Cardiac Diagnosis Flashcards
Cardiac Enzymes include? (3)
CK
CK-MB
Troponins
CK:
Order why?
(Creatine Kinase, general mm enzyme)
suspect acute coronary synd (chest pains, etc)
CK:
Order when?
order serially (every 6 hrs inpatient) Onset = 3-12hrs
Peak = 18-24hrs
Duration = 36-48hrs
CK:
Results mean?
High levels indicate:
cardiac mm injury/exertion,
skeletal mm injury/exertion
NOT conclusive for MI
CK-MB:
Order why?
If CK is ↑ and suspect acute coronary synd:
More indicative of heart mm vs skeletal
CK-MB:
Order when?
Serially:
Onset = 3-12hrs
Peak = 18-24hrs
Duration = 36-48hrs
Troponins:
Order why?
Cardiac regulatory protein for actin/myosin interaction,
levels ↑ w/ heart damage
Troponins:
Order when?
suspect ACS
Onset = 3-12hrs
Peak = 18-24hrs
Duration = up to 10 days
Troponins:
Results mean?
High sensitivity and specificity for heart damage
Telemetry is?
continuous ECG monitoring
Exercise ECG Stress Test:
Order when?
Stable pt w/ low risk factors
Stress Tests:
Order why?
Eval exert chest pain
Diag CAD in sympt pts
Assess functional capacity (during and after exercise)
Stress Tests:
Results mean?
Reveals imbalance b/w myocardial O2 demand and supply to diseased coronary arteries:
ST ↓
↑ HR
sxs develop (chest pain, SOB, etc)
Contraindications to Stress Test? (6)
Acute phase of uncomplicated MI/ACS Acute myo or pericarditis Rapid arrhythmias Severe aortic stenosis, anemia, infection Hyperthyroidism Acute aortic dissection
Stress Test does NOT tell me?
Site or extent of ischemia
LV fxn
(P) incorrect abnormal results
Nuclear Medicine Imaging is?
Radioactive tracers for better imaging,
Obtained at rest and exercise
Nuclear Medicine Imaging:
Order when?
myocardial ischemia present
Nuclear Medicine Imaging:
Order why?
Locate injured cardiac mm
Eval effectiveness of vessel surgeries
Nuclear Medicine Imaging:
Results mean?
Thallium visible in healthy mm w/ adequate blood flow
Transthoracic Echocardiogram (TTE) is?
US of heart
TTE:
Order why?
Eval wall motion at or post MI Calc EF (65% = normal) Measure heart chambers Eval valves Find masses, infection
TTE detractors?
Chest wall abnormality
Obesity
Movement
Boobs
Transesophageal Echocardiogram (TEE) is?
US probe down esophagus, behind heart
TEE:
Order when?
Need better clarity or access to heart
TEE:
Order why?
TTE findings + Septal defects Foramen ovale patency AAA Aortic Dissection
Stress Echocardiogram:
Ordered when?
Pt has stenosis
Reg ECG ST undiagnostic
Stress Echo:
Ordered why?
Preop eval
Conduction/repol abnormalities undiag on ECG ST
Eval valves or EF
Stress Echo:
Results mean?
Wall motion abnorm w/ stress = ischemia
Cardiac Cath/Angiogram is?
Gold for CAD diagnosis
Cath and dye threaded into heart
See patency of coronary arteries
Cardiac Cath/Angiogram:
Order when?
Known or suspected CAD
Atypical chest pain
Pre valve surgery if chest pain or ECG Δs
Cardiac Cath/Angiogram:
Order why?
locate lesions
Can stent or balloon right then
Holter monitor is?
ambulatory ECG
Holter monitory ordered when/why?
Correlate activity and symptoms
Eval syncope, palp
Variable HR
Find silent ischemia (ST seg monitoring)
NOT for infrequent events
Event Loop Recorder?
Similar to Holter but longer
Pt activates at event
Signal immediately transmitted
CT ordered when/why?
Detect aortic dissection
Detect coronary artery Ca2+ deposits
NOT good if movement
MRI ordered when/why?
Eval of: Aorta Pericardium Myocardium Valves Abscess/mass Myo perfusion
