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Cardio Exam 1 > Diagnostic tests in Cardiology > Flashcards

Diagnostic tests in Cardiology Flashcards

1
Q

Stress Testing options

A
  • Traditional ECG treadmill testing
  • Combined treadmill + imaging, e.g., stress echocardiography, stress SPECT
  • Chemical stress test: Adenosine/Regadenoson SPECT or PET/CT, cardiac MRI, dobutamine
    echocardiogram
  • Fractional flow reserve (FFR) during invasive angiogram
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2
Q

Septal defect assessment (PFO/ASD/VSD) options

A
  • Bubble Echocardiography
  • Transcranial doppler
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3
Q

Arrhythmias (atrial and ventricular) testing options

A
  • Electrophysiology study (invasive study)
  • Holter Monitor, Event Monitor, Loop Recorder, 12-Lead EKG, Rhythm Strip
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4
Q

Stress Testing purpose

A

Assesses if coronary arteries are supplying enough fuel (blood) to the
pump (heart muscle/conduction system)

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5
Q

How is a stress test performed?

A

Treadmill activity gradually increases activity (demand) to assess whether supply keeps up with the demand

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6
Q

Interpretation of stress testing

A

Negative = absence of symptoms, EKG changes, drop in SBP, and/or arrhythmias (VT)
Positive = development of symptoms, EKG changes, drop in SBP, and/or arrhythmias (VT)

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7
Q

EKG changes that can be seen on a stress test

A

ST depression (downslope or horizontal), ST elevation, T wave inversion

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8
Q

Stress Testing treadmill indications

A
  1. Patient with symptoms of suspected CAD, normal resting ECG and
    intermediate pre-test probability of coronary obstruction to
    provoke ischemic symptoms/findings who can tolerate exercise.
  2. arrhythmias and syncope
  3. prognosis and severity of known CAD
  4. functional capacity - “Clearance” for job or for non-cardiac surgery
  5. efficacy of therapy or intervention
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9
Q

Stress Testing treatmill contraindications:

A
  1. Acute MI (within 2 days)
  2. “Unstable angina” not previously stabilized by medical therapy
  3. Uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise
  4. Symptomatic severe aortic stenosis
  5. Uncontrolled symptomatic heart failure
  6. Acute PE or pulmonary infarction
  7. Acute myocarditis or pericarditis
  8. Acute aortic dissection
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10
Q

How is Combined treadmill + imaging: stress echocardiography, treadmill SPECT different from a traditional treadmill test?

A

a) More accurate generally, and specifically in identifying single (nuclear) and/or
two (echocardiogram/nuclear) vessel disease
b) Use in those with known coronary artery disease (CAD) w/wo history of heart
attack, patients with a calculated intermediate/high pretest probability of CAD
(i.e., diabetes) or presence of baseline ECG abnormalities

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11
Q

If CONTRAINDICATIONS to Treadmill testing are present or exist, what can be done?

A

USE chemical + Imaging test
(i.e., Adenosine/Regadenoson SPECT or PET; Cardiac MRI; dobutamine echo)

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12
Q

Pharmacologic Stress Test

A

Adenosine/Regadenoson SPECT/PET-
CT/cardiac MRI, dobutamine echocardiogram

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13
Q

The Pharmacologic Stress Test is best for patients who are:

A

a) unable to exercise (amputees, severe osteoarthritis, etc.),
b) unlikely to achieve valid maximal stress test (severe morbid obesity, advanced age, etc.),
c) baseline ECG changes (LBBB, ventricular pacing, WPW)
d) structural pathology (aortic stenosis)

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14
Q

Cardiac PET CT

A

Same imaging idea as SPECT…But….
- Imaging is several times better, clearer, less prone to artifacts.
- Patient experience: SPECT = 40 minutes; PET/CT = 14 minutes.
- Capability of assessing myocardial blood flow and coronary calcium

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15
Q

Fractional flow reserve (FFR), coronary angiography

A

FFR = Distal coronary pressure / Proximal coronary pressure
- measures blood pressure and detect myocardial ischemia

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16
Q

Septal defect assessment (PFO/ASD/VSD)

A
  • Bubble Echocardiography
    Echocardiogram, as seen previously, is a great way to visualize structures in the heart.
  • Bubble echocardiography does require inserting an IV and injecting microbubbles (agitated saline) and breath holding by the patient.
17
Q

Septal defect assessment (PFO/ASD/VSD)

A
  • Transcranial doppler
    Adjunct to assessment with bubble echocardiography when you suspect a PFO after an ischemic stroke (thought to be embolus). This also requires an IV and injection of microbubbles (agitated saline).
18
Q

