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In the early 1070’s, when I was in medical school, cardiology had a problem in the evaluation of the heart.  On the one hand, a lof of information about heart function could be evaluated by cardiac catherization and coronary arteriography, but this involved involved puncturing an arterin the groin or arm and inserting slender tubes near and into the heart.  This procedure carried a small but increased risk of serious complication.  On the other hand, the evaluation of patients short of catherization involvedindirect evidence shuch as the electrocardiographic response to treadmill exercise, a procedure of limited accuracy.  We could never see the heart except by the shadows cast by x-rays.

Then in the late 1970’s, all this began to change.  Advances in ultrasound, allowed the anatomy and contractile function of the heart to be visualized in a spectacular fashion, but a measure of blood flow through the coronary arteries was still lacking.  This need was met by nuclear medicine applied to cardiology.

Nuclear cardiology, as it came to be called, consisted of the simple intravenous injection of a radioactive tracer that is taken up by the heart in approximate proportion to blood flow through the coronary arteries.  An image of the distribution of this radioactivity is obtained using special cameras that “see” radiation.  At first these images were recorded in shadowy fashion on photographic film, but later high speed computers allowed the acquisition of a three dimensional distribution in computer space which could be looked at from any angle and “sliced” like a loaf of bread, for more accuracy.  Today, a nuclear cardiology examination consist of a rest study followed by a second study during some kind of stress which cand be treadmil exercise or “checmical stress” uning drugs that simulate exercise-related stress.

Significant blockages in the coronary arteries, due to atherosclerosis, show up as decrease in blood flow to certain sections of the heart usually only with stress, but sometimes at rest if a prior hear attack has occurred.

Nuclear Cardiology has revolutionized the evaluation of heart disease along with other high tech imaging techniques such as coronary CT scans and stress ultrasound.  Today we can use these amazing methods to give us a window on the heart.


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