Clin Lab Cardiology Flashcards
1
Q
what is dextrocardia
A
occurs when there is a transposition of the heart
can occur in isolation or with other organs, may be asymptomatic
2
Q
what is cardiomegaly
A
enlarged heart
3
Q
how will cardiomegaly look on a chest xray
A
heart is extra large; heart is more than half of the diameter of the chest cavity
4
Q
what conditions cause cardiomegaly
A
dilated cardiomyopathy
heart failure
left ventricular hypertrophy
5
Q
what is a pericardial effusion
A
fluid around the heart
6
Q
what does a pericardial effusion look like on CXR
A
water bottle sign = rounded/triangular sac
heart itself is not enlarged but fluid is apparent
7
Q
what will show up on CXR during congestive heart failure
A
pleaural effusions = bilateral blunting, kerly b lines
increased vasculature = cephalization of pulmonary vessels
8
Q
what are kerley b lines
A
horizontal lines of periphery of lungs, represent interlobular septum fluid
9
Q
what is cephalization of pulmonary vessels
A
swelling of veins and vasculature in the upper lobes
10
Q
what will aortic dissection look like on CXR
A
widened mediastinum
calcium sign
11
Q
what is a calcium sign on CXR
A
if blood is on the outside of the calcium line, indicates aortic dissection
12
Q
what is the first thing you should do when someone is having an aortic dissection
A
lower their blood pressure
13
Q
what is the gold standard test for a pericardial effusion
A
echocardiogram
14
Q
why would you order a CT for a pericardial effusion
A
if you need to quantify the pericardial effusion
15
Q
what is the worrisome thing about a pericardial effusion
A
it turning into cardiac tamponade
16
Q
what test do you order to show a coronary artery calcification
A
non-contrast CT
17
Q
how would coronary artery calcification show up on CT
A
will look bright white
18
Q
why would you order a CT for coronary artery calcification
A
to assess asymptomatic patients with a 10yr intermediate risk for coronary artery disease
19
Q
what are calcifications in the coronary arteries a sign of
A
atherosclerotic plaques from coronary artery disease
20
Q
what will an aortic aneurysm look like on CT
A
can see a widening of the mediastinum
21
Q
what will an aortic dissection look like on CT
A
dissection appears whiter and there will be a line in the middle indicating that the blood vessels have separated
22
Q
what are the two possible methods of an echocardiogram
A
transthoracic
transesophageal
23
Q
when is an echo used
A
to assess structure and function of the heart
24
Q
what information is gained from an echo
A
- wall motion during contraction
- filling of the ventricles during diastole
- estimation of ventricular size/wall size
- ejection fraction
- valve function/patency
- right ventricular systolic pressure
- pericardial effusion
- inferior vena cava congestion
- intracardial thrombus during atrial fibrillation
- patent opentings between chambers
25
what are the four views of a TTE
parasternal long axis
parasternal short axis
apical 4 chamber view
subcostal (subxiphoid)
26
what does a technically "difficult" study indicate
that there is a body habitus issue
27
how do you overcome technically difficult echo studies
can inject contracting solution
28
what are the two contracting solutions used to overcome technically difficult echo studies
agitated saline
definity microspheres
29
when do you order an echo
cardiac symptoms
evaluation of a murmur
stroke
congenital heart disease
cardiotoxic medications causing heart damage
30
what are the results of an echocardiogram
1. ejection fraction
2. diastolic dysfunction (in grades)
3. thickness of walls
4. wall motion
5. enlargement of chambers
6. valvues
7. right ventricular systolic pressure
8. pericardial/pleural effusion
9. IVC collapse
31
what is a normal ejection fraction
50-55%
32
what is a normal amount of IVC collapse
50%; could indicate that there are atherosclerotic plaques or an embolus preventing collapse
33
what does right ventricular systolic pressure indicate
potential of pulmonary hypertension
34
what impacts right ventricular systolic pressure
tricuspid valve
35
what are the abnormal types of wall motion
hypokinesis and akinesis
36
what are the indications to order a TEE
1. nondiagnostic TTE
2. tumors
3. valves
4. aortic dissection
5. native/prosthetic valve
6. stroke
7. intraoperative monitoring
37
what are the absolute contraindications of a TEE
recent esophageal/gastric surgery
esophageal stricture/obstruction
active upper GI bleed
perforated GI organ
38
what are the relative contraindications of TEE
history of coagulopathy or thrombocytosis
body malformations
history of a GI bleed or surgery
hiatal hernia
esophageal varices
39
what are esophageal varices
varicose veins of the esophagus
40
