Cardiology – Diagnostic Testing Flashcards
When to do stress ECHO?
When is stress ECHO Limited?
#Baseline EKG is abnormal #For information on a particular area of myocardium
#Baseline Wall Motion Abnormalities #Single Vessel disease
If stress ECHO imaging is suboptimal, can improve image quality with?
Microbubble transpulmonary contrast
Nuclear SPECT Is recommended when?
Correctable limitation? (and how to correct?)
LBBB - Conduction delay in the septum may cause false-positive abnormality (vasodilator stress)
#Abnormal baseline EKG #Particular area of my accordion needs to be evaluated #Viability testing with thalium
Basic Stress test recommended in patients who cannot exercise?
Contraindicated if? Test specific accommodation?
Dobutamine ECHO
#Severe baseline hypertension #Unstable angina #Arrhythmias
Hold beta blockers before test (if diagnosing CAD)
Stress test recommended in patients with LBBB who cannot exercise?
Options for drug? Contraindicated if? Test specific accommodation?
Vasodilator nuclear perfusion
Adenosine, dipyridamole, regadenoson
#Bronchospastic airway disease #Theophylline #Sick sinus syndrome #High degree AV block
Hold caffeine for 24 hours
Stress test of choice soon after myocardial infarction?
Vasodilator stress test
Stress test for patients who cannot exercise and have contraindications to vasodilators?
Contraindications? Test specific accommodation?
Dobutamine nuclear perfusion baseline
#Severe baseline hypertension #Unstable angina #Arrhythmias
Hold beta blockers before test
Test the provides the best perfusion images larger patients? Additional benefits of the test (in terms of diagnosis and comparative usefulness)?
PET/CT
#Provides data on perfusion, function, and viability #Lower radiation dose than conventional nuclear perfusion imaging #Absolute myocardial blood flow can be measured
Reasonable test in asymptomatic patients with intermediate risk for CAD?
Coronary artery calcium
Noninvasive test that can identify anomalous coronary arteries? Use in which patients? Limitations?
Coronary CT angiography
Intermediate risk for CAD
#Does not provide detailed images of distal vessel anatomy #limited by calcification
Test that uses gadolinium enhanced images to identify viable/infarcted myocardium?
Contraindications?
Cardiac MRI
#Pacemaker, ICD #Kidney failure #non-sinus or tachycardia rhythm (for improved image quality)
Duke treadmill score based on? Score provides information on?
Chest pain Hemodynamic changes ST segment depression Exercise duration Heart rate recovery (HR should drop over 12 BPM in first minute)
Five year mortality risk
On exercise testing, adequate workload generally defined as? Patients should ideally exercise for how long?
#85% age-adjusted maximal heart rate #Rate pressure product (HR x SBP) greater than 25,000
6-12 minutes
Medications that may be held before and exercise stress test?
When to continue versus hold for an exercise stress test?
Nitrates, beta blockers
Define prognosis/determine ischemia on current regimen versus diagnose CAD
Patients with these pathologies should not undergo exercise stress testing? (Instead should undergo?)
#Severe aortic stenosis #Abdominal aortic aneurysm #Severe hypertension #Uncontrolled arrhythmias
Vasodilator stress test
On stress Imaging, normal findings at rest but after stressor, notable LV dilation – interpretation?
Balanced ischemia or multi vessel CAD
On stress testing, Wall motion abnormality at baseline. Improvement with low dose exercise/dobutamine but worsens at higher levels. Suggests?
Hibernating myocardium
Preferred stress test for patients with Aortic stenosis and low ejection fraction?
Dobutamine stress test
Patient with wall motion abnormality.
If Baseline perfusion defect but metabolically active cells on viability study, suggests?
If no perfusion defect and metabolically inactive cells on viability, suggestive of?
Hibernating myocardium
Stunned myocardium
Technetium versus thalium as radiotracer?
Better in patients with breast attenuation (women)
Can assess viability (Potassium analog and can only be taken up by active myocytes) but more radioactivity
PET vs SPECT?
#More diagnostic accuracy #Also evaluates peak stress ejection fraction, myocardial blood flow, myocardial metabolism #Coronary calcification
Coronary artery calcium scoring?
Who gets it?
0 – no disease
1-99 – mild disease
100-399 – moderate disease
Over 400 – severe disease
Asymptomatic patients with intermediate Framingham risk score (10-20%)
Pharmacologic stress agents are associated with which adverse developments?
#AV block #Bronchospasm
Gadolinium associated with what adverse sequela?
Nephrogenic fibrosing dermatopathy
How to detect PFO or intracardiac shunt on cardiac imaging?
ECHO with IV agitated saline contrast (normally cleared in pulmonary vasculature, so should not be in left heart)
When to get a TEE instead of TTE?
#Endocarditis #Prosthetic valve dysfunction #aortic disease #Left atrial thrombus
Went to get three-dimensional ECHO?
#Mitral valve disease #ASD
Purpose of radionuclide angiography (MUGA)?
Evaluation of LV systolic function (for serial LVEF measurements)
Meijer indications for cardiac MRI?
#Congenital heart disease #Aortic disease #Myocardial diseases (infiltrative, myocarditis, hypertrophic cardiomyopathy) #Right ventricular cardiomyopathy #LV function
Arrhythmia monitoring (after basic EKG) if patient presents with:
- Daily arrhythmias
- Arrhythmias provoked by exercise
- Infrequent symptomatic arrhythmias that last over 1 minute
- Infrequent, symptomatic, brief arrhythmias
- Syncope
- Very infrequent arrhythmias
- Extremely rare arrhythmias
- Holter monitor (ambulatory EKG)
- Exercise EKG
- Patient triggered event recorder
- Loop recorder
- Loop recorder
- Implantable loop recorder and
- Mobile cardiac outpatient telemetry
Exercise ECG would need to be replaced/paired with additional imaging if patient has these EKG findings?
Patients that undergo an exercise stress test will have more false positives / more difficult to interpret findings if the patient has these EKG findings?
#LVH #LBBB #paced rhythm #WPW #greater than 1 mm ST segment depression
#Right bundle branch block #Bifascicular block #Digoxin
Stress testing is appropriate in patients with what pretest likelihood of CAD?
10 to 90%
Patient presents with intermediate pretest probability of CAD. Next test if:
- EKG normal and able to exercise
- EKG abnormal and able to exercise
- EKG abnormal patient unable to exercise
- Exercise treadmill stress test
- Exercise nuclear stress test OR exercise ECHO
- Pharmacologic stress test
A markedly positive Exercise treadmill stress test is defined by:
#ST segment depression at low workload #ST elevations #hypotension
A markedly positive Exercise nuclear stress test is defined by?
#Transient ischemic dilation #lung uptake of thallium #ischemia in over 2 vascular distributions #EF under 35
A markedly positive Exercise ECHO stress test is defined by?
#EF under 35 at rest #Ischemia over to vascular distributions #Drop in EF with stress
