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Clinical Medicine II > Cardiology : Diagnostic Modalities > Flashcards

Cardiology : Diagnostic Modalities Flashcards

1
Q

Indications for 12-Lead EKG

A

acute CP
current palpitations
LV Hypertrophy screening
evaluation of past MI

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2
Q

Contraindications for 12-Lead EKG

A

None

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3
Q

Indications for telemetry

A

hospital admission for CP or possible ACS

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4
Q

12 Lead EKG works by detecting ________ in the heart.

A

electrical activity

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5
Q

What is important when administering 12 lead EKG?

A

serial collection of data.

don’t use as a solitary assessment

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6
Q

Which cardiac enzyme test is preferred to diagnose and provide prognosis of MI?

A

high-sensitivity cardiac troponin

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7
Q

Is cTn I or cTn T more sensitive for cardiac infarct?

A

cTn I

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8
Q

troponin is considered a biomarker of what

A

cardiac injury

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9
Q

When should you expect to see elevated troponin and CK-MB?

A

trauma, surgery, inflammation, infection

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10
Q

what is an important consideration when evaluating both EKG and troponin?

A

must obtain serial enzymes and several EKGs to compare against baseline.

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11
Q

On serial cardiac enzymes, what is indicative of acute ischemia?

A

rise and fall of troponin

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12
Q

CK and troponin both have an onset of 3-12 hrs and a peak at 18-24, but troponin has a duration of ______ while CK’s duration is ______.

A

Troponin duration: 14 days

CK: 36-48 hrs

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13
Q

This is the primary noninvasive modality for quantitative and qualitative evaluation of cardiac anatomy and function….

A

transthoracic echocardiogram (TTE)

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14
Q

What are the indications for TTE?

A

evaluate wall motion, valve structure and function

calculate EF

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15
Q

This imaging modality can detect:

LA clots within the heart

valvular pathology

visualization of vegetations in endocarditis

A

transesophageal echo (TEE)

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16
Q

Who must be present when performing TEE?

A

cardiology and anesthesiology

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17
Q

TEE provides high resolution of what cardiac structures?

A

posterior cardiac structures

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18
Q

What are the indications for cardiac stress tests?

A

exertional chest pain

CHD with new/worsening symptoms

Newly diagnosed CHF or cardiomyopathy

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19
Q

What are the contraindications for cardiac stress testing?

A

acute MI in 48 hours

unstable angina

uncontrolled arrhythmia, heart failure, hypertension

acute aortic dissection

severe pulmonary HTN

acutely ill

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20
Q

This cardiac stress test is:

  • Less expensive
  • helps diagnose CAD in symptomatic patients
  • Useful in assessing functional capacity
A

Exercise EKG

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21
Q

What should a clinician look for during exercise EKG stress test?

A

EKG changes from baseline

Increased HR

Development of Sx

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22
Q

What is the protocol for an EKG stress test?

A
  1. baseline resting EKG
  2. exercise to target HR, Sx, or time
  3. monitor Sx and EKG
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23
Q

This cardiac stress test has the following advantages:

low cost

no radiation

determines exercise capacity

widely available

mimics physiological conditions

A

Exercise EKG

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24
Q

This cardiac stress test has the following disadvantages:

Doesn’t localize ischemia

doesn’t evaluate LV function

Lower sensitivity

Poor specificity in ST-T abnormal pts, digoxin use, LBBB or pacemakers, female population

A

exercise EKG

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25
Q

What radioactive tracers are used for the nuclear stress test? Where do these concentrate?

A

Technitium-99m or Thallium

concentrate in myocardium with adequate blood flow

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26
Q

Does a nuclear stress test utilize exercise or pharmacologic stressors?

A

pharmacologic

27
Q

What drugs are used in nuclear stress testing to cause cardiac stress?

A

Vasodilators: adenosine, dypyridamole

28
Q

What causes more dilation and by what degree: Exercise or pharmacologic intervention?

A

pharmacologic intervention by 3-5x

29
Q

Nuclear Stress Test Protocol:

A

Inject tracer

wait 20-40 mins

Scan at rest

Induce stress w/ adenosine/dypyridamole to achieve target HR/Sx

Inject tracer 2nd time

wait 20-40 min

2nd Scan

Compare scans

30
Q

With a nuclear stress test, reversible ischemia would be found with what results?

