Cardiac Diagnostics Flashcards
what does GDMT stand for
guideline directed medical therapy
what does OMT stand for
optimal medical therapy
what does EF stand for
ejection fraction
what does HFrEF stand for
Heart failure with reduced left ventricular ejection fraction (EF < 0.4)
what does HFpEF stand for
heart failure with preserved left ventricular ejection fracture (> 0.5)
what does HFmEF stand for
heart failure with midrange ejection fraction (EF < 0.5 but > 0.4)
what does RVSP stand for
right ventricular systolic pressure
5 tests of perfusion
- treadmill (Bruce Protocol)
- treadmill (MPS)
- stress echo
- PET
- arteriogram
Describe components of a stress test
- Protocol: Bruce vs Lexiscan vs Dobutamine
- +/- imaging or Myoview
- gives information about perfusion, chroncotropic competence, METs, arrhythmia, exercise tolerance
- Instructions to pt: hold BB/CCB 48 hrs, no caffeine 24 hrs
pros of a stress test
4
- relatively inexpensive
- gain info about METs, ischemia, arrhythmia, exercise tolerance
- easy to get insurance approval
- different modailities
cons of a stress test
- affected by body habitus
- false +/-
- equal balanced ischemia
downsloping of what more than what is an indication for termination of a stress test?
- ST segment
- 2mm
Absolute contraindications for stress test
9
- active endocarditis
- acute aortic dissection
- acute myocarditis/pericarditis
- decomponsated heart failure
- inability to exercise
- MI within 2 d
- ongoing unstable angina
- uncontrolled arrhythmias with hemodynamic compromise
- sx severe aortic stenosis
Relative Contraindications for stress tests
- Acquired complete heart block (LBBB)
- hypertrophic obstructive cardiomyopathy w/ severe resting gradient
- known L main CAD
- recent stroke or transient ischemic attack
- resting systolic blood pressure > 200 or diastolic > 110
- tachyarrhythmia w/ uncontrolled ventricular rate
pros of a stress echo
4
- quick interpretation at bedwisde
- less expensive than MPS
- info about heart valves, estimate RVSP
- can look for ASD/VSDs (bubble study)
cons for stress echo
4
- limited by body habitus
- need good tech
- more challenging if they have underlying wall abnormalities (LBBB/RBBB)
- prefer patient to be in NSR/SB
normal sinus rhythm/sinus brady
6 tests for heart anatomy
- cardiac CTA
- heart catheterization
- cardiac MRI
- 2-d echo
- transesophageal echo (TEE)
- cardiac MRA
pros of cardiac CTA
2
- high specificity
- leads to diagnosis of +/- ASCVD thus prossible interventional strategies
cons of Cardiac CTA
8
- dye and radiation exp
- weight restrictions
- must be brady
- hold breath for 20s
- can be difficult to get approval by insurance
- “blooming artifact”
- limiting imaging if hx CABG
- know your facility/readers
heart cath overview
5
- right vs left
- flow wire (FFR)
- intravascular ultrasound (IVUS)
- w/ or w/out LV gram
- Dye exposure
pros of left heart cath
4
- 99.9% accurate
- can evaluate anatomy and perfusion
- quick turn around/immediate interpretation
- final stop: can determine +/- fix while there