Cardiac Care through Nuclear Test Heart

Cardiac Care through Nuclear Test Heart Khyati Hospital episode in Gujarat drew our attention towards the misuse of govt scheme for financial gain in the name of medicare. When Govt Scheme or Mediclaim is there in support, hospital, a commercial entity tends to slip easily from a bill of ₹7000 for angiography to a bill of ₹70000 for angioplasty. Bypass surgery or angioplasty of a asymptomatic persons is a matter of research and debate in the medical world. Our life line is fixed at birth is a faith sentence followed by millions in this religious country. But allopathy has proved it wrong and many people have survived longer with the help of surgical and medical interventions. But what about use of the services of the doctor already placed in our body by the Almighty? If the blood supply to the heart is blocked by arteriosclerosis, the nature develops collaterals. There are individuals who survive and live quality life even if the LAD and RCA are blocked. My eldest brother had 95% blockage of LAD, and major blockage of the RCA, was advised for bypass surgery in 2019. He was about to leave for OT but we saw him and my sister in law in depression and mentally unprepared, took discharge from the hospital and manage him with medicines and lifestyle changes for last six years. Touchwood, he is going well at 82. There are individuals live healthy life even the LVEF has come down to 20%. Important part of the cure is to change the food and life style according to one’s need. This week, I met Dr. Gopal Maheshwari (67) who was HoD in GCRI, took VRS when came to know that his LVEF had come down to 21%. He was asymptomatic but obese with a body weight of 93 kg. He put his efforts on food restrictions and became punctual in medicine, pulled down his weight to 70 kg and living a healthy life without any intervention of angioplasty or bypass surgery. He could climb the stairs as good as a healthy person and was looking very energetic and active while interacting with me. Is angioplasty or open heart surgery is the only option for curing heart blockages? If there are blockages identified through the angiography, is it mendatory to intervene through angioplasty or bypass surgery for as asymptomatic person is a big question mark. Each individual may have different answer depending upon his/her understanding. But nuclear stress test is a wonderful option to review the blood flow to the heart first and thereafter evaluate the option to go for other intervention or not. Listen to the patient first before looking at his blockages. If he is fine, living a normal life without any intervention with the help of the collaterals developed by the nature why to put him in the stress of bypass surgery or making him a slave of blood thinner by putting a stent in his heart arteries? What is nuclear stress test? It is popularly known as thallium stress test, conducted to assess heart blood flow during rest and stress. Thallium201 is very expensive and is not available in India, therefore, small amount of radioactive tracer Technetium99 is injected intravenous for conduction of the test. It acts as a tracer, into the bloodstream. Special Gamma cameras then capture images of the heart as the radioactive isotopes travels through it, revealing areas with reduced blood flow. The test is typically done in two phases: one at rest and one while the heart is stressed, either through exercise or medication. The procedure of the test takes 4-5 hours. One has to consume good quantity of butter to clear the liver after the injection of isotopes so that the image of right heart blood flow is captured correctly. Once the images are taken in rest condition, thereafter stress is generated either through treadmill or meditations often called pharmacological stress agent to mimic the effects of exercise. One has to undergo Gamma camera images once again. If all the basal-antero-lateral regions of the heart are getting enough blood supply in rest as well as in stress condition without major changes in the ECG, there may be no need of any surgical or other major interventions. One can manage the life with life style changes and medicines. For those, who are in emergency of ischemia, myocardial infraction, heart attack/arrest, golden hour treatment of thrombotic drugs (alteplase/activase etc) and subsequent intervention of angioplasty of surgery (minimally invasive, open heart) may be necessary to save life. But for the asymptomatic individuals or persons with minor complaint, better to go first through the nuclear stress test and thereafter do angiography and opt for angioplasty and bypass surgery if there is issue of blood flow management during rest and stress conditions. One may follow the cardiologist/surgeon advice after the test. Nuclear Stress Test is a good benchmark test can be used in comparing heart health in future and opt for suitable intervention to manage the life of the heart. Medical science is changing very fast. Who knows man may discover a chemical that can remove the arteriosclerosis of the arteries and veins without surgical interventions. Heart transplant has also opened a door to extend lifeline. There is preparation stage 24 hours before the nuclear stress test by avoiding tea, coffee, coco etc., which may intervene in the process of the test. Except water nothing is allowed in the morning hours on the day of the test. One may drink water, enjoy lassi and meal rich in fat after the isotopes are injected. After the test is concluded one has to drink plenty of water and urinate frequently so that the radioactive substance is washed out faster. Body removes it in about 12-18 hours. The test dose is mild but better to keep oneself away (3 feet) from other individuals and avoid meeting children for a day. Punamchand 20 April 2025 Disclaimer: the writer is not a medical professional therefore his opinion is personal based on his personal experience and interactions with the doctors working in the field of cardiology.