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Clin Med Exam 1(Lauren) > Cardiology Diagnostics > Flashcards

Cardiology Diagnostics Flashcards

1
Q

What is the first test you’re going to do when someone complains of chest pain?

A

ECG

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2
Q

What are the risk factors for CAD?

A

Age

Gender

Hypertension

Hyperlipidemia

Diabetes

Smoking

Family history

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3
Q

Does ECG measure cardiac events directly or indirectly?

A

Indirectly

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4
Q

True or false:

ECGs can be quite subjective

A

True

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5
Q

Is it a good idea to have a baseline ECG to compare to?

A

Yes, because ECGs can be very subjective

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6
Q

True or false:

ECGs are commonly used as a solitary assessment

A

False, almost never used as solitary assessment for chest pain

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7
Q

What are the 3 cardiac enzymes discussed in lecture?

A

Creatinine Kinase

CK-MB

Troponins

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8
Q

Is creatine kinase specific for cardiac muscle?

A

No, it is found in many muscles throughout the body

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9
Q

Is CK-MB more or less specific for cardiac muscle than Creatine Kinase?

A

More specific

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10
Q

Which cardiac enzyme is the most specific for cardiac tissue, and is the most useful enzyme to measure?

A

Troponins

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11
Q

What are the two 3 types of troponin that can be measured, depending on the specific lab/hospital you’re at?

A

Troponin T (larger)

Troponin I (smaller)

High-sensitivity Troponin-T

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12
Q

How long after a cardiac event would you expect to see the ONSET of elevated enzymes?

(CK or troponin)

A

3-12 hours

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13
Q

How long after a cardiac event would you expect to see the PEAK of elevated cardiac enzymes?

A

18-24 hrs

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14
Q

How long after a cardiac event will elevated CK enzymes stick around?

A

36-48 hours

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15
Q

How long after a cardiac event will elevated troponin stick around?

A

Up to 10 days

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16
Q

If someone had chest pain 2 hours ago, but their enzymes are normal, does that mean they’re OK?

A

No, you wouldn’t expect to see an onset of elevated enzymes until 3-12 hours after the event

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17
Q

If someone comes in and says they had chest pain 2 days ago, and their troponin is not elevated at all, should you be suspicious that they had a heart attack?

A

No, because elevated troponin will stick around for up to 10 days

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18
Q

What is the point of obtaining serial enzymes?

A

To check for a CHANGE in values

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19
Q

What is a normal High-sensitivity Troponin T for men and women?

A

Men: 15ng

Women: 10ng

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20
Q

When comparing High-sensitivity troponin from time 0 to 2h, what level of change would indicate that a heart attack happened?

A

Delta 10 or higher

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21
Q

When comparing high-sensitivity troponin measurements from time 0 to 6h, what level of change would indicate that a heart attack happened?

A

Delta 12 or higher

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22
Q

When comparing high sensitivity troponins from time 0 to 2h, what change would indicate that nothing happened?

A

Delta 3 or less

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23
Q

When comparing high sensitivity troponins from time 0 to 2h, what change would indicate an intermediate risk for an acute myocardial injury?

A

Delta 4-9

Proceed to check hsT at 6h

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24
Q

Why would we do a CXR when someone comes in with chest pain?

A

To rule out things like pneumonia, pericarditis, pneumothorax, etc etc

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25
Q

Are males or females at higher risk of CAD?

A

Males

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26
Q

Does CAD risk increase with age?

A

Yes duh

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27
Q

What are the indications for doing a stress test?

A

Evaluation of CP on exertion

Assess significance of known CAD

Determine exercise capacity

Risk calculation for ischemic heart disease

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28
Q

What are the two ways we can “stress” the heart during a stress test?

A

Exercise

Pharmacologic

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29
Q

What are the 3 drugs used to stress the heart for an ECG stress test?

A

Adenosine

Dipyridamole

Dobutamine

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30
Q

Is exercise ECG stress test expensive?

A

No

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31
Q

Is exercise ECG stress test good for low risk patients?

A

Yes

32
Q

What can exercise ECG stress test be used for?

A

Diagnose CAD in symptomatic pts

Assess functional capacity

33
Q

Why would we do a stress test?

A

The stress increases cardiac oxygen demand and the test will reveal areas of hypoperfusion due to blocked coronary arteries

34
Q

When doing a stress test, should you take an ECG before they start exercising/take drugs?

A

Yes duh

35
Q

When doing an exercise ECG stress test, how long should the pt exercise for?

A

Until they reach:

Target HR

Symptoms develop

Time limit

36
Q

What are the absolute contraindications to doing an exercise ECG stress test?

A

Heart attack in last 2 days

Ongoing unstable angina

Uncontrolled arrhythmia with hemodynamic compromise

Endocarditis

Symptomatic aortic stenosis

Decompensated heart failure

Pulmonary Embolism/DVT

Myocarditis

Aortic dissection

Physical disability

(Sorry for this atrocity of a card, i just didn’t really know what to focus on)

37
Q

What are the RELATIVE contraindications to exercise ECG stress test?

A

Obstructive left coronary artery stenosis

Aortic stenosis

Tachyarrythmias

Advanced heart block

Hypertrophic obstructive cardiomyopathy

Recent stroke/TIA

Mental impairment/can’t cooperate

BP > 200/110

Uncorrected medical conditions like significant anemia, electrolyte imbalance, hyperthyroidism

(Sorry for this card)

38
Q

Will an exercise ECG stress test localize ischemia?

