cardiac testing Flashcards
- MOST BASIC DIAGNOSTIC TEST (BESIDES THE PHYSICAL EXAM)
- AN ELECTRICAL TRACING OF CARDIAC ACTIVITY
- HEART RATE
- HEART RHYTHM
- INDIRECT EVIDENCE CORONARY PERFUSION/ LACK OF PERFUSION
- INDIRECT EVIDENCE OF STRUCTURE OF THE HEART
- NON-INVASIVE STUDY
- LITTLE-TO-NO RISKS OR CONTRAINDICATIONS
- 2.5 SECONDS SNIPIT
- SHOWS 12 DIFFERENT VIEWS/ANGLES SIMULTANEOUSLY
- EACH VIEW/ANGLE HAS A DIFFERENT NAME
- CAN BE PERFORMED IN MOST OFFICE SETTINGS
- OUTPATIENT/ URGENT CARE/ PCP
- CARDIOLOGY OFFICE
- ER
- INPATIENT HOSPITAL
- PRINTS OFF ON A SINGLE SHEET OF PAPER 8X11
EKG
- “AUTOMATIC MEASUREMENT AND
TRANSMISSION OF DATA AT A
DISTANCE BY RADIO, CELLULAR
OR OTHER MEANS.” - MOBILE CARDIAC MONITORING
- REAL TIME
- FOR PATIENTS WHO ARE AT THE
RISK OF DEVELOPING AN
ABNORMAL HEART RHYTHM - INPATIENT SETTING
- NO CONTRAINDICATIONS/NO
RISKS - NON INVASIVE
- ABNORMAL RHYTHMS ARE
SAVED/STORED AND PRINTED FOR
PROVIDERS TO REVIEW - TECHNICIANS ARE ALERTED
IMMEDIATELY IF ARRHYTHMIA
OCCURS
telemetry
- BATTERY-OPERATED PORTABLE DEVICE THAT MEASURES AND RECORDS YOUR HEART’S ACTIVITY (ECG) CONTINUOUSLY FOR 24 TO 48
HOURS OR LONGER DEPENDING ON THE TYPE OF MONITORING USED - OUT PATIENT SETTING,
- PATIENT CAN GO HOME WITH ONE, FROM A CLINIC OR HOSPITAL DISCHARGE
- INDICATIONS: PRESYNCOPE, SYNCOPE, PALPITATIONS, MEDICATION EFFECTIVENESS
- LITTLE TO NO RISK
- REPORTS AND EVENTS ARE NOT MONITORED IN REAL TIME BY PROVIDER
- THEY ARE SENT A REPORT AT THE END OF 24- 48 HOURS
- MONITOR TECHNICIANS FROM THE COMPANY WILL MONITOR HEART RHYTHM AND PAGE THE ORDERING PROVIDER IF THERE IS AN EMERGENT ARRHYTHMIA
- LIMITATIONS: THE ARRHYTHMIA MUST OCCUR WHILE THE PATIENT IS WEARING THE DEVICE, 24-48 HOURS
holter monitor
HIGH-FREQUENCY SOUND WAVES TRANSMITTED FROM A HAND-HELD WAND PLACED ON YOUR CHEST
PROVIDES PICTURES OF THE HEART’S VALVES AND
CHAMBERS AND HELPS THE SONOGRAPHER EVALUATE THE PUMPING ACTION OF THE HEART
* ECHO IS OFTEN COMBINED WITH DOPPLER ULTRASOUND
* SOUND WAVES CHANGE PITCH WHEN THEY BOUNCE OFF
BLOOD CELLS MOVING THROUGH YOUR HEART AND BLOOD VESSELS. THESE CHANGES (DOPPLER SIGNALS) CAN HELP YOUR DOCTOR MEASURE THE SPEED AND DIRECTION OF THE BLOOD FLOW IN YOUR HEART.
* COLOR DOPPLER IS USED TO EVALUATE BLOOD FLOW ACROSS THE HEART’S VALVES
* FUNCTIONS/INDICATIONS:
* ASSESS THE OVERALL FUNCTION OF YOUR HEART
* DETERMINE THE PRESENCE OF MANY TYPES OF HEART DISEASE, SUCH AS VALVE DISEASE, MYOCARDIAL DISEASE, PERICARDIAL DISEASE, INFECTIVE ENDOCARDITIS, CARDIAC MASSES AND CONGENITAL
HEART DISEASE
* FOLLOW THE PROGRESS OF VALVE DISEASE OVER TIME
* EVALUATE THE EFFECTIVENESS OF YOUR MEDICAL OR SURGICAL TREATMENTS
* NON INVASIVE
* LITTLE TO NO CONTRAINDICATIONS
* UNLESS THE PATIENT CANNOT LAY DOWN
* RECORDED IN REAL TIME BY
ULTRASONOGRAPHER
* REPORT SENT TO PROVIDER (SECONDARY EVIDENCE)
* PROVIDERS MAY BE ABLE TO READ THE IMAGES (PRIMARY EVIDENCE) FOR THEMSELVES IF TRAINED) = BETTER
transthoracic echocardiogram
- SIMILAR INDICATIONS AS A GENERAL ECHOCARDIOGRAM
- USED TO SEE MUCH FINER DETAILS
- SPECIFIC VALVULAR ABNORMALITIES
- SMALL STRUCTURES (CHORDAE)
- INVASIVE= GREATER RISKS
- ESOPHAGEAL PERFORATION
- LARYNGEAL/TRACHEAL DAMAGE
- PATIENT IS SEDATED
- RISK OF RESPIRATORY DISTRESS
- THIS IS USUALLY ORDERED AFTER
ABNORMALITIES ARE FOUND ON A TTE - USUALLY PERFORMED BY A CARDIOLOGIST IN A CATH LAB, OR PROCEDURE ROOM
- INPATIENT OR OUTPATIENT
