Cardiovascular Diagnostic Test/Procedures Flashcards
rhythm abnormalities indicate what testing
holter monitor
12 lead / exercise ECG
ischemia indicates what testing
resting/exercise ECG
pharmacologic stress testing
PET scan
MRI
valve integrity is tested via
echocardiography
contrast echo
cardiac catheterization
ventricle size and EF is tested via
chest x-ray
angiogram imaging
echocardiography
cardiac muscle pumping is tested via
echocardiography
ventriculography
MUGA
acute MI is tested via
cardiac enzyme markers
resting ECG
vascular diagnostic testing is done via
ABI
segmental limb pressures
what biomarkers indicate cardiac injury
CPK-MB
troponin
myoglobin
carbonic anhydrase III
cardiac myosin light chains
explain difference between CPK-MB,MM, and BB
MB = myocardial injury
MM = skeletal muscle injury
BB = brain tissue injury
abnormal CPK-MB level
serum level >3%
abnormal troponin I value
- time associated
> 0.1 ng/mL
onset of rise = 4-6 hrs
time of peak = 12-24 hrs
return to normal = 4-7 days
abnormal troponin T value
- time associated
> 0.2 ng/mL
onset of rise = 3 to 4 hrs
peak = 10-24 hrs
return to normal = 10-14 days
abnormal creatine phosphokinase value
> 75 mU/mL
abnormal myoglobin value
> 100 ng/mL overall
- male = >96 ng/mL
- female = >65 ng/mL
what is CRP? what is the importance of it?
an acute-phase reactant to inflammation
- can be used to assess cardiovascular disease risk
higher levels are associated with lower survival rates in those with CAD
explain CRP values and risk for CVD development
<1 mg/L = low risk
1-3 mg/L = average risk
3 mg/L = high risk
explain BNP’s production / role
from cardiac ventricles (especially left) during pressure or volume overload
- dilates arteries and veins
- neurohumoral modulator in decreasing vasoconstricting / sodium-retaining hormones
BNP is important because
has been associated with increased risk for CV mortality, HF and CVA
what are abnormal hemoglobin ranges for males and females
males = < 14-18
females = <12-16
in (g/100mL)
what does low levels of hemoglobin result in
anemia
- lack of oxygen carrying capacity and low levels of oxygen available to the tissues
will put more stress on the myocardium as a result, due to need to get blood out
values for hematocrit in males and females
males = < 42g/100 mL
females = <37g/100 mL
what does an elevated hematocrit mean
blood flow is more viscous than normal
- can mean blood flow is also being impeded
what is used to measure coagulation of blood
prothrombin time
partial thromboplastin
what electrolytes are the most important to monitor
Na+
K+
CO2
what are normal sodium serum levels? what are abnormalities associated?
136-145 mmol/L
hyponatremia = <136
hypernatremia = >145
what are s/s with sodium levels being off
nausea
vomiting
headaches
seizures
value of serum potassium? s/s of abnormalities below and above
3.5-5 mEq/L
lower = life-threatening arrythmia
higher = myocardium contractility issue
s/s associated with low levels of CO2
alkalotic state
muscle weakness
dizziness
normal range of blood urea nitrogen
BUN
8-23 mg/dL
elevated vs depressed BUN levels
elevated = uremia or urea retention
decreased = starvation, dehydration, possible liver disease
what laboratory values are found in HF? what do those indicate
increased BUN
increased LDH
increased BNP
normal CPK-MB
increased creatinine levels
– indicate renal dysfunction
what lab values are representative of renal function
BUN
creatinine
normal creatinine levels
<1.5 mg/dL
> 1.5 mg/dL
what creatinine level indicates renal insufficiency/failure
> 4.0 mg/dL
what is the gold standard measure for heart failure
B-type natriuretic peptide
- both compensated and uncompensated
what is the value of BNP that is normal vs abnormal? what does that indicate
normal = <100 pg/mL
> 700 pg/mL = acute cardiac decompensation
100-700 pg/mL = chronic compensation
indication for exercise stress testing
chest pain suggestive of coronary disease
evaluation of atypical chest pain
prognosis and severity of CAD
effects of medical/surgical therapy
arrhythmic evaluation
hypertension w/activity evaluation
functional capacity assessment
exercise prescription screening
what differentiates max vs submax testing
point of stoppage
- submax = achievement of predetermined end point (certain % of predicted HRmax or attainment of certain work load)
max = end point of predicted HRmax
what are intermittent vs continuous exercise tests
intermittent = progressive workloads with short rest periods (decreases effect of peripheral fatigue)
continuous = incrementally progressive workloads until the test is terminated
low level exercise testing is most commonly done after
acute MI or CABG
– can be used prior to discharge
what can low level exercise testing be helpful for
prediction of subsequent course post-MI, even identifying high risk patients
what low level exercise tests are commonly done
5 meter walk test of gait speed test
what is indicated if ST-depression and angina are produced during low-level exercise testing
vs angina alone
increased risk of death after MI
– if done during the early period
angina alone = subsequent CABG
post myocardial injury, what does low-level exercise testing provide
treatment strategies for
angina =
arrythmia
hypertension
arrhythmia post myocardial injury during low level exercise can indicate what
therapeutic management before discharge
low-level exercise testing contraindications
unstable angina / angina at rest
severe heart failure - presence of S3 and rales
serious arryhthmias at rest
second/third degree heart block
disabling MSK abnormalities
valvular heart disease
BP >180/105
what low-level exercise protocols are commonly used in the hosptial?
