Internal Diseases · MU Sofia

Practical · 28. Non-Invasive and invasive cardiac diagnostic testing procedures

Explains the split between non-invasive and invasive cardiac diagnostic tests, then goes through ECG, transthoracic and transesophageal echocardiography, exercise and stress echo, Holter monitoring, cardiac CT and MRI, and the tilt table test. It then covers coronary angiography, electrophysiology study and endomyocardial biopsy. A comparison table sets risk, examples, patient preparation and diagnostic power side by side.

Inside: 5 sections · 4 labelled pictures · 1 table · 16 flashcards · 2 min

Topic 85 of 88 in the MU Sofia syllabus for Internal Diseases (Dental Medicine, Year 4). The free AceMed note covers it in 5 sections, about 278 words (2 min of reading), with 16 flashcards.

In this note

  1. 28 – Non-Invasive and Invasive Cardiac Diagnostic Testing Procedures
  2. I. Overview
  3. II. Non-Invasive Cardiac Tests
  4. III. Invasive Cardiac Tests
  5. IV. Comparison Table

I. Overview

Cardiac diagnostic testing can be classified into:

  • Non-Invasive Tests: No penetration of the body or vascular system
  • Invasive Tests: Involve catheters or contrast injection inside vessels or heart chambers

II. Non-Invasive Cardiac Tests

1. Electrocardiography (ECG)

  • Records electrical activity of the heart
  • Used to detect arrhythmias, myocardial ischemia/infarction, electrolyte abnormalities

2. Echocardiography (Echo)

  • Transthoracic Echo (TTE): 2D ultrasound of heart through chest wall
  • Transesophageal Echo (TEE): Probe passed into esophagus for clearer images

Assesses:

  • Chamber size, wall motion abnormalities, ejection fraction (EF)
  • Valvular disease, pericardial effusion, congenital defects

3. Exercise Stress Testing (Treadmill Test)

  • Patient walks/runs on treadmill while ECG is monitored
  • Detects effort-induced ischemia (ST depression, chest pain)
  • Indications: suspected coronary artery disease (CAD), risk stratification

4. Stress Echocardiography

  • Combines echo and exercise (or pharmacological stress like dobutamine)
  • Shows ischemia as wall motion abnormalities during stress

5. Holter Monitoring

  • 24–72 hour continuous ECG recording
  • For intermittent arrhythmias, palpitations, syncope

6. Cardiac CT (Calcium Scoring & CT Angiography)

  • Calcium scoring: Detects coronary artery calcification (CAD risk)
  • CT Angiography: Non-invasive coronary artery imaging

7. Cardiac MRI

  • Detailed imaging of cardiac structure, function, fibrosis (late gadolinium enhancement)
  • Used for myocarditis, cardiomyopathies, congenital heart disease

8. Tilt Table Test

  • For unexplained syncope
  • Assesses autonomic nervous system and orthostatic hypotension

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