Cardiac Diagnostics

Question 1

4 Etiological considerations in diagnosing cardiac problems

“Cardiac Chii”

Answer 1

Is the problem - in origin

Congenital
Hypertensive
Ischemic
Inflammatory

Question 2

4 Anatomical considerings in diagnosing cardiac problems

Answer 2

Which chambers are involved?
Are they hypertrophied, dilated, or both?

Which valves are affected?
Are they regurgitant, stenotic, or both?

Is there pericardial involvement?

Has there been a Myocardial Infarction?

Question 3

Physiological disturbances to consider in diagnosing cardiac problems

Answer 3

(Is an arrhythmia present?)

Is there evidence of congestive heart failure or myocardial ischemia?

Question 4

How to consider degree of functional disability in cardiac problems -
Class I - Class IV

Answer 4

How strenuous is the physical activity required to elicit symptoms?

Question 5

Lab that is seldom used to diagnose AMI, but can be used as an early evaluation because it rapidly rises within first 2-3 hours. Not specific.

Answer 5

Myoglobin

Question 6

Lab that rises 3-6 hours after event, peaks in 12-24 hours. Helpful to assess onset and size of AMI.

Answer 6

CKMB

Question 7

MB percentage of CK that is diagnostic of AMI

Answer 7

If MB >5% of total CK

Question 8

Lab which is highly specific to myocardial damage. Elevated in about 3 hours and stays elevated for 7-14 days. May be falsely elevated in renal disease.

Answer 8

TnI, TnT

Question 9

Lab which measures a neuroendocrine peptide that is released in response to stretch of ventricular walls.

Answer 9

BNP

Useful for determining CHF disease severity and mortality

Question 10

Physiological effects of BNP

Answer 10

Vasodilation, aldosterone inhibition from adrenals, and inhibits renin from kidneys. Naturesis- excess Na excreted with H20.

Question 11

What level of BNP is associated with dyspnea from CHF?

Answer 11

> 100ng/L

Question 12

What might be used to evaluated an arrhythmia which doesn’t show on the EKG?

Answer 12

Holter Monitor

Worn for at least 24 hours

Question 13

Second most commonly used cardiac diagnostic

Shows velocity, direction, and turbulence of blood flow in cardiac chambers, great vessels, and across valves

Answer 13

Echocardiogram

Question 14

When might a transesophageal echo be indicated?

Answer 14

To evaluate posterior cardiac structures:
Left atria / appendage
Mitral Valve
Aortic Valve
Distal Aortic root
Interatrial Septum
**Signs of infective endocarditis**

Question 15

Indications for stress testing

Answer 15

Chest pain evaluation
Cardiac rehab
Effectiveness of medical therapy (angina)
Detect exercise induced HTN

Question 16

EKG changes to be noted during stress test

Answer 16

> 1mm

Depression = ischemia
Elevation = injury

Question 17

Meds used in chemical cardiac stress testing

Answer 17

Dobutamine - inotropic and chronotropic

normal myocardium has increased contractility, ischemic myocardium does not

Question 18

Test used to evaluated suspected CAD or progression of ischemia. Often used with chemical stress testing to obtain rest and stress imaging

Answer 18

PET / SPECT test - Nuclear Imaging

Question 19

PET / SPECT results

Answer 19

Decreased uptake during stress = ischemia

Decreased uptake during rest and stress = old MI “fixed defect”

Question 20

Other uses for PET

Answer 20

Myocardial Viability

glucose uptake / metabolism to assess whether there is “hibernating” viable myocardium, which would benefit from REVASCULARIZATION

PET IS GOLD STANDARD FOR THIS

Question 21

“Gold Standard” for diagnosing vaso-occlusive CAD

Second most common operative procedure in US

Answer 21

Cardiac Catheterization