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As innovative technology has progressed throughout the field of medicine, so too has the ability to visualize the heart and its vasculature noninvasively. Several cardiac imaging modalities have become essential in the practice of modern cardiovascular medicine not only in diagnosis but also in the management of various cardiovascular diseases as well as in the guidance of invasive procedures. These modalities include echocardiography, myocardial perfusion imaging via nuclear scintigraphy, magnetic resonance imaging (MRI), and computed tomography (CT). The gold standard imaging modality for the visualization of the coronary arteries remains the invasive technique of coronary angiography via coronary catheterization. This activity reviews the different methods to image the heart, their advantages and disadvantages. Objectives: Review the role of echocardiography in assessing the heart. Describe how MRI can assist with imaging of the heart. Summarize the role of cardiac catheterization in evaluating the heart. Outline the importance of improving care coordination among interprofessional team members to improve outcomes for patients undergoing imaging tests of the heart. Access free multiple choice questions on this topic.

As innovative technology has progressed throughout the field of medicine, so too has the ability to visualize the heart and its vasculature noninvasively. Several cardiac imaging modalities have become essential in the practice of modern cardiovascular medicine not only in diagnosis but also in the management of various cardiovascular diseases as well as in the guidance of invasive procedures. These modalities include echocardiography, myocardial perfusion imaging via nuclear scintigraphy, magnetic resonance imaging, and computed tomography. The gold standard imaging modality for the visualization of the coronary arteries remains the invasive technique of coronary angiography via coronary catheterization. Each modality can be used individually or in combination depending on desired diagnostic needs. These studies are now routinely used together with history taking, physical examination, and laboratory testing and have come to define the practice of modern cardiovascular medicine. Additionally, appropriateness guidelines for the use of these imaging techniques are now standard in the assessment of the ideal imaging modality to be used in specific patient situations to optimize diagnostic and cost efficiency as well as minimize risk to the patient.[1][2][3][4]

The technique and the need for sedation during transesophageal echocardiography expose the patient to a variety of risks. These may include damage to the esophagus such as perforation, aspiration, and complications related to anesthesia. These complications are very rare, especially at experienced centers. Cardiac CT leads to exposure to ionizing radiation, which is well-known to have harmful side effects. The risk for malignancy following exposure is difficult to determine and likely small, nonetheless remains a possibility. Risk versus benefit must be discussed when considering these imaging modalities, and consideration of cumulative exposure should also be ascertained especially with repeat imaging studies and in performing these tests in patients at a young age. The use of contrast agents has a substantial impact on the diagnostic value of radiologic imaging and is commonly used for cardiac CT, cardiac catheterization, and CMR. The most feared complication remains contrast-induced nephropathy. In those with normal renal function, it is a self-limiting side effect. However, in those with baseline renal abnormality, especially with those that are diabetic; progression to chronic kidney disease remains high. Cardiac magnetic resonance imaging uses a magnetic field to generate an image. As a result, the presence of metallic hardware remains a major risk during testing. In 2011, the first cardiovascular magnetic resonance (CMR) compatible pacemaker became available, however, at this time a permanent pacemaker remains a contraindication to CMR. The same goes for implantable defibrillators. Cardiac catheterization remains the most invasive modality and has the most potential for harmful side effects. These include as mentioned renal injury and possible renal failure from contrast exposure, myocardial infarction, stroke, induction of arrhythmias, and vascular complications such as bleeding. There are no absolute contraindications to cardiac catheterization. However, relative contraindications do exist. They include decompensated heart failure, bacteremia, acute stroke, and acute renal failure.

When patients present with symptoms of heart disease, the primary care provider, nurse practitioner, internist, and emergency department physician have available numerous imaging methods to assess heart function. In order to avoid redundancy or duplication, it is important to consult with the cardiologist to confirm the best imaging test. The type of cardiac imaging test depends on the urgency of the problem and the symptoms.[11][12][13]