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ADV DIAG > exam 2 CVD > Flashcards

exam 2 CVD Flashcards

1
Q

risk factors for heart disease

A

hypertension, hyperlipidemia, smoking, diabetes, obesity, poor diet, inactivity, excessive alcohol, family history of early onset of CAD or sudden death

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2
Q

TTE is what

A

noninvasive US of heart
done with probe outside anterior chest
harmless, high freq waves emitted from transducer penetrate the heart and reflect back as series of echos

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3
Q

TTE gives info about what

A

structure and fx of heart

dx pericardial effusion, valve disease, wall motion abnormalities, CM, aneurysm, congenital heat disease

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4
Q

color flow doppler TTE

A

direction of blood flow across regurgitant or stenosed valves

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5
Q

TEE

A

high freq ultrasound transducer placed in distal esophagus behind heart

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6
Q

TEE avoids interference from what

A

subcutaneous tissue, bony thorax, and lungs

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7
Q

TEE shows better visualization of what

A

MV, masses on valves, thoracic aorta, endocarditis

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8
Q

risk of TEE

A

esophageal perforation or bleeding

CI in pts with liver varices

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9
Q

ECG detects what

A

electrical activity of heart displayed in ECG tracings

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10
Q

ECG uses

A

Evaluate arrhythmias
Conduction defects (heart blocks)
Myocardial injury (ischemic events), damage, hypertrophy,
Pericardial disease (ie pericarditis)
Adverse reaction to medications (ie dig tox)
Electrolyte abnormalities (like hypo- or hyper- kalemia)

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11
Q

II, III, aVF

A

inferior leads

give info about RCA

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12
Q

aVL, I, V5, V6

A

lateral leads

LCx

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13
Q

V2, V3, V4

A

anterior leads

LAD

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14
Q

V1 and V2

A

septal

RCA, LAD, posterior wall

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15
Q

acute myocardial damage on ECG shown as

A

STE or inverted T waves

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16
Q

old MI on ECG

A

deep q waves

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17
Q

pericarditis on ECG

A

diffuse STE

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18
Q

how many leads show STEMI on ECG

A

2 leads

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19
Q

interfering factors of ECG

A

inaccurate placement of electrodes, tremors, e-lyte imbalances, meds (ie dig)

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20
Q

Why is an ECG ordered for a patient with CHF?

A

To check for dysrhythmias, and to assess for ischemia and scarring. The ECG may also point to another diagnosis like pericarditis or pericardial effusion.

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21
Q

List all the abnormalities that might be found on an echocardiogram study done on a patient with CHF.

A

left ventricular enlargement, little or no movement of some parts of the heart wall or septum, thinning of the myocardium, leaking of heart valves, low ejection fraction

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22
Q

What is the best echocardiogram test for an obese patient and why?

A

TEE because there is less tissue for the sound waves to penetrate and the images will be more complete and accurate.

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23
Q

Why would an ECG be ordered for a patient with suspected acute or chronic coronary artery disease?

A

To check for arrhythmia, acute ischemia and evidence of chronic scarring.

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24
Q

Does a normal ECG in the ED rule-out cardiac chest pain?

A

No. The ECG maybe normal in the ED when the patient has acute coronary insufficiency. The likelihood ratio for a negative test is close to 1 so the odds of having acute insufficiency are not changed much by a normal EKG.

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25
Q

most common CXR views

A

anterior chest against the digital or film cassette (the PA or posterior anterior view)
taken with the cassette close to the side of the chest (the lateral view

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26
Q

CXR primary uses - cardiac

A

to assess heart size ( suspect CHF )

to check for fluid in the lungs and pleural space (pleural effusion)

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27
Q

B-type natriuretic peptide(BNP, NT-Pro BNP)

A

Neuroendocrine peptides produced by ventricular myocardial cells in response to stretching

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28
Q

BNP, NT-pro BNP uses

A

Most useful as a test to rule out heart failure in an acutely dyspneic patient
Helpful prognosticator in patients with episode of decompensated heart failure that have known HF (compare with previous BNP to help guide prognosis)