A

No

39
Q

Does exercise ECG stress test evaluate LV function?

A

No

40
Q

What are some circumstances where an exercise ECG stress test would have poor sensitivity?

A

ST-T abnormalities on their resting ECG

Digoxin use

LBBB

Pacemaker

Female population

41
Q

What are the common tracers used for nuclear medicine imaging?

A

Thallium-201

Technetium-99m agents (sestamibi, teboroxime)

42
Q

When doing a nuclear medicine imaging stress test, where does the thallium concentrate?

A

Areas with adequate blood flow and living myocardial cells

43
Q

When doing a nuclear imaging stress test, should we take resting images before we shoot em up with the stressful drugs?

A

Yes

44
Q

How do you tell that someone has a perfusion defect when doing a nuclear imaging stress test/scan?

A

You compare the areas of perfusion on the resting scan to the stressed scan. They should match

45
Q

Will nuclear medicine imaging tell us the location, size, and which artery is affected in an MI?

A

Yes

46
Q

Can we diagnose narrowed arteries and evaluate function of grafted vessels using nuclear medicine imaging?

A

Yes

47
Q

What are the 3 types of echocardiogram discussed?

A

Transthoracic

Trans esophageal

Stress echo

48
Q

What are some of the indications for a transthoracic echocardiogram?

A

Evaluate wall motion

Calculate ejection fraction

Determine diastolic filling

Evaluate size of chambers

Evaluate valves

Detect tumors, masses, or clots

Evaluate size of IVC

49
Q

Is a transthoracic echocardiogram considered to be invasive?

A

No

50
Q

What will Doppler echocardiogram help you evaluate?

A

Valves

51
Q

What kinds of things can affect the results of a transthoracic echocardiogram?

A

Chest wall abnormalities

COPD (barrel chest)

Thick chest wall/morbidly obese

Excessive movement

Large breasts

52
Q

If you suspect endocarditis or an infected valve, what kind of echocardiogram should you do?

A

Transesophageal

53
Q

Is your patient wide awake when you do a transesophargeal echo?

A

No, this procedure requires sedation from an anesthesiologist

(As well as a cardiologist because you will not actually be doing this proceure)

54
Q

What are some of the things that a transesophageal echocardiogram can detect?

A

Clots

Septal defects/patent foramen ovale****

Ascending aortic atherosclerosis

Aortic dissection

Valvular pathology, including vegetations AKA endocarditis***

Myocardial motion with less interference than TTE

55
Q

Is transesophageal echocardiogram an invasive procedure?

A

Yes

56
Q

What drug do we give to induce stress during an echocardiogram?

A

Dobutamine

57
Q

What are vegetations?

A

Lesions caused by endocarditis

58
Q

What two conditions make a pt unsuitable for stress echocardiogram?

A

AFib

LBBB

(Nuclear stress test would be better)

59
Q

What are the indications for a stress echocardiogram?

A

Known/suspected CAD

Evaluation of chest pain, SOB, dyspnea on exertion

Evaluation of valvular abnormalities

Pre-op risk assessment before major surgery

60
Q

If someone has afib, what stress-inducing drug must we avoid?

A

Dobutamine

61
Q

When doing a stress echocardiogram, at what % of max HR should we take peak-stress images?

A

85%

62
Q

If someone has ST-elevation, what should we do?

A

Send them straight to the cath lab lol

63
Q

What is the gold standard for diagnosing CAD?

A

Cardiac catheterization/angiogram

64
Q

What are the indications for cardiac catheterization/angiogram?

A

Known/suspected CAD (unstable angina, angina and + exercise test, history of MI with ECG changes, post resuscitation from cardiac arrest)

Atypical chest pain

Before valve surgery in pt with chest pain/ECG changes

65
Q

What is percutaneous coronary intervention?

A

Balloon angioplasty +/- stent placement

66
Q

How long does a patient wear a Holter monitor?

A

24-48 hrs, while keeping a diary of symptoms

67
Q

What is a common reason we would put a pt on a Holter monitor?

A

Evaluation of dizziness, syncope, palpitations

68
Q

Does a Holter monitor record continuously?

A

Yes

69
Q

Does an event “loop” recorder record continuously?

A

No.
Pt presses a button if they experience an event and the previous 5 minutes and subsequent few minutes will be recorded which can then be transmitted via phone to an interpreting center.

70
Q

How long does a pt wear an event “loop” recorder?

A

30-60 days

71
Q

Who would an implantable loop recorder be good for?

A

Someone with infrequent symptoms (like they pass out twice a year)

Someone in whom you suspect an arrhythmia but other testing has been inconclusive

72
Q

Does an implantable loop recorder record continuously?

A

No.

Records according to “programmed criteria” or when patient presses a button

73
Q

What kinds of cardiac things would we use a CT for?

A

Thoracic aorta

Pericardium

Aortic dissection

Calcium depositions on coronary arteries

Pulmonary embolism

74
Q

If you think someone is having an aortic dissection, should you send them to CT or MRI?

A

CT, much faster

75
Q

What is MRI good for evaluating?

A

Aorta

Pericardium

Myocardium

Valves

Cardiac abscesses/masses

Myocardial perfusion with contrast during adenosine stress

Clin Med Exam 1(Lauren) (8 decks)

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