Diagnostics EKG Quiz 2 Flashcards
Indications for an Echo
Ventricular function
Congenital Heart
Valvular Heart disease
Cardiopathy
Pericardial effusion
Suspected cardiac masses
Aortic disease (proximally
New heart murmur
What does an echo of the ventricular function assess?
Left ventricle function
What is a normal Ejection Fraction?*****
55% and up
Echo benefits
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
Disadvantages of an echo
Depends on operator expertise
Some patients have a poor acoustic window
fixed with transesophageal echo
What happens if the patient never reaches the required heart rate during a stress test?
It is an inconclusive test
What is a stress test
and
what is it used to look at
An EKG before, during and after exercise
The blood supply to the heart
What is the most widely used test to diagnose ischemic heart disease and the estimation of the risk and prognosis?
Stress test
Advantages of a stress test
Non invasive
Affordable
What is the protocol used to evaluate a stress test?
Bruce protocol
What is the Bruce protocol
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
How do you calculate max predicted heart rate for stress test Bruce protocol?****
220 - age = max predicted Heart rate
Reasons to stop a stress test early
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
What makes a positive stress test? (for ischemia)
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”
High risk criteria for stress test
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
Reasons a patient cannot do a stress test***
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 depressionWhat is a TTE?
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
What does a negative stress test rule out?
nothing
False positive/false negative in 1/3 of cases
What does a positive stress test indicate?
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
What is a VQ scan
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
S/S of Pulmonary embolism
Tachycardia (#1)
SOB
Chest pain
Dyspnea
Cough
Hemoptysis
hypoxia
tachypnea
S1Q3T3
(Elevated D-Dimer)
PE gets sent to the ER
Lung function test
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
Lung function test indications
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
What is the only way of interpreting COPD severity?
Spirometry
