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Cardiopulmonary > Cardiovascular Diagnostic Tests and Procedures > Flashcards

Cardiovascular Diagnostic Tests and Procedures Flashcards

1
Q

Purposes of medical tests

A
  • Facilitate the achievement of a correct diagnosis
  • Aid in the prevention of complications
  • Develop information to determine a prognosis
  • Identify subclinical disease states
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2
Q

Define Sensitivity

A
  • Proportion of individuals with the disease who have a true positive test
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3
Q

Define Specificity

A
  • Proportion of individuals w/o the disease with a true negative test
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4
Q

Describe positive versus negative predictive values

A
  • Positive: proportion of individuals who had a positive test & actually have the disease
  • Negative: proportion of individuals who had a negative test & truly do not have the disease
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5
Q

Serum enzymes and cardiac biomarkers may aid in assessing the _________________ or the _________________

A
  • Degree of myocardial damage
  • Effectiveness of reperfusion
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6
Q

Serum Enzymes and Cardiac Biomarkers that are most commonly used for the diagnosis of cardiac injury

A
  • Creatine kinase (CK-MB isoenzyme): abnormal if >5%
  • Troponins: gold standard for assessing myocardial damage
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7
Q

Describe acute coronary syndrome (ACS)

A
  • Unstable anginia: absences of cardiac myocyte death
  • MI: STEMI resulted from total occlusion thrombus and NSTEMI resulted from partial occlusion with/without collateral circulation
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8
Q

Define myoglobin

A
  • Heme protein found in all muscle tissue; potential diagnostic tool for acute MI
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9
Q

Define B type natriuretic peptide (BNP)

A
  • Protein produced by the ventricles of the heart used in diagnosing heart failure, with implications for CAD
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10
Q

Enzyme and isoenzyme levels increase within the first _______ hours after myocardial injury and reach their individual peaks at different rates

A
  • 2 to 6 hours
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11
Q

BNP lab values

A
  • Normal: <100
  • Pro BNP normal: <300
  • Heart failure likely if >400
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12
Q

What is considered a major risk factor for CAD in the blood

A
  • Hyperlipidemia (elevation in blood lipid levels)
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13
Q

Serum cholesterol and triglycerides are blood lipids of concern when elevated

A
  • Elevated cholesterol is associated with ingestion of excess amounts of saturated fat and cholesterol
  • Elevated triglyceride levels are defined as being higher than 150 mg/dL
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14
Q

Highly sensitive C-reactive protein (hs-CRP) assay is available to determine heart disease risk

A
  • Normal/low risk: <1.0
  • Average: 1.0-3.0
  • High risk: >3.0
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15
Q

What 3 components are included in a complete blood cell count test

A
  • White blood cells (WBC)
  • Hemoglobin (Hb)
  • Hematocrit
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16
Q

Hemoglobin (Hb) below what value is a red flag for out of bed activity

A
  • <8
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17
Q

Hematocrit is a significant indicator of the viscosity of the blood; list the implications for elevated/low lab values

A
  • Critically low Hb and hematocrit (<15-20%) may lead to cardiac failure or death
  • Hb values >20 or hematocrit >60% will increase viscosity of the blood causing increased resistance & stress on the heart
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18
Q

Prothrombin time and partial thromboplastin time measure ___________

A
  • Coagulation of blood
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19
Q

Electrolytes involved in maintaining cell membrane potential that are most important to monitor

A
  • Sodium (Na)
  • Potassium (K)
  • Magnesium (Mg)
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20
Q

Patients receiving diuretics (e.g., for hypertension or heart failure) should have their ________ and ________ levels monitored carefully because some diuretics act on the kidney

A
  • Sodium and potassium
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21
Q

Critical values and implications for sodium levels

A
  • Critical: <120 or >160
  • Hypernatremia:thrist, confusion, irritability, hyperreflexia, seizure, coma, tachycardia, hypotension, oliguria
  • Hyponatremia: HA, lethargy, hyporeflexia, seizure, coma, OH, pitting edema, confusion, weakness, nausea
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22
Q

