diagnostic procedures Flashcards

1
Q

what is the EVH (Eucapnic Voluntary Hyperpnea) challenge?

A

the sensitive and specific diagnostic method that triggers exercise-induced bronchoconstriction (EIBC) by hyperventilation of safe concentrations of dry gases

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2
Q

what is the EVH challenge protocol?

A
  • prior:
    • refrain from taking short-acting bronchodilators for 8 hours
    • refrain from taking long-acting/sustained release bronchodilators for 48 hours in order to maximize the airway response
    • FEV1 is taken before, 3 times.. highest one is the baseline for the test
  • a ventilation rate of 21x FEV1 at baseline = a positive response for those with asthma
  • a ventilation rate of 30x FEV1 at baseline is recommended for those without a diagnosis of asthma
  • FEV1 assessed after 5, 10, 15, and 20 mins post challenge
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3
Q

what do different EVH responses mean?

A
  • the percent decline between the FEV1 obtained pre-challenge and the FEV1 obtained post-challenge is used to determine the airway response
    • EVH response >12% is considered a positive response
  • FEV1 baseline - lowest FEV1 post-EVH x 100 = % decline
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4
Q

what will the FEV1 range be with someone with COPD?

A

between 50-79% of the predicted normal values with an FEV1/FVC of less than 70%

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5
Q

what are symptoms of COPD?

A
  • SOB after activity
  • cough & sputum production are more noticable
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6
Q

what is pulse oximetry?

A

measuring oxygen saturation or the percentage of hemoglobin saturated with oxyen in arterial blood

  • normal levels = 95-100%
  • 88% or below = hypoxemia
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7
Q

what is a holter monitor?

A

ambulatory or portable electrocardiogram (ECG)

  • records the electrical activity of the heart continuously over 24 hours or longer
  • a standard or “resting” ECG is one of the simplest and fastest tests used to evaluate the heart
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8
Q

why do people use holter monitors?

A

for patients suspected of/or with atrial fibrillation, pre ventricular contractions, pre atrial contractions, atrial flutter, and bradycardia

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9
Q

why would someone order a cholesterol test?

A

to get a better understanding of risk factors of a heart attack or other types of CVD

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10
Q

what does it mean when you have high triglycerides?

A
  • you regularly eat more calories than you burn
  • high levels can increase your risk of heart disease
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11
Q

how low should your triglyceride levels be?

A

less than 150 mg/dL (1.7 mmol/L)

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12
Q

what is non-high density lipoprotein (non-HDL-C)?

A

the difference between total cholesterol and HDL cholesterol

  • includes cholesterol in lipoprotein particles that are involved in hardening of the arteries
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13
Q

what are high sensitivity C-reactive proteins (HS-CRP)?

A
  • a protein made by the liver that plays an integral role in the body’s response to injury and infection
  • key in the inflammatory response
    • greater inflammation = increased risk of heart attack, stroke, and other CVDs
  • buildup of fats, cholesterol and other substances (plaque) can resrtict blood flow, triggering a blood clot
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14
Q

why should HS-CRP tests be done multiple times, and how often?

A
  • CRP levels can temporarily increase by many situations (ex: cold, or going for a long run)
  • should be done twice, two weeks apart
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15
Q

what HS-CRP levels indicate higher risk of heart disease and what medications help?

A
  • above 2.0 mg/L
  • cholesterol-lowering statin medications
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16
Q

what is the purpose of testing for troponin?

A
  • troponin T is found in heart muscle
  • mesuring levels can determine whether or not a heart attack has occured and can help determine risk of CVD
  • increased levels of troponin T = greater risks of CVD in those without symptoms
17
Q

what is an echocardiogram and how is it done?

A
  • a graphic outline of the heart’s movement
  • ultrasound from a hand-held wand placed on the patient’s chest (AKA transthoracic echocardiogram)
  • often combined with Doppler ultrasound and colour Doppler to evaluate blood flow across the heart’s valves
18
Q

what is a transesophageal echocardiogram (TEE)?

A
  • echocardiogram that provides clearer. images of the heart that are difficult to view with a standard echo
  • always preceded after the standard echocardiogram
  • ultrasound probe inserted in the esophagus to rest closer to the heart
19
Q

what is the purpose/goals of a coronary artery bypass graft (CABG)?

