The case
A 52-year-old female patient visited the hospital with chest pain and shortness of breath, after the second dose of COVID-19 vaccine. She had a past medical history of dyslipidemia, depression, and anorexia nervosa. Upon initial examination, ECG delineate SR and Poor R wave progression in anterior leads and ST&T inversion in inferolateral leads were seen. ECHO was showing good LVSF. Her temperature was 36.3C, pulse 102/beats/mins and BP was 102/61.
Based on her clinical presentation and cardiovascular risk factors, she was referred to Dr. Syed Sakib, Specialist Interventional Cardiologist at Fakeeh University Hospital, for coronary computed tomography angiography (CTCA) and further evaluation.
In cardiac imaging, arrhythmia (which is any disturbance of the normal rhythmic beating of the heart or myocardial contraction), is a hurdle to acquire best images. Advancement in CT technologies help Fakeeh University Hospital to overcome such clinical challenges. Advance CT scanner technical capabilities such as Dual Source Acquisition and Native Temporal resolution, help the hospital, like in this case, to overcome such high heart rate CT imaging challenges.
Course of intervention
Dr. Sakib and his team, Masood Ahmed-Radiology Manager and Dr. Latha PK-Specialist Radiologist, performed a study with cardiac ultra-fast imaging (Flash technology) to minimize the motion artifact and reduce the dose as low as possible. Study was performed with low kv flash calcium scoring and contrast timing was calculated with test bolus technique. Coronary CTA was performed with high pitch flash technique with 50ml of contrast and 40ml of saline at a flow rate of 5.5ml/sec.
Conclusion
Variability in heart rhythm (bradycardia, tachycardia, arrythmia etc.) in the coronary arteries, make diagnostic evaluation very unpredictable and mostly unreliable with conventional technologies. Advanced Dual source CT technologies with AI algorithms for heartrate variability, fastest rotation time, high native temporal resolution, high pitch low dose acquisition in conjunction with ECG-gating, to reconstruct images in the optimal phase of the cardiac cycle, are essential for sharp depiction of the coronary arteries with minimum blurring from the cardiac motion. This requirement is particularly critical in patients with high and variable heart rates. The technology improves the diagnostic quality for coronary artery diseases of such patients. In addition to making possible to diagnose these challenging clinical conditions, Dual Source technology helps to scan such patients with ultra-low dose.
With the right kind of advanced technology used for the patient, Dr. Sakib and his team were able to save the patient from a possible surgery.
Just like this case study, a smart hospital can provide many such advantageous outcomes for patients, and Fakeeh University Hospital is ensuring to retain its brand value as the first smart hospital of UAE, by adopting such timely interventions.
