An underwriter's guide to cardiac diagnostic testing

Question 1

What are the three factors to be evaluated by testing?

Answer 1

1. Ejection Fraction - how well the heart is functioning
2. How much the heart is damaged
3. Risk of sudden death

Question 2

How do you determine which test to us?

Answer 2

1. accuracy of the test
2. cost of the procedure
3. risks to the patient

Question 3

What is a sensitive test?

Answer 3

Will give positive result of condition early on.

Question 4

What is a specific test?

Answer 4

Only positive for one disease/condition.

Question 5

What are blood test we can use for cardiac diagnostic?

Answer 5

Lipids
NT-proBNP
Troponins
CPK
AST
LDH

Question 6

Which CPK is found mostly in the heart?

Answer 6

CPK-MB/CPK-2

Question 7

Which changes in an EKG are worriesome for someone with known cardiovascular risk?

Answer 7

ST-Segment or T wave

Question 8

EKG abnormalities are categorized into which five areas?

Answer 8

1. heart rate
2. heart rhythm
3. axis or position of the heart
4. cardiac hypertrophy
5. myocardial infarction and/or ischemia

Question 9

What are the echocardiogram report?

Answer 9

1. Results of the M-mode exam
2. 2-D study
3. Doppler flow

Question 10

When do you usually use a TEE?

Answer 10

Specialized evaluation of congenital cardiac abnormalities or when result of thoracic echocardiogram is suboptimal.

Question 11

TEE are better for which impairments?

Answer 11

1. atrial or ventricular septal defect
2. complex valvular heart disease and endocarditis
3. atrial enlargement with suspected atrial blood clots
4. intracardiac tumours

Question 12

What are the common criteria to stop a stress test?

Answer 12

1. maximum possible performance
2. emergence of sign and symptoms
3. achievement of predetermined end point

Question 13

In a stress test, an underwriter should consider?

Answer 13

1. type of exercise protocol use
2. stage and time exercise were concluded
3. max heart and BP rate
4. reason of termination
5. maximal ST-segment depression and slope of ST-segment depression
6. workload measurement
7. length of time ST changes persist into recovery phase
8. presence of arrhythmias

Question 14

What are the common abnormal response on a stress test?

Answer 14

1. reduced exercise capacity
2. changes in BP
3. changes in HR
4. unusual symptoms

Question 15

What ST-segment changes are likely related to CAD?

Answer 15

1. ST-segment depression at peak exercise is greater than 1-1.5mm
2. ST-segment change occurs early in the test
3. ST-segment change occurs in multiple rather than in single EKG leads
4. ST-depression persists longer than one minute into the recovery phase of the test.

Question 16

What are the five classification ventricular wall motion analyzed in echocardiographic stress testing?

Answer 16

1. normal.
2. Hyperkinetic
3. hypokinetic
4. akinetic
5. dyskinésic

Question 17

Hypokinesis suggests what?

Answer 17

Ischemia

Question 18

Akinesis or dysknesis implies?

Answer 18

Permanent myocardial damage

Question 19

What does PET very accurate for?

Answer 19

Identifying how much the heart has been damaged by infarction and how much is viable.

Question 20

What is the gold standard of cardiac testing?

Answer 20

Cardiac Catheterization

Question 21

What three parts cosists of cardiac catheterization?

Answer 21

1. Coronary arteriography
2. Intracardiac pressure measurements
3. Left ventriculogram

Question 22

Extent of CAD will be reported based on what in a cardiac catheterization?

Answer 22

1. number of coronary vessels involved
2. location of blockage
3. extent of obstruction