Arrhythmia Testing types

A
  • Rhythm Strip, 12-Lead EKG, Holter Monitor, Patch, Event Monitor, Loop
    Recorder
  • ways of assessing heart rhythm
    either “actively” or “passively” capture the heart rhythm and potentially any arrhythmias
19
Q

What Arrhythmia Testing to order If symptoms are occurring now, in clinic:

A
  • 12 lead EKG, rhythm strip/tele
20
Q

What Arrhythmia Testing to order If symptoms are not present but occur every day, several times a day

A
  • Holter Monitor/Patch
21
Q

What Arrhythmia Testing to order If symptoms are not present but occur 1-4 times a week:

A

Event Monitor

22
Q

What Arrhythmia Testing to order If symptoms occur ~ monthly or less:

A

Loop Recorder

23
Q

Additional Testing options cardiology

A
  • Ambulatory Blood Pressure Monitor (ABPM), 24 hour.
  • Head-Up Tilt (HUT) Table Testing
24
Q

Ambulatory Blood Pressure Monitor (ABPM), 24 hour

A

24 hour ABPM can help
clinicians and patients better understand actual blood pressure and
whether appropriate changes occur during waking hours as well as at
night.
Measurements occur every 20 minutes during the daytime and every
hour at night.

25
Q

Head-Up Tilt (HUT) Table Testing

A

Patients who suddenly faint or experience near fainting with or without preceding palpitations who have normal echocardiograms and
stress tests will often undergo tilt table testing

26
Q

Anatomical/Structural Assessments

A

TE - Transthoracic Echocardiogram
TEE - Transesophageal Echocardiogram
CAC - Coronary artery calcification
CCTA - Coronary CT Angiogram
CMRI - Cardiac MRI

27
Q

TTE and TEE indications

A

MANY. Generally, TTE’s are like EKG’s. If you suspect a cardiac issue (valve,
coronary, rhythm), an EKG is mandatory, a TTE should soon follow.
TTE is the what you order first. TEE is more invasive and is used when:
a) TTE is suboptimal - larger individuals, COPD, etc.
b) Better characterize valves, assess left atrial appendage for clot
c) Intraoperative for real time assessment of physiology during cardiac surgeries

28
Q

TTE and TEE contraindications

A

Routine use in asymptomatic individuals.

29
Q

Coronary Artery Calcification - CAC Indications

A

Screening.
ACCF/AHA 2019 guidelines: Class IIA
Asymptomatic patients with an intermediate (≥7.5 to <20%) or select patients of
borderline (5 to <7.5%) 10-year risk of cardiac events based on the ASCVD risk score or
other global risk algorithm

30
Q

Coronary Artery Calcification - CAC Contraindications

A

Routine use in asymptomatic individuals in low risk categories based on global risk calculators, <18 years old

31
Q

Cardiac MRI Indications

A

Assessing infiltrative disease (sarcoidosis, amyloidosis), cardiac
masses, pre-operative assessment of valvular disease/congenital disease,
myocardial scar/viability, and much more!!

32
Q

Cardiac MRI contraindications

A

Newly placed pacemakers, defibrillators, or other
implanted electronic devices. CAVEAT: MAGNASAFE, “MRI-Conditioned
Pacemakers/defibrillators”

33
Q

Serum Cardiac Markers

A

a) used to determine myocardial infarction (heart attack) in the setting of classic/typical ischemic chest pain
but absence of EKG changes (ie ST Elevation Myocardial Infarction [STEMI])
b) assessment of post-procedure (CABG/PCI) infarct
- Cardiac Troponins
- Myoglobin
- Creatine Kinases (CK

34
Q

Serum cardiac markers - Heart Failure

A
  • Brain Natriuretic Peptides (BNP, NT-proBNP)
    a) help to confirm a heart failure (HF) exacerbation
    b) potentially determine severity of HF
    c) +/- follow for efficacy of therapy (ie downtrend with diuresis)*
35
Q

CONTRAINDICATIONS of Serum Cardiac Markers

A

Renal failure and cardiac arrhythmias, contrast reactions; should be case-by-case.
If your patient is on Entresto, BNP will RISE initially – so we don’t typically follow BNP in these patients

36
Q

Cardiac Troponins

A

Three subunits regulatory proteins: troponin I, troponin T, and troponin C. ONLY I & T are distinct between
cardiac and skeletal tissue.
- Troponin I assays are not as precise and may miss those with events depending on what your local lab
uses for cutoffs of normal.
- Troponin T assays are more precise but not as widely available.
- Troponin assays, when elevated, predict future events, even when EKG is negative (is why NSTEMI
diagnosed based on elevated troponin)

Cardio Exam 1 (8 decks)

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