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Cardiology Block 1 > Diagnostic Studies (Lecture 2) > Flashcards

Diagnostic Studies (Lecture 2) Flashcards

1
Q

With transthoracic (echo) imaging, the patient is positioned to bring the cardiac structures close to the chest wall, usually in a ______ position,

A

left lateral decubitus

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2
Q

Indications for a ECHO?

A

Valvular lesions
Ventricular assessment (assess V width and EF)
CAD (every patient with heart attack gets an ECHO)
Cardiomyopathy
Pericardial (but what’s the gold standard)

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3
Q 
Implantable monitor
Cardiac stress testing (w/ IV meds)
Cardiac cath
EPS
Echo
A

Invasive studies

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4
Q

How soon shuold a CXR be obtained in patients with suspected cardic issues?

A

30 mins

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5
Q

In addition to enlargement/cardiomegaly, you can see wht on a CXR?

A

Ventricular aneuryms (“7 days after an MI”)

also, calcifications, cardiac malconfigurations

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6
Q

CXR in pt w/ COPD might show what?

A

Flattened diaphragm

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7
Q

Where do you hear aortic regurgitation? What would you see on CXR?

A

Erb’s point

LV dilation

Dilated aortic

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8
Q

WHere do you hear mitral stenosis? What accompanying sound would you hear?

A

Apex (5th MCL)

You’d hear an opening snap

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9
Q

Mitral regurgitation is accompanied by?

A

Pansystolic murmur accompanied by “blowing”

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10
Q

CT use in cardiology is limited. BUt it’s the gold standard for?

A

chronic obstructive pericarditis

It can also be used to assess great vessel problems in STABLE patients

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11
Q

If creatinine is lower than ___ we shouldn’t do a contrast CT

A

1

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12
Q

MRI using ____ can help differentiate between impaired (reversible) and infarcted (irreversible) myocardium

A

gadolinium

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13
Q

EF=(EDV−ESV) / ____

A

EDV

This can be estimated with a TTE

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14
Q

With stenotic and regurgitant valves, blood flow velocities may be as high as 5 to 6 m/second, requiring the use of the _____.

A

continuous-wave Doppler mode

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15
Q

_____ uses the Doppler principle to record the velocity of motion of the myocardial wall. _____ recordings of the myocardium adjacent to the mitral annulus are used to evaluate diastolic ventricular function.

A

Tissue Doppler

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16
Q

A standard echocardiographic study includes pulsed Doppler measurement of antegrade flow velocities (transmitral and transaortic) and evaluation for _____ by continuous-wave and color Doppler modalities

A

valve regurgitation

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17
Q

With a standard TTE, you probably won’t be able to visualize which ventricle very well?

A

LV

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18
Q

For definitive/exact EF, use _____; otherwise, TTE can be used for an estimate.

A

cardiac cath

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19
Q

Transesophageal echocardiography is much more sensitive than transthoracic echocardiography for detection of left atrial thrombus, _____, and prosthetic mitral valve regurgitation/prosthetic valve dysfxn

A

valvular vegetations

(also highly specific for aortic dissection, endocarditis,

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20
Q

Normal EF is anything > than?

A

55%

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21
Q

For eval of the aorta or LAA, we’ll probably use?

A

TEE

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22
Q

_____ is the clinical standard for evaluation of valvular stenosis. Cardiac catheterization is reserved for cases in which _____ is nondiagnostic, clinical data are discrepant with echocardiographic findings, or the coronary anatomy needs to be asses

A

Echocardiography

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23
Q

Even when transesophageal imaging might be helpful, most clinicians begin with a transthoracic examination; exceptions are for the patient with a possible acute ____, in whom transesophageal echocardiography should be performed as quickly as possible, and in the evaluation of possible _____

A

aortic dissection

left atrial thrombosis before cardioversion

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24
Q

The recommended scope of practice for point-of-care ultrasound studies includes diagnosis of pericardial effusion and evaluation of global left ventricular systolic function. In contrast, diagnosis of aortic dissection requires transesophageal echocardiographic or computed tomographic or magnetic resonance imaging. Diagnosis of aortic valve stenosis requires continuous-wave Doppler recording of the transvalvular velocity by an experienced sonographer. Acute anterior myocardial infarction results in hypokinesis or akinesis of the anterior wall, which can be visualized by _____, but evaluation of regional myocardial dysfunction is challenging and requires additional training and experience. Papillary muscle rupture might be diagnosed on transthoracic imaging, but transesophageal imaging often is required. Papillary muscle rupture is likely to be missed with current point-of-care ultrasound systems or by less experienced clinicians.