modified Naughton
modified Sheffield - Bruce
progressive workload from 2-6 METs
explain main disadvantage of bicycle vs treadmill exercise testing
bicycle is not a common activity like walking
- pts will develop muscular fatigue faster because they are using muscle groups that are “untrained”
Bruce vs Balke protocols
Bruce = speed increases, but incline stays the same. Begins at 10%
– typically causes test to be finished between 6-12 minutes typically
Balke - speed remains, but incline increases
allows for steady state to be attained at each level, therefore more accurate O2 consumption is recorded (more so with athletes)
incidence of sudden death is increased if _____ and _____ occur during exercise testing
inability to exceed 130mmHg SBP
increased frequency/severity of arrhythmias
low risk for developing CAD in women is predicted by what variables during exercise testing
test longer than 6 min
maxHR > 150 bpm
ST recovery less than 1 min
what is HR recovery defined as? what does it help predict
difference between maxHR and HR at rest 1 minute later
- likelihood of mortality
what gasses are observed during exercise testing
oxygen consumption
co2 production
what does cardiopulmonary testing with ventilatory gasses provide information regarding
cardiac performance
functional limitation
exercise limitation
what is the dyspnea index value
Minute Ventilation / Max Voluntary Ventilation
= > 50%
what occurs when VE/MVV = >70%
respiratory muscle fatigue will occur in minutes
dyspnea due to pulmonary disease during exertion will cause these things to occur
rapid/shallow breathing
reduction in peak ventilation
reduction in tidal volume
VO2 and CO2 max decrease
dyspnea due to HF during exertion will cause
dyspnea index will remain normal
- anaerobic threshold is achieved much earlier with a lower than maximal ventilation and maximal CO2 production
when is pharmacologic stress testing indicated
if any contraindications for exercise testing are met
what is pharmacologic stress testing
injection of pharmacologic agent that induces physiological stress on the body
what are the most common agents used during pharm stress testing
adenosine
dipyridamole
dobutamine
regadenoson
What does adenosine and dipyridamole induce
coronary vasodilation
dobutamine induces what response
adrenergic stimulant
– increased myocardial oxygen demand with the purpose of assessing that oxygen supply
can produce some nasty side effects, need B-blockers to regress them
indications for cardiac catheterizaton
cardiac arrest
primary v-fib
intolerance to medical therapy for angina
SBP <100 mmHg during exercise
>35% decrease in exercise duration
significant ST depression
LVent EF <35% without ischemia
how is cardiac catheterization done
brachial artery or femoral artery
passed into great vessels and into chambers
pressures in chambers across valves and CO are measured
radiopaque contrast is injected and followed to assess arteries / myocardium
ABIs are attained by assessing which arteries? what values are normal?
dorsalis pedis or post tib
to
brachial artery
<0.9 is abnormal
what do segmental limb pressures assess
localizing stenoses or occlusions
- thigh, calf, ankle or trans metatarsal region
arterial duplex US is a more diagnostic test than _______ for __________
segmental limb pressures for stenoses and occlusions
rubor dependency test is for
LE arterial circulation
leg elevated 35-45 degrees
assessment for color change at top, then leg placed in dependent position
normal = rapid pink flush
abnormal = deep red color after 30 sec
