Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NP 730 Diagnostic Measures > Cardiac Imaging > Flashcards

Cardiac Imaging Flashcards

1
Q

Types of Cardiac Testing

A
  • EKG
  • Ambulatory ECG Monitoring
  • Stress test
    • Exercise
    • Pharmacologic
  • Echocardiogram
    • Stress echocardiogram
  • CT scan
  • MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

EKG

Indications

A
  • Symptomatic patients
    • CP, palpitations, fatigue w/SOB, syncope (pass out), seizure
  • Eval/monitoring of:
    • Audible abnormalities (arrhythmia, murmur)
    • Suspected electrolyte imbalance
    • PE
    • Congenital heart disorders
    • CHF
    • Cardiomyopathy (enlargement)
    • Poisonings/electrocution
  • Drug monitoring - need regular EKG monitoring
    • Drugs that prolong QT (lithium, psych meds)
  • Presence of implanted defibrillator/pacemaker (yearly EKG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Screening EKGs

USPSTF

A
  • Adults at low risk of CVD events: Recommend AGAINST EKG screening (Grade D) → can lead to unnecessary tests
  • Adults at intermediate or high risk: Insufficient evidence for screening (Grade I)
  • Athletes - sports physical
    • History and physical most important
      • Worried about electrical abnormalities (asymptomatic arrhythmias) while exercising)
  • Pre-operative exams
  • Certain occupations may require screening EKG: cataract

If patient has no symptoms indicating an EKG → no need to test again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How to assess CVD risk by USPSTF?

A

Use Pooled cohort calculator

10-year ASCVD risk < 7.5% = low

“” >/= 7.5% elevated risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ambulatory EKG monitoring

A

Provides data over extended period of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ambulatory EKG monitoring Indications

A
  • Arrhythmias s/s
  • Eval effectiveness of arrhythmia therapy
  • Screening for asymptomatic arrhythmia
  • Eval prognosis post ACS
  • Assess for silent ischemia in someone with known/suspected CAD
    • DM, women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What arrhythmia s/s indicate for ambulatory EKG monitoring?

A
  • Unexplained syncope/near syncope
  • Episodic dizziness, unexplained recurrent palpitations
    • Frequent palpitations/palpitations associated w/other s/s: SOB, dizziness, etc
    • Vasovagal event precipitated by something (feel like I’m going to pass out)
    • Passing out
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Types of ambulatory Monitoring

A
  • Continuous EKG (Holter)*
  • Event (loop) monitors
  • Patch monitors*
  • Mobile Cardiac Outpatient Telemetry (MOCT)
  • Insertable cardiac monitoring

*** = see in primary care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Holter monitor

A
  • Best for daily or near daily symptoms and/or if continuous monitoring of all cardiac activity is required (gives you most info for shortest time)
    • Daily palpitations or dizziness
    • Assessment of rate control in afib (short time period to see rate) don’t need 30days, only snippet
  • Continuously records heart rhythm
  • Usually worn for 24-48 hrs
  • 3-5 electrodes on chest
  • Patient keeps symptom diary
    • Hit a button
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Patch monitor

A
  • Good for pts w/less frequent s/s or need for longer monitoring
    • Weekly or every other week s/s
  • More convenient and easier for pt to tolerate than Holter
  • Small all in one device - ONE electrode
  • Record only single lead but can record continuously for up to 30 days
    • 3, 7, 14, or 30d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Event Monitor

types

A
  • Good for less frequent symptoms (weekly or bi-weekly)
  • Not recording unless patient hits the button when they’re experiencing s/s → problem is the monitor may not be able to capture the duration while it’s occuring
  • Pre-symptom memory loop recorders - “continuous loop event recorder” - always recording and erasing data
    • Not for asymptomatic
  • Post-event recorders - “non-looping event recorder”
    • May miss rhythm problem
  • Auto-detect - GOOD FOR ASYMPTOMATIC automatically sends data to provider to interpret
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Insertable cardiac monitor

A
  • May be needed if other event monitors can’t provide enough data
  • Use if symptoms are infrequent
  • Size of pack of gum
  • Can be programmed to record when patient activates it or when s/s occur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cardiac stress tests

Indications? What limitation and other option is there?

A
  • Exercise stress testing used in symptomatic, intermediate-risk patients who can exercise and who have interpretable EKG results
  • No exercise → pharmacologic stress test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is stress testing NOT used?

A
  • In high-risk patients actively evaluated or treated for ACS; it may be used once ruled out ACS for risk stratification
  • Exercise stress testing not recommended in asymptomatic, low-risk patients
  • None on pt w/acute MI, going to ER w/CP → have it later on
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stress testing indications (7)

A
  • New CP or angina (not current) ASK THIS!
  • Known CAD and new/worsening symptoms (cardiac disease)
  • Hx of PCI/re-vascularization (stenting)
  • Valvular heart disease - stress ECHO
  • New HF or cardiomyopathy - evaluate ischemia as cause
  • Pre-operatively in pts w/known cardiac conditions
  • Assess heart health prior to cardiac rehab or new exercise regimen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Contraindications to Stress Testing

Absolute!

