Cardiopulmonary Diagnostic Services

Introduction

The Cardiopulmonary Diagnostic Services at Aga Khan University Hospital is the largest diagnostic centre of its kind in the region. Since 1985, the Non-invasive Cardiopulmonary services has expanded and evolved into a very sophisticated laboratory, providing the latest diagnostic facilities in the evaluation of adult and paediatric patients with heart and lung diseases.

The laboratory’s core is the Echocardiography section and is staffed with eight full-time, highly competent technologists and six cardiac fellows on rotation. There are four sophisticated color Doppler echocardiography machines. Over 6,000 examinations are performed annually to evaluate the structure and function of the heart muscles and valves in detail, minimising the need for invasive testing. Eight different echo modalities are performed: (i) Adult Transthoracic (ii) Transoesophageal (iii) Dobutamine Stress (iv) Contrast (v) Foetal (vi) Paediatric (vii) Interventional and (viii) Intraoperative.

The major aim of the Cardiopulmonary Lab is accuracy of results with promptness of service.

Services

The Cardiopulmonary Diagnostic Laboratory is located on the ground floor of the Nazerali-Walji Building and consists of the following five sections:

I) Pulmonary Function Test (PFT)

The PFT laboratory offers services for:

1. Spirometry;
2. Bronchodilator Reversibility;
3. Lung Volumes and Transfer Factor (these tests provide a comprehensive assessment of diseases of the lungs and airways);
4. MIP/MEP (Maximal Inspiratory/Expiratory Pressures), to measure muscle strength;
5. Pulmonary Rehabilitation Programme.

In addition, facilities for Pulse Oximetry and the six-minute Walk Test are also available.

II) Diagnostic ECG

Services offered include:

1. Resting Electrocardiograms (ECG);
2. Stress/Exercise Tolerance Testing (ETT);
3. Ambulatory Blood Pressure Monitoring (ABP).

III) Arrhythmia Evaluation

Services offered include:

1. Ambulatory ECG (Holter) Monitoring
   
   A Holter monitor is a 24-hour portable electrocardiogram monitor for the detection of heart rhythm problems, ischemia or frequent unexplained episodes of palpitation or syncope.
   
   
2. Head-up Tilt Test (HUT)
   
   This is a tool for the work-up of syncope. Currently, we are the only institution offering this test in Karachi. For neurocardiogenic syncope (vasovagal), this remains the gold standard of diagnosis.
   
   
3. Pacemaker Follow-up Check
   
   We also offer a pacemaker clinic under the supervision of Board Certified Heart Rhythm Specialists. This is a unique service for patients with permanent pacemakers and ICDs in place. For such patients, regular check-ups are important to ensure a smooth and trouble free service. This service is also offered to patients who had pacemakers implanted at other hospitals.

IV) Echocardiography

Services offered are:

1. Adult Echocardiogram
   
   Echos are performed on state-of-the-art equipment by highly trained technologists and reported by experienced cardiologists. Echo provides structural and functional information of the heart; i.e. systolic and diastolic function of the ventricles, morphology and function of the valves, etc. Echo is therefore mandatory for patients with heart failure and suspected valvular and congenital heart disease.
   
   
2. Paediatric Echocardiogram
   
   Paediatric studies are performed by paediatric cardiologists.
   
   
3. Foetal Echocardiogram
   
   Echo is performed during pregnancy to assess any congenital abnormalities in the foetus in high-risk patients. Early diagnosis and treatment of these abnormalities may be life-saving. This test requires highly-skilled paediatric cardiologists, technologists and state-of-the-art equipment which are available in our laboratory.
   
   
4. Trans-oesophageal Echocardiogram (TEE)
   
   TEE provides excellent cardiac images and can be used to visualise left atrial appendage, inter-atrial septum thoracic aorta, metallic prosthetic valves, small vegetations and complications of endocarditis. These are indicated in patients with sub-optimal images of transthoracic echo, suspected ASD, endocarditis, dissection of aorta, assessment of cardiac source of embolus and metallic prosthesis, etc.
   
   
5. Stress Echocardiogram
   
   Stress echocardiogram is a valuable tool in the assessment of coronary artery disease and the viability of damaged heart muscles. Its results are equivalent to information obtained from thallium scan. If the patients can exercise, Treadmill Stress Echo (TSE) is performed which also provides information on functional capacity. If the patient cannot exercise or a myocardial viability assessment is required, then Dobutamine Stress Echo (DSE) is performed. Stress echo is a safe test in stable patients.

V) Nuclear Cardiology

Nuclear cardiology has established its unparalleled role in helping both diagnose and prognosticate patients with heart disease. Nuclear cardiology is a special type of X-ray procedure that uses very small amounts of radioactive material to diagnose heart disease. Nuclear cardiology procedure is safe, and the amount of radiation exposure is no greater than a common chest X-ray. It is highly effective in determining the degree of blood flow to your heart muscle and in detecting the presence of arterial blockages in the heart. In addition, this test also helps your doctor to decide the extent of your risk and the best way to treat you. Imaging is performed on a state-of-the-art dual-head gamma camera which is designed to meet the high-throughput and high-quality demands of the most progressive cardiology practices. A nuclear cardiology test usually consists of taking two sets of pictures of your heart; one following stress (via exercise or injection), and the other during a resting phase. You may receive one or two injections of radioactive material at different time intervals. The entire test takes about five to six hours.

We offer the following studies:

1. Exercise treadmill myocardial perfusion imaging using Thallium 201;
2. Exercise treadmill myocardial perfusion imaging using Tetrofosmin;
3. Dipyridamole (Persantin) myocardial perfusion imaging using Thallium 201;
4. Dipyridamole (Persantin) myocardial perfusion imaging using Tetrofosmin;
5. Dobutamine myocardial perfusion imaging using Thallium 201;
6. Dobutamine myocardial perfusion imaging using Tetrofosmin;
7. Resting myocardial perfusion imaging studies for chest pain evaluation;
8. Dual isotope studies;
9. Gated imaging studies to estimate left ventricular function. This unique service enables determination of blood flow to the heart as well as cardiac function in one test.

VI) Off-site Non-invasive Services

We have commenced Transthoracic Echocardiogram, Holter monitoring, Ambulatory BP monitoring and ECG services at Clifton Medical Services.

All specialised tests are conducted under direct supervision of highly trained cardiologists, pulmonologists, and a team of skilled technicians. Except for the ECG, all specialised tests require prior appointment.

Upcoming Services
Event recording and loop recording service will be started soon.

Educational Programmes/Undergraduate and Postgraduate Training
The Cardiopulmonary Diagnostic Services offers basic and advanced training programme for non-invasive cardiology technologists that varies from six months to 24 months. A six-month training programme is also offered in the area of pulmonary function tests. Candidates are selected on the basis of merit only. A trainee will be provided with stipend for the training period. The training timings are 8:30 AM – 5:15 PM daily.

Our working hours are 8:30 AM – 7:00 PM from Monday to Friday and
8:30 AM – 5:00 PM on Saturday, except on public holidays.

To make an appointment for a non-invasive cardiopulmonary test, please call +92 21 486 5780, 486 5794 or contact us through email at cardio.pulmonary@aku.edu.