Diagonostic Tests

Question 1

Sensitivity

Answer 1

proportion of those individuals with the disease who have a true positive test

Question 2

Specificity

Answer 2

proportion of those individuals without the disease with a true negative test

Question 3

Positive predictive value

Answer 3

proportion of individuals who had a positive test and actually have the disease

Question 4

Negative predictive value

Answer 4

proportion of individuals who had a negative test and truly do not have the disease

Question 5

What does troponin assess?

Answer 5

the gold standard for cardiac injury

Question 6

BNP

Answer 6

protein produced by the ventricles of the heart, important in the diagnosis of heart failure
B-type natriuretic peptide

Question 7

Normal BUN range

Answer 7

8 to 23 mg/dl

Question 8

What does elevated BUN indicate?

Answer 8

heart failure or renal failure

Question 9

Holter Monitoring

Answer 9

Continuous 24-hour electrocardiographic monitoring of a patient’s heart rhythm
Essential to the diagnosis and management of episodes of cardiac arrhythmias and symptoms

Question 10

Echocardiography

Answer 10

Uses pulse of reflected ultrasound to evaluate the functioning of the heart
Provides real time images of beating heart
Quantify volumes of left ventricle, estimate SV and ejection fraction

Question 11

Transesophageal Echocardiography

Answer 11

High quality 2D images

Use of flexible endoscope inserted into esophagus

Question 12

Pharmacological Stress Testing

Answer 12

Used when a patient is unable to perform upright exercise on a treadmill or cycle
Injection of a pharmacological agent to induce physiological stress

Question 13

Adenosine or dipyridamole-walk protocol

Answer 13

Combined low-level treadmill exercise during adenosine infusion

Question 14

Ergonovine stimulation

Answer 14

Important diagnostic test of coronary spasm
Performed in cardiac catheterization laboratory
If positive response occurs, patient is managed with medications that reduce or prevent occurrence of spasm

Question 15

Indications for Cardiac Catheterization

Answer 15

Cardiac arrest or ventricular fibrillation
Pulmonary edema
Intolerance of or noncompliance with medical therapy for angina
Job description mandate
Significant decrease in exercise duration (>35%)
Progressive decline in systolic BP to less than 100 mm Hg during exercise
Evidence of symptomatic hypoperfusion during exercise (intense diaphoresis, pallor, mental confusion with dec in BP)
Left ventricular ejection fraction (<35%)
Ventricular tachycardia with exercise

Question 16

Endocardial Biopsy

Answer 16

Samples of right or left ventricular endomyocardium may be obtained at time of catheterization
Determines myocardial rejection in patients with a cardiac transplant
May be use to diagnose hypertrophic and congenital cardiomyopathy

Question 17

ABI greater than 1.10

Answer 17

normal

Question 18

ABI 0.5 to 1

Answer 18

claudication

pain in calf with ambulation

Question 19

ABI 0.2 to 0.5

Answer 19

critical limb ischemia
atrophic changes
rest pain
wounds

Question 20

ABI less than .02

Answer 20

severe ischemia

gangrene/necrosis

Question 21

Submaximal Tests

Answer 21

Terminated on achievement of predetermined end point (unless symptoms otherwise limit completion of the test

Question 22

Low-Level Exercise Testing

Answer 22

Performed when patients are post-MI or CABG
Useful in predicting subsequent course of MI or bypass surgery
Identifying high-risk patients

Question 23

Contraindications for low level testing

Answer 23

unstable angina or angina pectoris at rest
severe heart failure
serious arryhthmias at rest
second or third degree heart block
disabling MSK abnormalities
valvular heart disease
BP> 180/105
no patient consent

Question 24

Criteria for Termination of Maximal Testing

Answer 24

Increasing frequency or pairing of premature ventricular complexes
Development of ventricular tachycardia
Rapid atrial arrhythmias, including atrial fibrillation or atrial flutter, with uncontrolled ventricular response rates
Development of second- or third-degree heart block
Increased angina pain (Level 2 on a scale of 4)
Hypotensive blood pressure response (20 mm Hg or greater decrease)
Extreme shortness of breath
Dizziness, mental confusion, or lack of coordination
Severe ST-segment depression.
Observation of the patient reveals pale and clammy skin (pallor and diaphoresis)
Extremely elevated systolic or diastolic blood pressure, or both, which may or may not be associated with symptoms
On achievement of predicted maximal heart rate; it is usually safe to proceed with the test beyond the predicted maximal heart rate if the patient is able and willing to continue and if other indications to terminate the test are absent.
Presence of leg fatigue or leg cramps or claudication pain
Patient request for termination of test