what are the complications of TEE
esophageal rupture that could lead to pneumothorax
vocal cord injury
arrhythmia
sore throat or mouth injury
41
what is a stress test
heart function is evaluated at rest and under stress to help determine who needs a heart catheterization
EKG or imaging may be done at the same time to evaluate issues
42
what are the indications to order a stress test
symptomatic but no EKG changes and negative work up
these patients have an intermediate risk of CAD (HEART score from 4-6)
preoperative evaluation of symptomatic patients undergoing noncardiac surgery
43
what happens if a patient has a positive stress test
patient needs to go to the cardiac cath lab
44
what are the contraindications of stress test
people that are asymptomatic and have low risk
recent MI
acute cardiac infection/inflammation
severe aortic stenosis
hemodynamically unstable
HTN urgency
recent stroke or TIA
45
what are the complications of a stress test
arrhythmia
MI
chest pain
syncope
headache (from medication)
46
what are the three types of stress test
1. exercise stress test with EKG
2. exercise stress test with echo
3. pharmacological stress test
47
what is the indication for an exercise stress test with EKG
best initial test if patient can exercise and have a low probability of CAD
48
what is the standard procedure during a stress test with EKG
patient will use a treadmill/bike to increase speed/incline on a fixed schedule
49
what does 4 METs indicate
1 flight of stairs
50
what does 10 METs indicate
3.4 miles/hour with a 14% incline for 3 minutes
51
when is a stress test with an echo used
patient can exercise and has a low probability of CAD
but the baseline limits interpretation
52
who should get a stress test with echo
left bundle brunch block
taking digoxin
pacemaker
baseline ST changes
accessory pathway
53
when is pharmacological stress testing used
patients cannot exercise
54
what is the nuclear medication used for in stress testing
cardiolite
55
what do you look for in a nuc med test
areas where the nuclear medication is not being absorbed, it indicates an area where there is no perfusion/oxygenation
56
what two types of medications do patients get when their heart is being stressed
vasodilators
sympathomimetic
57
what are the vasodilators that stress the heart
adenosine
lexiscan
dipyridamole
58
what is the sympathomimetic medication used to stress the heart
dobutamine
59
what is the gold standard testing for coronary artery disease
heart catheterization
60
what comes in a lipid panel
total cholesterol
triglycerides
HDL
LDL
VLDL
non-HDL
LDL/HDL ratio or chol/HDL ratio
61
what is the normal level for total cholesterol
less than 200
62
what is an abnormal level for total cholesterol
above 240
needs medication
63
what are the levels for total cholesterol that indicate lifestyle/diet modification
200-239
64
what is a normal level of triglycerides
under 150
65
what is an abnormal level of triglycerides
above 200
66
what is a the range for triglycerides that can be helped with lifestyle/modification changes
150-199
67
what is the appropriate level for HDL
above 40
68
what is a normal level for LDL
lower than 130
69
what is an abnormal level for LDL
above 160
70
how is the LDL fraction measured
total cholesterol - HDL - (triglycerides/5)
71
what are the two lipoprotein measurements
Apo A1
Apo B
72
where is Apo A1 found on
predominantly on HDL
73
where is Apo B found on
predominantly on LDL
74
which lipoprotein is a better indicator of risk
Apo B
75
what do smaller, denser LDL particles indicate
contribute to plaque formation more than just small LDL particles
in patients with an increase in LDL, they are at higher risk if the LDL particles are smaller
76
what is the atherosclerotic form of LDL
an indicator and reason for plaque build up
77
what is LAP A2
an enzyme that is associated with inflammation of blood vessels
increased levels are associated with CVD
78
what is hsCRP
high sensitivity CRP
79
when is hsCRP used
other tests for CVD
a result greater than 3 means that there is high risk for CVD
80
when should you not order an hsCRP
inflammatory disorders because patients will already have a high CRP
81
what does a score of 0 indicate on coronary artery calcification CT
no evidence of calcification
82
what are the scoring ranges on a coronary artery calcification CT
0 = no evidence
1-10 =minimal
11-100 = mild
101-400 = moderate
401+ = severe
83
when do you need to talk to patients about being on a statin for a coronary artery calcification CT
above 11
above 400 NEEDS to be on a statin
84
what are the scoring ranges for an ABI
0.9-1.3 = normal
<0.9 = occlusive peripheral arterial disease with 50% stenosis; a lower number is worse
>1.3 = calcifications of arterial walls
