This is a free website for Nuclear Medicine Technologists and Students who wish to broaden their understanding of Nuclear Cardiology Practices and Principles.

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Syllabus
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1a: History
1b: Guidelines
1c: Epidemiology
1d: Structure
1e: Circulation
Lesson 1 REVIEW

2a: Anomalies
2b: Dextrocardia
2c: Coronary Arteries
2d: Indicators of Function
Lesson 2 REVIEW

3a: Electrophysiology
3b: Conduction
3c: Action Potential
3d: Autonomic System
Lesson 3 REVIEW

4a: Electrocardiography
4b: EKG Slideshow
4c: EKG Interpretation
4d: Myocardial Damage
Lesson 4 REVIEW

5a: Cardiovascular Disease
5b: Coronary Syndromes
5c: Atherosclerosis
5d: Myocardial Infarction
5e: Cardiac Stress Testing
5f: Cardiac Medications
5g: Revascularization
Lesson 5 REVIEW

6a: Diagnostic Imaging
6b: Radiopharmaceuticals
6c: Thallium Scintigraphy
6d: Tc99m MPI Agents
6e: PET Imaging
6f: Blood Pool Imaging
6g: Cardiac Function
Lesson 6 REVIEW

7a: Planar Cardiac Imaging
7b: Cardiac SPECT Imaging
7c: Cardiac SPECT Anatomy
7d: Interpretation
7e: Attenuation Correction

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Review of Section 6 : Self-test

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 1. What is myocardial ischemia?  Ischemia is defined as deficiency of blood supply.

 2. What is the rationale in evaluating for ischemia using an exercise stress test?  Exercise causes vasodilation in normal vessels, but diseased areas remain narrow. Stress flow is compared to rest flow.

 3. What is the treatment for arrhythmias?  An Electrophysiology study identifies abnormal conduction zones and ablates tissue with radio frequency, laser or cryotherapy.

 4. Explain what is meant by myocardial “stunning”  'Stunned' myocardium is viable but recovering from prolonged inadequate oxygen (blood flow). Contracile function may remain depressed for weeks.

 5. What happens with chronic or repeated stunning?  'Stunning' shifts chronically ischemic myocardium to anaerobic metabolism.

 6. What is remodeling?  Inelastic scar tissue replaces muscle tissue and performance declines.

 7. What does electrocardiography tell us about cardiac function?  Electrocardiography cannot tell us about cardiac function.

 8. What is the most important indicator of prognosis?  Left Ventricular Ejection Fraction.

 9. What is an “infarct-avid” isotope?  An isotope absorbed in or around necrotic cells.

10. How does Tc99m Pyrophosphate localize in infarcted tissue?  Tc99m-Pyp is absorbed into hydroxyapatite crystals surrounding dead cells.

11. What is thallous chloride’s mechanism of localization?  Thallous chloride enters cells with the Sodium-Potassium pump mechanism, being chemically similar to Potassium ions.

12. What type of photons are used for thallium imaging?  X rays from Mercury L-alpha and K-beta characteristic x-rays in the range of 69 to 83 keV. Decays by Electron Capture.

13. What are some of the factors that define an electrically "positive" stress test?  ST segment depression or elevation greater than 1 mm compared to a normal baseline, 2 mm or more increase in the ST-segment abnormality in patients with a baseline ST-segment depression.

14. What characteristics of thallium allows us to perform stress and rest imaging in the same day?  After rapid first pass extraction post stress injection, TL201 migrates out of the cellular space and redistributes.

15. Where does MIBG localize for adrenergic neuronal mapping?  MIBG is absorbed by intact sympathetic nerve endings.

16. What PET myocardial imaging agent is similar to Thallium-201?  Rubidium-82


  

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