CAD

Question 1

If EKG is unclear or EKG is not diagnostic - perform

Answer 1

ETT ( exercise tolerance testing). Looking for ST segment depression

Question 2

Appropriate Exercise during ETT if

Answer 2

Heart rate > 80 % of maximum

Question 3

Maximum heart rate during ETT

Answer 3

= 220 - patient age

Question 4

Thallium( nuclear) stress test. Normal myocardium picks up thallium like

Answer 4

Potassium via Na/K- ATPase (similar)

Question 5

If myocardium is normal -you see on Stress or Dobutamine Echo

Answer 5

Moves on echo

Question 6

Myocardial Abnormalities on Stress or Dobutamine Echo. If ischemia

Answer 6

Decrease wall motion ( dyskinesis, akinesis, hypokinesis)

Question 7

Ischemia vs infarction during thallium test or echo

Answer 7

Ischemia is reversible (perfusion) wall motion or thallium uptake between rest and exercise. Infarction is irreversible or “fixed”

Question 8

What you are looking for during echo or thalium

Answer 8

Reversible changes

Question 9

If pt can’t exercise

Answer 9

Persantine( dipyridamole) or adenosine with nuclear isotopes ( thallium or sestamibi) or dobutamine in combination with echo

Question 10

Increases myocardial oxygen consumption, provokes ischemia=> decreases wall motion on echo

Answer 10

Dobutamine

Question 11

Avoid in asthma pts, inc cAMP

Answer 11

Dipyridamole may provoke bronchospasm

Question 12

If can’t read EKG( already have ST depression, R or LBBB, pacemaker, digoxin )

Answer 12

Do exercise thallium( decreased uptake of nuclear isotope) or = exercise echo ( decr. Wall motion) .

Question 13

If can’t exercise do

Answer 13

Dipyridamole thallium test( decreased uptake of nuclear isotope) or =Dobutamine echo ( decreased wall motion)

Question 14

Stenosis( narrowing) is insignificant if

Answer 14

< 50 % of CAD diameter

Question 15

Surgery or angioplasty should be done for at least CAD

Answer 15

70% stenosis