Exam 1: Diagnostics In Cardiology Flashcards
What cardiac diagnostic tool detects electrical activity of the heart?
EKG
When is an EKG most helpful?
Acute chest pain (Angina, MI)
What does telemetry mean?
Continuous EKG monitoring in an inpatient setting
What are the two cardiac enzymes that can be measured to assess for cardiac injury?
Which is more sensitive and specific?
Troponin and creatine kinase.
Troponin is more sensitive and specific
Why is it important to obtain serial cardiac enzymes?
A rise and fall in troponin is indicative of acute ischemia
Is CK or CK-MB more specific for cardiac injury?
CK-MB, however it is not more specific than Troponin
When will CK and Troponin start to increase after cardiac injury?
Between 3 and 12 hours
When does CK and Troponin levels peak after cardiac injury?
Between 18 and 24 hours
How long does CK remain elevated after cardiac injury?
36-48 hours
How long does troponin stay elevated after cardiac injury?
Up to 14 days
What is the primary noninvasive modality for quantitative and qualitative evaluation of cardiac anatomy and function?
Transthoracic Echocardiogram (TTE)
What are the indications for TTE?
Evaluation of wall motion, calculating EF, and evaluate structure and function of the heart
What is it called when a smaller US probe is placed on an endoscopic device down the esophagus behind the heart to evaluate the posterior cardiac structures?
Transesophageal echocardiogram (TEE)
What are TEEs good at detecting?
Clots, aortic dissection, valvular pathology, and septal defects
What are the contraindications of TEE?
AMS, compromised cardiorespiratory status, recent or active esophageal tear, thrombocytopenia, esophageal stricture
What are the 3 kinds of stress tests?
EKG stress test, nuclear stress test, and stress echocardiogram
What are the indications of cardiac stress tests?
Exertion also chest pain, known CHD with new/worsening symptoms, and newly diagnosed heart failure or cardiomyopathy
What are the contraindications of cardiac stress testing?
Sorry this one sucks
Acute MI within 48 hours, unstable angina, uncontrolled cardiac arrhythmia, severe and symptomatic aortic stenosis, uncontrolled heart failure, uncontrolled HTN, severe pulmonary hypertension, acute aortic dissection, or acutely ill
What radioactive tracers are used in nuclear stress tests?
Technetium-99m or thallium
What are the two vasodilators often used in nuclear stress tests prior to imaging?
Adenosine and Dipyridamole
What are the indications for a nuclear stress test?
The patient has an abnormal EKG, to assess areas of myocardial ischemia, determine location and size of injured muscle after MI, and diagnose coronary artery stenosis
What is the pharmacologic stress often given during a stress echocardiogram?
Dobutamine
What are the indications for a stress echocardiogram?
Known for suspected CAD, evaluation of CP, SOB, or DOE, and evaluation of valvular abnormalities
What is a holter monitor?
A form of ambulatory electrocardiography that records electrical events over 24-48 hours
What are the indications for a holter monitor?
Syncope, palpitations, rhythm recording, heart rate viability, and ST segment monitoring?
What is a stress echocardiogram used for?
Diagnosis of ischemia related to development of wall motion abnormality with exercise/stress
How does a nuclear stress test work?
The radioactive tracers are concentrated in areas of the myocardium with adequate blood flow and living myocardial cells
What is an event monitor?
Similar to a holter monitor, but not a continuous recording (patient must activate it when they experience symptoms and it will record the previous 2-5 minutes and the subsequent few minutes)
-can be worn for 30-60 days
Who is the implantable cardiac monitor useful for?
Patient with infrequent symptoms, or patients with suspected arrhythmias but noninvasive testing has been inconclusive
How does a Coronary CT angiography (CCTA) work?
The patient is given IV contrast and then CT scan of the heart to evaluate presence and extent of the coronary artery occlusion
How does the coronary CT calcium scan work?
The patient is NOT given IV contrast. CT assess for calcium deposits in the coronary arteries and therefore risk of MI
What are Cardiac CT scans useful for?
Evaluating the thoracic aorta and pericardium because they are less mobile than the heart (Aortic dissection, coronary artery calcium, extent of CAD)
What are the contraindications for cardiac CT scan?
- Allergy to contrast
- Severe renal insufficiency due to renal clearing of contrast dye
What is the modality of choice for assessing the functional and tissue properties of the heart?
Cardiac MRI
What is the gold standard for diagnosing CAD?
Cardiac catheterization
What are the indications for a cardiac cath?
- known or suspected CAD
- atypical chest pain
- before valve surgery in patient with chest pain or EKG changes