A
  • Acute MI w/in 48hrs
  • Acute myocarditis/pericarditis
  • Rapid Afib or ventricular arrhythmias
  • Symptomatic severe aortic stenosis
  • Severe anemia, acute illness, infection
  • Uncontrolled hyperthyroidism
  • Acute aortic dissection, PE, recent CVA (stroke)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Contraindications to stress testing

Relative - cardiology would decide

A
  • Hypertrophic obstructive cardiomyopathy
  • Suspected L main disease > 50%
  • Severe HTN, > 200/110 mmHg
  • Congestive heart failure (CHF)
  • Severe ST depression at rest (unstable angina)uPermanent Pacemakers/ LBBB
    • Left bundle branch blocks
    • Specific way to stress ppl with these to get data
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the components of a stress test?

A
  • Stressor: exercise or pharmacologic
  • Imaging modality: EKG, Echo, Nuclear (myocardial perfusion imaging - MPI)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Exercise (2 imaging tests) vs Pharmacologic (drug) as stressor

Imaging for each type?

A
  • Exercise as Stressor - PREFERRED
    • EKG imaging only = Exercise Tolerance Test (ETT) Level 1 stress test
    • Nuclear imaging = Treadmill Nuclear Stress Test
  • Pharmacologic as Stressor (drug)
    • Always includes either nuclear or echocardiogram imaging
    • NOT EKG monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Best way to stress the heart?

A

EXERCISE PREFERRED

21
Q

When should a patient not utilize exercise as a stressor?

Limitations

A
  • Not able to exercise to 85% of age-predicted max HR
  • On BB or other AV blocking agents inhibiting HR increase needed
    • Take these off - sensitivity to detect coronary stenosis reduced

Consider these patients for pharmacologic stress testing

22
Q

Can your patient exercise to a satisfactory level?

Algorithm

A

If pt on BBs or other AV blocking agents, or have any conditions (LBBB, paced rhythm) that would inhibit HR increase needed to achieve stress or reduce stress test sensitivity → YES → Pharmacologic

Need to be mental and physical limitations (respiratory, elderly, dementia)

23
Q

What do you always need before a stress test?

A

Baseline EKG

24
Q

Bruce Protocol vs Modified Bruce Protocol (treadmill)

