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Cardio GW Flashcards

1
Q

Atrial depolarization

A

P wave

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2
Q

AV slowing pulse down

A

PR interval

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3
Q

Ventricular depolarization

A

QRS wave

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4
Q

Rest period between depolarization and repolarization of vent

A

ST segment

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5
Q

Repolarization of ventricles

A

T wave

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6
Q

Depression of ST segment means

A

decreased blood flow to myocardium

Indicated myocardial ischemia

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7
Q

Elevated ST segment may mean

A

Acute MI

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8
Q

What is hibernating myocardium

A

severely, chronically ischemic tissue that is viable but appears to be nonfunctioning and has decreased perfusion

-high likelihood of benefiting from revascularization

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9
Q

What is myocardial stunning

A

A temporary response where the myocardium is deprived of blood flow.

Occurs after the pt experiences acute episode of severe ischemia or an acute MI that is terminated by thrombolysis or revascularization

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10
Q

Myocardial perfusion imaging RPs

A

Tl201 thallous chloride

99mTc Sestamibi

99mTc Tetrofosmin

Rb82 chloride, N13 ammonia, F18 FDG

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11
Q

Exercise prep

A

Fast for at least 3 hours prior

No physical exertion 12 hours prior

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12
Q

Drugs that can affect exercise

A

Beta blockers 72 hrs
Calcium channel blockers 48-72 hours
Antihypertensives 4-7 days
Anti arrhythmic agents 2 days
Sedatives 1 day
Nitroglycerin 1 hr
Long acting nitrates 12 hr
Digitalis (digoxin) 1-2 weeks

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13
Q

Target heart rate calculation

A

(220 - pts age) x 85%

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14
Q

Right and left arm electrode placement

A

Midclavicular line, below clavicle

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15
Q

Rt and left leg electrodes are placed where

A

Just below rib cage on either side

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16
Q

Pharmacological stress test prep

A

NPO minimum 4 hours prior
D/C xanthine derivatives 12-24 hours
No caffeine 12 hours prior

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17
Q

If possible, aminophylline should not be administered until ____ minutes after tracer

A

1-2 minutes

Can cause false positive if injected too early

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18
Q

1-6 EKG placement

A

1 - fourth intercostal space on left side of sternum
2 - fourth intercostal space on right side of sternum
3 - in between 2 and 4
4 - fifth intercostal space directly below midclavicular line
5 - right beside or 4 at left anterior axillary line
6 - right beside or 4 at left midaxillary line

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19
Q

Dipyridamole (Persantine) contraindications

A

Bronchospasm, pulmonary disease, active wheezing, hypotension, severe mitral valve disease

MI within 2 days, unstable angina within 48 hours, severe aortic stenosis, severe obstructive hypertrophic cardiomyopathy, and severe orthostatic hypotension

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20
Q

Contraindications for adenosine

A

Same as dipyridamole +

Second or third degree AV block (without pacemaker)

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21
Q

If patient is taking oral dipyridamole for heart medication and needs stress test

A

Cannot give adenosine

Must d/c dipyridamole 2 days before regadenoson

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22
Q

Contraindications for regadenoson

A

2nd or 3rd AV block (without pacemaker)

Bronchospasm, low BP, hypersensitivity to reg.

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23
Q

Contraindications for exercise

A

LBBB

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24
Q

Combination of low level or isometric exercise with dipyridamole, adenosine, or regadenoson (during or after drug) has what benefits

A

Decreased side effects
Decreased sub diaphragmatic uptake
Increased target to background ratio

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25
Q

Dobutamine stimulates what receptors

A

B1

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26
Q

Dobutamine is indicated for

A

Pts who cannot exercise and cannot undergo pharmacologic stress due to severe bronchospastic disease

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27
Q

Pt prep for dobutamine

A

NPO at least 4 hours

Withhold beta blockers for 24-48 hours

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28
Q

Contraindications for dobutamine

A

Recent MI less than 1 week, unstable angina, critical aortic stenosis, atrial tachyarrhythmias, v-tach, uncontrolled HBP, aortic dissection, large aortic aneurysm

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29
Q

Planar MPI, a zoom factor of _____ should be used if using large FVOC

A

Zoom factor of 1.2-1.5

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30
Q

Diaphragmatic attenuation on planar MPI may cause

A

False positive defect in inferior wall of left ventricle

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31
Q

Quantitative myocardial perfusion information on planar imaging

A

Circumferential profile analysis

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32
Q

Heart to lung ratio things to remember

A

Same size ROIs

The myocardial ROI should not be placed on the anterior or anteriolateral wall because of heart/lung overlap

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33
Q

SPECT MPI acquisition step and shoot method

A

32 or 64 stops for 180°

Or

64 or 128 stops for 360°

34
Q

recommended pixel size for SPECT MPI

A

6.4 + or - 0.2 mm

For a 64 x 64 matrix

35
Q

ECG configuration for gated MPI

A

Standard lead II configuration

36
Q

Gated SPECT allows for evaluation of

A

Wall motion, Thickening, And EF

37
Q

SPECT MPI most common low pass filter

A

Butterworth

-smooths and suppresses noise, loss of resolution

38
Q

Reconstruction of planar projections may be performed with

A

Filtered back projection technique or iterative technique

39
Q

Reconstruction methods for planar MPI

A

Filtered back projection

Iterative reconstruction

40
Q

Filtered back projection uses what filter

A

Ramp (high pass filter)

