Diagnostics in Cardiology Flashcards
What are EKGs most helpful for? In what setting?
ACUTE CHEST PAIN in an acute setting
Provides a “snapshot” of electrical activity for 10 seconds
What are the indications and contraindications for EKG?
Indications
- ACUTE CHEST PAIN
- palpitations
- screenig for left ventricular hypertrophy
- eval past myocardial infarction
Contra
-none
What is telemetry
continuous EKG monitoring in an inpatient setting
what does Troponin do?
what are the two types?
which has the best sensitivity?
Troponin controls calcium-mediated interaction of actin and myosin, regulating muscle contraction
(cTn) I and (cTn) T
(cTn) I is best
Troponin is the preferred method of diagnosis and prognosis of what?
Acute MI
What is a rise and fall in troponin indicative of?
Acute ischemia
What is troponin a biomarker of? 4 examples
biomarker of cardiac injury
- trauma
- surgery
- inflammation
- infection
besides troponin, what is another cardiac enzyme found in cardiac injury?
CK-MB
from ischemia, trauma, surgery, inflammation and infection
Onset, Peak, and Duration of both CK and Troponin?
onset: 3-12 hours
Peak: 18-24 hours
Duration: CK-36-48 Hours Trop up to 14 days
Echocardiography Transthoracic Echocardiogram indications
- 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
What is the advantage of Transesophageal Echocardiogram and what can it detect?
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
what do cardiac stress tests indicate?
coronary artery disease or inadequate oxygen supply
what are the 3 types of stress tests
- EKG
- Nuclear
- Stress echocardiogram
what are the indications for cardiac stress test
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
contraindications to all forms of cardiac stress testing
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
What are the radioactive tracers, vasodilators, and ionotropes used for nuclear stress test
Tracers: TECHNETIUM-99M AGENTS and thallium
Vasodilators: ADENOSINE, DIPYRIDAMOLE,
Ionotropes: Dobutamine
indications and contras for stress echocardiogram
indications:
known or suspected CAD
evaluation of valvular abnormalities
preoperative risk assessment prior to major surgery
contra:
aviod in patients with Afib and LBBB
What is the Holter Monitor used for
form of ambulatory electrocardiography
24-48 hours
pt keeps symptom diary
what are the indications for a Holter monitor
eval of syncope and PALPITATIONS
rhythm recording
heart reate variability
ST segment monitoring
important points of an event monitor
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
important points of an implantable cardiac monitor
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
important points of fingertip monitor
instant portable EKG to use at home without clinician assistance
good for MONITORING ARRHYTHMIAS such as afib
what are the 2 types of cardiac CT scanning
- 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
what are the major applications for cardiac CT scan
detection of AORTIC DISSECTION
DETECTION OF CORONARY ARTERY CALCIUM deposition as an indicator for atherosclerosis
detection of presence and extent of CAD
indications and contraindications of cardiac CT scan
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
Indications and contras for cardiac MRI
indications: myocardial disease valvular disease pericardial disease cardiac tumor coronary artery disease myocardial perfusion
Contraindicatons
metal or electrical implants, devices or foreign bodies
Cardiac catheterization/ coronary angiography important points
GOLD STANDARD FOR DIAGNOSING CAD
Indications for cardiac catheterization/coronary angiography
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
