Cardiovascular Diagnostics Flashcards
Worn externally, monitors a continuous EKG for 24 to 48 hours and allows patients to “mark” events of symptoms.
Holter monitor
Who is a holter monitor useful for?
A patient who is having frequent episodes of symptoms that could be cardiac related
Who is an event/loop monitor useful for?
A patient who is having sporadic episodes of symptoms that could be cardiac related; monitors continuous EKG for WEEKS!
On a chest X-ray, how much of the heart should be on each side of the thoracic cavity?
2/3 on the left, 1/3 on the right. Should not take up more than 1/2 of thoracic cavity
What is the normal cardiothoracic ratio?
0.5:1
What will you see on CXR in a patient with pulmonary edema or CHF?
Interstitial edema Kerley B lines Perihilar infiltrates Peribronchial cuffing Cephalization of vessels
Short, parallel lines at lung periphery that are distended into interlobular septa
Kerley B lines
Redistribution of blood to upper lobe vessels
Cephalization of vessels
With full inspiration, what is visible? How many ribs should you be able to see?
Right heart border is visible
8-10 ribs
What are some x-ray limitations?
Heart may appear falsely enlarged or small (COPD) with X-ray
The image may be obscured from effusions or pneumonia
The AP view shows _____ of the heart and _____ of the mediastinum
Magnification
Widening
Who should the AP view be reserved for?
Patients who cannot stand
What are some things that echocardiography can detect?
- Defects between chambers
- Pericardial effusions
What are the benefits of echocardiography?
- Minimally invasive
- Can view in real time
- Can evaluate chamber size, wall motion, and valve abnormalities
When is a stress echo useful?
To look for functional abnormalities under the stress of exercise
Standardized stress testing is designed to take patients to ___% or higher of their predicted max HR
85
Women have ___X more false positive on standardized stress testing than men
5
What does standard stress testing reveal?
- Exercise induced ischemia = coronary artery disease
- Stress induced arrhythmias
- BP response to exercise
- Patient’s functional capacity
What are the three orientations of perfusion imaging?
Short axis
Vertical long axis
Horizontal long axis
What type of nuclear stress testing is most common?
Technetium (myoview)
The technetium is attracted to the functional _____ of the heart and accumulates in viable heart muscle
Mitochondria
What is nuclear imaging useful for with resting heart tissue?
Shows which tissue is viable vs non-viable
What is nuclear imaging useful for with exercised heart tissue?
Ischemic vs non ischemic
When you compare rest and stress images with nuclear perfusion, a filling defect after rest indicates ____ and filling defect after exercise indicates _____
After rest = old MI
After exercise = Ischemia
What does a MUGA (multi-gated acquisition) scan evaluate?
Ventricular function, wall motion, and ejection fraction (volume)
What chemical does MUGA use and how does it work?
Technetium labeled RBCs imaged with Gamma camera
What chemical is used in a chemical stress test? What does it do?
Dobutamine/Persantine puts stress on the heart
During a chemical stress test, areas that lack perfusion reveal?
A filling defect
Yields anatomic and functional pictures of the heart, can see chamber wall thickness and motion
Cardiac MRI
Images during phases of cardiac cycle, will provide an image of the heart and cardiac vessels with excellent resolution very quickly
Cardiac CT
What is indicative of CAD?
Coronary artery calcification score
What ist he most invasive type of cardiac imaging?
Coronary angiography
What is the “gold standard” to diagnosing coronary heart disease?
Coronary angiography
Where is the catheter inserted in coronary angiography?
Femoral artery
What is a disadvantage to coronary angiography?
Risk of bleeding, perforation, and contrast reaction
What is an advantage of coronary angiography?
Can fix what is broken while doing the cardiac cath; can perform angioplasty and stent placement
What is a normal ABI?
1.0-1.4
What is an “acceptable” ABI?
0.9-1
What ABI shows some arterial disease?
0.8-0.9 - treat risk factors
What ABI shows moderate arterial disease?
0.5-0.8 - refer
What ABI shows severe arterial disease?
Less than 0.5 - refer
What is a non-invasive, inexpensive imaging technique often used in the evaluation of carotids, aorta, and deep veins of lower extremities?
Ultrasound
What is the best assessment of an AAA?
CT
What is the gold standard for diagnostic imaging of an aortic dissection?
MRA (MRI angiography)
What is the diagnostic gold standard for an AAA?
Angiography
What does digital subtraction angiography do to help the reader see the image?
Digitally reduces background noise of other images
Catheter inserted into chosen vessel and contrast injected
Vascular angiography
