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OS 205 > Cardiac Diagnostics > Flashcards

Cardiac Diagnostics Flashcards

1
Q

What is the “Five-Finger” approach to cardiac diagnosis?

A 
History
Physical Examination
ECG
X-ray
Lab Tests
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2
Q

What are examples of non-invasive cardiac diagnostic tests?

A 
Chest X-ray
ECG
Treadmill Stress Test
Echocardiogram
Nuclear Scan
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3
Q

What is an example of an invasive cardiac diagnostic test?

A

Coronary Angiogram

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4
Q

What are the basic indications for cardiac diagnosis?

A 
Document electrical abnormalities
Define structural abnormalities
Detect myocardial ischemia
Determine the myocardial function/viability
Detect coronary artery obstruction
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5
Q

What is the basic difference between PA and AP views?

A

Whether clavicle is present or not

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6
Q

What x-ray view should you recommend to a patient who can stand?

A

Postero-anterior (PA) view

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7
Q

What x-ray view should you recommend to a patient who cannot stand?

A

Antero-posterior (AP) view

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8
Q

What condition should NOT be read from an AP view x-ray? Why?

A

Cardiomegaly

The cardiac chambers and heart shadow are magnified.

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9
Q

In PA view, what structures of the heart make up the (patient’s) right border?

A

Small portion of the IVC
SVC
RA
Ascending Aorta

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10
Q

In PA view, what structures of the heart make up the (patient’s) left border?

A

Aortic Knob
Main Pulmonary Artery
LA
LV

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11
Q

What structure of the heart can be seen in PA Lateral view but not in PA view?

A

Right Ventricle

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12
Q

What is the most important information you can derive from a chest PA view?

A

Cardio-Thoracic Ratio (CTR)

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13
Q

What is the Cardio-Thoracic Ratio (CTR)?

A

(Widest diameter of heart)/(Widest internal rib cage diameter)

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14
Q

What is the normal CTR in adults? babies?

A

Adults: <0.5
Babies: ~0.65

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15
Q

In what cases will a CTR >0.5 still be considered normal?

A 
Portable AP (heart more anterior)
Obesity
Pregnancy
Ascites
Straight Back Syndrome
Pectus Excavatum
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16
Q

What are the causes of abnormal CTR?

A

Obstruction to ventricular outflow
Left ventricle hypertrophy
Abnormalities with structures associated with contours

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17
Q

Manifestations of Left Ventricular Hypertrophy

A

PA VIEW

Inferolateral displacement of apex
Apex 0.5

LATERAL VIEW

Posterior displacement of postero-inferior border of heart

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18
Q

Manifestations of Right Ventricular Hypertrophy

A

PA VIEW

Rounding and upliftment of cardiac apex

LATERAL VIEW

Retrosternal fullness/haziness

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19
Q

Manifestations of Left Atrial Enlargement

A

PA VIEW

Double density
Enlargement of LA appendage
Upliftment of left mainstem bronchus
Widening of carinal angle
Cardiac waistline disappears (most common)

LATERAL VIEW

Prominent posterosuperior cardiac border
Posterior displacement and upliftment of left mainstem bronchus

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20
Q

Manifestations of Right Atrial Enlargement

A

Lateral bulging of right cardiac border (>2.5 cm from lateral aspect of thoracic vertebra and >5.5 cm from mid thoracic spinous process)
Elongation of right heart border

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21
Q

What do you call the condition wherein your heart is located at the right side?

A

Dextrocardia

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22
Q

What measurement of the aortic knob is indicative of left atrium enlargement?

A

Greater than 35 mm (measured from lateral border of air in trachea to edge of aortic knob)

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23
Q

What are the signs of a patient with left ventricular hypertrophy with congestive heart failure and effusion?

A

Enlarged aortic arch and descending aorta
Presence of white fluid
Possible aortic aneurysm

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24
Q

The normal osmotic tendency is to ______ the pulmonary interstitium and alveoli.

A

Dehydrate

Pulmonary Capillary Hydrostatic Pressure: 7 mmHg
Plasma Colloid Oncotic Pressure: 28 mmHg

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25
Q

What are the stages of pulmonary congestion?

A
  1. Cephalization
  2. Kerley B Lines
  3. Pulmonary Intestitial Edema
  4. Pulmonary Alveolar Edema
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26
Q

In cephalization, which vessels of the lung increase in size?

A

Upper lobe vessels increase in size relative to lower lobe

Hint: It’s called “cephalization”, so the vessels near the head become more prominent

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27
Q

What are Kerley B Lines?