A

echocardiography

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25
Q

CT is used to diagnose ___ and ____. It can identify abnormal pericardial fluid, thickening, and calcification. Myocardial abnormalities, such as regional hypertrophy or ventricular aneurysms, and intracardiac thrombus formation can be distinctly visualized by CT

A

aortic dissections and aneurysms

26
Q

Normal QTc range for men?

Women?

A 
Men = 390-450 msec
women = 390-460 msec
27
Q

HR for newborn?

At what age does a child’s normal HR become the same as an adults?

A

110-150

Age 6

28
Q

Details/side effects of amiodarone?

(it’s a C3 K+ channel blocker)

300 mg, then 150

A

CI in hyperthyroidism/iodine allergy, 3rd HB,

Pulmonary function tests/CXR required to assess fibrosis…

May turn them blue

Liver toxicity

Lots of drug interactions

29
Q

Lidocaine, what about it?

Fast Na Channel blocker

A

Terminate Vtach w/ pulse (alternate if pulseless if no amiodarone)

Least toxic Na channel blocker (only IV/IM)

CI in 3rd HB

30
Q

Procainamide?

A

Ventricular/SVTs

HOTN if given too quickly (which is why PO is MC)

QT PROLONGATION

Lupus-like effects

31
Q

_____ is useful for narrow-complex tachycardias both diagnostically and therapeutically. For example, if the tachycardia continues with flutter waves or P waves during atrioventricular (AV) block, then a diagnosis of atrial flutter or atrial tachycardia is established. Likewise, the termination of the tachycardia with a P wave that is not conducted to the ventricle is much more likely to be an AV or AV nodal re-entrant tachycardia.

A

Adenosine

32
Q

MUGA (aka RVG) is a nuclear imaging study that cna be used for ?

Why do this over an Echo?

What are its pitfalls?

A

1 board question = not very accurate for patients w/ arrhythmias (e.g., pt with AFib) (maybe use a PET scan instead)

LV fx (do this over an echo if you have a “fluffy” patient)

NO INFO ON VALVULAR STRUCTURES

33
Q

PET scan is a nuclear imaging study that can be used for ?

A

myocardial perfusion

34
Q

Usually first non-invasive assessment For frequent, recurrent arrhythmias?

A

Holter monitor (will last for 24-48 hrs)

outpatient procedure

35
Q

Usually reserved for pts w/ infrequent arrhythmia-type sxs OR patients w/ non-diagnostic holter monitor eval?

A

Event monitor (3 days - 3 weeks)

36
Q 
Recent STEMI < 2 days
High risk ACS (perform coronary angiogram)
Decompensated HF
Active Endocarditis
Severe Aortic stenosis
Symptomatic HOCM
Acute myocarditits
Physical disability
A

CI to ALL stress testing

37
Q

Bayes theorem?

A

Post test prob = pre test prob x likelihood ratio

38
Q

If they have a high probability of CAD (>85%) would you do a cardiac stress test?

(High probability is men>40, women>60 with typical angina OR patients with a buncha risk factors; smokin, DM, etc.)

A

No, typically reserve stress tests for those at intermediate to low risk

39
Q

TEST QUESTION:

Baseline EKG abnormalities that preclude ECG based testing (i.e., stress test)?

A

LBBB

Any ST depression > 1mm

LVH or digoxin w/ any ST depression

WPW

40
Q

RAD/extreme RAD causes?

