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Imaging Clinical Decision Making > Cardiac Imaging > Flashcards

Cardiac Imaging Flashcards

1
Q

What is the accumulation of lipid-rich materials on the surface of, or within the sub-endothelial layer of muscular arterial vessels.

A

Atherosclerosis

Considered the sequellae of chronic inflammatory reaction to injury to the blood vessel wall.

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2
Q

What do atheromas contain histologically (3)

A

Fat
Macrophages
T cells
+ other elements

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3
Q

Advancing atherosclerosis is associated with increasing ____________ content in plaques

A

Calcium

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4
Q

What would your workup be for a coronary artery disease in asymptomatic patients to determine risk for future coronary artery event? (3)

A
  • Framingham Risk Assessment
  • Stress ECG is the first step
  • Electron Beam CT (EBCT)
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5
Q

Gender-specific algorithm used to estimate the 10-year cardiovascular risk?

A

Framingham Risk Assessment

When used in conjunction with Electron Beam CT, the 2 represent a fairly powerful risk assessment matrix

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6
Q

What does the Framingham Risk Assessment mean at each of these levels:

1) low risk (e.g. _____% risk at ___# years)
2) intermediate risk
3) high risk

A

1) 10% or less CHD risk at 10 years
2) 10-20% risk
3) >/= 20% risk

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7
Q

What is the first step in nearly all scenarios for an asymptomatic patient to determine risk for future coronary artery event

A

Stress ECG

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8
Q

Pros for Stress ECG

A

Cheap, available, fast, non-invasive

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9
Q

Cons for Stress ECG

A

Relatively low sensitivity, many non-diagnostic findings, does not localize ischemia

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10
Q

Aim of Stress ECG

A

Adequate workload (W/kg, age dependent), at least submaximal heart rate 0.8x(220-age)

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11
Q

What is the submaximal heart rate equation that Stress ECG aims for

A

0.8x(200-age)

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12
Q

What test can quantify the presence of calcium (even small amounts in small anatomy) in coronary arteries

A

Electron Beam CT (EBCT)

When used in conjunction with Framingham Risk Assessment, the 2 represent a fairly powerful risk assessment matrix

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13
Q

The result of the EBCT test is a calcium score, the higher the score, the greater the:

A

Risk for health problems

  • Score of 100 is “high risk” depending on age and gender
  • Greater than 400 is BAD
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14
Q

What is your workup for coronary artery disease in symptomatic patients (8)

A

1) plain films FIRST
2) ECG
3) Scintigraphy
4) PET scan
5) Cardiac ultrasound
6) CT angiography
7) Cardiac MRI
8) Conventional angiography

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15
Q

What is the first test if you suspect coronary artery disease in a symptomatic patient

A

Plain film

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16
Q

Benefits of plain film

A

Inexpensive
Low radiation burden
Effective at identifying cardiac size, shape, global relationship between heart and lungs

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17
Q

The diagnostic yield for plain films is low, but so is

A

Cost and radiation burden

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18
Q

The sensitivity and specificity to identify late disease in the chest are relatively _______ in plain film

A

High

19
Q

How does plain film do with calcification in the vasculature and pulmonary parenchyma

A

Moderately sensitive

20
Q

Plain film has very low sensitivity to most diagnostically and therapeutically significant findings of cardiovascular disease, until

A

late in the natural history when decompensation of the heart and lungs is occurring

21
Q

Thallium and Technetium are isotopes of choice for conventional heart _____

A

Scintigraphy

Areas of tracer uptake are measured — looking for “cold spots” of ischemia or infarction

22
Q

Scintigraphy is more sensitive than ____

A

Stress ECG alone

23
Q

Scintigraphy is valuable with stress testing to identify areas of

A

Transient ischemia

25
Q

IV radioactive agent that binds to membranes in cardiac muscle

A

18 Fludeoxyglucose for PET scan

26
Q

What are you looking for in PET scan

A

Gamma radiation emission

Measurement of relative left ventricular perfusion

27
Q

Pros of PET scan

A

Quantification and localization of ischemia, high specificity, offers estimate of tissue viability

28
Q

Cons of PET scan

A

Intermediate sensitivity, high radiation dose, very expensive, technically difficult to conduct

29
Q

What dynamic study allows real-time visualization of cardiac muscle as well as blood flow through the heart, great vessels and with specialized transducers, the coronary vessels

A

Cardiac ultrasound

30
Q

What study allows aberrant motion and function to be isolated?

A

Cardiac ultrasound

E.g. visualization of heart movement and contractility at rest and during chemical stress

31
Q

The trans-thoraco echo (TTE) uses

A

Intercostal probe

32
Q

The trans esophageal echo (TEE) visualizes the heart from within the esophagus. What are the risks?

A

Sedation

33
Q

What is superior, TEE or TTE?

A

Trans esophageal echo is better because it has superior images

34
Q

When TEE is performed with stress ECG it detects:

A
  • Ischemia
  • Viability
  • Low-gradient aortic stonisis
35
Q

What can measure Left Ventricular Ejection Fraction?

A

Trans esophageal echo (TEE)

36
Q

Iodine-based contrast injected, beta-blocker administered to slow HR and nitroglycerin to dilate coronary arteries

A

CT angiography

Note: ECG gating- imaging during end-diastole

37
Q

Pros of CT angiography

A

Superb sensitivity, fast, additional anatomic information, calcium score

38
Q

Cons for CT angiography

A

Lower specificity for ischemia, poor performance in A-fib, requires Helical, rapid CT and experienced interpretation

39
Q

IV Gadolinium contrast agen, prosepctive imaging planes

A

Cardiac MRI

40
Q

Pros for Cardiac MRI

A

Best for myocardial disease, LV and RV volumes, masses, function and viability testing and for congenital heart disease

41
Q

Cons of Cardiac MRI

A

Expensive, time consuming, difficult to interpret, perfusion, stress and wall motion MRI are rarely available, does not resolve coronary arteries as well as CT, CT angiography, echo or conventional angiography

42
Q

Access site via radial, femoral or brachial artery with Seldinger technique (needle, wire, sheath)

A

Conventional angiography

43
Q

Selective engagement of left and right coronary Ostia

A

conventional angiography

44
Q

Pros for conventional angiography

A

Gold standard for coronary stenosis assessment, allows simultaneous stent placement, additional intravascular imaging and pressure measurement

45
Q

Cons for conventional angiography

A

Expensive, bleeding and contrast nephropathy

Imaging Clinical Decision Making (4 decks)

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