Written collaboratively by Jonathan Upton, adult congenital heart patient and Helena Francis, Adult Congenital Heart Clinical Nurse Specialist at University Hospital Southampton NHS Foundation Trust
Perhaps these words are familiar to you. Being told by your cardiologist that you need a cardiac MRI scan can evoke feelings of apprehension, even great fear for some. Recently I underwent a cardiac MRI scan, which is one of many I have had over the years. I remember my first MRI scan many years ago now and how anxious I felt about the procedure. I have noticed that people often post messages about this subject on the GUCH PA message board, so I got together with Helena Francis to write an article to help explain what is involved and hopefully put to rest any worries some of you may have. In the first part of the article, Helena answers some common questions people may have about the scan and what is involved. In the second part I write briefly about my own recent MRI scan from the patient’s perspective.
Jonathan: “What is a cardiac MRI scan?”
Helena: “Unlike an X-ray, a Magnetic Resonance Imaging (MRI) scan does not use radiation, instead the MRI machine uses magnetic and radio waves to build a picture of a patient’s heart and great blood vessels (e.g. aorta and pulmonary artery). The scan provides very clear pictures which help the cardiologists with diagnosis and planning of treatment.”
Jonathan: “Why am I having an MRI scan?”
Helena: “A cardiac MRI scan is used to view your heart’s structure and to assess how well it is pumping. This type of scan is particularly helpful for patients born with a heart condition. The scan can help doctors see the structural problems with the heart and check the heart valves and arteries such as the aorta. It is also helpful in providing information about the heart muscle and function.”
Jonathan: “I have a mechanical heart valve, is it safe to have an MRI scan?”
Helena: “Mechanical heart valves have been tested and found to be safe with an MRI scan. However if you have recently had a mechanical valve fitted, an MRI scan will not be performed for the first six weeks following your surgery. Today many patients requiring pacemakers have MRI compatible pacemakers inserted. However, patients who have an Implantable Cardiac Defibrillator (ICD) should not have an MRI performed. Compatible devices are currently in development for the future.”
Jonathan: “What happens during a cardiac MRI scan?”
Helena: “You will be asked to change into a gown and lie flat on a bed. A member of the radiology team will attach some ECG electrodes to you. A buzzer will be placed in your hand. A strap will be placed over your chest area which helps with the imaging. Finally some headphones will be placed over your ears. The bed is then moved slowly inside a tunnel-shaped scanner that is open at both ends. You will be asked through the headphones to lie as still as possible while the scan takes place.
During the scan the radiographer (the person operating the scanner) will ask you to hold your breath for a few seconds and then breathe normally. Usually the scan takes between 20-40mins, but may last up to an hour.
You can press the buzzer in your hand at any time if you need to speak to the radiographer. The scanner is quite noisy – you’ll be able to hear banging or knocking sounds. Some hospitals allow you to bring a favourite music CD which they can play through your headphones.
For some cardiac MRI scans the doctor (radiologist) will use a dye known as a contrast agent to enable images of the blood flow to and from your heart to show up more clearly on the scan. If your cardiologist has requested that you have the contrast dye in your scan you will be fitted with a cannula (small tube) into a vein in your arm before the scan starts so that during the scan the contrast dye can be injected.
The MRI scan is pain free. If you suffer from claustrophobia tell your doctor before the test.”
Jonathan: “I know some GUCHs do suffer from claustrophobia. What can they do?”
Helena: If a patient is concerned about this, they should talk to their consultant and ACHD CNS (Cardiac Nurse Specialist) about it, as steps can be taken to reduce stress.
Jonathan: “Will they give me the results of my scan on the day?”
Helena: “No. The Consultant Cardiac Radiologist will examine all the images and write a detailed report to your Consultant Cardiologist along with the images. Sometimes, particularly in cases where a interventional cardiac procedure or cardiac surgery is being considered, the images and report will be reviewed at the Adult Congenital Multidisciplinary Team Meeting (MDT). Once a decision has been reached on the best treatment for you, you will be notified.
We’re unable to cover every question a patient may have, however, you can always speak with your GUCH Cardiac Liaison Team at the hospital you attend if you have more concerns.
Jonathan’s Cardiac MRI Experiences
Two years ago at a routine check-up my consultant explained that the echo I had done earlier had shown a tiny area of my aorta that they were concerned about and they recommended I have a cardiac MRI scan with contrast dye which would provide more detailed images. During my detailed discussion with the consultant, I was prepared for the possibility that I may need an interventional procedure, even open-heart surgery. As I had had MRI scans before and knew what to expect, I was less worried about the procedure and more concerned about the results and whether I would need another big operation on my heart. I completely understand how worrying it can be for anyone, whether they’ve had an MRI scan before or not.
The day of my MRI came and, as was my experience before with the MRI team at Southampton, everyone was helpful, calm and explained things clearly. I was in the scanner for about 45 minutes. I did what I was asked when I heard the instructions through the headphones which had been placed over my ears. I kept my eyes closed and kept visualising happy times; like being on holiday in the sun when I was in Tenerife last May, and about some GUCH events I have been at with friends. Do you know, the time flew past really quickly and soon enough I heard through my headphones “that’s it, we’re finished, and we have some great images. Someone will be in to take you out of the scanner”.
For me, the hardest part was waiting for the results. The scan had to be analysed and reported, then reviewed by the cardiologist and presented at the MDT meeting. Although all hospitals are different, processes like these can take time. Several weeks later I received the letter and report telling me that things were unchanged from the year before which put my mind at rest. This time I’ve been informed I don’t need a re-scan for 2 years! Great news! I do hope my experience has helped reassure you. The thought of having the scan is worse than the reality!