Critical values and implications for potassium levels

A
  • Critical: Newborn -> <2.5 or >8; Adult -> <2.5 or >6.5
  • Hyperkalemia: muscle weakness or paralysis, muscle tenderness, paresthesia, dysrhythmia, bradycardia
  • Hypokalemia: extremity weakness, hyporeflexia, paresthesia, leg cramps, dysrhythmia, hypotension
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23
Q

Critical values and implications for magnesium levels

A
  • Critical: <0.5 or >3
  • Hypermagnesemia: N/V, hyporefelxia, hypotonia, somnolence (drowsy), bradycardia, dysrhythmia, hypotension, respiratory depression
  • Hypomagnesemia: hypertonia, hyperreflexia, tremors, muscle cramping, seizures, apathy, nystagmus, dysrhythmias
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24
Q

Elevated BUN may indicate

A
  • renal failure, uremia, or retention of urea in the blood
  • Unsuitable as a single measure for renal disease; creatine value should also be noted
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25
Q

Critical values and implications for serum creatine levels

A
  • Critical: >4 indicates serious impairment in renal function
  • Elevated: edema, dyspnea, abdominal/back pain, arthralgia, myalgia, myopathy, fatigue/malaise, insomnia, HA, confusion, pruiritis
  • Low: fatigue (uncommon)
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26
Q

Normal glucose levels

A
  • Fasting normal: 90-130
  • Elevated 120-130 suggests prediabetic states & warrants further testing for DM
  • Hyperglycemia: >200 denotes a crisis situation requiring immediate insulin (should not exercise)
  • Normal A1C: <5.7%
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27
Q

Symptoms of hyper/hypo glycemia

A
  • Hyper/Ketoacidosis: N/V, fruity breath, confusion, weak/rapid pulse, kussmaul respiration
  • Hypoglycemia: perspiration, weakness, pallor, nervousness, seizure, lethargy, irritability, tachycardia, palpitation, altered mental status, hunger, HA, shaking, blurred vision, LOC
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28
Q

Describe Holter monitoring

A
  • Continuous 24hr ECG monitoring of heart rhythm
  • PT should obtain interpretation of results to determine whether modifications are needed in the pt’s activities
  • Pts with abnormal Holter monitor results may be referred for treadmill exercise testing to assess arrhythmia or for echocardiography to assess valve functioning
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29
Q

Patients demonstrating _________________ with ambulatory monitoring may be referred to electrophysiologic mapping studies (EPS)

A
  • Life threatening arrhythmias
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30
Q

Describe an echocardiography

A
  • Provides real time images of beating heart
  • Uses pulses or reflected ultrasound to evaluate functioning of the heart
  • Transducer is placed on chest wall at the 3rd-5th intercostal space near L sternal border
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31
Q

Information that can be obtained from the echocardiogram

A
  • Size of ventricular cavity
  • Thickness/integrity of inter arterial/ventricular septa
  • Function of valves
  • Motions of ventricular wall
  • Degree of normal thickening of the myocardium
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32
Q

Advantages and disadvantages of a PET (position emission tomography)

A
  • Direct measurement of metabolic function & blood flow of the heart
  • Advantages: gold standard for blood flow, detects jeopardized but viable myocardium w/o exercise
  • Disadvantages: requires specialized tech & highly trained staff, costly & not available at many hospitals
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33
Q

What can different types of CT scans show in the heart

A
  • Used to identify masses in cardiovascular system or to detect aortic aneurysms or pericardial thickening
  • Single-photon emission computed tomography (SPECT)—detects and quantifies myocardial perfusion defects and contractility defects
  • Electron beam computed tomography—detects calcium in coronary arteries and quantifies coronary atherosclerosis
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34
Q

Describe a Multigated acquisition imaging (MUGA)

A
  • Calculates L ventricular ejection fraction (LVEF)
  • Radioactive tracer injected intravenous & gamma camera acquires images
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35
Q