A

good perfusion at rest, ischemia under stress

31
Q

With a nuclear stress test, non-reversible ischemia (infarction) would be found with what results?

A

ischemia at rest and during stress

32
Q

This cardiac stress test has the following indications:

abnormal resting EKG

To asses areas of myocardial ischemia

to determine location and size of injured muscle after MI

Dx coronary artery stenosis

evaluate function of grafted vessels after bypass

A

Nuclear stress test

33
Q

This cardiac stress test has the following indications:

known or suspected CAD

evaluation of CP, SOB, DOE

Evaluation of valvular abnormalities

preop risk assessment

A

stress echo

34
Q

Which drug is used to cause stress in a stress echo?

A

dobutamine

35
Q

This stress test can evaluate ischemia related to wall motion abnormalities when stressed

A

stress echo

36
Q

When should a stress echo be avoided?

A

afib and LBBB

37
Q

What is the protocol for a stress echo?

A

TTE at rest

administer dobutamine

reach target HR, administer stress echo

compare baseline and stress images

38
Q

When wearing a Holter Monitor, a patient’s cardiac electrical events are recorded over ________

A

24-48 hours

39
Q

What are the indications for a Holter Monitor?

A

syncope, palpitations

40
Q

What is a major limitation of Holter Monitor?

A

79% of patients are asymptomatic during the 24-48 hour period

41
Q

How long can an event monitor be worn?

A

30-60 days

42
Q

What is a major difference between an event monitor and a holter monitor?

A

Holter is continuously recording

43
Q

How does a patient record a cardiac event when wearing an event monitor?

A

patient pushes button to capture previous 2-5 minutes to present.

44
Q

For how long does an implantable cardiac monitor record?

A

3 years

45
Q

What activates an implantable cardiac monitor?

A

automatically activated, or patient activated

46
Q

indictions for implantable cardiac monitor?

A

infrequent sxs

suspected arrhythmia with inconclusive non-invasive testing

47
Q

What is a fingertip monitor used for?

A

monitoring afib and other symptomatic arrhythmias

48
Q

What are the two main forms of cardiac CT?

A

coronary CT angiography

coronary CT calcium scan

49
Q

This cardiac imaging modality:

assesses presence and extent of coronary artery occlusion

given with contrast

A

CCTA

50
Q

This cardiac imaging modality:

assesses for calcium deposits in coronary arteries/MI risk

Given without contrast

A

Coronary CT calcium scan

51
Q

This imaging modality is the following major applications:

detection of aortic dissection

detection of coronary artery calcium deposition/atherosclerosis

detection for presence and extend of CAD

A

Cardiac Computerized Tomography

52
Q

The indications for cardiac CT scan:

A

Aortic dissection

stable angina

r/o CAD

53
Q

What are the contraindications for cardiac CT scan?

A

allergy to contrast dye

severe renal insufficiency

54
Q

This imaging modality has the following characteristics:

assessment of functional and tissue properties of heart

highlights atrial and ventricular anatomy

highlights myocardial tissue composition

A

Cardiac MRI

55
Q

Cardiac MRI is typically used for what patients?

A

complicated patients after 1st line testing/echo

56
Q

Indications for cardiac MRI:

A

myocardial, pericardial, or valvular disease

cardiac tumor

CAD

myocardial perfusion

57
Q

What are the contraindications for cardiac MRI?

A

metal or electrical implants, devices or foreign bodies

58
Q

What is the gold standard to diagnose CAD, but is often not 1st line test?

A

cardiac catheterization/coronary angiography

59
Q

What is the protocol for cardiac catheterization?

A

Thread catheter through groin, arm, neck

inject radiopaque dye

view patency of coronary arteries via fluoroscopy

60
Q

What risks accompany cardiac catheterization?

A

bleeding, arrythmia, vessel injury

61
Q

Indications for cardiac catheterization?

A

known/suspected CAD

Atypical chest pain

before valve surgery in CP patients

62
Q

What conditions would make you suspect CAD, and therefore order cardiac cath?

A

unstable angina

angina and (+) exercise stress test

history of MI w/ EKG changes

post-resus from cardiac arrest

63
Q

What are two methods of percutaneous coronary intervention?

A

balloon angioplasty

cardiac stenting

Clinical Medicine II (31 decks)

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