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29
Q

BNP lab values

A

<100 pg/mL HF is unlikely
100 pg/mL - 400 pg/mL it is indeterminate, use clinical judgement
> 400 pg/ml, positive depending on age, sex and presence or absence of obesity

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30
Q

NT-Pro BNP (isolated peptide)

A

< 300 pg/mL HF unlikely
< 50 years of age; > 450 pg/mL HF likely
50-75 years; >900 pg/mL HF likely
> 75 years; >1800 pg/mL HF likely

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31
Q

bnp levels in women

A

tend to be higher when compared with men

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32
Q

bnp levels do what with age

A

rise

older ppl have higher baseline levels than younger ppl

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33
Q

bnp levels in obese ppl

A

tend to be lower

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34
Q

What factors influence the cut-off point for a BNP/NT-Pro BNP to help make a diagnosis of CHF?

A

age, sex, obesity

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35
Q

TLP includes what

A 
total cholesterol
high density or HDL cholesterol
low density or LDL cholesterol
Triglycerides (aka fat in the blood)
Sometimes very low density or VLDL cholesterol is included
36
Q

TLP goal in heart disease/high risk populations

A

raising HDL, lowering LDL

37
Q

goal for LDL in ppl with minimal risk

A

130 mg/dL or less

38
Q

goal for LDL in ppl with very high risk

A

70 mg/dl or less

39
Q

USPSTF screening recommendations for lipid disorders

A

Men over 35 and women over 45
Start screening earlier if elevated risk
Repeat every 5 years if normal
age cut-off for screening is uncertain

40
Q

Why would the practitioner order a lipid panel for a patient with coronary artery disease?

A

Because an elevated LDL and/or a low HDL are risk factors for progression of CAD. It is ordered as a baseline for treatment decisions.

41
Q

stress test w/o imaging

A

ordered for pt with low probability of CAD
Sensitivity: 61-73% (not great), specificity: 59-81%
Exercise usually on a treadmill with the patient connected to an ECG machine for continuous monitoring.
Goal: get HR elevated
When 85% of predicted maximum heart rate is reached, the test is terminated
Determined by 220 – pts age x .85 = predicition
also terminated if ECG changes are suggestive of ischemia, ST segment variance > 1 mm = positive test.

42
Q

stress test with imaging

A

Echo and Nuclear scans are done to increase sensitivity of stress testing (Sensitivity 81%, specificity 85-95%)

43
Q

Nuclear: Myocardial Perfusion Imaging

A

Radiotracer injected, gamma camera used to scan before and after exercise to assess blood flow in the heart.
Looking for ST changes
Exercise causes the vasodilation

44
Q

nuclear- myocardial perfusion imaging with regadenoson

A

Pharmacologic agent for those who cannot exercise: Regadenoson which causes vasodilation to coronary vessels.
Does not raise HR
Resting images are compared to stress images, look at blood flow in heart
Safe for ppl with impaired renal fx
Does not speed up heart, so it safe for a fib (will not cause RVR)

45
Q

stress echo

A

Echo performed before and after exercise or infusion of dobutamine if unable to exercise
Do not use dobutamine for pt with a fib, will cause RVR
Looking for wall motion abnormalities with increase contractility
Do not want to see 1 wall that cannot keep up with the other walls w/ exercise

46
Q

stress test recommendations

A

Performed when there is a possibility of cardiac disease but the chance of coronary artery disease is small enough that it is not necessary to take the patient directly to the cath lab.

Performed on low risk pts

47
Q

duplex US

A

used to detect obstruction in larger arteries
carotid, femoral

recommended for symptoms of possible vascular obstruction

48
Q

carotid duplex US recommendations

A

syncope (w/o clear etiology), TIA, frequent strokes, light headedness especially when looking up

49
Q

femoral artery duplex US recommendations

A

claudication, non-healing foot ulcers in a patient without diabetes

50
Q

holter monitor

A

continuous recording of a limited number of leads of the ECG
usually set for 24 hours and the patient keeps a log during that time recording chest pain or dizziness or other symptoms possibly related to the heart