Describe MRI of the heart

A
  • Evaluates morphology, cardiac blood flow, and myocardial contractility
  • Similar diagnostic accuracy as PET imaging, but more available and less expensive
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36
Q

Describe MRA (magnetic resonance angiogram)

A
  • uses magnetic and radio wave energy to take pictures of blood vessels
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37
Q

Most common agents used for a pharmacological stress test

A
  • Adenosine
  • Dipyridamole
  • Dobutamine
  • Regadenoson
  • Adenosine or dipyridamole-walk protocol—combined low-level treadmill exercise during adenosine infusion
38
Q

General goals of cardiac catheterization

A
  • Establish or confirm a diagnosis of cardiac dysfunction or heart disease.
  • Demonstrate the severity of CAD or valvular dysfunction.
  • Determine guidelines for optimal management of the patient, including medical and surgical management and a program of exercise
39
Q

Data obtained from cardiac catheterization

A
  • Cardiac output
  • Shunt detection
  • Angiography (coronary and ventriculography
  • L and R heart pressures (hemodynamics)
  • Ventricular ejection fraction (normal ~65)
40
Q

What are the normal pressure in the L/R segments of the heart

A
  • Right atrial (normal = 0–4 mm Hg)
  • Right ventricle (normal = 30/2 mm Hg)
  • Pulmonary artery (normal = 30/10 mm Hg)
  • Pulmonary artery wedge (normal = 8–12 mm Hg)
  • Left ventricular end-diastolic (normal = 8–12 mm Hg)
41
Q

Specific determinations that can be made from cardiac catheterization

A
  • The presence of and severity of CAD (degree of stenosis)
  • Presence of left ventricular dysfunction or aneurysm or both
  • Presence of valvular heart disease and the severity of the dysfunction
  • The presence of pericardial disease
42
Q

Cardiac catheterization has greater predictive accuracy in assessment of __________ than exercise testing

A
  • CAD (coronary artery disease)
43
Q

What does an endocardial biopsy determine

A
  • Determines myocardial rejection in patients with a cardiac transplant
44
Q

Most common dysfunctions/diagnostic tests for aortic dysfunctions

A
  • Dysfunctions: aneurysms, atherosclerotic disease, aortic valve dysfunction, arteritis
  • Diagnostic tests: ECG, angiography, CT scan, & chest x-ray
45
Q

Current methods to determine presence of peripheral arterial disease (PAD) include

A
  • History of symptoms
  • History of risk factors for atherosclerotic disease
  • Physical examination of pulses
  • Use of noninvasive vascular tests
46
Q

ABI (ankle brachial index) levels

A
  • No symptoms/normal: >1.1
  • Claudication: 0.5-1.0
  • Critical limb ischemia: 0.2-0.5 (suggestive of severe arterial occlusive disease)
  • Severe ischemia: <0.2
47
Q

Arterial duplex ultrasonography is a more precise diagnostic test for defining _________ and __________

A
  • Arterial stenosis
  • Occlusions
48
Q

Claudication often limits activity before any cardiac symptoms are evoked, so a graded exercise test may not be an effective method of evaluating cardiac disease if patients have PAD (True/False)

A
  • True
49
Q

Define Rubor dependency test and Venous filling time test

A
  • Rubor: assesses LE arterial circulation using skin color changes and positional changes
  • Venous: measures the efficiency of arterial blood flow through the capillaries and into the veins
50
Q

Direct visualization with duplex ultrasonography can identify the following

A
  • Plaque
  • Stenosis
  • Occlusions in the internal, common, & external carotid arteries
  • Flow direction in the vertebral arteries
51
Q

Typical arterial blood gases (ABG) report contains the following

A
  • Arterial pH
  • Partial pressures of carbon dioxide(PaCO2)
  • Partial pressures of oxygen (PaO2)
  • Oxygen saturation (SaO2)
  • Bicarbonate (HCO3−) concentration
  • Base excess
52
Q

