Exam 1: Diagnostics In Cardiology

Question 1

What cardiac diagnostic tool detects electrical activity of the heart?

Answer 1

EKG

Question 2

When is an EKG most helpful?

Answer 2

Acute chest pain (Angina, MI)

Question 3

What does telemetry mean?

Answer 3

Continuous EKG monitoring in an inpatient setting

Question 4

What are the two cardiac enzymes that can be measured to assess for cardiac injury?

Which is more sensitive and specific?

Answer 4

Troponin and creatine kinase.

Troponin is more sensitive and specific

Question 5

Why is it important to obtain serial cardiac enzymes?

Answer 5

A rise and fall in troponin is indicative of acute ischemia

Question 6

Is CK or CK-MB more specific for cardiac injury?

Answer 6

CK-MB, however it is not more specific than Troponin

Question 7

When will CK and Troponin start to increase after cardiac injury?

Answer 7

Between 3 and 12 hours

Question 8

When does CK and Troponin levels peak after cardiac injury?

Answer 8

Between 18 and 24 hours

Question 9

How long does CK remain elevated after cardiac injury?

Answer 9

36-48 hours

Question 10

How long does troponin stay elevated after cardiac injury?

Answer 10

Up to 14 days

Question 11

What is the primary noninvasive modality for quantitative and qualitative evaluation of cardiac anatomy and function?

Answer 11

Transthoracic Echocardiogram (TTE)

Question 12

What are the indications for TTE?

Answer 12

Evaluation of wall motion, calculating EF, and evaluate structure and function of the heart

Question 13

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?

Answer 13

Transesophageal echocardiogram (TEE)

Question 14

What are TEEs good at detecting?

Answer 14

Clots, aortic dissection, valvular pathology, and septal defects

Question 15

What are the contraindications of TEE?

Answer 15

AMS, compromised cardiorespiratory status, recent or active esophageal tear, thrombocytopenia, esophageal stricture

Question 16

What are the 3 kinds of stress tests?

Answer 16

EKG stress test, nuclear stress test, and stress echocardiogram

Question 17

What are the indications of cardiac stress tests?

Answer 17

Exertion also chest pain, known CHD with new/worsening symptoms, and newly diagnosed heart failure or cardiomyopathy

Question 18

What are the contraindications of cardiac stress testing?

Sorry this one sucks

Answer 18

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

Question 19

What radioactive tracers are used in nuclear stress tests?

Answer 19

Technetium-99m or thallium

Question 20

What are the two vasodilators often used in nuclear stress tests prior to imaging?

Answer 20

Adenosine and Dipyridamole

Question 21

What are the indications for a nuclear stress test?

Answer 21

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

Question 22

What is the pharmacologic stress often given during a stress echocardiogram?

Answer 22

Dobutamine

Question 23

What are the indications for a stress echocardiogram?

Answer 23

Known for suspected CAD, evaluation of CP, SOB, or DOE, and evaluation of valvular abnormalities

Question 24

What is a holter monitor?

Answer 24

A form of ambulatory electrocardiography that records electrical events over 24-48 hours

Question 25

What are the indications for a holter monitor?

Answer 25

Syncope, palpitations, rhythm recording, heart rate viability, and ST segment monitoring?

Question 26

What is a stress echocardiogram used for?

Answer 26

Diagnosis of ischemia related to development of wall motion abnormality with exercise/stress

Question 27

How does a nuclear stress test work?

Answer 27

The radioactive tracers are concentrated in areas of the myocardium with adequate blood flow and living myocardial cells

Question 28

What is an event monitor?

Answer 28

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

Question 29

Who is the implantable cardiac monitor useful for?

Answer 29

Patient with infrequent symptoms, or patients with suspected arrhythmias but noninvasive testing has been inconclusive

Question 30

How does a Coronary CT angiography (CCTA) work?

Answer 30

The patient is given IV contrast and then CT scan of the heart to evaluate presence and extent of the coronary artery occlusion

Question 31

How does the coronary CT calcium scan work?

Answer 31

The patient is NOT given IV contrast. CT assess for calcium deposits in the coronary arteries and therefore risk of MI

Question 32

What are Cardiac CT scans useful for?

Answer 32

Evaluating the thoracic aorta and pericardium because they are less mobile than the heart (Aortic dissection, coronary artery calcium, extent of CAD)

Question 33

What are the contraindications for cardiac CT scan?

Answer 33

• Allergy to contrast

- Severe renal insufficiency due to renal clearing of contrast dye

Question 34

What is the modality of choice for assessing the functional and tissue properties of the heart?

Answer 34

Cardiac MRI

Question 35

What is the gold standard for diagnosing CAD?

Answer 35

Cardiac catheterization

Question 36

What are the indications for a cardiac cath?

Answer 36

• known or suspected CAD
• atypical chest pain
• before valve surgery in patient with chest pain or EKG changes