Technetium Heart Scan
The technetium heart scan is a noninvasive nuclear scan that uses a radioactive isotope called technetium to evaluate blood flow after a heart attack.
The technetium heart scan is used to evaluate the heart after a heart attack. It can confirm that a patient had a heart attack when the symptoms and pain usually associated with a heart attack were not present; identify the size and location of the heart attack; and provide information useful in determining the patient's post-heart attack prognosis. The scan is most useful when the electrocardiogram and cardiac enzyme studies do not provide definitive results—after heart surgery, for example, or when chest pain occurred more than 48 hours before the patient was examined. It is also used to evaluate the heart before and after heart surgery.
Pregnant women and those who are breastfeeding should not be exposed to technetium.
The technetium heart scan is a nuclear heart scan, which means that it involves the use of a radioactive isotope that targets the heart, and a radionuclide detector that traces the absorption of the radioactive isotope. The isotope is injected into a vein and absorbed by healthy tissue at a known rate during a certain time period. The radionuclide detector, in this case a gamma scintillation camera, picks up the gamma rays emitted by the isotope.
The technetium heart scan uses technetium Tc-99m stannous pyrophosphate (usually called technetium), a mildly radioactive isotope that binds to calcium. After a heart attack, tiny calcium deposits appear on diseased heart valves and damaged heart tissue. These deposits appear within 12 hours of the heart attack. They are generally seen two to three days after the heart attack and are usually gone within one to two weeks. In some patients, they can be seen for several months.
After the technetium is injected into a blood vessel in the arm, it accumulates in heart tissue that has been damaged, leaving "hot spots" that can be detected by the scintillation camera. The technetium heart scan provides better image quality than commonly used radioactive agents such as thallium, because it has a shorter half-life and can thus be given in larger doses.
During the test, the patient lies motionless on the test table. Electrocardiogram electrodes are placed on the patient's body for continuous monitoring during the test. The test table is rotated so that different views of the heart can be scanned. The camera, which looks like an xray machine and is suspended above the table, moves back and forth over the patient. It displays a series of images of technetium's movement through the heart and records them on a computer for later analysis.
The test is usually performed at least 12 hours after a suspected heart attack, but it can also be done during triage of a patient who goes to a hospital emergency room with chest pain but does not appear to have had a heart attack. Recent clinical studies demonstrate that technetium heart scans are very accurate in detecting heart attacks while the patient is experiencing chest pain. They are far more accurate than electrocardiogram findings.
The technetium heart scan is usually performed in a hospital's nuclear medicine department but it can be done at the patient's bedside during a heart attack if the equipment is available. The scan is done two to three hours after the technetium is injected. Scans are usually done with the patient in several positions, with each scan taking 10 minutes. The entire test takes about 30 minutes to an hour. The scan is usually repeated over several weeks to determine if any further damage has been done to the heart. The test is also called technetium 99m pyrophosphate scintigraphy, hot-spot myocardial imaging, infarct avid imaging, or myocardial infarction scan.
The technetium heart scan is not dangerous. The technetium is completely gone from the body within a few days of the test. The scan itself exposes the patient to about the same amount of radiation as a chest x ray. The patient can resume normal activities immediately after the test.
Two to three hours before the scan, technetium is injected into a vein in the patient's forearm.
If the technetium heart scan is normal, no technetium will show up in the heart.
In an abnormal technetium heart scan, hot spots reveal damage to the heart. The larger the hot spots, the poorer the patient's prognosis.
DeBakey, Michael E., and Antonio M. Gotto Jr. "Noninvasive Diagnostic Procedures." In The New Living Heart. Holbrook, MA: Adams Media Corporation, 1997.
Iskandrian, A. S., and Mario S. Verani. "Instrumentation and Technical Considerations in Planar and SPECT Imaging." In Nuclear Cardiac Imaging: Principles and Applications. 2nd ed. Philadelphia: F. A. Davis, 1996.
Sandler, M. P., et.al. "Radiopharmaceuticals." In Diagnostic Nuclear Medicine. 3rd ed. Vol. 1. Baltimore: Williams & Wilkins, 1996.
Kim, Samuel C., et. al. "Role of Nuclear Cardiology in the Evaluation of Acute Coronary Syndromes." Annals of Emergency Medicine 30, no. 2 (Aug. 1997): 210-218.
American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. <http://www.americanheart.org>.
Texas Heart Institute. Heart Information Service. P.O. Box 20345, Houston, TX 77225-0345. <http://www.tmc.edu/thi>.
Lori De Milto
Electrocardiogram—A test in which electronic sensors called electrodes are placed on the body to record the heart's electrical activities.
Noninvasive—A procedure that does not penetrate the body.
Radioactive isotope—One of two or more atoms with the same number of protons but a different number of neutrons with a nuclear composition. In nuclear scanning, radioactive isotopes are used as a diagnostic agent.
Technetium—A radioactive isotope frequently used in radionuclide scanning of the heart and other organs. It is produced during nuclear fission reactions.