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Physiology > Assessing cardiac function > Flashcards

Assessing cardiac function Flashcards

1
Q

cardiac function

A

maintaining the circulation, BP and perfusion of vital organs
adaptable to changing needs

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2
Q

what does the heart need to function properly

A

rate and rhythm
structures - competence of valves
efficient heart muscle contraction

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3
Q

what are the different ways of assessing cardiac function?

A

functional testing
CT angiography
cardiac MRI
invasive coronary angiography

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4
Q

what is functional testing?

A

exercise ECG

imaging stress test - ECHO or perfusion scan

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5
Q

what is MET?

A

metabolic equivalent of task
a physiological measure expressing the energy cost of physical activity
1 MET =1kcal/ kg x h = 4.13kJ/kg x h
= basal metabolic rate

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6
Q

what is the importance of MET?

A

allows activities to be graded on energy expenditure, used as a reference to see how patients can cope with the physiological stress on the heart

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7
Q

types of stress testing

A
  1. physiological - on treadmill or bicycle ergometer

2. pharmacological

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8
Q

how does stress testing work?

A

ECG leads and BP cuff constantly monitoring
increase stress gradually
tests for ischaemia

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9
Q

what is pre-test probability

A

looks at risk factors for ischaemia/ coronary heart disease

done before stress testing

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10
Q

when to and when not to use exercise testing

A

dependent on physical capacity of patient
NICE guidelines says not be used for primary diagnosis/ exclusion as lots of false positives and negatives
useful for seeing if there is a causal relationship between patient’s symptoms and ischaemia

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11
Q

what are the categories of angina?

A

typical

atypical

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12
Q

typical angina

A

has all 3 features of angina

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13
Q

atypical angina

A

2/3 features of angina

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14
Q

what does it mean if a patient only has 1/3 of the features of angina?

A

unlikely to be coronary disease related pain

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15
Q

what are the 3 features of angina?

A

central constricting chest pain, radiating to arms, neck or jaw
brought on by exercise or physiological stress
relieved by rest and/ or use of nitrates or vasodilator like GTN spray

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16
Q

when is pharmacological stress testing done?

A

if a patient for other reasons cannot undergo exercise testing

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17
Q

what happens in pharmacological stress testing?

A

infusion of dobutamine - beta agonist
could use infusion of vasodilator - adenosine/ dipyridamole
method varies depending on the doctor
use imaging techniques

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18
Q

what does dobutamine/ beta agonist do?

A

raises BP
increases HR
increases cardiac contractility
increases demand of heart muscle for blood supply
mimics effect of exercise
induces ischaemia - where flow is inadequate to meet needs

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19
Q

how does pharmacological stress testing show ischaemia?

A

where there are ischaemic areas vasodilation is not possible because of fixed stenosis and so they appear on imaging as hypoperfused and relatively ischaemic

20
Q

when is myocardial perfusion scan used?

A

useful in patients with intermediate probability of coronary disease
especially if mobility limits treadmill testing of it resting ECG abnormal

21
Q

how does a myocardial perfusion scan work?

A 
thallium injected
taken up by myocardium in proportion to blood flow
no thallium is taken up by scar tissue 
detected by a gamma camera
images taken under 'stress' or at rest
22
Q

interpreting myocardial perfusion scan

A

lit up = healthy

less lit up = ischaemia

23
Q

ECHO

A

echocardiography

24
Q

what are the different types of ECHO?

A

transthoracic

transoesophageal

25
Q

how is an ECHO done?

A

in hospital
at rest
done by cardiologists or technicians

26
Q

what are ECHOs used for?

A 
viewing chambers
viewing spetum
chamber size
muscle contractility
can be used under pharmacological stress
calculating ejection fraction
valve function
27
Q

what is transoesophageal ECHO better for?

A

best views of left and right atria
infective endocarditis
infectious lesions on valves
diagnosis of PFO

28
Q

what to look for when assessing valve function?

A

direction of flow
stenosis
regurgitation
requires doppler to look at direction of blood flow

29
Q

aortic root diameter - ED

A

2-3.6cm

30
Q

what does ED and ES stand for?

A

End diastolic

End systolic

31
Q

left atrial dimension - ED

A

1.9-4cm

32
Q

RV internal dimension - ED

A

0.7-2.3cm

33
Q

LV internal dimension - ED

A

3.7-5.6cm

34
Q

LV internal dimension - ES

A

2.5-4.1cm

35
Q

Interventricular septal thickness - ED

A

0.7-1.2cm

36
Q

LV posterior wall thickness - ED

A

0.7-1.1cm

37
Q

what causes right heart strain and inhalation pain?

A

Pulmonary embolism

38
Q

what is a crytogenic stroke?

A

where the origin/ cause of the stroke is undetermined

39
Q

what is cardiac CT scan used for?

A

structure of heart and great vessels
looks at calcification of vessels and valves
3D reconstruction - good for coronary artery mapping
not best for looking at myocardium
calcium deposits can be seen
remember radiation exposure

40
Q

calcium scoring

A

higher number more likely to have coronary heart disease

41
Q

what are cardiac MRIs used for?

A

not as good at looking at calcification as CT
excellent for structure and overall muscle function
excellent for detailed muscle structure and looking for fibrosis
used in young people for looking at congenital abnormalities due to no radiation

42
Q

benefits of cardiac MRI?

A

no radiation
can add contrast - gadolinium
repeatable

43
Q

constant cardiac monitoring

A

holter ECG

implantable loop recorders

44
Q

holter ECG

A 
24h ambulatory monitoring
rhythm disturbances 
AF
daily palpitations
syncope
dizzy spells
automatic detection
patient triggered events
45
Q

implantable loop recorders

A 
reveal device
detects rhythm for multiple years
less regular symptoms
records every 20mins
stores when fast or slow or when activated by patient 
can be downloaded

Physiology (46 decks)

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