A
  • Bruce Protocol - most common in office-based testing - extensively validated
  • Modified Bruce Protocol - can be used in patients unable to complete Bruce protocol - going slowly
25
Who needs a Pharmacologic Stress Test?
* Any patient unable to exercise to a satisfactory workload * Patients w/baseline LBBB or ventricular pacing * Electric pathway not in line - make sure heart is getting adequate perfusion - need more tracing
26
Does Pharmacologic Testing include imaging?
YES
27
What kind of meds are involved in pharmacologic stress test?
Vasodilating agents Ionotropes/chronotropes
28
Vasodilating agents MOI
* Increase coronary blood flow by acting on Adenosine receptors in heart - primarily A2A * When activated these receptors result in vasodilation * Also present in brain, lungs, spleen * **Preferred agents for stress testing** * Can be combined w/low level exercise → decrease SEs from vasodilator + provide better assessment of exercise capacity
29
Vasodilating agents: which drugs
Adenosine Regadenosen (selective for A2A receptors - **best tolerated**) Dipyridamole (long ½ life; not used as frequently)
30
Vasodilating agents Contraindications
* Significant reactive airway disease such as asthma (acting on beta receptors) * Significant HoTN * High degree AV block * Unstable or complicated ACS * Theophylline and caffeine should be withheld prior to vasodilator stress * Theophylline hold for 48 hours; caffeine for 12 hours
31
Dobutamine
* (+) ionotrope and chronotrope → stimulates beta1 and beta2 receptors * Rapid onset (1-2m) + short half-life * Can be given w/ atropine to achieve target heart rate if needed * **Preferred agent in stress echos: 2nd in MPI - nuclear**
32
Dobutamine contraindications
* Sustained arrhythmias or Afib w/RVR * Recent MI/unstable angina * Aortic dissection * Moderate to severe HTN (SBP \> 180)
33
Purpose of imaging the heart
* Helps determine whether inducing stress (using exercise or pharmacologic agents) caused myocardial ischemia → significant coronary stenosis * Imaging types: EKG, Echo, Nuclear
34
Which test(s) require a cardiac stress agent?
Nuclear stress/stress echo
35
Does the patient have an abnormal baseline EKG? Yes → then what? No → then what?
* No → ETT * Yes → add imaging to stress
36
List of abnormal baseline EKG reading conditions
* LVH - any wall abnormalities - echo (structural) * LBBB * Paced rhythm * WPW syndrome * ST-T wave changes \> 1mm * On digoxin * Hx of revascularization, angiography
37
Nuclear Exercise Stress Test What
* Stress radionuclide myocardial perfusion imaging (rMPI) * _Single photon emission CT (SPECT)_ - common IMAGE * Can be used in exercise MPI or pharmacologic MPI OR * Positron emission tomography (PET) - more exepensive * ONLY used in pharmacologic MPI
38
Nuclear Exercise Stress Test Process
* IV Radioactive tracer administered → wait 30m → RESTING pictures taken 1st * Exercise/stress inducer starts → 2nd tracer administered → STRESS pictures taken * Total time 2-3hrs → longer than ETT * Compare REST VS STRESS pictures → see how well heart is perfused → cardiologist interprets this
39
SPECT imaging interpretation
* Gamma radiation measured directly * Images after 45 minutes of rest are compared to stress images * Nuclear imaging - **“cold spot” areas are considered areas of low or no blood flow → less activity** * Interpretation based on rest images * Re-perfused (ischemic area) → reversible defect * Fixed defect (infarct area)
40
ETT Imaging vs. W/o imaging
* W/o imaging * Provides ONLY EKG tracings * Acceptable for most patients who are able to exercise * W/imaging * Provides EKG TRACING and IMAGING * More sensitive * For pt who is ABLE TO EXERCISE w/any of following * WPW (ventricular pre-exication) * ST-T wave changes * LVH * On digoxin * Requires ischemia localization or assessment of viability
41
Stress test preparation (7 things)
* **NPO 4hrs prior** * **No caffeine for 24hrs prior** * Meds to hold day of test: Isosorbide, NTG, BBs, CCBs * No smoking 4hrs prior * No exercise day of test * Comfortable shoes and clothing (no jumpsuit) * No lotions to help electrodes stick
42
Two types of echocardiogram
* Trans**thoracic** Echocardiogram (TTE) → on side, external * Trans**esophageal** echocardiogram (TEE) → going into behind the heart → need **sedation** Can have both done to get bigger picture of heart. Both dependent on skill level of technician
43
Echocardiogram indications
* _Structural evaluation_ * **Pericardium** (pericardial effusion) * **Ventricles** (hypertrophy, dilation, wall motion abnormalities, visualize thrombi) * Pumping appropriately * **Valves** (stenosis, prolapse * **Great vessels** (aortic dissection) * **Atria and septa** between chambers (congenital heart disease, trauma) * _Hemodynamic evaluation_ - blood flowing and how it's flowing * Blood flow through **valves** (stenosis, regurgitation) * Stenosis - blood not able to get through (only a little) * Regurgitation - goes through but comes back * Blood flow through **chambers** (ejection fraction) * How efficient the heart is pumping and how it's pumping out
44
Conditions to order an Echo for (8)
* New or monitoring * Valvular disease (suspected) * CHF * LVH/cardiomyopathy * New afib - look at valves * Pulmonary HTN (suspected) * Post ACS/pts w/CAD - remodeling of heart structure * Congenital heart disease * Endocarditis or thrombus or tumor
45
TTE
* Most common * Less invasive with no prep * Image quality affected by amount of tissue between transducer and chest * Difficult to see **posterior images**
46
TEE and indications
* Clearer image - behind heart, not as optimal for front of heart * **Sedation** * **Fasting 4-6hrs prior** * Esophagus can restrict transducer position * Indications * Concern for infective endocarditis/complications of * Suspected acute aortic pathology * IF TTE non-diagnostic w/high suspicion for cardiac etiology * Complex congenital disease
47
Bubble study Testing for? Risk of having this?
Shake saline and pump BUBBLE into vein → if they see bubble travel to other side of heart (go into LV) - Patent Foramen Ovale +PFO → clot → stroke
48
Stress echocardiogram Purpose + Process
* Stress test + ECHO * Allows eval of cardiac function to see if parts of heart not getting perfused * Real-time eval of cardiac function from exercise * Echo before and after exercise * Same considerations and patient selection criteria * Rest echo → Treadmill, bicycle, or pharmacologic stress → immediate post-exercise echo
49
Stress Echo indications
* THINK STRUCTURE OF HEART * Detection and eval of intra-ventricular gradients in hypertrophic cardiomyopathy * See how blood flow is through valves * Can see ischemic changes * Eval of LV wall motion abnormalities * Eval pulmonary HTN, mitral regurgitation, mitral stenosis during exercise w/pulmonary artery systolic pressure - help w/surgical decision * Can see ischemic changes w/ventircular hypokinesis, akinesis, or dyskinesis

NP 730 Diagnostic Measures (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions