Cardiac CT Scan

Heart disease is the world’s biggest cause of death and a heart attack is often the first symptom of heart disease. This form of heart disease is due to a blockage/s of the coronary arteries. Invasive coronary angiogram is the standard test to assess the coronary artery blockages and this requires a catheter to be inserted into the heart.

A cardiac CT scan is a non-invasive alternative test to look at the coronary arteries. The process which is similar to an x-ray procedure examines the coronary arteries for blockages and abnormalities that cause reduced blood flow and can result in chest pains (angina) or heart attacks. It can also be used to evaluate the presence and extent of calcium in the coronary arteries and the ‘calcium score’ obtained can be used to predict the likelihood of coronary artery disease.

CT scanning is like looking into your heart by cutting it into thin slices; hence the frequent reference to the cardiac scanner as a “multi-slice CT”. A Cardiac CT scan uses special x-ray equipment to produce detailed cross-sectional pictures of the heart and is used to visualise the blood vessels to the heart. The information is then used to optimise patient care, helping to determine what treatments or further evaluations are needed and to tailor long-term health goals as appropriate.

WHAT TO EXPECT?

BEFORE

• Your physician will schedule the examination and you will be given appropriate instructions as to how can prepare for the examination.
• A nurse will assist you during the day of the examination.
• An intravenous (IV) line will be inserted in your arm to facilitate the injection of contrast (X-ray dye) in order to visualize the coronary arteries. 

DURING

• You will be positioned inside the scanner. Breathe and hold instructions will be given.
• During the scan, you will feel the table move onto the scanner. A cardiac angiographer, who is specially trained in the use and operation of CT scanners, will perform the scan.
• The scan is done within a single breath hold but preparation for the examination may take up to thirty minutes.

AFTER

• You can go home once the procedure is done and the IV line has been removed.
• Our specialized team of cardiologists will analyze the images after the images are reconstructed using a sophisticated computer program. The results will then be sent to your referring physician who will discuss the findings with you.

Any appointment for Cardiac CT procedure, kindly call Radiology Counter (Block B) at +603 – 2617 8362.

Nuclear Cardiology Scan

Nuclear Cardiology is one of the important specialties in non-invasive imaging in cardiology practice. Its contribution to patient care and management is substantial and continuously improving over time.

We started our Nuclear Cardiology service in 1992 and since 2001 we have been performing more than 1500 procedures annually. We cater for our own institution as well as those requests from other hospitals in Malaysia. Essentially, this non-invasive imaging is using a radioisotope with short half-life (Technetium99m) which is introduced intravenously for the stress and rest scans.

Multiple pictures or images – Single Photon Emission Computerized Tomography (SPECT) are taken at different angles over a period of time. The software will enable us to compile, process and produce cine images that will be read by our Cardiologist or Visiting Radiologist.

Nuclear Cardiology is currently one of the gold standards to safely evaluate patients with suspected coronary artery disease. It is a functional assessment to check adequacy of coronary blood flow. This study has a 90% Sensitivity and 85% Specificity in identifying underlying coronary artery disease.

In June 2007 Institut Jantung Negara has upgraded and installed a new Dual Detector Gamma Camera, GE VENTRI SW VERSION: 1.004.040.0 which is a dedicated cardiac system with upgraded software’s that will enable us to acquire images faster and provide additional data that will further assist in this non-invasive cardiac assessment.

Institut Jantung Negara is proud to acquire this system in the Asia region thus demonstrating our seriousness in striving to live up to the expectation of being a centre of excellence in the diagnosis and treatment of cardiovascular diseases and commitment to offer the very best in cardiac imaging to our patients.

WHAT TO EXPECT?

BEFORE

• Your physician will schedule the examination and you will be given appropriate instructions as how to prepare for the examination.
• You must not have had any caffeine or carbonated drinks (coffee, tea, chocolate or coke) 24 hours before the day of the procedure.
• Any Beta blockers drugs, CCB and nitrates must be stopped 24 hours before procedure.

DURING

• An intravenous (IV) line will be inserted in your arm to facilitate the injection of isotope in order to visualize the perfusion of cardiac muscle.
• You will be positioned under the camera. During the scan you will feel the camera move around you.
• A cardiac angiographer, who is specially trained in the use and operation of Nuclear Camera, will perform the scan.
• The scan is approximately 10 minutes per session but the entire procedure may take about 6-8 hours. This will be due to Stress scan portion and Rest scan portion.

AFTER

• You can go home once the procedure is done and the IV line has been removed.
• Our specialized team of cardiologists will analyze the images after the images are reconstructed using a sophisticated computer program.
• There will be residue of isotope for approximately 2 days after the procedure. Thus, it is advisable for you to not be near pregnant women or young children after the procedure. If you are breast feeding, do not do so after the procedure.
• Please allow yourself a whole day for the procedure, though the examination can be completed earlier

Any appointment for Nuclear Cardiology procedure, kindly call Radiology Counter (Block B) at 03-2600 8318/8362.

Cardiac MRI Scan

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

WHAT TO EXPECT?

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.

Any appointment for Cardiac MRI procedure, kindly call Imaging Counter (Block A) at 03-2600 6469.

GENERAL X-RAY

General X-ray is a painless medical test that helps physicians in the diagnosis and treatment of medical conditions. In IJN, the most commonly performed diagnostic X-ray examinations are Chest X-rays. A chest X-ray shows images of the heart, lungs, airway, blood vessels and the bones of the spine and chest.

GENERAL ULTRASOUND

Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to high-frequency sound waves to produce images of organs within the body. As the name suggests, ultrasound scanning uses the principle of Sound Waves to produce images of the organs, thus no ionizing radiation (as is used in X-rays) is involved. Ultrasound images are captured in real-time, and they can show the structures and movement of the body’s internal organs, as well as blood flowing through blood vessels. Ultrasound imaging is a non-invasive medical test that helps physicians in the diagnosis and treatment of medical conditions.

Advancement in ultrasound technology has enabled a three-dimensional (3-D) ultrasound that formats the sound wave data into 3-D images as what is available in IJN. A Doppler ultrasound study may be part of an ultrasound examination to evaluate blood as it flows through a blood vessel, including the body’s major arteries and veins in the abdomen, arms, legs and neck.