CV outcome measures & diagnostics

Question 1

scores for 6 minute walk test in chronic HF population:
– avg distance:
– score indicative of poor prognosis
– score predictive of hospitalization and mortality

Answer 1

– 310-427 m
– < 300 m
– < 200 m

Question 2

an improvement of _____ has a positive effect on morbidity and mortality
an improvement of _____ has QOL benefits

Answer 2

30-50 m
80 m

Question 3

in HF population, what is the MCID for the 6 minute walk test?

Answer 3

54 m –> an increase in this distance is indicative of clinical change

Question 4

scores for gait speed (10m walk test) in chronic HF population:
– score that increases risk of all cause mortality
– score that increases risk of all cause hospital admission

Answer 4

– < 0.65 m/s
– < 0.8 m/s

Question 5

MCID for gait speed:

Answer 5

0.05-0.12 m/s

Question 6

TUG:
– normal time:
– inc. risk of falls
– slower speeds are associated with:
– valid and reliable for what population:

Answer 6

– 8.2 seconds
– > 13.5 sec.
– inc. mortality and CVD risk
– HF

Question 7

sit to stand tests:
– reliable and responsive to ____ populations
– time on 5x STS needing further fall risk assessment

Answer 7

– cardiac rehab and geriatric populations
– >/= 12 seconds

Question 8

short physical performance battery (SPPB):
– assesses?
– better for what type of patients?
– MCID?
– score of ____ increases mortality

Answer 8

– balance, sit to stand, and gait speed
– lower functioning patients
– 1 point
– < 10/12

Question 9

activity measure for post-acute care (AMPAC 6 clicks):
– used in ___ setting most often
– predicts:
– _____ uses for approval/denial
– score that indicates pt MIGHT need post acute rehab

Answer 9

– acute care
– discharge destinations and functional impairment level
– medicare
– < 17/24

Question 10

Minnesota Living with Heart Failure Questionnaire
Seattle Angina Questionnaire
Kansas City Cardiomyopathy Questionnaire
– all are what kind of outcome measures?

Answer 10

health related quality of life measures specific to heart disease

Question 11

what is a holter monitor?

Answer 11

continuous, ambulatory 24 hour monitor of heart activity that can be worn up to 30 days (worn around neck)

Question 12

indications for use of holter monitor:

Answer 12

arrhythmias
palpitations
unexplained dizziness or syncope
assessment of ICD functioning

Question 13

imaging that is good for viewing fluid accumulation and does not visualize internal structures of the heart well

Answer 13

chest X Ray

Question 14

indications for getting a chest X ray

Answer 14

heart failure
pulmonary edema
cardiomegaly
post-op CT surgery
device placement
post extubation

Question 15

a detailed imaging technique to assess structure and function of the heart - like an ultrasound of the heart

Answer 15

echocardiogram

Question 16

what things can an echocardiogram detect?

Answer 16

atrial & ventricular size
cardiac muscle function
valve function
heart chamber thickness and movement

Question 17

what is a pro of using an echocardiogram?

Answer 17

provides real time images of a beating heart
estimates EF, SV, and flow rates

Question 18

indications for performing echocardiogram

Answer 18

valve conditions
congenital heart disease
thrombus
ischemia
cardiac muscle dysfunction
cardiomyopathy
aortic dissection

Question 19

transthoracic echocardiogram (TTE):
– invasive/noninvasive
– gives ____ views of the heart

Answer 19

– noninvasive
– anterior & superior

Question 20

transesophageal echocardiogram (TEE):
– invasive/noninvasive
– gives ____ views of the heart
– used for:

Answer 20

– invasive - requires anesthesia
– posterior & inferior
– more accurate & closer view of cardiac structures

Question 21

why would you want to have a contrast echocardiogram?

Answer 21

allows for improved resolution and more accurate intracardiac blood flow
helps detect cardiac defects
looks closely at coronary blood flow without more invasive diagnostics

Question 22

what does a MRI of the heart evaluate?

Answer 22

cardiac form and structure
cardiac blood flow
myocardial contractility

Question 23

what is magnetic resonance angiogram (MRA)?

Answer 23

MRI imaging with IV contrast to evaluate vasculature

Question 24

a CT of the heart is used to identify ___

Answer 24

structural defects of the heart, aorta, and other large vessels

Question 25

true or false. CT cannot be performed with contrast

Answer 25

false - can be performed with or without IV contrast depending on indication and comorbidities

Question 26

Positron Emission Tomography (PET):
– what is it?
– invasive/noninvasive
– cons

Answer 26

– nuclear imaging that can detect glucose uptakes, blood flow, and cardiac metabolism
– noninvasive
– not as accessible, expensive, requires equipment

Question 27

what is cardiac catheterization?
– arterial access

Answer 27

invasive procedure used for diagnosis or management of cardiac disease - IV contrast injected into heart chambers and coronary arteries
– femoral or radial arterial access

Question 28

indications for cardiac catheterization

Answer 28

CAD
heart failure
cardiac arrest
valve disease
angina
worsening exercise tolerance
pending organ donation

Question 29

what information can we gather from a cardiac catheter?

Answer 29

presence of and severity of CAD - % of stenosis or blockage
valvular heart disease and severity of dysfunction
pericardial disease
cardiac output, ejection fraction
shunts, structural heart defects
chamber pressures
pulmonary artery pressures

Question 30

what is a more accurate assessment performed of CAD than exercise testing?

Answer 30

cardiac catheterization

Question 31

what is endomyocardial biopsy?
– determines ?

Answer 31

samples of the endomyocardium are taken from the ventricle or intraventricular septum through a cardiac catheter
– determines myocardial rejection after heart transplant

Question 32

indications for endomyocardial biopsy?

Answer 32

cardiac transplant
sarcoidosis
amyloidosis
myocarditis
cardiomyopathy
tumors
genetic conditions

Question 33

what is an ankle-brachial index (ABI)?
– compares BP in ___ and ___ to brachial artery

Answer 33

% of blood reaching the feet
– post. tib or dorsalis pedis

Question 34

indications for ABI

Answer 34

diagnosing degree of PAD
determining tissue healing

Question 35

ABI levels:
> 1.30
0.9-1.3
0.6-0.89
0.4-0.59
< 0.4

Answer 35

poorly compressible vessels, arterial calcification
normal
mild arterial obstruction
moderate obstruction
severe obstruction

Question 36

what is a doppler ultrasound?
– esp. useful with ___

Answer 36

sound waves used to determine degree of blood flow
– small or diseased vessels

Question 37

indications for doppler ultrasound

Answer 37

DVT
endothelial injury
arterial occlusion
aneurysm
venous insufficiency

Question 38

a carotid ultrasound is used to detect ____ or measure ____

Answer 38

ischemia or measure blood flow to the brain

Question 39

indications for carotid ultrasound:

Answer 39

new CVA
PAD
cardiac arrest
syncope