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Cardiology > CAD: Diagnosis > Flashcards

CAD: Diagnosis Flashcards

0
Q

type II error

A

false negative

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1
Q

type I errors = ?

A

false positives

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2
Q

Target HR in stress test

A

85% of age predicted HR (220-age)

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3
Q

Rate Pressure Product

A

peak HR x SBP

measures myocardial workload

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4
Q

Sn and Sp of ETT

A

both around 70%

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5
Q

on ETT does ST elevation or depression localize ischemia?

A

ST elevation does

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6
Q

ECG changes prognostic on ETT

A
  • max ST depression
  • # leads involved
  • time to ST shift
  • recovery time
  • inducible ventricular arrhythmias
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7
Q

Hemodynamic changes prognostic on ETT?

A
  • peak HR (Chronotropic incompetence)
  • BP (exercise induced hypotension)
  • rate pressure product
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8
Q

what does exercise induced hypotension on ETT mean?

A

LM or 3VD

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9
Q

Are HOCM, high degree AVB, severe HTN absolute contraindications to ETT?

A

no

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10
Q

at what high BP do you stop a ETT?

A

250/115

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11
Q

absolute reasons to stop an ETT (7)

A 
1- ischemia w/ SBP dec by 10mm Hg
2- mod-sev angina
3- CNS sxs
4- cyanosis/pallor
5- sustained VT
6- >1mm ST elev (other than V1 or aVR)
7- pt requests
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12
Q

which conditions obscure ST changes on ETT?

A 
WPW
PPM
ST dep 1mm at rest
LBBB
LVH
Dig
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13
Q

ST depression in which leads of an ETT don’t matter?

A

V1, aVR

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14
Q

ST Elevation on ETT

A

Should be in leads without Q waves

Transmural ischemia from coronary spasm or myocardial injury

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15
Q

Duke Treadmill Score

A

Exercise time (mins) - (5 x mm ST dep) - (4 x angina index)

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16
Q

Angina index

A

0- no CP
1- CP
2- CP stops exercise

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18
Q

Scores and corresponding mortality for Duke treadmill

A

Low risk > 5 (0.5%)
Intermediate risk +4 to -10 (.5-5%)
High risk < -11 (>5%)

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19
Q

HR reserve and chronotropic incompetence

A

HR Reserve = 220-age-resting hR

Chron. incomp is inability to inc HR by 80% of HR reserve

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20
Q

what is considered a low level of exercise?

A

HR<70% max HR

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21
Q

differences in SN/Sp b/w stress echo and nuclear

A

similar Sn

stress echo- higher Sn (fewer false +)

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22
Q

adenosine stress MOA

A

A2A receptor agonist–> 4x inc in coronary blood flow

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23
Q

adenosine effect on HR and BP

A

inc HR

modest dec in BP

24
Q

*adenosine side effects by receptor-type

A

A1 : AVB
A2b: periph vasodilation, bronchospasm
A3: bronchospasm

25
Q

adenosine stress contraindication (5)

A 
asthma/COPD
high degree AVB/SSS w/o PPM
SBP<90
recent dipyridamole/aggrenox
on methyl xanthones (aminophylline, caffeine) w/in 12hrs
26
Q

regadenoson receptors

A

binds selectively to A2A receptor

- low affinity for A1, A2b, A3 so less side effects

27
Q

persantine (dipyridamole) stress test MOA

A

indirectly increases adenosine by preventing its reuptake

28
Q

dobuatmine stress dosing

A

5-10 mcg/kg/min, inc q3min to 20/30/40 mcg/kg/min

atropine .25mg IV q2min upto 1-2mg

29
Q

dobutamine antidote

A

short acting IV BB

30
Q

Dobutamine stress absolute contraindications

A

symptomatic severe AS
acute Ao dissection
ACS
HOCM

31
Q

absolute contraindications to atropine

A

myasthenia gravis
narrow-angle glaucoma
pyloric stenosis

32
Q

does dobuta stress have good PPV or NPV?

A

NPV

33
Q

what type of contraindications are recent ventricular arrhythmias and high degree AVB for dobuta stress?

A

relative

34
Q

4 Class I indications for angiography

A 
1- CCS class III/IV angina on meds
2- high risk stress test
3- SCD
4- sustained MONOMORPHIC VT (>30s)
5- non sustained POLYMORPHIC VT (<30s)
35
Q

CCS classification for angina

A

I- can do normal physical activity (angina only w/ a lot of exertion)
II- slight limitation w/ normal activity (running up stairs, emotional stress/morning hours/uphill)
III- marked limit. 1 flight of stairs.
IV- unable to do activity. Rest angina.

36
Q

intermediate risk Duke treadmill score

A

-11 to 5

37
Q

what category of risk is inc’d lung uptake on stress test?

A

high

38
Q

> ? segments on stress echo with low dose dobuta is high risk?

A

> 2 segments

39
Q

if a pt has DM, 2VD + pLAD, is it Appropriate to do PCI?

A

yes

40
Q

for which of the following is it Appropriate to do CABG in DM: 2VD +pLAD, 3VD, LM Dz, or LM + 1VD?

A

All

41
Q

in asxs pt’s w/ no known CAD, when is it APPROPRIATE to do cardiac CT?

A

family hx of premature CAD and low to intermediate risk of CHD

42
Q

is it APPROPRIATE to do a cardiac CT on a symptomatic pt. to assess stent patency

A

no

43
Q

in pt’s w/ CM, when is it APPROPRIATE to do a cardiac CT?

A

low-intermediate CHD risk

44
Q

when is it APPROPRIATE to do a cardiac CT for atrial or ventricular arrhythmias?

A

never

45
Q

what conditions to use cardiac CT to assess structure and fxn?

A 
congenital heart dz
RV fxn
Arrhythmogenic RV dysplasia
pericardial anatomy
PV anatomy (afib ablation)
localization of CABG grafts pre thoracic Sx
46
Q

what to look for on CMR to assess myocardial viability?

A

late gadolinium enhancement

47
Q

what is considered a positive EKG on ETT for ischemia if baseline EKG has <1mm ST depression?

A

> 2mm ST depression (horizontal or downsloping)

48
Q

if a patient has ventricular ectopy/bigeminy, etc. on ETT, what is its significance if it happens during a) exercise b) recovery

A

a) decreased LVEF

b) decreased LVEF and inc’d mortality

49
Q

persantine contraindications are same as adenosine plus what?

A

liver failure b/c of hepatic metabolism

50
Q

if pt has normal nuclear with strongly positive exercise EKG or angiographic stenosis, what is their cardiac event rate per year?

A

<1%

51
Q

what is TID due to?

A

subendocardial ischemia

52
Q

can cardiac CT or MR be used to screen for CAD?

A

no

53
Q

what perfusion defect percentage at rest or stress is considered high risk (>3% death/MI per yr)?

A

10%

54
Q

what CAC score is high risk?

A

> 400

55
Q

Class I rec for noninvasive imaging in asymptomatic pt’s

A

none

56
Q

if ETT already done, when is it appropriate to do CTA?

A

intermediate risk

Cardiology (32 decks)

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