51
Q

TSH in cardiac disease

A

thyroid disease freq accompanies dysrhythmias such as tachycardia and a fib

52
Q

hyperthyroidism with cardiac disease

A

can be correlated with tachycardia, a fib, elevated BP

53
Q

hypothyroidism with cardiac disease

A

can be correlated with bradycardia, lipid disorders, pericardial effusions

54
Q

CK-MB

A

enzyme produced by myocardial muscle when there is ischemia

55
Q

CK-MB vs troponin, which is faster

A

CK-MB rises quickly and is cleared from blood faster than troponin

56
Q

CK-MB can also rise with

A

shock, hypothermia, myocarditis, severe skeletal injury, myopathy

this limits the specificity of test

57
Q

test of choice to dx or r/o myocardial ischemia

A

troponin

58
Q

troponin is what

A

biochemical marker for cardiac disease

highly specific for myocardial cell injury
protein components for striated muscle

59
Q

troponin levels change with time

A

elevate 2-3 hrs after injury

do 2-3 sets (q4-8 hrs) over 24 hrs

60
Q

how long do troponins stay elevated after MI

A

7-10 days

also with cardiac surgery, stents

61
Q

troponin limitations

A

falsely elevated with HD pts and in severe muscular injury

62
Q

Why are troponins ordered for a patient who may have acute coronary syndrome?

A

Troponins are released from ischemic cardiac muscle so the concentration rises in the blood with ACS and other conditions that stress the heart such as pulmonary embolism and CHF. They are measured in some situations post coronary artery stenting or surgery to assess reperfusion.

63
Q

What is the usual time-frame for the rise and fall of troponin levels after acute coronary obstruction?

A

Troponins are elevated as soon as three hours and remain elevated for 1 - 2 weeks after myocardial ischemia.

64
Q

Under what circumstances would a Holter monitor be ordered?

A

Answer: Holter monitors are useful when the ECG in the office shows no dysrhythmia, but the patient has periodic chest pain, dizziness, palpitations, shortness of breath or syncope.

65
Q

Why would the practitioner order an ECG for a patient with hypertension?

A

To check for dysrhythmia, cardiac hypertrophy, and evidence of coronary artery disease.

66
Q

why would echo be useful for pt with HTN

A

to assess for cardiac hypertrophy

67
Q

2nd right interspace

A

aortic area

68
Q

2nd left interspace

A

pulmonic area

69
Q

lower left sternal border

A

tricuspid area

70
Q

apex

A

mitral area

71
Q

blood flow through the heart

A 
Superior and inferior vena cavas
Right atrium and the right ventricle
Pulmonary arteries 
Left atrium and left ventricle
Aorta and the aortic arch
72
Q

systole

A

ventricles contraction

The right ventricle pumps blood into the pulmonary arteries (pulmonic valve is open)
The left ventricle pumps blood into the aorta(aortic valve is open)

73
Q

diastole

A

ventricles relax

Blood flows from the right atrium → right ventricle (tricuspid valve is open)
Blood flows from the left atrium → left ventricle (mitral valve is open)

74
Q

PMI tapping per palpation

A

normal

75
Q

PMI sustained during palpation

A

suggests LV hypertrophy from HTN or aortic stenosis

76
Q

PMI diffuse during palpation

A

suggests dilated ventricle from CHF or cardiomyopathy

77
Q

Harsh 2/6 medium-pitched holosystolic murmur best heard at the apex describes

A

mitral regurgitation

78
Q

Soft, blowing 3/6 decrescendo diastolic murmur best heard at the lower left sternal border describes

A

aortic regurgitation

79
Q

diastolic murmurs

A

MV stenosis , heard at apex, does not radiate, low pitch ruble with bell of stethoscope

80
Q

systolic murmur

A

MV regurg

thrill

81
Q

s3

A

tends to be early diastole, happens with increased ventiruclar filling

82
Q

s4

A

right before s1, from ventricular stiffness, little laides with prolonged HTN, stiff ventricles

83
Q

blood flow through cardiac valves

A

TPMA

84
Q

Troponin T normal range

A

< 0.1 ng/ml

85
Q

troponin I normal range

A

<0.03 ng/ml

ADV DIAG (23 decks)

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