The new kid in town – Cardiovascular MRI

In today world of modern medicine it goes without saying that most practicing doctors with their busy daily clinics and long lines of procedures find it difficult to keep up with recent advances in almost all fields in medicine. This is more so apparent than in the field of cardiology where research work clearly leads the way at break neck speed and we are left staring at the Jurassic world if we don’t take constructive efforts to keep updated.

There can be no doubt that imaging is the way forward. As doctors now become spoilt for choice in a wide range of imaging methods that help in making diagnosis, prognosticating and treatment strategies best suited for individual patients.

The most recent foe of imaging modality to hit the stage in cardiology is Cardiac MRI as it comes with a whole host of possibilities that we could have only dreamt of previously. And apparently the best is yet to come. It’s important to stress here that all this comes without an ounce of radiation.

Hence what is CMR? Magnetic Resonance Imaging (MR) is a safe, non-invasive test that creates detailed pictures of your internal organs and tissues. It does not expose you to any form of ionizing radiation, as that in a chest x-ray or CT scan. Cardiac MR (CMR) creates pictures of the heart as it is beating, producing both still and moving pictures of the heart and major blood vessels. In this way, the structure and function of the heart can be evaluated.

CMR not surprisingly has been accepted very well here in IJN. It is used to diagnose and evaluate a number of cardiac conditions with astounding ease as it plots 3D images of the complex cardiovascular system at any plane and reconstructs these live images in dynamic motion with impressive accuracy among which the most common are:

• Ischemic heart disease Viability Study
• Heart failure
• Cardiomyopathy
• Valvular heart disease
• Congenital heart disease
• Cardiac masses
• Pericardial disease
• Myocarditis
• Thalassemia patients for assessment of the iron loading in the heart and liver.

CMR is the current gold standard for the recognition of :

1. Infarcted myocardium
2. The assessment of global and regional cardiac wall motion abnormalities.
3. Ischemic heart disease
4. Non-Ischemic dilated cardiomyopathy; and

Some of the major advantages of CMR are :

1. No radiation
2. Non invasive
3. Tissues characterization

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BEFORE
Patient will be requested to change into a hospital gown for the test.
A checklist must be completed before the start of the cardiac MRI. The checklist will ask whether the patient has had previous surgeries, has any metal objects in the body, or any medical devices (like a cardiac pacemaker) surgically implanted.
Most, but not all, implanted medical devices are allowed near the MRI machine.
No caffeine or beta blockers drugs to be consumed 24 hours prior to examination.
An IV line (maybe two) will be inserted into patient’s left and right arm for infusion of contrast and Adenosine or Dobutamine.
Consent must be valid and complete.
Patient’s financial status needs to be cleared before-hand.

DURING
Cardiac MRI usually takes 45 to 90 minutes, depending on how many pictures are
needed.
The MRI machine makes loud humming, tapping, and buzzing noises. Patient will
be provided with earphone to listen to music during the procedure.
Patient will need to remain very still during the test. Any movement may blur the
pictures.
Breathe holding for 10 to 15 seconds at a time will be instructed while the cardiac
angiographer takes pictures of the heart. This will be repeated several times.
Gadolinium may be injected into a vein through the IV line.

AFTER
Patient will be allowed to go home or return to the ward upon completion of the procedure and removal of the IV lines.

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