16836 Cardiac Imaging

Overview

Cardiac imaging means tests that take pictures of your heart. Doctors use these pictures to see how your heart looks, how well it pumps, and whether blood is flowing to it properly. There are several types, including an echocardiogram (an ultrasound scan of the heart), a CT scan of the heart arteries, a cardiac MRI (a scan using magnets, not X-rays), a nuclear heart scan, and a coronary angiogram (a test where dye is used to show the heart's blood vessels). Each one shows something a little different, so your doctor will choose the test that best fits your symptoms.

Very common. Heart scans are done millions of times a year around the world. In the UK, the NHS carries out hundreds of thousands of echocardiograms and other heart scans every year, so the staff doing your test will have done it many times before.

Anyone can be offered cardiac imaging. It is most often used for adults with chest pain, breathlessness, palpitations (a feeling of a fast, fluttering or pounding heartbeat), swelling in the legs, high blood pressure, or a family history of heart disease. Children may have a scan if a heart murmur is heard, or if they were born with a heart problem. Older adults may be scanned to check how the heart is coping with age-related changes.

Symptoms

Common symptoms

• Chest pain, tightness or pressure, especially during activity
• Shortness of breath when walking, climbing stairs or lying flat
• Palpitations — a racing, fluttering or pounding heartbeat
• Feeling very tired or lacking energy for normal activities
• Swelling in the ankles, feet or legs
• Dizziness or feeling light-headed
• Fainting or nearly fainting

Symptoms in children

• A heart murmur heard by a doctor during a check-up
• Tiring quickly or getting out of breath during play or feeding
• Poor weight gain or slow growth in a baby
• Bluish lips or fingertips (this needs urgent medical review)
• Fainting during exercise or sport

Symptoms in older adults

• Breathlessness after only light activity
• Swollen ankles that get worse during the day
• Unusual tiredness or confusion
• Palpitations or an irregular pulse
• Fainting or falls that may be linked to a heart rhythm problem

Causes

Main causes

• Suspected coronary artery disease — narrowed or blocked blood vessels supplying the heart
• Heart failure — the heart not pumping as strongly as it should
• Heart valve problems, such as a narrowed or leaky valve
• Heart rhythm problems, such as atrial fibrillation (an irregular heartbeat)
• Heart problems present from birth (congenital heart disease)
• Damage to the heart after a heart attack
• Checking the heart before surgery, or monitoring it during treatment that can affect the heart (for example some cancer treatments)
• Inflammation or infection of the heart muscle or the sac around it

Risk factors

• Smoking or vaping
• High blood pressure
• Diabetes
• High cholesterol
• Being overweight
• Not being physically active
• A family history of heart disease at a young age
• Getting older
• Drinking too much alcohol
• Stress and poor sleep, which can add to heart strain over time

When to see a doctor

See a doctor urgently if:

• Chest pain at rest, or chest pain that keeps coming back
• Breathlessness that has become much worse over hours or days
• Palpitations with dizziness, chest pain or breathlessness
• Fainting, or a near-fainting spell
• Sudden swelling in both legs

Book a routine appointment if:

• Breathlessness or tiredness that limits what you can normally do
• A heart murmur found at a check-up
• Occasional palpitations without other symptoms
• A strong family history of heart disease or sudden cardiac death at a young age
• You want to talk about your heart risk, blood pressure or cholesterol

Diagnosis

The scan itself is part of how your doctor works out what is going on. First they will ask about your symptoms, your past health and your family, and check your blood pressure and pulse. A simple heart tracing (ECG) is usually done first. Then, depending on what they find, they will choose the heart scan that gives the clearest answer.

Tests that may be done

• ECG (electrocardiogram) — sticky patches on the chest record the heart's electrical rhythm in a few minutes
• Echocardiogram — an ultrasound scan that shows the heart's chambers, valves and pumping action
• Stress test — an ECG or echo done while you walk on a treadmill or after a medicine that makes the heart work harder
• CT coronary angiogram — a detailed CT scan that shows whether the heart arteries are narrowed
• Cardiac MRI — a magnetic scan that gives very detailed pictures of the heart muscle and structure
• Nuclear heart scan — a small safe tracer is used to show blood flow to the heart muscle
• Invasive coronary angiogram — a thin tube is passed to the heart and dye is used to photograph the arteries
• Holter or event monitor — a small portable recorder worn for a day or more to catch an irregular rhythm

What to expect at your appointment

Most scans are quick and painless. For an echo you lie on a couch with some gel on your chest and a small probe is moved around; it takes about 30 to 45 minutes. A CT scan takes only a few minutes but you must lie very still, and the dye can give a brief warm flush or a metallic taste. An MRI is noisy and can take 30 to 60 minutes; you will be asked about metal implants or pacemakers first. A nuclear scan involves a small injection and then waiting between pictures, so allow a few hours. An invasive angiogram is usually a day case: you may be given light sedation, a small tube goes into an artery in the wrist or groin, and you will need someone to take you home. Staff will tell you exactly how to prepare, including whether to eat, drink caffeine, or pause any of your usual medicines.

