Nuclear diagnostic tests are relatively new and facilities are available only in a few hospitals in the country.
Dr Mahapatra G N, Consultant in Nuclear Medicine and Thyroid Diseases, Fortis Raheja Hospital, Mumbai, elaborates about its advantages.
Why is nuclear cardiological diagnostic still relatively unknown to a large number of heart patients?
Typically, three categories of doctors refer patients to a nuclear diagnostic test - interventional cardiologists, non-interventional cardiologists and clinical cardiologists.
We get physicians also referring their patients to us sometimes, but not many people have heard of this test because cardiac surgeons don’t refer patients as the test would mean losing the patients.
What is the advantage of nuclear cardiological diagnostic tests?
Through diagnostic tests like the stress thallium myocardial perfusion scan, it is possible to find out the viability of a surgery on the patient.
This means, we can tell the patient how much of the heart muscles are dead and how much of can be operated upon to restore normal functioning of the organ. It also gives us the extent of blood flow through the blocked vessel.
The tests are still in very early stages in India and a handful of hospitals in New Delhi and Mumbai have it.
Most hospitals are yet to purchase and set up the equipment.
How will cardiac surgeons ‘lose’ patients to nuclear cardiologists?
Many patients who go to cardiologists complaining of chest pain, and are diagnosed with myocardial infarction, are immediately asked to undergo Coronary Artery Bypass Grafting or stenting whether or not it is absolutely necessary.
But, there is no proper viability study done on them. Stress ECG and MRIs are available, but they do not find the extent to which the surgery will be effective. So, if cardiac surgeons refer them to us, they lose a potential surgery candidate, which is why most don’t.
What will happen if surgeons go ahead and operate patients without checking the viability?
Patients have to easily part with `3.5 to 4 lakh to undergo a bypass surgery or any other intervention.
The surgery is performed even if the patient does not experience pain. But then, there is a relapse a few months after the surgery as the scar is found much later when they need treatment again.
Why is the stress thallium myocardial perfusion scan better than other tests?
ECHO tests cannot pick up a dead muscle that is not moving at all and MRI tests are too expensive.
Moreover, it cannot quantify how much of the muscle cannot actually be fixed. Nearly 70 per cent of the patients needing intervention should ideally undergo this test.
All post-myocardial infarction patients should undergo this test before considering further treatment.