CV testing lecture

Question 1

2 ECG leads are monitored and recorded by a device (cassette recorder) that patient wears for extended period of time. Provides continuous recording of ECG for 24 hours. Useful for detection of cardiac arrhythmias and determination if their presence correlates with patient symptoms.

Answer 1

Ambulatory monitoring (AKA Holter Monitor)

Question 2

External event recorders can monitor for…

Answer 2

weeks

Question 3

Implantable loop recorders: monitoring for up to

Answer 3

3 years

Question 4

What is used to determine pretest probability for CHD

Answer 4

Age
Gender
Character of chest pain

Question 5

Is CP substernal?
Is CP brought on by exertion?
Is CP relieved by rest or NTG?

Answer 5

(Character of chest pain)
0/3=Asymptomatic
1/3=Nonanginal CP
2/3=Atypical angina
3/3=Typical (classical) angina

Question 6

Asymptomatic men/woman of all ages.

Woman under 50 yrs with atypical CP

Answer 6

Avoid stress testing in this group. Hi incidence of false positives.

*low pretest probability, under 10%

Question 7

Intermediate pretest probability is ____ to ____%

Answer 7

10 to 90%

Question 8

Men of all ages with atypical angina
Woman ≥50 yrs with atypical angina
Woman 30-60 yrs with typical angina

Answer 8

Intermediate pretest probability

**STRESS TEST!

Question 9

Stress test may confirm Dx but negative test does not exclude Dx.
Stress testing may provide prognostic valued in this group.
Some of these patients will benefit from coronary angiography.

Answer 9

High pretest probability group (over 90%)

Question 10

Men ≥40 yrs with typical angina

Women ≥60 yrs with typical angina

Answer 10

High pretest probability (over 90%)

Question 11

Exercise increases CO and coronary flow up to…

Answer 11

5 times

Question 12

1 met: resting O2 consumption= ____ml/min/kg.

Answer 12

3.5

Question 13

Adenosine and Dipyridamole

Dobutamine

Answer 13

Pharmacologic stress testing

Question 14

Reproduce symptoms and/or diagnostic evidence of ischemia (ECG).
Achieve target heart rate: 85-90% of PMHR if no ischemic changes.

Answer 14

Goals of exercise stress testing

Question 15

If BP decreases during stress test…

Answer 15

STOP IT!

Question 16

Stress echocardiography overall SENSITIVITY?

SPECIFICITY?

Answer 16

sensitivity: 60-70%
specificity: 80-85%

Question 17

Single vessel CAD stress echo sensitivity

Answer 17

50%

Question 18

2 vessel CAD stress echo sensitivity?

3 vessel CAD?

Answer 18

2 vessel: 65%

3 vessel: 85%

Question 19

predicted max HR men:

predicted max HR women:

Answer 19

men: 220-age
women: 210-age

Question 20

For patients without symptoms/ECG changes, need to achieve 85-90% PMHR before concluding…

Answer 20

negative test or ischemia

Question 21

Stress echoes have a high incidence of false positives in..

Answer 21

young, healthy women

Question 22

Stress echocardiography have decreased ______ in women with documented CHD.

Answer 22

sensitivity

bc women usually have single vessel dz