assessing cardiac function

Question 1

LVEDV

Answer 1

left ventricle end diastolic volume - most full

Question 2

LVESV

Answer 2

left ventricle end systolic volume - least full

Question 3

what is the portion of the LVEDV called that is ejected

Answer 3

ejection fraction

Question 4

what does starling law state

Answer 4

The Frank-Starling Law states that the stroke volume of the left ventricle will increase as the left ventricular volume increases due to the myocyte stretch causing a more forceful systolic contraction

Question 5

how many stages of heart failure are there

Answer 5

4
class1 - no symptoms with normalphsycial activity and normal function status
Class 2 - mild symptoms, normal physical activity, slightly limitation at functional
Class3 - moderate , less than normal physical activity - cofnrotable only at rest
class 4 - severe with features with minimal physical activity and even as rest.

Question 6

if there is right ventricular failure where will you find swelling

Answer 6

sacrum or ankles

Question 7

what is the costophrenic angles

Answer 7

places where the diaphragm meet the ribs

Question 8

atrial fibrillation can be checked if the QRS complexes are lined up - what else can you identify on an ECG

Answer 8

no p waves

QRS normal but irregular irregular

Question 9

what is a holter ECG

Answer 9

24-72hr ambulatory monitoring - these electrodes are applied to the chest wall - full read out for this time very valuable piece of info to acquire
Used when someone presents with palpitations, dizzy spell, blackouts , frequently recurring ( daily) - want to capture that event
Automatic detection and patient triggered events - record what they did

Question 10

what is a dual chamber pacemaker

Answer 10

if pick abnormalities - one in atrium and ventricle detect rhythm and provides electrical stimulus to generate rhythm - continuous stimulation of both chambers

Question 11

what does a straightline on an ECG show

Answer 11

defibrillation shock

Question 12

Acute admission - 63 driver, smoker , sudden onset chest pain - ambulance - persistent chest pain so do ECG
ST elevation

Answer 12

full thickness damage most likely STEMI - ST segment elevation

Question 13

if there is an anterior septal myocardial infarction St elevation is seen in what leads
what artery is occluded

Answer 13

V2,3,4

Left anterior descending artery occlusion

Question 14

what is exercise testing and why is it useful

Answer 14

Dependent on physical capacity of patient
Useful for seeing if there is a causal relationship between patients symptoms and ischaemia
Eg for working out whether something having recurrent cardiac CP or not MSK pain
Npt used for diagnosis/exclusion alone - lots of false positives and negatives

Question 15

1MET= 1kcal/kgh =4.13kJ/kgh

true or false

Answer 15

true

Question 16

Testing for ischaemia exercise treadmill stress test
Measure heart activity with ECg during this
Modified bruce protocol - make them run then adjust the grade of the treadmill - gradually increasing the speed and you have to keep up

when exhausted look atECG

Answer 16

Testing for ischaemia
Stress testing - pharmacological
Infusion of dobutamine - beta agonist
Raising blood pressure , heart rate
Increasing cardiac contractility
Increasing demand of heart muscle for blood supply
Induces ischemia , where flow is inadequate to meet needs

Question 17

Thallium myocardial perfusion scan

when sued and what does it do

Answer 17

Useful in patients with intermediate probability of coronary disease
Particularly useful if mobility limits treadmill testing or if resting ECG is abnormal
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
basically looks less orange

Question 18

left ventricle dimension - ED

Answer 18

3.7cm to 5.6 cm diameter

Question 19

left ventricle internal dimension ES

Answer 19

2.5-4.1cm

Question 20

when is a Transthoracic echocardiography TTE - using ultrasound used

Answer 20

In hospital usually imaging at rest
Chamber size
Muscle contractility
Can also be stressed

Question 21

two types of stress to asses cardiac function

Answer 21

exercise and pharmacologically- dobutamine

Question 22

when is a Transoesophageal echocardiography TOE

used

Answer 22

When TTE view poor
Whenc clear view of valves needed ( infective endocarditis )
When clear view of interatrial septum and atrial appendages needed
Cryptogenic stroke

Question 23

pros and cons of cardiac CT

Answer 23

Cardiac CT
Excellent for structure of heart and great vessels
3D reconstruction - good for coronary artery mapping
Not best for looking at myocardium
Radiation exposure

Question 24

what is a PET scan

Answer 24

Positron emission tomography (PET) scans produce detailed 3-dimensional images of the inside of the body.
The images can clearly show the part of the body being investigated, including any abnormal areas, and can highlight how well certain functions of the body are working.
coronary bypass
epilepsy surgery and dementia

Question 25

pors and cons of cardiac MRI

Answer 25

Excellent for structure and overall muscle function
Excellent fro detailed muscle structure
No radiation repeatable
Not as good at CT for looking at calcification

Question 26

pros and cons of cardiac MRI

Answer 26

Excellent for structure and overall muscle function
Excellent fro detailed muscle structure
No radiation repeatable
Not as good at CT for looking at calcification