Radionuclide Ventriculogram

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Assessment of global left ventricular (LV) systolic function and regional wall motion
  • Evaluation of LV function in known or suspected coronary artery disease (CAD) with or without prior myocardial infarction (MI)
  • To distinguish systolic from diastolic causes of congestive heart failure (CHF) in patients with known CHF
  • Evaluation of cardiac function in patients undergoing chemotherapy with cardiotoxic agents.
  • Assessment of ventricular function in patients with valvular heart disease
  • To assess cardiac risks for noncardiac surgery in patients with risk factors for CAD and poor functional capacity
  • To monitor response to surgery or other therapeutic cardiac interventions
CONTRAINDICATIONS
  • Inability to lie still or be positioned properly for scintigraphy
  • Arrhythmia, including premature ventricular contractions (PVCs), accounting for ≥ 10% of the patient’s heart beats (interferes with ability to obtain accurate data). Atrial fibrillation may cause significant underestimation of ejection fraction (EF).
  • Pregnancy or breastfeeding
EQUIPMENT
  • ECG gating device and scintigraphy imaging device
  • Equipment for obtaining IV access
    • 16- to 18-gauge IV catheter
    • 3-cc syringe with small (25- or 30-gauge) needle for infiltration of local anesthesia
    • Local anesthesia for subcutaneous infiltration
    • Alcohol or other sterile skin prep
    • Gloves (need not be sterile)
    • Tape, transparent sterile dressing, or other method for securing the IV catheter
    • Saline or heparin “lock” for IV catheter
    • Gauze or bandage for IV site after IV removal
  • 10 mL normal saline
  • Blood tracking form
  • Kit for preparation of technetium TC 99m–labeled red blood cells (RBCs)
  • Patient ID labels
  • Tc99m-Pertechnetate unit dose from commercial nuclear pharmacy
  • 100-Unit heparin
  • 3-cc syringe
  • 10-cc syringe
ANATOMY

Images of both the right and left ventricles can be obtained. Images are usually obtained in three views: anterior, left anterior oblique (LAO), and lateral for multi-image techniques. If a single-pass technique is used, imaging will occur too rapidly to allow for multiple views. The right anterior oblique (RAO) plane is the one most commonly used for single-pass imaging.


PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Answer patient’s questions.
  • No other specific care is needed after the procedure.
  • Provider creates report of study result.
COMPLICATIONS
  • Possible vasovagal reaction with IV initiation
  • Discomfort, bruising, possible bleeding at IV site
  • Although minimization of radiation exposure is always a priority, there is no evidence of significant risk from the level of exposure experienced during this type of study.
RESULT ANALYSIS

Qualitative review of the cinematic loop of the cardiac cycle allows assessment of:

  • Size of heart chambers and great vessels
  • Regional wall motion abnormalities
  • LV and RV global function
  • Extracardiac uptake of tracer (as in splenomegaly)

Quantitative data of tracer activity over time (the ventricular time-activity curve) allows quantitative analysis of ventricular function (eg, ejection fraction).

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