How nuclear medicine can help avoid unnecessary angioplasty

The crackdown on stent pricing may not be enough to whip into shape heart healthcare in India. Dr GN Mahapatra, Head of Department of Non Invasive Cardiology at Seven Hills Hospital, says change is needed at the diagnostic level to bring down instances of unnecessary angioplasties. According to him, nuclear medicine is one of the many ways.

What concerns do you have with current angioplasty practices?

Several patients who undergo angioplasty return with the symptoms. That’s because the patient did not need an angioplasty. After the first heart attack, certain heart muscles die and cannot be recovered. But cosmetic angioplasties are still carried out throughout India.

You believe nuclear medicine can help fill the gap. How?

Angiography can only detect blockages, and often gives false positives in female patients. Nuclear medicine, which has been around for two decades, can also show if the heart muscle is already dead and helps avoid unnecessary surgeries. The tests are also painless and non-invasive, and it costs about a third of an angiogram.

How do these tests work?

Nuclear medicine relies on radioactive isotopes to assess the blood flow in the heart. A technician inserts radioactive isotopes such as thallium intravenously. The isotope marks the blood flow and a gamma camera maps it.

The test includes readings in active and resting positions. Besides thallium, we now also use technetium, the lightest element of radioactive isotopes. It does not leave behind any radiation and is excreted from the body in six hours. In Europe and USA, most cardiologists compliment their practice with nuclear medicine.

If the tests are a better option, why isn’t it prescribed often?

Cardiologists must offer a conclusive test such as the thallium test before going ahead with surgery. Unfortunately, some cardiologists say creating more awareness about this would affect business.