A

They are distended interlobular septa located at the bases of the lungs characterized by:

1 - 2 cm long lines
Horizontally oriented
Perpendicular to the pleural space

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28
Q

Presence of donut rings in pulmonary congestion is a sign of which stage? What event do the donut rings signify?

A
  1. Pulmonary Interstitial Edema

2. Peribronchial Cuffing

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29
Q

What are the three zones of the lung when assessing pulmonary congestion?

A
  1. Central Zone
  2. Middle Zone
  3. Outer Zone
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30
Q

T/F: Can you diagnose cardiac chamber enlargement using ECG?

A

True

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31
Q

What part of the ECG measures the potential difference across two points?

A

Galvanometer

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32
Q

How many ECG electrodes are there total?

A

Ten

6 precordial/chest electrodes
4 limb electrodes

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33
Q

What are the length (time) and amplitude of one small square on the ECG paper?

A

Length: 0.04 s
Amplitude: 1 mm or 0.1 mV

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34
Q

What are the length (time) and amplitude of one big square on the ECG paper?

A

Length: 0.20 s
Amplitude: 5 mm or 0.5 mV

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35
Q

An ECG is an important diagnostic test for what?

A 
Cardiac Rhythm
Conduction Abnormalities
Myocardial Ischemia/Infarction
Cardiac Abnormalities
Monitoring Drug Treatment
Detection of Metabolic Disturbances
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36
Q

What is the conduction pathway of the heart?

A
  1. SA Node
  2. Atrial Muscles
  3. AV Node
  4. Common Bundle of His
  5. Right and Left Bundle Branches
  6. Ventricular Muscles
37
Q

T/F: SA node activity is represented by the P-wave

A

False

The P-wave is a representation of atrial depolarization. SA node activity is typically not seen in an ECG.

38
Q

What does the P-wave represent?

A

Atrial depolarization

39
Q

What does the PR interval represent?

A

AV nodal activity (0.12 to 0.20 seconds)

40
Q

What does the QRS wave represent?

A

Ventricular depolarization

41
Q

What does the T wave represent?

A

Ventricular repolarization

42
Q

What is the formula for the heart rate (per minute) obtainable from the ECG?

A

1500/# of small squares

43
Q

What are the normal characteristics of the P-wave?

A

Amplitude: 0.05 to 0.35 mV
Duration: 0.06 - 0.11 seconds

44
Q

What is the normal length of the QRS wave/complex?

A

0.06 to 0.12 seconds

45
Q

What is the QT interval?

A

QRS complex + T wave

Normally 0.36 to 0.44 seconds
Less than half of the R-R interval for heart rates below 100 bpm

46
Q

Describe the ST segment.

A

Line from end of QRS complex to start of T wave

It is flat, being neither positive nor negative

47
Q

What test is most commonly used to gauge cardiac perfusion and function?

A

Treadmill Exercise Stress Test

48
Q

T/F: Treadmill Exercise Stress Test is used to assess the condition of coronary arteries

A

True

It is used in diagnosing coronary artery disease (CAD)

49
Q

What is the procedure for a Treadmill Exercise Stress Test?

A

Involved 3-minute periods for achievement of steady state before workload increase
Starts with 1.7 mph and uses incremental workload (METS)
4 limb leads are placed on torso to allow running

Electrical deflections, although more rapid during exercise, should mirror the pattern present at rest.

50
Q

If a person has a bad Treadmill Exercise Stress Test, what test should you recommend?

A

Pre-discharged Stress Test

This will help assess what activities he can and cannot do.

51
Q

What will manifest in the ECG if the patient has ischemia?

A

ST segment is lower than the PR line

52
Q

What can be obtained from the Treadmill Exercise Stress Test?

A

Maximal Heart Rate
Blood Pressure Response
Exercise Capacity of Functional Capacity
Interpretation of ECG Changes

53
Q

What is a metabolic equivalent (MET)?

A

It is the unit of oxygen taken up in a sitting, resting person

1 MET = 3.5 mL O2/kg/min of body weight

54
Q

How do you obtain predicted maximal heart rate?

A

220 - age

55
Q

What % of predicted maximal heart rate must you attain to say that you had an adequate stress test?

A

90%

56
Q

What are the contraindications to the Treadmill Exercise Stress Test?

A 
Unstable Angina (at rest)
Critical Aortic Stenosis
Severe Hypertrophic Obstructive Cardiomyopathy
Uncontrolled Hypertension
Acute Systemic Illness
Acute Myocarditis or Pericarditis
Untreated Life Threatening Arrythmia
Uncompensated Congestive Heart Failure
Advanced AV Block
57
Q

What are the types of echocardiography?