A
  • use for those patients with coronary artery disease to improve blood flow to the heart
  • goal:
    • improve the patients quality of life
    • decrease angina, and other CVD symptoms
    • improve the pumping action of the heart
    • lower risk of heart attack
    • allow patient to resume/begin a more active lifestyle
20
Q

what is the procedure for CABG?

A
  • take a healthy artery/vein from body and connecting/grafting to the blocked coronary artery
    • healthy artery will go around (bypass) blocked artery and blood
  1. chest bone opened to access the heart
  2. heart gets stopped by medication & heart-lung bypass machine used to keep body functioning
  3. after surgery, blood flow to heart is resotred and heart typicall will start beating on its own
21
Q

what is the success rate for CABG?

A
  • sometimes patients will need a repeat CABG is grafted arteries/veins become blocked or if there are new blockages
  • 85% of patients who undergo CABG experience reduced symptoms, less risk of heart attacks, and a 10 year decrease in dying
22
Q

what is off pump CABG?

A
  • similar to traditional CABG since the chest bone is opened, but the heart isn’t stopped, and heart-bypass machine isn’t used
23
Q

what is coronary artery bypass grafting and why is it used?

A
  • similar to off-pump CABG but there is no large cut to open chest bone
  • uses small incisions on the left side of the chest between the ribs
  • used for bypasing the blood vessels in front of the heart
  • done less often than other CABG types
  • not done on those who need one or two coronary arteries bypassed
24
Q

what valves are most commonly replaced?

A

aortic valve

mitral valve

25
Q

what is the most common surgical procedure for aortic stenosis/narrowing of the aortic valve?

A

aortic valve replacement

26
Q

what is another common valve problem that may require valve replacement?

A

aortic regurgitation

  • AKA aortic insufficiency
27
Q

what is aortic regurgitation?

A

the valve allows blood to return backward throught the valve and into the heart, instead of moving it forward and out to the body

  • can eventually lead to heart failure
28
Q

what is mitral regurgitation?

A
  • the mitral valve allows oxygenated blood to flow backward into the lungs instead of continuing through the heart as it should
  • may experience SOB, irregular heartbeats, and chest pain
29
Q

how do surgeons fix damaged valves?

A
  • can repair/replace it with an artificial valve or biological valve made from pig, cow, or human heart tissue
  • one option is to insert a catheter through a large blood vessel, guide it to the heart and inflate & deflate a small balloon at the tip of catheter to widen the narrow valce
30
Q

what is the success rate after a mitral valve repair?

A
  • 95% of patients are free of reoperation at 10 years
  • 90% free of reoperation at 20 years
31
Q

when would some undergo cardiac ablation?

A
  • unsuccessful with medications to treat arrhythmia
  • have had serious side effects from medication to treat arrhythmias
  • have a certain type of arrhythmia that respond well to ablation
  • have a high risk of complications from their arrhythmias
32
Q

what is the procedure of a cardiac ablation?

A
  • scarring or destroying tissue in your heart that triggers or sustains an abnormal heart rhythm
  • referred to as the MAZE procedure since surgeons create a maze of scar tissue throughout the heart
  • sometimes done through open-heart surgery, but often done through catheters
33
Q

what is the success rate of cardiac ablations?

A
  • 70-95% of people free of AFib long term after procedure
  • some may still need medication after
34
Q

what is a heart transplant and the criteria to get one?

A
  • surgical procedure used to treat the most serious cases of heart disease
  • criteria: people who’ve experienced heart disease/failure due to:
    • a cogenital defect
    • coronary artery disease
    • a valve dysfunction or disease
    • a weakened heart muscle
    • cardiomyopathy
  • also criteria considered:
    • age (under 65)
    • overall health
    • attitude (commitment of change from patient)
35
Q

how is heart failure caused in adults?

A
  • a weakening of the heart muscle
  • coronary artery disease
  • heart valve disease
  • a heart problem you’re born with
  • dangerous recurring abnormal heart rhythms not controlled by other treatments
  • failure of a previous heart transplant
36
Q

what are risks of heart transplants?

A
  • rejection of the donor heart
    • immunosuppressants helps avoid that
  • primary graft failure
37
Q

what is primary graft failure?

A
  • the most frequent cause of death in the first few months after transplant
  • the donor heart doesn’t function
38
Q

what is a ventricular assist device?

A
  • a mechanical pump implanted in your chest that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body
  • commonly used as temporary treatments for people waiting for heart transplants