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Clinical Medicine LAB - Professor Sample > Cardiac Imaging and Supplemental > Flashcards

Cardiac Imaging and Supplemental Flashcards

1
Q

Holter monitor Type?

A

Electrophysiology

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2
Q

Holter monitor indications?

A

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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3
Q

Holter monitor - explanation?

A

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

Creates recording

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4
Q

Holter monitor - quality of test?

A

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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5
Q

Holter monitor methodology / procedure?

A
  1. 3-8 electrodes placed on body
  2. Records general conduction of heart
  3. Typically worn for about 24 hours
  4. Sent to medical company for evaluation
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6
Q

Normal Holter monitor interpretation?

A

Normal sinus rhythm

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7
Q

Abnormal Holter monitor interpretation?

A 
Atrial fibrillation or flutter
Multifocal atrial tachycardia
Paroxysmal supraventricular tachycardia ( AVNRT)
Ventricular tachycardia
Bradycardia
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8
Q

Holter monitor Interpretation and diagnosis ?

A 
Atrial fibrillation or flutter
Multifocal atrial tachycardia
Paroxysmal supraventricular tachycardia
bradycardia
Ventricular tachycardia
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9
Q

Further testing after holder monitor?

A

Event monitor
Stress test
Cardiac catheterization

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10
Q

Types of stress testing?

A

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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11
Q

Indications of stress testing

A

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

Unexplained:
Fatigue
Dyspnea

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12
Q

Stress test explanation?

A

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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13
Q

Stress test quality of test?

A

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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14
Q

Contraindication to Stress test?

A

recent MI

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15
Q

Complications to stress test?

A

Ischemia

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

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16
Q

Limitations or interferences to stress test?

A

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

10-30% false positive rate

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17
Q

Methodology / Procedure for Stress test?

A

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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18
Q

Stress Test Interpretation, normal values?

A

Tachycardia with no ischemia

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19
Q

Stress Test Interpretation, abnormal values?

A

> 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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20
Q

Stress Test abnormal perfusion interpretation?

A

Mismatches

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21
Q

Stress Test abnormal echo interpretation?

A

Valve abnormalities

Ejection fraction
is it changing?

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22
Q

Diagnosis of stress test ?

A

Coronary Artery Disease

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23
Q

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

A

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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24
Q

Cardiac Catheterization ( angiography) type?

25
Q

Cardiac Catheterization indications?

skip stress test a go right to CC

A

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

26
Q

Background for CC?

A

Evaluates for stenosis of coronary vessels

Gold standard for coronary artery disease

May also be used to look at valves and cardiac output

27
Q

Contraindications with CC?

A

Severe contrast allergy

28
Q

Complications for CC?

A

Puncture
Hematoma - femoral artery
Aneurysm

29
Q

Methodology / Procedure for CC?

A

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
30
Q

Normal value for CC interpretation?

A

No stenosis

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

31
Q

Abnormal value for CC interpretation?

32
Q

Diagnosis using CC?

A

CAD - severity (% stenosis)

33
Q

Mild CAD?

A

<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

34
Q

> 50% stenosis on CC?

A

clinically significnt

35
Q

> 70% stenosis on CC?

A

very significant ( likely to cause ischemia)

36
Q

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

A

expensive
invasive
PCTA

severe symptoms require stenting

some people have many stents at one time

37
Q

Patient education if pos. CC?

A

Educate about CAD and lifestyle risk factors

May be candidate for CABG

38
Q

ABI type?

A

manual test

39
Q

Indications for ABI?

A 
Signs of Peripheral arterial disease
Leg pain
Leg swelling
Discoloration of legs
Abnormal pulses
intermittent claudication
40
Q

Where is the main site for atherosclerosis to occur?

A

superficial femoral artery

41
Q

ABI background?

A

checks for decrease in blood flow in peripheral arteries

42
Q

ABI quality of test?

A

sensitive for significant PAD

specificity is not as high cause other causes like DM, vasculitis and dissection

43
Q

Methodology / Procedure for ABI?

A

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

44
Q

ABI interpretation, Normal value?

A

> 0.9 (0.9-1.30) - Normal

45
Q

ABI, mild PAD value?

A

0.89-0.60  Mild PAD

46
Q

ABI, moderate PAD value?

A

0.59-0.40  moderate PAD

47
Q

ABI, severe PAD value?

A

<0.39  Severe PAD

48
Q

ABI interpretation and diagnosis?

A

Decreased lower extremity blood flow

Degree of peripheral arterial disease

49
Q

ABI interpretation diagnosis of further testing include?

A

Peripheral angiogram

Can identify site
stent can be placed

50
Q

Peripheral Angiography type?

51
Q

Indications for Peripheral Angiography?

A

Abnormal ABI

Concern for PAD

52
Q

Test Explanation and background for Peripheral Angiography?

A

Evaluates for stenosis with contrast in lower extremity arteries

GS for identifying a PAD

53
Q

Peripheral Angioplasty Quality of test?

A

Gold standard for identifying lesions in PAD

54
Q

Peripheral Angiography contraindications?

A

Severe contrast allergy

55
Q

Complications for Peripheral Angiography?

A

Arterial damage

56
Q

Methodology / Procedure for Peripheral Angiography?

A
  1. Catheter placed in artery (most commonly femoral)
  2. Threaded to aorta
  3. Contrast injected
  4. Fluoroscopy identifies blood flow ) live X-RAY
57
Q

Normal Peripheral Angioplasty finding?

A

No stenosis

58
Q

Abnormal Peripheral Angioplasty finding?

59
Q

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

A

Superficial femoral artery
Popliteal Artery

Degree of stenosis
can place a stent
helps with planning for bypass

Clinical Medicine LAB - Professor Sample (36 decks)

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