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Diagnostics Exam 2 > Cardiac Imaging > Flashcards

Cardiac Imaging Flashcards

1
Q

What are the indictions for EKG?

A
  • cp, palpitations, fatigue/sob, syncope, seizure
  • evaluate for aarrythmia, murmur, electrolyte imbalance, PE, CHF, cardiomyopathy, poisonings/electrocution
  • drug monitoring
  • check for defibrillator, pacemaker
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2
Q

What is the ASCVD risk score?
What is a good or bad score?

A

ASCVD is a 10 year CVD risk rating
Below 7.5% is low risk
Equal to or Above 7.5 is elevated risk

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3
Q

What can an EKG help diagnose?

A
  • MI or potential CVD
  • Detect arrythmias
  • PE
  • Enlargement of ventricles
  • electrolyte disturbances
  • drug effects on the heart
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4
Q

What is the electrical pathway of the heart? (

A

SA node –> internodal pathway –> AV node –> bundle of his –> left and right bundle branches –> purkinje fibers

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5
Q

What are the indications for stress testing?

A
  • new cp or angina
  • new hf of cardiomyopathy
  • pre-op for patients with known cardiac conditions
  • known cad and new or worsening sx
  • valvular heart disease
  • to assess heart health prior to new exercise regime or cardiac rehab
  • hx of pci or revascularization) more than 5 yrs after CABG and 2 yers after pci if asx
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6
Q

ABSOLUTE contraindications to stress testing? (11)

A
  • acute MI within 48 hrs
  • acute myocarditis or pericarditis
  • rapid afib or ventricular arrhythmias
  • sx severe AS
  • severe anemia, acute illness, infx
  • uncontrolled hyperthyroidism
  • acute aortic dissection, PE, recent CVA
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7
Q

RELATIVE contraindications

A
  • Hypertrophic obstructive cardiomyopathy
  • suspected left main diseases (greater than 50%)
  • severe htn (200/110)
  • chf
  • severe ST depression at rest
  • permanent pacemakers/LBBB
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8
Q

What type of imaging needed for pharmacologic stress test?

A

always nuclear or echocardiogram imaging

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9
Q

When is pharmacologic stress test indicated?

A

If the patient is not able to exercise adequately to achieve 85% of the age-predicted max heart rate

OR

when beta-blockers or other AV blocking agents inhibit the heart rate increase needed

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10
Q

What vasodilators are used for pharm stress test?

A
  • lexiscan (best tolerated)
  • adenosine
  • dipyridamole (used less frequently)

Contraindications:
- significant reactive airway disease (asthma)
- significant hypotension
- high degree AV block
- unstable or complicated ACS

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11
Q

What is troponin?

A

a protein found in cardiac and skeletal muscle that helps with contraction

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12
Q

When is troponin detectable?
When does troponin peak?

A

2-4 hours after cardiac injury
Peaks at 12 hours

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13
Q

When is troponin released?

A

It’s released when the muscle cells are damaged

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14
Q

What is the ACC/AHA definition of ACS?

A

“A group of clinical syndromes compatible with acute myocardial ischemia”

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15
Q

What is the physiologic definition of ACS?

A

Plaque rupture leading to thrombus formation, leading to partial or complete blockage of coronary artery with or without myocyte death

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16
Q

What are differentials for chest pain?

A

Cardiac vs non cardiac

  • angina vs ACS
  • PE
  • Pericarditis
  • costochondritis
  • GERD
  • aortic dissection
  • PNA
  • CHF
17
Q

What are the ASCVD risk categories?

A

under 5% – low risk
5-7.5% – borderline risk
7.5–20% – intermediate riks
above 20% – high risk

18
Q

What should cholesterol levels be at?

A

LDL under 100
Total cholesterol 125 to 200

19
Q

What factors are included in ASCVD risk calculation?

A

Age
Sex
Race
BP
Total cholesterol, HDL, LDL
Hx of diabetes
Smoker (yes, no, former)
On HTN tx?
On a statin?
On aspirin?

20
Q

What is VLDL and what does it do?

A

Very low density lipoprotein
It carries mainly triglycerides

21
Q

What are triglycerides?
What do they do?
What is a healthy number?

A
  • Triglycerides are fatty acid chains that are transported to tissues for energy.
  • Unused calories are converted into triglycerides for storage in fat cells
  • Triglycerides increases LDL, decreases HDL
  • Healthy triglycerides = under 150
22
Q

How is non-HDL cholesterol calculated?

A

Total cholesterol - HDL = Non HDL

23
Q

How to check for re-infarction or occlusion pots coronary intervention?
WHY??

A

Check CK-MB

Troponin stays elevated longer (back to baseline 7-14 days), so it’s hard to know if a new infarct has occurred.

CK-MB is not as sensitive a cardiac marker, but returns to baseline numbers within 48-72 hrs, so if there has been a new infarct, an elevated CK-MB would be the way to identify it.

24
Q

What does INOCA mean?
What does MINOCA mean?

A

INOCA: Ischemia with non-obstructive coronary disease
MINOCA: MI with non-obstructive coronary arteries

  • more common in women, younger, black or hispanic/latinx
  • accounts for up to 14% of MIs
  • underlying etiologies: spontaneous artery dissection, plaque rupture, erosion, clot resolved before cath, microvascular angina (syndrome x), coronary artery vasospasm (variant angina or prinzmetal angina)
25
Q

What is the H.E.A.R.T. score? What are the 3 levels of risk?

A

H: history
E: ECG
A: age
R: risk factors
T: troponin

** each category gives 0, 1, or 2 points

Score of 0-3 = low risk
4-6 = moderate risk
7-10 = high risk

26
Q

What are the different BNP levels?
What factors alter BNP reliability?

A

obesity skews BNP low
High creatinine skews BNP high

BNP under 100 = NO hf
BNP 100-300 = suggest hf
BNP above 300 = mild hf
BNP above 600 = moderate hf
BNP above 900 = severe hf

27
Q

What is d-dimer?
How is it used? Why is it faulty?

A

D-dimer is one of the degradation products released upon clot breakdown

Highly sensitive for evaluating DVT/PE
Poor specificity (because other conditions can elevate d-dimer: pregnancy, renal failure, malignancy, recent trauma, sepsis)

28
Q

What is the Wells score?
What do the scores mean?

A

Assesses risk of DVT

greater than 6 = high probability
2 to 6 = moderate probability
less than 2 = low probability

Diagnostics Exam 2 (2 decks)

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