COMPS: CV Dx Tests and Procedures: Exam 1 Flashcards
Noninvasive Dx test:
EKG
the 12 lead EKG
what is it
<5 mins monitoring rhythm @ rest
GIVES MORE INFO ON RHYTHM!!!
Electrocardiographic/EKG monitor
Obtains what:
- rate
- timing/strength of electric impulses
- normal rhythm vs. arrythmias
Noninvasive tests:
Holter/Telemetry
what is it?
- continuous >24 hr EKG monitoring of pts heart rhythm while pt completes ADLs
Holter/Telemetry
Obtains:
- SAME INFO:
- RATE
- timing/strength of electric impulses
- normal rhythm vs arrythmias
Holter/Telemetry is ESSENTIAL to:
Dx and Med mgmt of episodes of cardiac arrythmias and sx’s
Noninvasive Tests:
ECHO
Echocardiography
what is it?
- US
- uses pulses of reflected high freq sound waves and receives their echo
- evals functioning of heart
- uses pulses of reflected high freq sound waves and receives their echo
ECHO
info derived:
- size of ventricular cavity
- thickness of walls
- integrity of interatrial and intraventricular septa
- functioning of valves
- motions of indiv. segments of ventricular wall
ECHO
Quantifies what volumes?
- Left vent. SV
-
Ejection Fraction (EF)
- EF== SV/EDV
This type of ECHO has improved view of heart AND mediastinum
Transesophageal ECHO
TEE
US device goes INTO esophagus
*if you want to see BACK of heart *
Noninvasive dx tests:
Cardiac CT scan
computed tomography
used to dx:
- masses in CV system
- aortic aneurysms
- pericardial thickening
*uses multiple xray angles*
NONinvasive dx tests:
MRI
magnetic resonance imaging
used to Eval:
- congenital morphology or malformations (born w/)
- anatomy
- cardiac blood flow of coronary aa’s
-
myocardial contractility
- masses
- thrombi
- valvular disease
*NOTE: <2-4yo DO NOT USE!!!
NONINVASIVE Dx tests :
Exercise test/Exercise Stress test
involves what ?
- systematically AND progressively INCing VO2 demand to eval resp’s w/ EKG readings
*NOTE: used if @ risk for MI PRIOR to sx—-Uncle Barry!!!
Ex test/Ex Stress Tests
prognostic tool for ….
Used for…
MAX exercise testing
- dx AND mgmt coronary artery disease (CAD)
- GREATER Sn and Sp in MALES >40yo vs. females
Noninvasive Dx tests:
Pharmacologicl Stress Testing
when is this used?
when pt is unable to perform upright ex. on TM or cycle
Pharmacological stress testing uses injection of what to induce physio. stress
pharmacological agent
*SNS NT’s
Who would you use pharmacological stress test on?
med. fragile
immobile/non-ambulatory
fall risk pt
Pts demo’ing life-threatening arrythmias on EKG/Holter monitor may be referred to this……
EPS
Electrophysiological study
noninvasive
INVASIVE dx tests:
Cardiac Catheterization/Coronary Angiography
same thing
Indications?
- cardiac arrest OR vent. fibrillation
- pulm. edema
- angina w/ diff. medical mgmt
- job descript. mandate
- sig. DEC in ex. tolerance
Cardiac Catheterization/Coronary Angiography
indicated for sig. DEC in ex. tolerance
evident by what?
WHY?
- DROP in SBP w/ exertion
- WORSENING stress test
- sx’s
- pallor, mental confuse
- angina
- ST changes on EKG
- L. VENT EF <35%
- normal= 60-70%
- If phys. needs it for more conclusive dx
Procedure for Cardiac Catheterization
- catheter into CV system
- measure pressures OR perform angiography
- Interventional Radiology
- Cath into brachial aa OR femoral aa
Per MD order w/ cardiac catheterization
pt needs what?
1-6hrs of bedrest
per MD!!!
WHO reviews cardiac cath films
cardiologist
Cardiac cath/angiography
what is used to get EDV
Vein is used to get EDV
cardiac cath/angiography
see pics
Noninvasive Vascular tests:
Abdominal US
indications?
- Descending aortic aneurysms and dissections (aneurysm burst)
NOTE: only checks BELOW heart
NONinvasive Vascular tests:
Vascular or Venous US’s
+ indicated
DEEP VEIN THROMBOPHLEBITIS
DVT
GOLD STANDARD screening for DVT
Vascular or Venous US
Impression for Vascular or Venous US
- Veins/aa’s visualized
- Presence or absence of clots
NONinvasive Vascular tests:
Ankle-Brachial Index
ABI
what are we looking for?
PAD
In a nutshell….
What is ABI explaining?
How much LESS blood is getting to toes/feet compared to arm (UE)
ABI measurement
1.0-1.40
-
Sx’s
- NONE
-
Clinical presentation
- NORMAL
ABI Measurement:
.5-.9
-
Symptoms:
-
Claudication
- supply not meeting demand
-
Claudication
-
Clinical present:
- pain in calf w/ ambulation
ABI measurement
.2-.5
-
Sx’s
- critical limb ischemia
-
Clinical present
- atrophic changes
- rest pain
- wounds
ABI measure:
<0.2
-
Sx’s
- SEVERE ischemia
-
Clinical presentation
- gangrene/severe necrosis
ABI measure:
> 1.40
====> PAD
-
sx’s
- Rigid aa’s
-
Clinical present:
- PAD
NONinvasive Vascular tests:
Rubor of Dependency
+ test indicates what?
- Arterial insuff.
- PAD
Rubor of Dependency
noninvasive Vascular test looking for PAD
Arterial test!!
How to do it?
- place client supine and observe feet
- elevate leg to 45degs (above heart)
- foot may/may not become pale here
- bring left foot to dependent pos. sitting EOB w/ leg on floor OR dangling
Rubor of Dependency
+ vs. - resonse
-
(-) Normal response:
- rapid pink flush in the feet/ no change in color
-
(+) Arterial insuff.:
-
demo a deep red color (rubor) after 30s in dependent pos.
- Reactive hyperemia
-
demo a deep red color (rubor) after 30s in dependent pos.
*NOTE: good test to do if pt has not seen Dr. or cardiologist
Noninvasive Vascular tests:
Homan’s Sign
+ indicates what?
DVT
NONinvasive Vascular tests:
Homan’s sign
- pain in upper calf w/ forced ankle DF
- 50% chance you have DVT
-
BASIC screen. tool for DVT
- 50% Sp
- HIGH false pos.
Noninvasive Vascular tests:
Claudication Time
+ quantifies
SEVERITY of claudication
Noninvasive Vascular tests:
Claudication time
- pt ambulates on TM or flat surf. until subjective claudication occurs
-
DOCUMENTING:
- TIME or DIST. ambulated @ onset/beginning of claudication
Medical Chart review: or
PT consult
