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PAM Semester 2 > Diagnostics EKG Quiz 2 > Flashcards

Diagnostics EKG Quiz 2 Flashcards

1
Q

Indications for an Echo

A

Ventricular function

Congenital Heart

Valvular Heart disease

Cardiopathy

Pericardial effusion

Suspected cardiac masses

Aortic disease (proximally

New heart murmur

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2
Q

What does an echo of the ventricular function assess?

A

Left ventricle function

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3
Q

What is a normal Ejection Fraction?*****

A

55% and up

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4
Q

Echo benefits

A

Real time

Inexpensive

Widely available

Wealth of Information

Non-invasive

No radiation

Can be done bedside

Immediate results

Can be combined with a stress test to assess inducible MI using wall motion analysis of L ventricle function

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5
Q

Disadvantages of an echo

A

Depends on operator expertise

Some patients have a poor acoustic window
fixed with transesophageal echo

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6
Q

What happens if the patient never reaches the required heart rate during a stress test?

A

It is an inconclusive test

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7
Q

What is a stress test
and
what is it used to look at

A

An EKG before, during and after exercise

The blood supply to the heart

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8
Q

What is the most widely used test to diagnose ischemic heart disease and the estimation of the risk and prognosis?

A

Stress test

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9
Q

Advantages of a stress test

A

Non invasive

Affordable

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10
Q

What is the protocol used to evaluate a stress test?

A

Bruce protocol

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11
Q

What is the Bruce protocol

A

Stage 1
1.7mph @ 10% grade

Stage 2
2.5mph @ 12% grade

Stage 3
3.4mph @ 14% grade

3 minutes each, (9 minutes total)

!00% of Max predicted HR in 9 minutes

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12
Q

How do you calculate max predicted heart rate for stress test Bruce protocol?****

A

220 - age = max predicted Heart rate

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13
Q

Reasons to stop a stress test early

A

Angina with dynamic ST changes

Severe SOB

Dizziness

Severe fatigue

ST segment depression >0.2mV (2mm)

A drop in SBP > 10mmhg

Severe HTN SBP > 250 or DBP > 120

Development of ventricular/supraventricular arrhythmia other than PVC or PAC

Signs of cyanosis or poor perfusion

New 2nd or 3rd degree block

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14
Q

What makes a positive stress test? (for ischemia)

A

2mm or more rapidly up sloping ST Depression
(when slope is more the 1mV/s)

1.5mm or more slowly up sloping ST depression
(when the slope is less than 1mV/S)

1mm or more horizontal or down sloping ST depression

“ST Depression below baseline = positive stress test”

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15
Q

High risk criteria for stress test

A

Hypotension with SBP drop >20mmhg

Early positivity, within the first or second stage

Late recovery

Diffuse ST-T changes

More than 2mm ST depression in multiple leads

ST elevation

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16
Q

Reasons a patient cannot do a stress test***

A 
Unstable angina
poorly controlled heart failure
poorly controlled BP with SBP>200 at rest
Worsening aortic stenosis (by echo), 
              symptomatic/severe aortic stenosis
MI with last week
Acute PE or DVT
Acute inflammation of pericardium or myocardium
Severe pulmonary hypertention
LBBB
LVH
Paced rhythm
WPW (wolf parkinson white)
>1mm ST depression
17
Q

What is a TTE?

A

Transthoracic Echo

Ultrasound to evaluate the heart and great vessels

Real time image for motion of cardiac structures

With Doppler it can evaluate blood flow

With Doppler, assessment of

  • Cardiac chamber function
  • Valvular function
  • Intracardiac shunts
18
Q

What does a negative stress test rule out?

A

nothing

False positive/false negative in 1/3 of cases

19
Q

What does a positive stress test indicate?

A

Positive result on exercise indicates likelihood of CAD is 98% in males who are >50 with a history of typical angina and who develop chest discomfort during test

20
Q

What is a VQ scan

A

Ventilation perfusion scan

Nuc Med scan that uses a radioactive gas to examine airflow (ventilation) and blood flow (perfusion) in the lungs.

Used to look for Pulmonary embolism
(not gold standard) (Gold = CT angiography w/ contrast)

Used in the ER

21
Q

S/S of Pulmonary embolism

A

Tachycardia (#1)
SOB
Chest pain
Dyspnea

Cough
Hemoptysis
hypoxia
tachypnea

S1Q3T3
(Elevated D-Dimer)

PE gets sent to the ER

22
Q

Lung function test

A

Assess lung function by measuring the volume of air that the patient can expel from the lungs after a maximal inspiration

non invasive test to determine lung function

23
Q

Lung function test indications

A

Baseline lung function
Evaluate dyspnea
Detect pulmonary disease (obstructive, restrictive)
monitor effects of therapy
Evaluate respiratory impairment
evaluate operative risk
Surveillance for occupational related lung disease

24
Q

What is the only way of interpreting COPD severity?

A

Spirometry

25
Q

Obstructive vs restrictive

A

Obstructive = lung problem

Restrictive = Lung works, chest wall or other problem

26
Q

FVC

A

Forced vital capacity

the total air that that the patient can forcibly exhale in one breath

27
Q

FEV1

A

Forced expiratory volume in one second

The volume of air that the patient is able to exhale in the first second of forced expiration

28
Q

FEV1/FVC

A

The ratio of FEV1 to FVC
Expressed as a fraction

Normal FEV1/FVC is between 0.7 & 0.8

Below 0.7 is a marker of obstruction

29
Q

COPD classification by spirometry

A

Stage 1
FEV1 >80% of predicted

Stage 2
FEV1 50-80% of predicted

Stage 3
FEV1 30-50% of predicted

Stage 4
FEV1 <30% of predicted

FEV1/FVC <0.7 in all stages

30
Q

PFT Graph loops

A

Concave C is obstructive

Normal shape but smaller loop is restrictive

31
Q

PFT Spirometry Values

A 
FEV1
FVC
FEV1/FVC
FEV6
FEF25-75%
32
Q

Other PFT ordered tests

A

DLCO (diffusing capacity)*****
EIB (Exercise induced bronchoconstriction)
LLN (Lower limit of normal)
TLC (total lung capacity)

33
Q

What does an echo with doppler assess?

A

With Doppler it can evaluate blood flow

With Doppler, assessment of

  • Cardiac chamber function
  • Valvular function
  • Intracardiac shunts
34
Q

What does an echo combined with a stress test assess for?

A

Can be combined with a stress test to assess inducible MI using wall motion analysis of L ventricle function

35
Q

What does a normal echo show?

A

No gradient

No Regurg

PAM Semester 2 (22 decks)

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