Diagnostics in Cardiology

Question 1

What are EKGs most helpful for? In what setting?

Answer 1

ACUTE CHEST PAIN in an acute setting

Provides a “snapshot” of electrical activity for 10 seconds

Question 2

What are the indications and contraindications for EKG?

Answer 2

Indications

• ACUTE CHEST PAIN
• palpitations
• screenig for left ventricular hypertrophy
• eval past myocardial infarction

Contra
-none

Question 3

What is telemetry

Answer 3

continuous EKG monitoring in an inpatient setting

Question 4

what does Troponin do?
what are the two types?
which has the best sensitivity?

Answer 4

Troponin controls calcium-mediated interaction of actin and myosin, regulating muscle contraction

(cTn) I and (cTn) T

(cTn) I is best

Question 5

Troponin is the preferred method of diagnosis and prognosis of what?

Answer 5

Acute MI

Question 6

What is a rise and fall in troponin indicative of?

Answer 6

Acute ischemia

Question 7

What is troponin a biomarker of? 4 examples

Answer 7

biomarker of cardiac injury

• trauma
• surgery
• inflammation
• infection

Question 8

besides troponin, what is another cardiac enzyme found in cardiac injury?

Answer 8

CK-MB

from ischemia, trauma, surgery, inflammation and infection

Question 9

Onset, Peak, and Duration of both CK and Troponin?

Answer 9

onset: 3-12 hours
Peak: 18-24 hours
Duration: CK-36-48 Hours Trop up to 14 days

Question 10

Echocardiography Transthoracic Echocardiogram indications

Answer 10

• Evaluate WALL MOTION
• calculate EJECTION FRACTION/SYSTOLIC FUNCTION
• determine diastolic function
• evaluate size of heart chambers
• evaluate VALVE STRUCTURE AND FUNCTION
• detect tumors, masses, or clots in heart

Question 11

What is the advantage of Transesophageal Echocardiogram and what can it detect?

Answer 11

It can give higher resolution of posterior cardiac structures
-can detect
CLOTS
septal defects or patent foramen ovale
ascending aortic atherosclerosis
aortic dissection
VALVULAR PATHOLOGY, SUCH AS VEGETATIONS IN ENDOCARDITIS
better myocardial motion without as much interference

Question 12

what do cardiac stress tests indicate?

Answer 12

coronary artery disease or inadequate oxygen supply

Question 13

what are the 3 types of stress tests

Answer 13

• EKG
• Nuclear
• Stress echocardiogram

Question 14

what are the indications for cardiac stress test

Answer 14

EVAL OF EXERTIONAL CHEST PAIN
KNOWN CHD WITH NEW/WORSENING SYMPTOMS
risk of stratification of ischemic heart disease
determine exercise capacity
patients with prior coronary revascularization
patients with valvular heart disease
NEWLY DIAGNOSED HEART FAILURE or CARDIOMYOPATHY
patients undergoing non-cardiac surgery

Question 15

contraindications to all forms of cardiac stress testing

Answer 15

acute MI within 48 hours
unstable angina not yet stabilized with medical therapy
uncontrolled cardiac arrhythmia
uncontrolled heart failure
uncontrolled hypertension
acute aortic dissection
acutely ill

Question 16

What are the radioactive tracers, vasodilators, and ionotropes used for nuclear stress test

Answer 16

Tracers: TECHNETIUM-99M AGENTS and thallium
Vasodilators: ADENOSINE, DIPYRIDAMOLE,
Ionotropes: Dobutamine

Question 17

indications and contras for stress echocardiogram

Answer 17

indications:
known or suspected CAD
evaluation of valvular abnormalities
preoperative risk assessment prior to major surgery

contra:
aviod in patients with Afib and LBBB

Question 18

What is the Holter Monitor used for

Answer 18

form of ambulatory electrocardiography
24-48 hours
pt keeps symptom diary

Question 19

what are the indications for a Holter monitor

Answer 19

eval of syncope and PALPITATIONS
rhythm recording
heart reate variability
ST segment monitoring

Question 20

important points of an event monitor

Answer 20

not a continuous recording
can be worn for up to 30-60 days
if an “event” is experienced, pt must activate device to capture the previous 2-5 minutes

Question 21

important points of an implantable cardiac monitor

Answer 21

can record up to 3 years
device is automatically activated according to programmed criteria
pt can also activate the device
useful in patients with INFREQUENT SYMPTOMS

Question 22

important points of fingertip monitor

Answer 22

instant portable EKG to use at home without clinician assistance
good for MONITORING ARRHYTHMIAS such as afib

Question 23

what are the 2 types of cardiac CT scanning

Answer 23

• coronary CT angiography CCTA: patient given IV contrast and then CT scan of the heart to eval presence and extent of coronary artery occlusion
• coronary CT calcium scan: no IV contrast given: assesses for calcium deposits in the coronary arteries and therefore risk for MI

Question 24

what are the major applications for cardiac CT scan

Answer 24

detection of AORTIC DISSECTION
DETECTION OF CORONARY ARTERY CALCIUM deposition as an indicator for atherosclerosis
detection of presence and extent of CAD

Question 25

indications and contraindications of cardiac CT scan

Answer 25

indications: stable angina ACS: used in patients with low probability of ACS to exclude CAD AORTIC DISSECTION Contras: allergy to contrast dye severe renal insufficiency

Question 26

Indications and contras for cardiac MRI

Answer 26

``` indications: myocardial disease valvular disease pericardial disease cardiac tumor coronary artery disease myocardial perfusion ``` Contraindicatons metal or electrical implants, devices or foreign bodies

Question 27

Cardiac catheterization/ coronary angiography important points

Answer 27

GOLD STANDARD FOR DIAGNOSING CAD

Question 28

Indications for cardiac catheterization/coronary angiography

Answer 28

``` KNOWN/SUSPECTED CAD unstable angina angina and positive exercise stress test history of MI and EKG changes post-resuscitation from cardiac arrest atypical chest pain ```