Cardiac Imaging/Labs

Question 1

Pulsus paradoxus

Answer 1

• Drop in systolic pressure by 10+ mm Hg during inspiration

- D/t increased pressure in thoracic compartment

Question 2

Pulsus alterans

Answer 2

Pulse alternates in amplitude from beat to beat when rhythm is normal

Question 3

What might pulsus alterans suggest?

Answer 3

LV failure

Question 4

2 types of murmurs:

Answer 4

1. Stenotic

2. Insufficient (regurgitation)

Question 5

Approach to the cardiac patient by NYHA guidelines:

Answer 5

1. Underlying etiology
2. Anatomic abnormality present (or not)
3. Physiologic disturbance or not
4. Functional disability or not

Question 6

BNP - what is it, where is it produced?

Answer 6

• Brain natriuretic peptide
• Made in the ventricles
• Marker for ventricular dysfunction

Question 7

When do BNP levels increase?

Answer 7

-In response to increased ventricular volume and pressure overload (decreased EF)

Question 8

What is BNP useful in diagnosing/assessing?

Answer 8

Severity of CHF

*400+ pg/dL is high predictor for CHF

Question 9

What are the 3 CK isoenzymes?

Answer 9

1. CK-BB (brain/lung)
2. CK-MB (myocardial cells)
3. CK-MM (skeletal muscle)

Question 10

Tell me about CK-MB levels

Answer 10

• Levels rise 3-6 hours after infarction

- Peak 12-24 hrs and return to normal 12-48 hrs after infarction IF no further damage

Question 11

What does CK-MB tell us about an infarct?

Answer 11

• Quantifies the severity of an MI

- Determines the onset of an MI

Question 12

Myoglobin is more ___ than CK isoenzymes but not as ____

Answer 12

More sensitive

Not as specific

Question 13

Tell me about myoglobin levels

Answer 13

• Rise in 2-3 hours after muscle injury/death

- Peaks at 6-9 hours

Question 14

What is LDH?

Answer 14

• Lactate dehydrogenase

- Increased levels indicate cellular death and leakage of the enzyme from the cell

Question 15

What do elevated levels of LDH indicate?

Answer 15

• Nonspecific

- Increase 36-55 hrs after MI (but can increase d/t a number of things)

Question 16

What are troponins?

Answer 16

• Proteins present in skeletal and cardiac muscle
• Regulate Ca interaction for contraction
• Types = TC, TI, TT

Question 17

What are cardiac troponins?

Answer 17

T and I

Question 18

When do Troponin I and T levels increase/return to normal?

Answer 18

• 1-3 hours after injury

- Returns to normal within 5-7 days

Question 19

Troponin I remains increased longer than ___ and is more cardiac specific

Answer 19

CK-MB

Question 20

Troponin T is more ___ than CK-MB but less ___

Answer 20

More sensitive

Less specific

Question 21

What is the preferred test to diagnose an MI?

Answer 21

Troponins

Question 22

Why do we care about AST levels?

Answer 22

• Increased with an MI

- Not specific though

Question 23

What does a lipid panel include?

Answer 23

Total cholesterol
LDL
HDL
Triglycerides

Question 24

Types of echo

Answer 24

Transthoracic (TTE)

Transesophageal (TEE)

Question 25

What is the gold standard for evaluating valve morphology and motion?

Answer 25

TTE

Question 26

What is the gold standard for detecting pericardial effusions and tamponade?

Answer 26

TTE

Question 27

What is the advantage of TEE?

Answer 27

Gives more detailed pic of heart (especially posterior structures - LA, mitral valve, aorta)

Question 28

What is the difference between Holter and Event monitoring?

Answer 28

Holter = 24-48 hour recording Event = up to 30 days recording *Both are continuous EKG*

Question 29

What is the basic principle behind exercise stress testing?

Answer 29

- Occluded arteries will be unable to meet heart's increased demand - Pt will become symptomatic or develop EKG changes

Question 30

What is the gold standard in assessing anatomy and physiology of the heart?

Answer 30

Cardiac cath and coronary angiography

Question 31

What is the MC risk with cardiac cath and coronary angiography?

Answer 31

Access site bleeding