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Anatomical Sciences > Assessing Cardiac Function > Flashcards

Assessing Cardiac Function Flashcards

1
Q

why is maintaining cardiac function important?

A
  • circulation
  • blood pressure
  • perfusion of vital organs and adaptability to change to emotions/stress
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2
Q

The hearts function as a pump

A
  • regulates HR and rhythm
  • Chambers and valves/structures
  • contraction (regularity and strength)
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3
Q

what does MET stand for

A

Metabolic equivalent of Task

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4
Q

what is MET measure of

A

a physiological measure expressing the energy cost of physical activity

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5
Q

1MET =

A

1Kcal/kg/h

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6
Q

The reference metabolic rate is set by convention to

A

3.5 ml O2·kg−1·min−1

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7
Q

what is the average expenditure of energy at rest?

A

3.5 ml O2·kg−1·min−1

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8
Q

1MET

A

resting

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9
Q

2MET

A

Eat, move and go to the toilet

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10
Q

4MET

A

light house work

still a dangerous group dot be in if its the max

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11
Q

10MET

A

safe level, good functional level - can do light sport

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12
Q

stress testing includes

A

treadmill and bicycle egonometer

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13
Q

stress testing is putting the body under

A

physiological stress - moving/excersising

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14
Q

how would you test for ischaemia

A
  • exercise using the treadmill stress test
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15
Q

what would you test before heart surgery to work out how healthy/fit a person is?

A

ECG leads, cardiopulmonary testing, testing gases/saturationin the blood, total energy used during the activity
- try and get the patient to 5MET

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16
Q

what is the excersise treadmill test looking for

A

looking for any abnormalities, CHD with the ECG

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17
Q

where do you put the ECG leads?

A

over the main coronary arteries

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18
Q

what would you see on the ECG when the patient is starting to struggle and want to stop exercising?

A

the STZ wave drops down

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19
Q

what are you looking for on the ECG of the

A
  • looking for changes at the peak of exercise
  • T wave inversion
    (V2 and V3 leaders have inversion of the T wave)
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20
Q

T wave inversion is typical of

A

impairment of the blood vessels in the heart

21
Q

what would some of us with the healthy people in the low risk group have with the treadmill test

A

false positive tests - this test should be carried out on people who have chest pains etc - more of a discriminator then

22
Q

what test would have low false positives?

A

coronary angiogram

23
Q

If patient is UNLIKELY to have disease to start with, an abnormal test has greater chance of being a

A

false positive

  • influences pre-test probability of CAD on post test probability of CAD
24
Q

what other factor influence pre-test probability of CAD

A

age sex and symptoms

25
Q

Any tests are most likely to be most useful in those whose age, sex and symptoms put them in a

A

higher risk group

26
Q

what 2 ways can you test for Ischaeima by stress testing?

A

physiological and pharmacological

27
Q

what is dobutamine?

A

a beta antagonist

which raises BP and HR, increases cardiac contractility and demand of heart muscle for blood supply

28
Q

how is dobutamine used during stress testing?

A

Induces ischaemia, where flow is inadequate to meet needs

29
Q

what are adenosine and dipyridamole?

A

vasodilators

30
Q

how do adenosine and dipyridamole work as to show ischaemia?

A

Relative ischaemia where vasodilatation not possible because of fixed stenoses >75% lumen area

31
Q

what does dobutamine mimic?

A

excersise stress test

32
Q

What is the myocardial perfusion scan useful in?

A
  • patients with intermediate probability of CHD

- Particularly useful if mobility limits treadmill testing or if resting ECG is abnormal

33
Q

how is myocardial perfusion scan carried out

A

Thallium is taken up by myocardium in proportion to blood flow. Not by scar tissue.

Detected by a gamma camera.
Images taken under “stress” or at rest.
“Stress”: pharmacological

34
Q

what are you looking for myocardial perfusion scan images?

A
  • impaired bloood supply (ischaemia)
  • change in the colouring on the images - gaps
  • stress when blue - coronary arteries not supplying enough blood
35
Q

what is the first sign that a piece of heart muscle is becoming ischemic?

A

stops contracting well

36
Q

what changes do you see in a piece of heart muscle that is becoming ischaemic?

A
  • stops contracting well
  • change in systolic function
  • changes in ECG
  • symptoms
37
Q

thallium is taken up into the heart muscle in proportion to

A

the blood flow

radioisotope that is visualised by a gamma gun

38
Q

with the myocardial perfusion scan which is the donut scan?

A

cutting a horizontal cross section through the heart

39
Q

Myocardium perfusion scan with problem in circumflex artery

A

big branch across the lateral wall - can see that under stress you – dark blue part of the lateral part - not got a good blood supply – area of ischemia

40
Q

what is Echocardiography

A

Imaging at rest

41
Q

what is Echocardiography looking at

A 
Chamber size
Muscle contractility
Can also be stressed 
pharmacologically 
Valve function 
stenosis or regurgitation
Doppler
42
Q

can you remember some of the measured chamber dimensions?

A 
Aortic Root Diameter (ED) 2.0 – 3.6cm
Left Atrial Dimension (ED) 1.9 – 4.0
RV Internal Dimension (ED) 0.7 – 2.3
LV Internal Dimension (ED) 3.7 – 5.6
LV Internal Dimension (ES)  2.5 – 4.1
IV Septal Thickness (ED) 0.7 – 1.2	
LV Post Wall Thickness (ED)  0.7 – 1.1)
43
Q

TOE/TEE

A

Transoesophageal echocardiography

44
Q

what is Transoesophageal echocardiography used for?

A

When clear view of valves is needed (infective endocarditis)

When clear view of inter-atrial septum and atrial appendages needed (cryptogenic stoke)

45
Q

what is CT scan and what is it used for?

A

Radiation
Excellent for structure of heart and great vessels
3 D reconstruction

46
Q

what is CT coronary angiogram used as?

A

1st line investigation of cardiac sounding chest pain

47
Q

what is the cardiac MRI used for?

A

Excellent for structure, and for muscle function ( right and left heart)
Excellent for detailed muscle structure (fibrosis)
No radiation, repeatable.

48
Q

what is a hotter ECG?

A

24h ambulatory monitoring
Frequently recurring (daily)
Palpitations, dizzy spells, blackouts.
Automatic detection and patient triggered events

Anatomical Sciences (6 decks)

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