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Cardiology Board Prep > CAD > Flashcards

CAD Flashcards

1
Q

absolute contraindications for ETT

A 
AMI 
High risk unstable Angina 
Uncontrolled CHF 
Uncontrolled Arrhythmia 
Severe AS - Symptomatic 
Myocarditis/Pericarditis 
Aortic dissection 
Pulmonary embolus
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2
Q

Relative contraindications of ETT

A 
Left main CAD 
Moderately stenotic valvular heart dz 
HOCM 
Electrolyte abnormalities 
HTN > 200/100mmHg
Tachy/bradyarrhythmia 
High degree AV block
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3
Q

Indication to stop ETT

A 
patients desire to stop
moderate angina 
CNS symptoms 
ST elevation >/= 1mm 
BP drop of >/= 10mmHg from baseline 
Serious arrhythmias

some labs stop exercise once ST depression reaches 2.0mm

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4
Q

Risk of death or MI associated with ETT

A

1 in 2500 tests

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5
Q

Most serious contraindications for ETT that can be easily overlooked in the setting of chest pain

A

Aortic dissection

Pulmonary embolus

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6
Q

represents an ischemic response on ETT

A

> /= 1mm horizontal or downsloping ST depression measured 60 to 80msec after the J point

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7
Q

Issue with up-sloping ST depression in setting of ETT

A

up-sloping ST depression increase sensitivity for the test but at the expense of an unacceptable decrease in specificity.

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8
Q

True or false. ST depression that develops in the recovery phase has the same diagnostic accuracy as depressions during exercise

A

True

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9
Q

The most common site for ST changes during ETT

A

> 90% of positive responses occur in leads V4 - V6 regardless of the site of anatomical CAD.

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10
Q

ST depressions in confined to these leads likely represents a false positive finding

A

ST depressions confined to the inferior leads alone usually represents a false positive finding.

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11
Q

Unlike ST depression ST elevation during ETT provides this benefit..

A

STE during ETT can localize the site of ischemia and usually reflects high grade stenosis.

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12
Q

Calculate sensitivity

A

TP/TP+FN

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13
Q

Calculate specificity

A

TN/TN+FP

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14
Q

PPV

A

TP/TP+FP

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15
Q

NPV

A

TN/TN+FN

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16
Q

Calculate the overall accuracy of a test

A

TN/All tests

not very accurate due to verification bias (aka referral bias) only patients with positive test get referred for procedure.

If very few patients with a negative test a referred for the procedure the sensitivity gets closer to 100% & specificity closer to 0%

17
Q

what is the sensitivity and specificity of an ETT

A

Sensitivity - 68%
Specificity - 77 %
the above was derived by meta-analysis

a study performed here the cath all patients regardless of ETT result reported a sensitivity of 45% and specificity of 68%

the major impact of verification bias is the artifactual increase in the test sensitivity and decrease in its specificity.

18
Q

In the interpretation of the ECG during ETT in pt with a RBBB what modification is necessary?

A

ignore V1 - V3, interpretation is confined to the left precordial leads (v4 - v6)

19
Q

The factors decrease the sensitivity of an ETT

A

beta blocker

20
Q

Factors that reduce test specificity of ETT

A

presence of LVH
ST/T wave changes at baseline
Digoxin use

21
Q

The strongest prognostic ETT variable

A

Exercise duration

22
Q

calculating the bruce score

A

exercise capacity (time in minutes) - 5x Magnitude of ST deflection (in mm) - 4x angian index (0 = none, 1=non limiting, 2= limiting)

23
Q

Duke treadmill score low, intermediate, high

A

low >/= 5 ( 0.3)
intermediate -10 to +4 (1.3)
High < -10 (5.0)

Annual CV mortality in parenthesis

24
Q

common application of cardiopulmonary exercise testing

A
  1. Identification of underlying cardiac and pulmonary disease in a patient with unexplained dyspnea and prognostic assessment.
  2. assessment of candidacy for cardiac transplantation in a patient with congestive heart failure.
25
Q

what are the 3 groups of patients whom guideline recommends addition of an imaging modality to stress testing?

A
  1. an inability to exercise with requirement of pharmacologic stress
  2. Significant abnormalities on the resting ECG that preclude interpretation of the stress ECG
  3. High pretest probability of CAD
26
Q

Indication for coronary artery calcium scoring?

A

used for further refinement of cardiovascular risk assessment in asymptomatic individual categorized as intermediate risk on the basis of medical variables.

27
Q

These factors decrease the sensitivity of a stress echo

A
  1. delay in obtaining images > 90s
  2. single vessel dz (smaller ischemic territory)
  3. shorter exercise duration in which ischemic threshold is not met.
  4. Poor endocardial visualization (improved with echo contrast)
28
Q

Calculate LV Mass

A

LV Mass = 0.8 x 1.4[(IVS+LVID+PWT)^3 - LVID^3] + 0.6g

29
Q

At what 10 year ASCVD risk level is statin recommended in diabetic patients

A

Statins are recommended for primary prevention in all diabetic patients regardless of ASCVD risk.

High intensity Statins are indicated for ASCVD risk > 7.5%

30
Q

what are the 4 phases of valsalva in a normal patient

A

Phase 1. Increase aortic pressure due to increased intra-thoracic pressure

Phase 2. Decline in Pressure due to decreased pre-load. subsequent increase in HR due to baroreceptor response

Phase 3. with release of Valsalva, the aortic pressure declines further in response to decrease in intrathoracic pressure.

Phase 4. recovery period with increase in LV preload, aortic pressure, and pulse pressure.

31
Q

Response to valsalva in a patient with Heart failure

A

Square wave response.

Pt may have an absent overshoot of phase 4

The absent overshoot pattern indicates decreased systolic function and the square-wave response indicates elevated filling pressures.

32
Q

Half life of thallium

A

73.1 hrs

33
Q

half life of ammonia-13

A

10 minutes

34
Q

half life of rubidium

A

75 secs

Cardiology Board Prep (5 decks)

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