Cardiology Imaging and Guidelines

Question 1

What imaging technique can be done to visualise the heart and assess diameter of ventricles?

Answer 1

Ultra sound

Parasternal Short Axis View - PSAX

Apical 4 chamber - its upside down

Question 2

How is ejection fraction measured? What is normal?

Answer 2

Ultrasound Doppler - measuring size of ventricle at its largest during diastole then its smallest during systole

At least 50%.

Question 3

What is the gold standard for assessing coronary heart disease?

Answer 3

Invasive Angiography - Catheterization

Question 4

What are the two main types of echos performed?

Answer 4

Trans-thoracic

Trans-esophageal - invasive

Question 5

When carrying out a stress test, which drug can be used to mimic exercise stress on the heart?

Answer 5

Dobutamine

Question 6

Name some cons to using echo

Answer 6

• user dependant

- good window to be seen

Question 7

When is nuclear perfusion used? and what are the pros and cons?

Answer 7

Used in:

• assessing ischemia
• assess ejection fracture

Pro -
readily available

Cons:

• radiation
• no structural detail

Question 8

What is Cardio CT good for? name some pros and cons:

Answer 8

good for looking at the vessels around the heart and seeing the extend of stenosis

• coronary artery anatomy
• great vessel anatomy

Pro:

• good for ruling out CAD.
• low risk

Con:

• no functional assessment of ischemia
• require low heart rate

Question 9

When is invasive angiography done?

and pros and cons

Answer 9

Ischemia
Valve assessment (first echo)
assessment of ventricular pressures

Pros:

• gold standard - measuring stenosis of valve
• option for intervention whilst there
• availability

Cons:

• radiation
• risks of CVA, MI

Question 10

MRI

Answer 10

Most detailed assessment of heart function

Produces the most accurate assessment of ejection fracture.

characterise and assess myocardium via Gladolinium

• scar burden
• previous infarctions

Question 11

What is Gladolonium?

Answer 11

radioactive substance that allows viewing of fibrosis formation of the heart.
- seen on MRI

Question 12

MRI pros and cons:

Answer 12

Pros:

• gold standard LV assessment
• reproducible
• no radiation

Cons:

• cost
• availability
• clostrophobia - 5% can’t do it
• pacemakers

Question 13

Guideline recommendations of Class I are what?

Answer 13

Evidence and general agreement on that treatment being useful.

Question 14

Guideline recommendations of Class IIa are what?

Answer 14

Bit of conflicting evidence but general thought is the treatment is useful

Question 15

Guideline recommendations of Class IIb are what?

Answer 15

Usefulness and efficacy is less well established

Question 16

Guideline recommendations of Class III are what?

Answer 16

evidence and general agreement that the treatment is not useful or effective. May actually cause harm

Question 17

What is the level of evidence of Class A?

Answer 17

lots of data from multiple randomised clinical trails and meta-analyses

*ACE inhibitor is an example of this

Question 18

What is the level of evidence of Class B?

Answer 18

Data from single randomised clinical trial
or
large non- randomised studies

Question 19

What is the level of evidence of Class C?

Answer 19

Consensus of opinion from experts **diuretics in heart failure is a good example of this

or

small studies and retrospective