85
when do you use a carotid doppler
to look for calcifications which would indicate that there is calcification everywhere in the body
86
what are the acute diagnostics for an MI
1. need a detection of change in cardiac biomarkers and with at least one of the following
-ischemic symptoms
-evidence of ischemic changes on EKG
-intracoronary thrombus
-imaging of wall motion changes/myocardium ischemia
87
what are ischemic changes that could be seen on an EKG
ST-segment-T wave changes
left bundle branch block
pathologic q waves
88
what are the three old biomarkers
myoglobin
lactate dehydrogenase
creatinine kinase and Ck-MB
89
what is a Ck-MB
measures an enzyme released from cells when damaged found in striated muscle, brain, GI, and heart
90
what are the three types of creatinine kinase enzymes that can form isoenzymes
MM
MB - heart
BB
91
when does a Ck-MB peak
12-24 hours
92
what is troponin
protein that regulates contraction of striated muscles; released in times where there is no oxygen
93
what are the three forms of troponin
cTnC
cTnT
cTnI
94
what are the two forms of troponin that are in the heart
cTnT
cTnI
95
what are the differences between cTnT and cTnI
cTnT = peaks in 12 hours, lasts from 5-14 days
cTnI = peaks in 24 hours, lasts around 5-10 days
96
what is the higher sensitivity troponin
5th generation
97
what is significant about hsTroponin
it is way more sensitive to levels of troponin
everyone has low levels of troponin so need to detect a delta troponin to give an indication of heart attack
98
what are the lab values you need to order in the ER when someone is having ACS
serial serum cardiac biomarkers
CBC
BMP (electrolytes, BUN, creatinine, and glucose)
could order:
PT/INR/, aPTT
magnesium
serum lipids
99
what are the two new ACS tests
ischemia-modified albumin
copeptin
100
where does copeptin come from
ADH
101
how is CHF diagnosed
clinically
102
what pieces of information help rule in/out CHF
imaging = echo, EKG, CXR
labs = BNP, proNT-BNP
103
when is BNP released
released in response to overload
works to control sodium by peeing and remains in circulation longer than CMP/AMP
104
what is a level of BNP that helps rule out CHF
less than 100
105
what is a level of BNP that is consistent with a diagnosis of CHF
above 400
106
what are the 5 tests for peripheral vascular disorders
1. ABI
2. Arterial plethysmography
3. CT angiography
4. MR angiography
5. Angiography
107
what is arterial plethysmography
inflatable cuffs on extremities to test for arterial studies
normal = tall, sharp peak
abnormal = decreased
108
when are the indications for arterial plethysmography
lower extremity ulcers/wound
surgical preplanning
thoracic outlet syndrome evaluation
109
what are the indications to use CT angiography
s/sx of peripheral arterial disease
evaluation for aneurysm and dissection
surgical preplanning
trauma
110
what are the contraindications for CT angiography
kidney dysfunction
allergy
111
what are the benefits of CT angiography
less invasive and fewer complications
112
what are the indications to do a MR angiography
stroke
113
what are the benefits to MR angiography
less invasive
no radiation
114
what is the downside of an MR angiography
very costly and timely
115
what is an angiography study
dye injected to femoral arteries
very invasive
116
what are the indications to do angiography
unable to do an MRA, CTA, need to do an abdomen or brain study
117
what are the benefits of angiography
good visualization
118
what are the complications of angiography
perforation/bleeding
thrombus
dissection
allergic reactions
119
what could happen after an MI
dressler's syndrome
inflammation after an MI
120
what is dressler syndrome
pericarditis --> pericardial effusion or pleural effusion
one week after
need to order: CRP, ESR, CBC, troponin, EKG, echo, CXR
may see anti-actin/anti-myosin antibodies
121
how to treat autoimmune dressler syndrome
steroids
122
what are the five types of cardiac monitoring
1. holter
2. cardiac event monitor
3. patch monitor
4. mobile cardiac telemetry
5. implantable
123
when should a holter monitor be used
when there are constant symptoms
lasts 24-48 hours
124
when should a cardiac event monitor be used
when there are less often symptoms
patient will push a button when they feel their symptoms
125
when should a patch monitor or mobile cardiac. telemetry
when patients have no symptoms but need monitoring
126
when would an implantable cardiac monitor
severe but infrequent symptoms
lasts for years
127
when would pericardial fluid be tested
if purulent
if malignancy
possible TB
128
what are the fluid analyses tha tare run on pericardial fluid
gram stain, culture, PCR multiplex
AFB stain, mycobacterial, IGRA for TB
cytology for malignancy
