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Nuclear Cardiology
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The feasibility of having rest cardiolyte (sestamibi) available
24 hours a day, 7 days a week for use in chest pain patients with
low probability of having ischemic heart disease. |
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The current status of using rest sestamibi in the risk stratification
of chest pain patients with low probability of having ischemic heart
disease was recently discussed in a panel session with Dr. Ethan Spiegler
at St. Agnes HealthCare, Baltimore, Maryland, James Tatum, MD Medical
College of Virginia (VCU) and Stephen Stowers, MD St. Luke's Hospital
in Jacksonville, Florida. (1) The benefit of having sestamibi available
24 hours a day, 7 days a week was encouraged and made easy with the
following comments from Dr. Spiegler. |
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"The patient is hopefully injected during the chest pain
symptoms. After a call to Nuclear Medicine, it usually takes
10 minutes for the dose to be given. Sestamibi is useful because
it basically works like a microsphere. It imbeds into the heart
muscle according to blood flow so that scanning does not have
to take place immediately. The scanning process with the new
kind of cameras and computer software available takes approximately
15 minutes so that the patient spends a short time in the scanner.
The images can be gated as they are acquired. The gated images
provide the ability to look at each tomographic slice of the
heart beating and allow information on not only the perfusion,
but also wall motion, wall thickening, and ejection fraction.
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With this single test a lot of patient evaluation information
is made available. In high volume institutions, an in-house
technologist is available 24 hours a day, 7 days a week such
as takes place at the Medical College of Virginia (VCU). In
our own institution (St. Agnes HealthCare) the technologist
is available until 10 pm. After that, the emergency physician
has been taught and licensed to give the dose. Since scanning
does not have to take place immediately, in most cases after
10 pm it can be done early the next morning. At any time the
data can be relayed from the computer at the hospital via a
modem to the physician at home for the data to be interpreted
rapidly. To make this program acceptable one must make sure
that there is a mechanism in place not to pay for doses of radio
pharmaceuticals that are not injected. Presently at St. Agnes
HealthCare, if the sestamibi dose is not used then there is
no charge for it. Similar arrangements can be made with local
radio pharmacies which makes good financial sense". |
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In summary the availability of sestamibi for early risk stratification
presenting in the emergency department is feasible 24 hours a day
for 7 days a week with minimal cost utilizing the strategy outlined
above. |
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Raymond D. Bahr, MD, FACP, FACC
Medical Director
The Paul Dudley White Coronary Care System
St. Agnes HealthCare
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References:
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(1)
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Spiegler EJ. Implementation of an acute myocardial perfusion imaging program for patients
with chest pain and nondiagnostic electrocardiogram: the St. Agnes experience. The
Strategy of Chest Pain Units (in Emergency Departments) in the War Against Heart Attacks.
Proceedings from the First Maryland Chest Pain Center Research Conference. Maryland
Medical J 1997 46:10 33-35. (Suppl.).
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(2)
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Spiegler EJ, Stowers S, Tatum J. Current status of sestamibi in the risk stratification
of chest pain patients: a panel discussion. The Strategy of Chest Pain Units (in
Emergency Departments) in the War Against Heart Attacks. Proceedings from the First
Maryland Chest Pain Center Research Conference. Maryland Medical J 1997 46:10 1-4.
(Suppl.).
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