CARDIAC IMAGING Flashcards
CONTRAINDICATION TO EXERCISE STRESS TEST.
- Acute MI within 2 days
- Ongoing unstable angina
- Uncontrolled hmd significant arrhythmia
- Active endocarditis
- Symptomatic severe AS
- Decompensated HF
- Acute PE
- Pulmonary infarction
- DVT
- Acute myocarditis/pericarditis
- Acute Aortic dissection
- Physical limitations
POSITIVE STRESS TEST
> 1mm STE
1 mm STD ( horizontal or downslowping)
high risk features on stress test
– Duke Treadmill Score -11 or less
– <5 METs achieved
– Low threshold angina / ischemia
– STE
– Severe STD ≥ 2mm
– Ischemia on ≥ 5 leads
– Ischemia ≥ 3 mins into recovery
– Abnormal BP response
[failure to achieve SBP>120, drop in BP >10, drop below baseline]
– Ventricular arrhythmia
most common pharmacological stress test
Dipyridamole (aka persantine) most commonly used for nuclear stress
most common substance used for stress echo
dobutamine
drug interaction with dipyridamole
- caffeine
- theophyline
false negative non-pharmacological stess test
- severe flow limiting ( triple vessel/left main disease)
contraindications to pharmacological stresss test
- severe asthma/copd ( as dypiridamole can cause born chospasm)
reversal agent for dipyridamole
aminophylline
indication for Coro CT angio
- CAD dx w/ low intermediate probability patients
- risk stratification with stable CAD
whend o you do a coronary calcium score
- furhter risk stratificaton of intermediate risk patients ( FR 10-19%)
- asx patients >40y not candidate for statin
- fhx premature CV disease
- genetic dyslipidemia
CI to coronary angio CT
- ACS
- Strucutral heart disease ( AS/HCM)
- contrast allergy
- pregnancy
- renal failure
CAC score above 100, what do you start
statin