What does a blood gas analysis assess

A
  • Assesses problems related to acid-base balance, ventilation, & oxygenation
53
Q

Adequacy of alveolar ventilation: reflected by PaCO2

A
  • Hyperventilation—PaCO2 < 40 mm Hg
  • Hypoventilation—PaCO2 > 40 mm Hg
  • Ventilatory failure—PaCO2 > 50 mm Hg
54
Q

Normal and abnormal pH levels in the blood

A
  • Normal: 7.35-7.45
  • pH <7.35 is acidemia: Low HCO3- leads to metabolic acidosis and High PaCO2 = respiratory acidosis
  • pH >7.45 is alkalemia: High HCO3- is metabolic alkalosis and Low PaCO2 is respiratory alkalosis
55
Q

Presentation of respiratory Alkalosis (increase pH, decrease PaCO2, normal HCO3-)

A
  • Lightheaded
  • Dyspnea
  • Paresthesia
  • Chest tightness
  • Seizure
56
Q

Presentation of respiratory Acidosis (decrease pH, increase PaCO2, normal HCO3-)

A
  • Anxiety
  • Confusion
  • Fatigue/lethargy
  • Tachypnea
  • Coma
  • Seizure
57
Q

Presentation of metabolic Alkalosis (increase pH, normal PaCO2, increase HCO3-)

A
  • Confusion
  • Delirium
  • Dysrhythmias
  • Hypotension
  • Muscle cramping
58
Q

Presentation of metabolic Acidosis (decrease pH, normal PaCO2, decrease HCO3-)

A
  • Dyspnea (Kussmaul breathing)
  • Fatigue
  • Nausea/vomiting
  • Tachyarrhythmias
  • Hypotension
59
Q

Compensated versus uncompensated respiratory acidosis

A
  • Uncompensated: PaCO2 levels increase without a corresponding change in HCO3- levels.This can be caused by type II respiratory failure, which can be due to CNS disorders, neuropathy, or myopathy.
  • Compensated: PaCO2 levels increase, and HCO3- levels also increase, which helps to balance the pH within the normal range.
60
Q

Compensated versus uncompensated metabolic acidosis

A
  • Uncompensated: Increased HCO3- without an increase in PaCO2
  • Compensated: pH is within normal range, decreased HCO3- with decreased PaCO2
61
Q

Normal pH, PaCO2, and HCO3- values

A
  • pH: 7.35-7.45
  • PaCO2: 35-45
  • HCO3-: 23-27
62
Q

Describe the anion gap

A
  • A blood test to determine the difference between free cations and frees anions
  • Free cations: Sodium (Na) and Potassium (K)
  • Free anions: Chloride (Cl) and Bicarbonate (HCO)
63
Q

Pulmonary function tests (PFTs) provide information about the

A
  • Integrity of airways
  • Function of respiratory musculature
  • Condition of lung tissues
64
Q

Describe a body plethysmograph

A
  • Pt sits in airtight chamber
  • Determines how much air is in lungs after taking a deep breath
  • Also measures amount of air left in lungs after person exhales as much as possible
65
Q

TLC (total lung capacity) always __________ in obstructive lung diseases and _________ in chronic restrictive lung diseases

A
  • Elevated
  • Reduced
66
Q

Define forced vital capacity

A
  • Forced vital capacity (FVC): maximum volume of gas the patient can exhale as forcefully and quickly as possible
67
Q

Define force expiratory volume in 1 second (FEV1)

A
  • Force expiratory volume in 1 second (FEV1): volume of air exhaled during the first second of the FVC; reflects airflow in the large airways
68
Q

Define forced midexpiratory flow (FEF 25-75)

A
  • Forced midexpiratory flow (FEF25-75): volume of air exhaled over the middle half of the FVC, divided by the time required to exhale it
69
Q

Define forced expiratory flow, 200-1200 (FEF200-1200)

A
  • Forced expiratory flow, 200 to 1200(FEF200–1200): the average expiratory flow during the early phase of exhalation
70
Q

