Cardiac Diagnostic Studies Lecture Powerpoint Flashcards

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1
Q

Most important tool in evaluating cardiac patient

A

History and physical

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2
Q

10 year old experiencing palpitations suddenly, what are the 5 big tests would you order for diagnosis?

A
  • EKG #1
  • Echocardiogram
  • Holter monitor
  • Event recording
  • Symptom diary and pulse checks
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3
Q

Holter Monitor definition and one big disadvantage

A

5 lead EKG recording that records every heartbeat up to 48 hours, provides avg heart rate as well as minimum and max heart rate, patients should self record symptomatic moments to correlate to the arrhythmia

-Disadvantage: short time frame relatively speaking so many patients will not have symptoms

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4
Q

Holter Monitor indications

A

-Evaluate symptoms such as palpitations, chest pain, syncope caused by dysrythmia, or evaluate medical therapy being used to suppress dysrhythmia

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5
Q

Event recorders definition and one big disadvantage

A
  • Devices that continously monitor ECGs for 30-60 days, device has a memory that will store a triggered event (regardlss of if patient is aware or if patient triggers device manually) as well as the previous 10 minutes
  • Disadvantage is that patient must wear for a month and change patches
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6
Q

Event recorders indications

A

Suspected dysrhythmia not occurring on a daily basis

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7
Q

Implantable cardiac monitor

A

Implanted on upper chest wall subcutaneously, hand held device activator placed over device to mark and save rhythms before, during, and after event, new models can automatically send transmission to physician

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8
Q

Tilt table test

A

Older test that is used for evaluation of vasovagal syncope opposed to a cardiac syncope, thru strapping patient to table that moves from horizontal to vertical position while monitoring heart rate and blood pressure and assessing for syncope

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9
Q

65 year old presenting to cardiologist complaining of intermittent dyspnea related to activity, what are 4 tests you would order?

A
  • EKG
  • Echocardiogram
  • Stress Test
  • Chest X ray
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10
Q

Echocardiography and 3 subtypes

A
  • 2D mapping allows for evaluation of anatomy, hemodynamics, function of cardiac structures, assessment for clot presence, tumor, or pericardial effusion
  • Transthoracic echo, transesophageal echo, or doppler
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11
Q

White on an echocardiogram represents ____ and black represents ___

A

muscle, lumen

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12
Q

Doppler imaging

A

A continuous wave doppler that can measure the velocity of the fluid in the heart helpful in diagnosing stenosis or other conditions (color flow mapping)

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13
Q

Benefits and limitations of echocardiography

A

Benefits - non invasive, inexpesnive, mobile

Limitations - poor windows, technologist dependent, subjective interpretations by physicians

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14
Q

Poor windows

A

Refers to when there is extra tissue (adipose, muscle, etc) that makes it difficult to obtain clear echocardiogram images

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15
Q

65 male with mildly elevated cholesterol presents with chest tightness when walking, what 4 tests do you order?

A
  • EKG
  • echocardiogram
  • exercise stress test
  • Holter monitor
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16
Q

Cardiac stress testing and 2 ways to enhance the study

A

Goal is to evaluate perfusion/function of myocardium at times of stress (exercise induced or pharmacologically induced) that can evaluate exercise intolerance or rhythm abnormalities, can evaluate for ST segment changes, BP response, maximum achieved predicted HR

-enhanced with imaging studies such as echocardiogram or nuclear imaging

17
Q

Stress test indications (4)

A
  • Evaluate patients with known or suspected CHD
  • assess therapeutic effects of drugs
  • post MI
  • Preop risk assessment
18
Q

Exercise stress tests without imaging advantages and disadvantages

A

Advantages - assessment of ischemia, equipment widely available
Disadvantages - Sensitivity lower than that of stress imaging techniques, female population not as accurate

19
Q

Absolute and relative contraindications for exercise testing

A

Absolute - recent MI, unstable angina, acute aortic dissection or PE
Relative - Left coronary artery stenosis, electrolyte abnormalities, mental or physical impairment

20
Q

Stress test Echocardiography advantages and disadvantages

A

Advantages - Useful for diagnosing CAD, provides immediate results
Disadvantages - interpretation subjective and not standardized, images may be nondiagnostic

21
Q

Pharmacological alternatives to treadmill for stress testing (3)

A
  • Dobutamine
  • Adenosine
  • Persantine
22
Q

Dobutamine stress testing function

A

Prominent inoropic and less prominent chronotropic effects on myocardium that increases heart rate, blood pressure, and contractility closely simulating exercise, up titrated as infusion to achieve max acheived predicted HR

23
Q

Adenosine stress testing function

A

Coronary vasodilator that decreases blood pressure but has no effect on HR, can cause transient heart block or induce bronchospasm, can accurately assess CAD in patients unable to exercise and is relatively safe with side effects that can be rapidly reversed

24
Q

Nuclear stress test (perfusion imaging)

A

Involves nuclear isotope with an affinity for the heart is injected, ischemic areas will have decreased uptake and infarcted will have none, highly sensitive for coronary artery disease as it directly measures PERFUSION

25
Q

Interpreting nuclear stress test

A

Compare rest image with stress image, if defect present at stress and rest then that indicates previous MI in the artery of the region

26
Q

Cardiac catheterization

A

Angiogram that allows for location of stenosis or aneurysm in blood vessels, allows to assess hemodynamics, pressure in heart and lungs, biopsy, and identify congenital heart defects

27
Q

Cardiac catheterization risks (4)

A
  • bruising
  • stroke
  • arrhythmia
  • dye can have allergic rxn
28
Q

Cardiac MRI

A

Examines size of heart chambers and thickness of the wall and other anatomy, determines extent of damage caused by heart attack or progressive heart disease, detects plaque buildup, assesses a patients recovery following treatment

29
Q

Teens with chest pain and elevated troponin levels indicates ____ for which the study of choice to image is ____

A

Viral myocarditis, cardiac MRI

30
Q

Benefits and drawbacks of cardiac MRI

A

Benefits - 3D analysis, non invasive, no radiation

Drawbacks - no pacemakers, only diagnostic not therapeutic

31
Q

Nuclear stress test is directly measuring ____

A

perfusion

32
Q

Cardiac CT angiogram

A

Uses CT and IV contrast to obtain 3D images of heart and great vessels, enable visualization of plaque or ca2+ deposits on artery walls, noninvasive method to detect blockages

33
Q

Cardiac CT angiogram benefits and drawbacks

A

Benefits - 3D, noninvasive analysis, superior to catheter angiography
Drawbacks - Radiation exposure, diagnostic not therapeutic, risk of contrast allergy

34
Q

Electrophysiology study

A

Tests function of heart’s electrical system, can be useful in identifying an arrhythmia and helping decide best therapy for it especially when there is risk for future cardiac events

35
Q

Risks and benefits of electrophysiology study

A

Benefits - may be able to cure arrhythmia via ablation

Risks - bleeding, infection, injury

36
Q

Calcium score screening CT

A

Method for predicting risk for CAD in asymptomatic patient by detecting Ca2+ buildup, quick screening tool but may miss some plaques and gives radiation exposure