Treatment

A heart scan does not treat anything by itself — its job is to give you and your doctor a clear picture so the right plan can be made. Sometimes the answer is that your heart is fine and no treatment is needed. If something is found, treatment may involve lifestyle changes, medicines, a procedure, or simply monitoring with a repeat scan in the future.

Self-care at home

• Follow the preparation instructions you are given — some scans need you to avoid food or caffeine for a few hours beforehand
• Bring a list of all your medicines, including anything you buy over the counter, and tell staff about allergies, pregnancy, or kidney problems
• Mention any pacemaker, metal implant, cochlear implant or recent surgery before an MRI or CT scan
• Arrange for someone to travel home with you if you are having sedation
• Drink plenty of water afterwards if you had contrast dye, unless your doctor has told you to limit fluids
• Keep a simple diary of your symptoms while you wait for results — it helps your doctor understand your pattern

Medical treatments

If your scan shows a heart problem, treatment is tailored to what was found. It may include medicines to lower blood pressure or cholesterol, medicines to protect the heart and reduce strain on it, medicines to control the heart's rhythm, or medicines to prevent clotting when that is needed. Your doctor or pharmacist will explain what each medicine is for and why it has been chosen for you. Some people are also offered a structured cardiac rehabilitation programme, which combines supervised exercise, education and support — this is safe and helpful for many people with heart conditions.

When is surgery considered?

If imaging shows seriously narrowed heart arteries, a badly narrowed or leaky valve, or a problem with the heart's structure, your care team may discuss a procedure. Options can range from a stent (a tiny mesh tube that holds an artery open) to bypass surgery or valve repair or replacement. These are not needed for most people who have a heart scan. If a procedure is suggested, your team will explain the benefits, the risks and the alternatives so you can decide together.

Living with this condition

Waiting for scan results can feel unsettling, and it helps to keep your normal routine going as much as you can. Note down any new symptoms and keep taking your usual medicines unless your doctor tells you to change them. If you are given a diagnosis after your scan, your GP and specialist team will set out a clear plan, including what to watch for and when you will be reviewed.

Lifestyle tips

• Stay active within what feels comfortable — walking is a good place to start
• Stop smoking; your GP or pharmacist can offer free support and treatments to help
• Keep alcohol within the recommended limits
• Aim for regular sleep and find ways to manage stress, such as breathing exercises or time outdoors
• Go to your follow-up appointments and repeat scans when they are offered

Diet and exercise

A heart-friendly way of eating means plenty of vegetables, fruit, beans and whole grains, with fish, nuts and olive-style oils, and less salt, sugar and heavily processed food. Aim for about 150 minutes of moderate activity a week — something that makes you slightly warm and breathless but still able to talk. If you have chest pain, you have just had a procedure, or you are new to exercise, ask your care team what is safe for you before starting.

Mental health and emotional wellbeing

It is very normal to feel anxious before a heart scan or while waiting for results. Some people find their mind jumps to worst-case scenarios, or they have trouble sleeping. Talking to a friend, writing down your worries to bring to your appointment, or using slow breathing can help. If worry is lasting weeks, affecting your sleep or mood, or making you avoid things you used to do, please tell your GP — support such as talking therapy is available and can make a real difference. If you ever feel you cannot cope, contact your local crisis line or emergency services straight away.

Prevention

You cannot always prevent needing a heart scan, but you can lower your chance of heart disease — which is what most scans are looking for. Not smoking, keeping blood pressure and cholesterol in a healthy range, staying active, eating well and limiting alcohol all make a real difference, at any age.

Screening programmes

In the UK, the NHS Health Check is offered every five years to adults aged 40 to 74 and includes blood pressure and cholesterol checks. If you have diabetes, high blood pressure or a strong family history of heart disease, your GP may check your heart risk sooner or more often. Ask your GP or pharmacist what applies where you live.

Complications

If left untreated

• A heart problem that is not found or treated may get worse over time
• Narrowed heart arteries can lead to a heart attack if they are not managed
• Heart failure can make everyday activities harder and cause fluid build-up in the legs and lungs
• Some heart rhythm problems raise the risk of stroke if they are not treated
• The scans themselves carry small risks: a low dose of radiation from CT and nuclear scans, a rare allergic reaction to contrast dye, and bruising or bleeding where a tube is inserted during an angiogram

Long-term outlook

The outlook is generally good. Cardiac imaging is one of the best tools we have for catching heart problems early, when they are easiest to manage. Many people are reassured by a normal scan; others find a treatable problem and go on to live full, active lives with the right care and follow-up.

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