Cardiac Imaging and Supplemental Flashcards by Korey koper

Holter monitor Type?

Electrophysiology

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Holter monitor indications?

Palpitations - especially

Syncope

Unexplained fatigue or dyspnea

work up and then everything is negative well it might be time for a home monitor

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Holter monitor - explanation?

Evaluates the general conduction of the heart for for 24 hours or more ( up to a month)

Creates recording

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Holter monitor - quality of test?

Only useful if symptomatic while wearing the monitor

Only use full if they are symptomatic …otherwise you are just going to see sinus rhythms

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Holter monitor methodology / procedure?

3-8 electrodes placed on body
Records general conduction of heart
Typically worn for about 24 hours
Sent to medical company for evaluation

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Normal Holter monitor interpretation?

Normal sinus rhythm

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Abnormal Holter monitor interpretation?

Atrial fibrillation or flutter
Multifocal atrial tachycardia
Paroxysmal supraventricular tachycardia ( AVNRT)
Ventricular tachycardia
Bradycardia

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Holter monitor Interpretation and diagnosis ?

Atrial fibrillation or flutter
Multifocal atrial tachycardia
Paroxysmal supraventricular tachycardia
bradycardia
Ventricular tachycardia

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Further testing after holder monitor?

Event monitor
Stress test
Cardiac catheterization

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Types of stress testing?

Electrophysiology OR

Perfusion OR ( nuclear study yo ID blood flow and actual perfusion in the heart)

Echocardiography US of heart, ID abnormalities of the heart walls

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Indications of stress testing

Angina - especially
Abnormal EKG- LBBB people may not have pain but EKG s abnormal indicative of CAD

Unexplained:
Fatigue
Dyspnea

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Stress test explanation?

Stresses the heart by exercise or medication which causes damage and demand for the heart so we look for areas that become ischemic.

Evaluates for reproducible ischemia

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Stress test quality of test?

Considered a provocative test
Less invasive than cardiac catheterization

Not the gold standard for evaluation of coronary artery disease

When is a stress test not appropriate - COPD, >65 abnormal EKG finding then we can jump right to cardiac catheterization instead of stress test. low risk chest pain individuals is the best indication to use stress test.

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Contraindication to Stress test?

recent MI

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Complications to stress test?

Ischemia

MI, 1 in 1000 ( more common if recent one)

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Limitations or interferences to stress test?

Exercise tolerance, or overweight and have severe osteoarthritis (knees hurt to much to run)

10-30% false positive rate

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Methodology / Procedure for Stress test?

12 lead EKG electrodes set up on patient

Option of echo OR
Perfusion

Treadmill ( cheap but they need to be in decent health) or medication like Dobutamine or
Adenosine ( induces ischemia)

Evaluate for ischemia

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Stress Test Interpretation, normal values?

Tachycardia with no ischemia

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Stress Test Interpretation, abnormal values?

> 1mm ST depression - (60-80% of people with significant CAD identified ( but remember the false positive rate) we will still probably move on to cardiac catheter cause it is abnormal stress test. )

> 2mm ST depression ( severe CAD)

convex - fowny face - bad

concave - happy face - good

ST depression indicates ischemia during stress but not death of the heart - so this is a positive stress test ( 2mm or more is a positive stress test )

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Stress Test abnormal perfusion interpretation?

Mismatches

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Stress Test abnormal echo interpretation?

Valve abnormalities

Ejection fraction
is it changing?

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Diagnosis of stress test ?

Coronary Artery Disease

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A stress test can indicate further testing is needed, like what?

Cardiac catheterization - coronary angiography

if stress test is positive ? yes

some patients we just go right to this

if stress test is neg? we are done we do nothing

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Cardiac Catheterization ( angiography) type?

Imaging

Cardiac Catheterization indications? | skip stress test a go right to CC

MI Angina Abnormal stress test Cardiac surgery prep ST segment elevation - standard of care is within 90 min get then to the cath lab and and have a balloon angioplasty ready

Background for CC?

Evaluates for stenosis of coronary vessels Gold standard for coronary artery disease May also be used to look at valves and cardiac output

Contraindications with CC?

Severe contrast allergy

Complications for CC?

Puncture Hematoma - femoral artery Aneurysm

Methodology / Procedure for CC?

Cather placed in artery (typically femoral) Threaded to ascending aorta Fluoroscopy: - Cather placed in right coronary and contrast injected - Placed in left coronary and contrast injected

Normal value for CC interpretation?

No stenosis no plaques or “areas bitten out of it” - nice vessel outlines as it goes down - 0% stenosis - clean vessels

Abnormal value for CC interpretation?

Stenosis

Diagnosis using CC?

CAD - severity (% stenosis)

Mild CAD?

<50% stenosis - do not do anything - just watch it, no angioplasty a lot of people have coronary disease but it has not yet caused symptoms

>50% stenosis on CC?

clinically significnt

>70% stenosis on CC?

very significant ( likely to cause ischemia)

CC is the gold standard for CAD and is better than stress tests but they are more _________ and ________ and you can also imply ____ (stents)

expensive invasive PCTA severe symptoms require stenting some people have many stents at one time

Patient education if pos. CC?

Educate about CAD and lifestyle risk factors May be candidate for CABG

ABI type?

manual test

Indications for ABI?

``` Signs of Peripheral arterial disease Leg pain Leg swelling Discoloration of legs Abnormal pulses intermittent claudication ```

Where is the main site for atherosclerosis to occur?

superficial femoral artery

ABI background?

checks for decrease in blood flow in peripheral arteries

ABI quality of test?

sensitive for significant PAD specificity is not as high cause other causes like DM, vasculitis and dissection

Methodology / Procedure for ABI?

Take systolic blood pressure of b/l brachial artery Take systolic blood pressure of b/l dorsalis pedis and posterior tibialis Calculate ratios: Right= Lower extremity/ Upper extremity Left= Lower extremity/ Upper extremity

ABI interpretation, Normal value?

>0.9 (0.9-1.30) - Normal

ABI, mild PAD value?

0.89-0.60  Mild PAD

ABI, moderate PAD value?

0.59-0.40  moderate PAD

ABI, severe PAD value?

<0.39  Severe PAD

ABI interpretation and diagnosis?

Decreased lower extremity blood flow Degree of peripheral arterial disease

ABI interpretation diagnosis of further testing include?

Peripheral angiogram Can identify site stent can be placed

Peripheral Angiography type?

Imaging

Indications for Peripheral Angiography?

Abnormal ABI | Concern for PAD

Test Explanation and background for Peripheral Angiography?

Evaluates for stenosis with contrast in lower extremity arteries GS for identifying a PAD

Peripheral Angioplasty Quality of test?

Gold standard for identifying lesions in PAD

Peripheral Angiography contraindications?

Severe contrast allergy

Complications for Peripheral Angiography?

Arterial damage

Methodology / Procedure for Peripheral Angiography?

1. Catheter placed in artery (most commonly femoral) 2. Threaded to aorta 3. Contrast injected 4. Fluoroscopy identifies blood flow ) live X-RAY

Normal Peripheral Angioplasty finding?

No stenosis

Abnormal Peripheral Angioplasty finding?

Stenosis

Peripheral Angioplasty will diagnose PAD and the location of stenosis, where are some locations?

Superficial femoral artery Popliteal Artery Degree of stenosis can place a stent helps with planning for bypass