A
  1. Transthoracic (TTE)

2. Transesophageal (TEE)

58
Q

What is the sound frequency range used in echocardiography?

A

2.50 to 5.00 mHz

59
Q

Complete the statement:

“In echocardiography, the image depends on the acoustic ____1____ of ____2____ waves off various heart structures.”

A
  1. reflection

2. ultrasound

60
Q

How do solids and liquids appear in an echocardiograph?

A

Black: Fluids
Gray: Solids
Bright White: Calcium

61
Q

What procedure is used to assess the velocity of blood flow for assessment of hemodynamics?

A

2D-echo Doppler

62
Q

What is a Doppler Shift?

A

Difference in frequency between transmitted and reflected sound.

63
Q

What is used to diagnose mitral regurgitation?

A

Doppler color flow

64
Q

What do the different colors in Doppler color flow signify?

A

Blue: moving away
Red: moving closer
Mosaic Flow: regurgitation

65
Q

What are the advantages of echocardiography?

A
  1. Portable
  2. Non-invasive
  3. Real-time Imaging
  4. Instantaneous Interpretation
66
Q

What are the limitations of echocardiography?

A
  1. High-quality images cannot be obtained in certain individuals (i.e. obese or COPD patients)
  2. Highly operator, equipment and interpreter-dependent
67
Q

What are the three views used in echocardiography?

A
  1. Long axis parasternal view
  2. Short axis view
  3. Four-chamber view
68
Q

What is M-Mode used for?

A

Measuring thickness of cardiac muscles. May be used to diagnose right and left ventricular hypertrophy

69
Q

What is the most common primary tumor of the heart?

A

Left atrial myxoma (mass)

70
Q

What condition is represented by vegetations attached to the aortic valve?

A

Infective Endocarditis

71
Q

What type of echocardiography involves a Treadmill Exercise Stress Test followed by a post-exercise echocardiography?

A

Stress echocardiography

72
Q

What is stress echocardiography used to confirm?

A

Ischemic Heart Disease

At rest, heart muscles may actually contract very well. However, blood flow during stress may be compromised.

73
Q

In stress echocardiography, if a patient can’t perform the Treadmill Exercise Stress Test, what drugs can he/she use?

A
  1. Dobutamine (most common)
  2. Dipyramidole
  3. Adenosine
74
Q

What pharmacological agents can be used to induce a perfusion defect?

A
  1. Adenosine

2. Dipyramidole

75
Q

What isotopes are used in nuclear cardiology?

A
  1. Technetium 99m (99mTc)

2. Thalium 201 (201 Tl)

76
Q

What are the governing principles of nuclear cardiology?

A
  1. Viable myocardial cells take up circulating isotopes and light up well both at rest and during exercise.
  2. Stenosed areas and ischemic myocardia take up less isotopes, significantly lighting up only during rest.
  3. Dead myocardium does not light up at all since it cannot take up isotopes.
77
Q

What is the special camera used in nuclear cardiology?

A

Single Photon Emission Computed Tomography (SPECT)

78
Q

What do the different colors and densities of images in SPECT indicate?

A

White image: good blood supply

Dark image: low/absent blood supply (CHD or ischemia)

79
Q

A lateral wall defect is commonly associated with a problem in which coronary artery branch?

A

Left circumflex artery

80
Q

An anterior wall defect is commonly associated with a problem in which coronary artery branch?

A

Anterior descending artery

81
Q

T/F: There is no difference between myocardial perfusion imaging at rest and during exercise in cells that have experience myocardial infarction

A

True

82
Q

T/F: Nuclear cardiology is needed for coronary angiography and subsequent revascularization.

A

True

83
Q

When is a cardiac MRI ordered?

A
  1. Complex Congenital Heart Disease

2. Cardiac Tumors

84
Q

What is a cardiac CT scan ordered?

A
  1. Cardiac Calcification

Note: CT angiography is used to detect calcium in the coronary arteries

85
Q

What is the gold standard for diagnosis of most cardiovascular diseases?

A

Invasive diagnostic tests

86
Q

Where are cardiac catheters usually inserted?

A

Femoral or radial arteries

87
Q

What is the gold standard in diagnosis of coronary artery disease?

A

Coronary angiography

88
Q

The choice of diagnostic modality should be based on:

A
  1. Major problem
  2. Other clinical questions
  3. Local expertise
  4. Equipment availability
  5. Cost of procedure
  6. Side effects on patients

OS 205 (2 decks)

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