41
Q

SPECT reconstruction MPI uses what filter

A

Butterworth (low pass filter)

42
Q

which reconstruction method for planar MPI is more accurate

A

Iterative reconstruction

43
Q

Tl201 thallous chloride is a ____ analog

A

Potassium

-this is why tl201 is redistributed because of the sodium potassium pump
-potassium is used to make heart contract

44
Q

Tl201 redistribution can be seen

A

On delay images (2-4 hours)
Resting images
24 hour delays
Or reinjection images

45
Q

SPECT or planar is more commonly preferred for Tl201 stress/redistribution images

A

SPECT, unless pt cannot lie still

46
Q

Tl201 planar injection to image time

A

10 minutes

47
Q

Tl201 dose

48
Q

Info about tl201 energy

A

Mercury X-rays in the 68-89 keV range are emitted during the decay
- a 30% window is over 72 keV

An optional second 20% window is over 167 keV

49
Q

Tl201 planar imaging acquisition parameters

A

LEAP

128 x 128 word mode

600,000 counts minimum

50
Q

Tl201 instructions between stress image and 3-4 delay image

A

Don’t eat

May have a light snack but avoid caffeine, sugar, and carbs because glucose ingestion results in accelerated clearance of tl201

51
Q

How long is each image acquired for in Tl201 SPECT

A

40 seconds

52
Q

Resting Tl201 indication

A

Previous possible Acute MI

53
Q

Resting tl201 dose and acquisition

A

2.5-3 mCi
Image at 10-15 mins
Image delays at 3-4 hours

54
Q

Stress tl201 dose and acquisition

A

2-4 mCi
Image at 10 minutes
Image delays at 3-4 hours

55
Q

Reinjection tl201 dose and acquisition

A

Wait until after delays are taken, then inject 1.5 mCi at 3-4 hours or even 24 hours
Image at 10-15 minutes

56
Q

What is the purpose of reinjection images for Tl201

A

Increase the sensitivity of stress/redistribution imaging for the detection of viable myocardium

57
Q

How is sestamibi excreted

A

Hepatobiliary

58
Q

Injection to image time for Sestamibi

A

Rest: 15-60 minutes
Stress: 60-90 minutes

*max 4 hours

59
Q

Acquisition time per view for Sestamibi

A

Planar: 5 mins/view
Gated planar: 10 mins/view

SPECT: 20-25 secs/stop for high dose
40 sec/stop for low dose

60
Q

differences between Tetrofosmin and Sestamibi

A

Can image earlier due to rapid uptake and background clearance

Localizes in mitochondria

Clears from the liver and lungs faster

61
Q

Dual tracer MPI SPECT

A

Rest: Tl201 2.5 mCi

Stress: 99mTc agent 22-25 mCi

62
Q

MUGA/ERNA RP and dose

A

99mTc pertechnetate labeled RBCs (15-30 mCi)
Or
99m Tc human serum albumin

63
Q

Tagging method % labeling efficiency

A

In vitro: 95%
Modified in vivo: 90%
In vivo: 60-90%

64
Q

Resting muga pt prep

65
Q

Number of counts for each view for MUGA

A

3-7 million

66
Q

During MUGA, if assessment of right ventricular function is indicated, can do a gated first pass study but remember:

A

Do it in list mode

Acquired in 10°-15° RAO position

Take flow while injected labeled RBCs

67
Q

MUGA data is acquired by dividing the cardiac cycle into _____ frames

A

16, 24, and 32

68
Q

The time that an individual frame will accumulate counts during a single cardiac cycle depends on

A

The average length of the r-r interval

69
Q

Ventricular EF formula

A

LVEF% = [(EDV - EDS)/ EDV] x 100

70
Q

The volume of blood ejected by either ventricle during ventricular systole

A

Stroke volume

71
Q

The volume of blood that the heart pumps per minute

A

Cardiac output

72
Q

Cardiac output formula

A

CO = SV x heart rate

73
Q

The capacity of the ventricle after it is completely filled with blood; the largest volume reached by ventricle during a cardiac cycle

A

End diastolic volume

74
Q

The residual capacity of the ventricle at the end of contraction; the smallest volume reached during a cardiac cycle

A

End systolic volume

75
Q

Stroke volume formula

A

SV = EDV - ESV

76
Q

First pass is useful for

A

Right ventricular dysfunction
Interventricular shunts
Ischemia and infarction

77
Q

First pass RP

A

Any 99mTc pharmaceutical

If only first pass study then DYPA or Pertechnetate is preferred

78
Q

What must be done before first pass study

A

Baseline ECG

79
Q

What is essential for a successful first pass study

A

Regular rhythm
Small rapid unfragmented bolus of <1mL with large needle, flushed with 10 mL saline

Because first pass are representative of only 2-3 beats

80
Q

Acquisition preference for first pass

A

Multi crystal camera or gamma camera that can take 200,000 counts/sec or greater
High sensitivity collimator

Procedures (17 decks)

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