Define maximum voluntary ventilation (MVV)

A
  • Maximum voluntary ventilation (MVV): maximal volume of gas a patient can move during 1 minute-
71
Q

Define peak expiratory flow (PEF)

A
  • Peak expiratory flow (PEF): maximum flow that occurs at any point in time during the FVC
72
Q

Define the Diffusing capacity of lung (DL) or diffusing capacity of lung for carbon monoxide (DLCO)

A
  • The amount of gas entering the pulmonary blood flow per unit of time relative to difference between partial pressures of gas in alveoli and pulmonary blood
  • DL measures integrity of functional lung unit.
73
Q

Abnormal values of DLCO test attributed to three factors

A
  • Decreased quantity of hemoglobin per unit volume of blood
  • Increased “thickness” of the alveolar–capillary membrane
  • Decreased functional surface area available for diffusion
74
Q

Severity and classification of DLCO reduction

A
  • Normal DLCO: >75% of predicted, up to 140%
  • Mild: 60%to LLN (lower limit of normal)
  • Moderate: 40%to 60%
  • Severe: <40%
75
Q

During a flow-volume loop following a period of normal, quiet breathing, the patient is instructed to

A
  • Perform a maximal inspiratory maneuver
  • Hold the breath for 1 to 2 seconds
  • Do an FVC maneuver
  • Do another maximal inspiratory maneuver
76
Q

Slide 85

A
77
Q

What does the BODE index for COPD estimate

A
  • Estimates 4 year survival
78
Q

Slides 90-92

A
79
Q

Standard radiograph, or chest x-ray (CXR), provides a static view of chest anatomy that is used to

A
  • Screen abnormalities
  • Provide baseline for further assessments
  • Monitor progress of a disease process or treatment
80
Q

How does air and bone present on chest x-ray

A
  • Air in the lungs results in a dark image (radiolucency).
  • Bone results in a white image (radiopacity).
81
Q

What are the 2 standard views for a chest x-ray

A
  • Posteroanterior (PA): patient in standing position with the front of the chest facing the film cassette
  • Left lateral view: helpful in localizing the position of an abnormality
82
Q

Describe a decubitus, lordotic, oblique, and anteroposterior (AP) views in a chest x-ray

A
  • Decubitus: taken to confirm the presence of an air– fluid level in the lungs or a small pleural effusion
  • Lordotic: used to visualize the apical or middle region of lungs or to screen for pulmonary tuberculosis
  • Oblique: taken to detect pleural thickening, to evaluate the carina, or to visualize the heart and great vessels.
  • Anteroposterior (AP) view: taken at the patient’s bedside
83
Q

CT scanning of chest primarily used for diagnosis of ________ versus calcifications or nodules

A
  • Tumors
84
Q

Describe a high-resolution computed tomography of the lungs (HRCT)

A
  • Detects diseases of the lung parenchyma
  • Detects lung disease in symptomatic patients with normal chest radiograph
85
Q

What is the gold standard for diagnosing a pulmonary embolism (PE)

A
  • Pulmonary arteriography
86
Q

Due to the disadvantages of pulmonary arteriography what imaging has become more widely used to test for PE

A
  • Chest CT scan
87
Q

Chest MRI is primarily indicated for evaluation of ______________________

A
  • Chest wall processes
88
Q

Normal V/Q scans show ________ ventilation and perfusion in the bases of the lung and ________ ventilation and perfusion in the apices.
Perfusion defects with normal ventilation strongly suggest a ______________________

A
  • Greater; less
  • Pulmonary embolism (PE)
89
Q

Bronchography is used for

A
  • Evaluation and management of some congenital pulmonary anomalies & acquired disease (usually of the tracheobronchial tree)
90
Q

Describe a bronchoscopy

A
  • Fiberoptic bronchoscopy permits direct visualization of previously inaccessible areas of the bronchial tree.
  • Usually performed with a flexible fiberoptic tube inserted through mouth or nose

Cardiopulmonary (9 decks)

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