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C.P.K.

One of the cardiac markers, protein substances (enzymes), the serum level of which increases after a heart attack, and therefore suitable as one of the parameters indicating Myocardial Infarction.

CPK is found in many tissues of the body, mainly in skeletal muscles, and therefore its increase does not necessarily mean cardiac damage. In fact, any muscular trauma, even the slightest (for instance after an intramuscular injection) can significantly increase CPK levels.

Therefore, in the examination of CPK when a heart attack is suspected, an iso-enzyme, called CPK-MB, is evaluated. Increasing levels of this iso-enzyme are much more specific for cardiac damage.

Cardiac CT (virtual catheterization)

An imaging examination of the Coronary arteries by means of CT scan.

The purpose of the examination, like in usual catheterization, is the localization of stenoses and occlusions in the Coronary arteries.

The big advantage compared to usual catheterization is the fact that it is not an invasive procedure.

Between its disadvantages: limited imaging potential and the fact that it is an exclusively diagnostic examination and does not allow a consecutive therapeutic intervention if such is necessary.

Coronary angiography (heart catheterization, cardiac catheterization)

Imaging technique of Coronary arteries by serial X-ray photographs following injection of contrast medium. This procedure enables identification of stenotic or occluded segments in the Coronary arteries as well as cardiac imaging for identification of anatomical defects and alterations.

The procedure is usually performed under local anesthesia by inserting a catheter into a Femoral blood vessel and its advancement up to the area to be demonstrated.

ECG, Electrocardiogram
Recording of the electrical activity of the heart. The heart is a pump activated by electrical power. These electrical potentials can be recorded by ECG. The standard ECG is recorded from 12 different points. These reference points are created by placing electrodes on the body surface surrounding the heart. The points are exactly defined and each electrode records the electrical progress from its point of view. The electrodes are commonly called leads. The standard ECG is a 12-lead ECG. ECG recording can detect various heart problems such as rhythm disturbances or signs of a heart attack. .
Echocardiography
A technique, which uses sound waves (ultrasound) for the imaging of the cardiac anatomy and information regarding wall thickness, size of the cardiac chambers and the function of valves. Sometimes echocardiography is combined with stress test. Echo stress test provides information about the state of the coronary arteries as well.
Ergometric stress testing
This test is designated for the identification or exclusion of Ischemic heart disease. In the course of the examination, the patient is submitted to physical exercise (ergometer bicycle or walking on a treadmill) in order to increase the pulse rate. As the pulse rate rises, ECG is recorded aiming at detecting ECG changes that may occur as evidence of cardiac distress caused by relative oxygen deficit.
Heart scan

A method for the assessment of cardiac anatomy and physiology as well as of its Coronary arteries. It is based on injecting a radioactive substance and examining its distribution in the various segments of the heart walls.

In the course of this test, radioactive substances are used (mainly thallium 201 or technetium 99). These substances are characterized by their ability to reach such areas in the myocardium that are supplied with blood and include viable muscle cells.

A computerized gamma camera rotates around the patient and registers heart images from different perspectives.

Scanning of the heart (also called Scintigraphy) can be performed at rest and in stress situations.

Holter monitoring

An examination for identifying and documenting heart rate disorders. The patient is connected to a portable device, which continuously records the electrical activity of the heart for a 24-hour period.

After the examination is completed the result is analyzed in order to identify and diagnose the rhythm disorder.

Among the advantages of this test the fact must be mentioned that the examination is made during 24 hours and does not depend on the feelings and reactions of the person tested, whereby rhythm disorders that are difficult to identify can be evaluated, including such that the patient is not aware of their existence or such occurring during sleep or appearing for a very short time and therefore difficult to distinguish.

Among the disadvantages is the fact that an episode that did not occur during the particular 24-hour period of measurement cannot be documented.

Lead

This term is associated with Electrocardiographic (ECG) recording.

The term "lead" relates to the point in space received in result of placing of electrodes in pre-defined points in the body around the heart.

The standard ECG includes 12 leads, i.e. 12 points in space that "look", each one from its perspective, at the electrical activity of the heart. Each lead records the activity that it "observes".

As a general rule, when a lead identifies electrical activity approaching it, a rising graph is recorded and when the activity is drawing away, a descending graph is drawn.

The knowledge of the location of the leads in space and of the pathways of the electrical activity flow in the heart helps to decipher the ECG and to identify pathology.

MUGA (Multiple Gated Acquisition Scan)

A method for the evaluation of cardiac anatomy and physiology by injecting a radioactive substance, Technetium 99.

One of the most important indices that can be obtained from this examination is the value called ejection fraction (EF).

Ejection fraction is the percent of what enters the left ventricle and what leaves it during each heart beat. In a healthy heart, ejection fraction is about 55% or more. This means that 55% of the blood content included in the left ventricle at the peak of its filling phase (end diastolic) is expelled from it at the peak of the contraction (end systolic).

The lower the EF values the more severe is the functional impairment of the heart.
The examination can be performed at rest or during effort in order to evaluate changes in cardiac output under stress conditions.

Myoglobin

A pigmented material contained in muscle cells, which serves as oxygen reservoir of the muscular fiber.

Increased level of Myoglobin in blood may indicate damage to the Myocardium (heart muscle), as encountered in a heart attack and thus be helpful in the diagnosis of myocardial infarction.

However, it must be stated that increased Myoglobin level in blood is an unspecific finding and can occur in various conditions, other than Myocardial Infarction, because any muscular damage can increase its blood level.

Stress test

see Ergometry

Thallium Heart Scan

A method for the assessment of blood flow in the Coronary arteries and diagnosing flow disturbances caused by stenosis (narrowing) of these arteries.

The examination is performed by injecting the radio-isotope Thallium 201 and following its absorption in various areas of the Myocardium.

Perfusion (blood flow) defects show as areas emitting less or no radioactive radiation and are visible as "cold spots" on computerized imaging making use of a gamma scanner.

Troponin

A protein substance, one of the cardiac markers or enzymes (as they were called earlier) assisting in the diagnosis of Myocardial Infarction.

As a general rule, enzymes are protein substances found normally in the Myocardium (heart muscle) cells.

When infarction occurs, i.e. when cells are destroyed, enzymes are released into the blood stream and their blood level increases. Therefore it is possible to use them as markers for the diagnosis of Myocardial Infarction.

Troponin levels begin to rise 6 hours after the start of infarction.

Its presence is a strong evidence of Myocardial Infarction and its blood level remains high for several weeks.

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