A 
Left posterior fascicular block
Lateral myocardial infarction
Right ventricular hypertrophy
Acute lung disease (e.g. Pulmonary Embolus)
Chronic lung disease (e.g. COPD)
Ventricular ectopy
Hyperkalaemia
Sodium-channel blocker toxicity
WPW syndrome
Normal in children or thin adults with a horizontally positioned heart
41
Q

Maximum heart rate?

A

220-age

42
Q

A stress test continues until any of the following occurs?

A

Angina
Signs of myocardial ischemia on EKG
Target HR is achieved (85%)
Patients become too fatigued

43
Q

coronary revascularization is pursued if (1) the patient’s symptoms of angina do not respond adequately to antianginal drug therapy, (2) unacceptable side effects of medications occur, or (3) the patient is found to have high-risk coronary disease for which revasculariza- tion is known to improve survival (as described in the next section). The two techniques used to accomplish mechanical revascularization are ______ and _____

A

percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery.

44
Q

How could you localize areas of ischemia on a treadmill test?

A

ECHO
EKG

Radionucleotide study (technetium/PET scan)

45
Q

TEST question…

Markedly positive findings on a stress test include:

  • Ischemic findings w/in 3 minutes of exercise OR persist 5 minutes AFTER stopping
  • ST depression greater than 2 mm
  • Systolic pressure decreases
  • High grade ventricular arrhythmias develop

AND?

A

Pt unable to exercise for at least 2 min b/c of cardiopulmonary limitations

46
Q

“Regular” positive test findings (i.e., not necessarily “marked”) on cardiac stress test include (2)?

A

Chest pain

ST segment changes

47
Q

For a stress echocardiogram, a heart rate can be artificially stimulated by continuous intravenous infusion of ____

A

dobutamine

48
Q

With a nuclear stress myocardial perfusion study, patients who are unable to exercise, ____, ___, and ___ may be used as to induce a “chemical stress test”

A

dobutamine, adenosine, or dipyridamole

49
Q

____ and ____ induce relative coronary artery dilation that approximates the effects of exercise WITHOUT inducing an increased HR

A

ADENOSINE and DIPYRIDAMOLE

“For old people, unable to exercise, this is great for a stress test…”

50
Q

Gold standard for invasive cardiac measurements?

A

Cardiac catheterization

51
Q

Left cardiac cath normally accessed through?

A

Femoral, but brachial and axillary are possible too.

Use fluoroscopy

52
Q

Cardiac caths are risky.. typically reserved for?

A

STEMIs

NSTEMIs that aren’t responsive (typcially 24-48 hours after lack of responsive)

53
Q

Indications for left cardiac cath?

A 
Acute ST elevation
Unstable angina or NSTEMI
Post infarction angina
Refractory stable angina
Previous cardiac arrest
Assess LV function
Evaluate proximal aortic dz
Assess hemodynamics in pericardial constriction
54
Q

Weird name for the balloon-tipped catheter used in right catheterization

A

Swan-Ganz catheter

55
Q

An elevated wedge pressure (meaning high atrial pressure) would probably be accompanied by?

A reduced wedge pressure would imply?

A

Elevated = volume overload = wet = S3

Reduced = volume depletion = dry = treat w/ fluids

56
Q

INdications for right heart cath?

A

Assess filling pressures/CO in HF

Assess volume status/vascular resistance

57
Q

Creatinine level greater than 1?

A

DON’T GIVE CONTRAST

from a Chem 7

58
Q

For electrophysiology studies, Primary diagnostic indications include?

A

supraventricular tachycardia
ventricular tachycardia
sudden cardiac death

(WPW, Brugada, AF refractory to treatment)

59
Q

Right ventricular systolic pressure is increased by ____ or pulmonary hypertension. Right ventricular diastolic pressure increases when the right ventricle is subjected to pressure or volume overload and may be a sign of right heart failure

A

pulmonic valve stenosis

60
Q

Elevation of the mean PCW is seen in left-sided heart failure and in

A

mitral stenosis or regurgitation

Cardiology Block 1 (8 decks)

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