7. Christoff - Diagnostic Tests Flashcards
What is the primary indication of stress testing pt selection?
Chest discomfort or dyspnea
What are 3 of the 6 secondary indications of stress testing pt selecting?
- Coronary disease screening
- Pre-operative evaluation
- Arrhythmia evaluation
- Heart valve evaluation
- Insurance exams in older clients
- Exercise capacity evaluations
Absolute contraindications to maximal exercise testing
- Known or suspected triple vessel disease
- Acute MI
- High risk unstable angina
- Unstable arrhythmia
- Heart failure
- Aortic stenosis or aortic dissection
- PE or pulmonary infarction
- Acute MI or pericarditis
Relative contraindications to maximal exercise testing
- Vascular disease
- Chronic respiratory disease
- Neurological abnormalities
- Medications (b-blockers, CCB, digoxin, nitrates)
- Poor motivation
- Poor physical condition
- Orthopedic problems
What should be monitored during a stress test
HR, BP, ECG, overall pt appearance
What are the 4 exercise protocols?
- Masters’ step test
- Modified Bruce or super Bruce
- Ariadne or recumbent bicycle
- Bruce treadmill - every 3 minutes increase speed and incline
What are the 4 pharm stress protocol?
- Adenosine (bronchoconstrictor)
- Regadenoson - interferes w/ caffeine
- IV dipyridamole - coronary vasodilators
- Dobutamine/atropine - increase HR
When should you stop the stress test?
Goal HR is reached, chest pain, dyspnea, fatigue, rhythm disturbances, BP drops, pt hits panic button, etc.
What are some characteristics of myocardial perfusion imaging?
- Increases sensitivity and specifics of detecting disease
- Women tend to have false negative regular stress test
- Used to differentiate purfused and non-purfused tissues
- Considered a non-invasive technique
- Complete in 2 phases, rest and stress
What are the two radio pharmaceuticals used in diagnostic testings?
- Thallus Chloride
2. Technetium 99 - sestamibi and tetrofosmin
How do you calculate a target heart rate when performing a myocardial perfusion protocol?
Target heart rate = 0.85 X (220-age in years)
In a thallus chloride test, what do cold spots indicate?
Cold spots indicate areas of infarct or ischemia
What are some advantages of Tc-99m radiopharmaceuticals?
- Higher quality images compared to TI-201
- shorter half life, meaning a larger dose can be given w/ lower radiation exposure
- inexpensive to produce and is readily available via Mo-99/Tc-99 generators
What are some advantages of Ultrasound Cardiac Imaging?
- Devoid of ionizing radiation
- non-invasive option
- safe
- inexpensive
- portable
What are some limitations of Echocardiography?
- COPD/mechanical ventilation
- patient unable to be rolled onto left side
- patient size
