardiac imaging center, Montefiore uses only state-of-the-art digital equipment that results in clearer images that are more easily accessed by doctors working remotely.
Cardiac Imaging Procedures
Montefiore-Einstein's cardiac imaging center is built on a solid foundation of four standard imaging procedures:
Echocardiograph (echo)
The echocardiograph, or "echo," is a non-invasive test that provides cardiologists with a survey of the heart using the same kind of ultrasound technology used on pregnant women. The echo allows cardiologists to examine the size of a patient's heart and the condition of the patient's valves, to determine how efficiently the heart contracts. Echos are also used to find common congenital problems and explore possible causes for murmur, palpitations, chest pain, and shortness of breath.
An echo is performed by a technician, called a stenographer, who spreads a gel over the chest to make sure that the ultrasound camera maintains good contact with the skin. During the exam, the stenographer will take still pictures of the heart, recording video of the heart beating, and examine the direction of blood flow. Based on the results of this 20 to 30 minute test, cardiologists determine if more invasive tests are needed.
Stress echo
While the regular echo gives the cardiologist a picture of the heart at rest, the stress echo gives the cardiologist a picture of the heart after the patient has been exercising on a treadmill. By comparing a stress echo to an at-rest echo, the cardiologist may catch problems that only surface when the heart is under strain. Roughly 95 percent of stress echoes are done to look for evidence of blocked arteries in patients who are experiencing chest pain, shortness of breath or palpitations.
For patients who are unable to walk on the treadmill due to disability or lung problems, the stress echo can be done with dobutamine, a drug that that increases the heart rate without exercise.
Nuclear stress test
The nuclear stress test and the stress echo both test the condition of the heart when taxed. However, if a patient is unable to exercise and they can't take dobutamine because of an arrhythmia (irregular heartbeat), the nuclear stress test can use adenosine instead of dobutamine. In some cases, the nuclear stress test offers a clearer image. But the procedure takes much longer than a traditional test and the results aren't immediately available because they have to be processed by a technician before the cardiologist can view them. A cardiologist can look at a traditional stress test immediately upon completion.
Transesophageal echocardiography (TEE)
Where an echo is done from outside the body, the TEE is performed with a probe inserted into the esophagus. The picture available through the esophagus is much clearer than the picture available from outside the body because there is less skin, bone, and muscle to navigate. For example, although the aorta can not be seen on a traditional echo, a clear picture of the aorta is available with TEE.
Advanced imaging as an alternative to invasive testing
At Montefiore-Einstein Heart Center, medical professionals from every discipline function together as one heart center. For example, cardiologists in the imaging center meet regularly with radiologists to discuss improved techniques for imaging the heart. Because of such interdisciplinary cooperation, the imaging center has access to cutting edge technologies such as:
Multi-slice CT angiography
As the first test to give doctors a truly three-dimensional picture of how a patient's coronary arteries run along the surface of the heart, this test is the latest advance in the fight to map blockages in coronary arteries.
With a stress echo, a cardiologist is able to make an educated guess about the existence of a blocked artery based on how the heart responds to exercise; when there is suspicion of a block, cardiologists generally recommend that patients receive an angiogram, an invasive test that probes the coronary arteries. But with CT angiography, cardiologists receive a clear picture of the actual block. Eventually, this cutting-edge improvement may reduce the number of patients who need invasive testing such as angiogram.
Cardiac MRI
MRI is used to search for tearing and aneurysm (or bulging) of the aorta. MRI is also an effective tool for mapping the overall heart structure of patients with congenital heart problems. For patients who are potential candidates for coronary artery bypass surgery or angioplasty, MRI can also help cardiologists pinpoint areas of heart tissue that are still healthy to help determine if overall function will improve if these procedures to increase blood flow to the heart are performed.
Trust your heart to the center that knows cardiac imaging best. If you think cardiac imaging is right for you, contact Dr. Daniel Spevack at 718-920-4808 or via email at dspevack@montefiore.org to schedule an evaluation.