transesophogeal echocardiogram
- Indications: Define structure and function of heart and associated vasculature
- Very invasive
- Risk of:
- Multiple organ injury/trauma
- Bleeding
- Stroke
- Cardiac Arrythmia
- Renal failure (Dye)
- Respiratory Failure (Sedation)
- Refer to Cardiologist
- Not First Line Test
- Inpatient or Outpatient
- Elective or Emergent
cardiac catherization
- EVALUATES:
- AORTA
- SIZE, SHAPE, FUNCTION OF THE LEFT VENTRICLE
- CORONARY ARTERIES
- INJECTS RADIOPAQUE DYE INTO SPECIFIC STRUCTURES OF THE HEART TO OBTAIN A VISUAL OUTLINE TO THEN MEASURE
- RECORDS PRESSURE MEASUREMENTS FROM
INSIDE THE HEART CHAMBERS - GETS ACCESS FROM AN ARTERY SOMEWHERE IN THE BODY
- CARDIOLOGIST PUSHES “ADVANCES” THE CATHETER AGAINST BLOOD FLOW, TO THE
ASCENDING AORTA
left sided heart catherization
- EVALUATES
- RIGHT ATRIAL PRESSURES
- RIGHT VENTRICLE PRESSURES
- PULMONARY ARTERIES PRESSURES
- RARELY USES DYE
- GET ACCESS FROM A VEIN
- CARDIOLOGIST PUSHES “ADVANCES” CATHETER WITH BLOOD FLOW INTO
RIGHT ATRIUM
Right sided heart catherization
- WHEN A PATIENT HAS AN ARRHYTHMIA, PERFORMED BY AN EP CARDIOLOGIST TO DETERMINE WHERE THE ABNORMAL ELECTRICAL ECTOPY FOCI IS COMING FROM
- INVASIVE
- CATH LAB
- OUTPATIENT OR INPATIENT
- DIFFERENT TYPES OF EP STUDIES:
- SVT
- WPW
- ATRIAL FIBRILLATION
- ATRIAL FLUTTER
- VT
- INDUCTION VS. MAPPING VS. ABLATION
electrophysiology study
- STRESS
How will you stress the
heart?
exercise/treadmill (bruce protocol)
chemical (vasodilator)
chemical (inotrope)
- 2 STEP PROCESS: MIX AND MATCH!
- MULTIPLE DIFFERENT TYPES OF
TESTS USED TO “STRESS” THE
HEART AND OBSERVE HOW IS
REACTS TO THAT STRESS - MULTIPLE DIFFERENT WAYS TO
OBSERVE AND RECORD - CORE PRINCIPLE: COMPARE THE
FUNCTION OF THE HEART AT
BASELINE TO THE FUNCTION OF
THE HEART DURING STRESSED
STATE
stress testing
- Visualization/Data Collection
How will you image the heart?
EKG
echocardiogram
nuclear imaging (radionuclide imaging)
- EXERCISE CAPACITY IS ONE OF THE MOST IMPORTANT
DETERMINANTS OF PROGNOSIS AND A STRING
PREDICTOR OF MORTALITY AND CV EVENTS.” - PROVIDES THE MOST INFORMATION CONCERNING
SYMPTOMS AND THE HEMODYNAMIC RESPONSE
DURING EXERCISE.” - ↑ CARDIAC OUTPUT, ↑ STROKE VOLUME ↑ SYMPATHETIC
DISCHARGE ↓ PARASYMPATHETIC DISCHARGE ↑ EPINEPHRINE/NE ↑ SKELETAL BLOOD FLOW, ↓ PVR ↑ SBP - INCREASE MYOCARDIAL WORK AND OXYGEN DEMAND
- MEASUREMENTS/END POINTS:
- HEART RATE,
- BLOOD PRESSURE
- EXERCISE CAPACITY
- EKG ABNORMALITIES (BASELINE VS STRESS)
- SYMPTOMS ONS:
- TO DIAGNOSE AND RISK STRATIFY PATIENT WITH
SUSPECTED CAD. (NOT ACTIVE ANGINA! ) - PROVIDE INFORMATION FOR PRE-OPERATIVE
EVALUATION AND “CARDIAC CLEARANCE” - TO ASSESS LOCATION AND DEGREE OF ISCHEMIA
IN THOSE WITH KNOWN CAD, PRIOR TO REVASCULARIZATION - ELICIT AN ARRHYTHMIA
- TO SEE IF A MEDICATION IS WORKING AFTER YOU HAVE PRESCRIBED IT
- NON INVASIVE
- RISKS: BEING ON A FAST MOVING TREADMILL
- FALL, ESPECIALLY FOR THOSE NOT STEADY ON THEIR FEET
- ELICITING UNSTABLE ANGINA/MI
- RESPIRATORY DISTRESS
treadmill stress test (with EKG)
WHAT IF A PERSON
CAN’T (WON’T) WALK
ON A TREADMILL?
chemical stress test
vasodilator medication: regadenosen
ionotrope medication: dobutamine
- Comparing
echocardiogram images at
baseline (resting and
relaxed to images while the
heart is stressed - WALL FUNCTION!
- Indirect assumption of perfusion
- Treadmill or Pharmacologic stress
stress echocardiogram
