EXAM #2: NON-INVASIVE CARDIAC DIAGNOSIS

Question 1

What are the three elements of typical chest pain? What differentiates between typical, atypical, and non-cardiac chest pain?

Answer 1

1) Location
2) With exertion
3) Relieved with rest of NTG

3x= typical
2x= atypical
1 or less= non-cardiac

Question 2

What is the target pre-test probability to order a stress-test?

Answer 2

50% - 70%

Question 3

What is the goal of a stress test?

Answer 3

To mimic the ischemic cascade

Question 4

What is the purpose of a nuclear stress test?

Answer 4

This is a sensitive test to evaluate for hypoperfsion

Question 5

What is gold standard stress test for a patient that can exercise?

Answer 5

Treadmill ECG

Question 6

What is a drawback to exercise stress test?

Answer 6

Lowest sensitivity and specificity, especially in women

Question 7

What ST changes indicate a positive exercise stress test?

Answer 7

1) Horizontal ST depression
2) Downsloping ST depression

*Note that the ST depression cannot be localized to a specific coronary artery

Question 8

What makes an uninterpertable ECG?

Answer 8

Baseline abnormal ECG i.e.

• Paced
• WPW
• LBBB
• LVH

….etc.

Question 9

What do “mets” tell you about a patient?

Answer 9

Can the patient exercise enough to induce a positive stress test

Question 10

What is the target heart rate in an exercise ECG?

Answer 10

85% of (220-age)

Question 11

What is the basic process for an exercise Echo?

Answer 11

1) Achieve THR on treadmill

2) Immediate ECHO

Question 12

What is the most specific type of stress test?

Answer 12

Exercise echo

Question 13

How does the exercise echo compare to treadmill?

Answer 13

1) More specific
2) Can localize
3) Determine EF

*EF is the most determinant of prognosis

Question 14

Who should get a pharmacological stress test?

Answer 14

Patients that cannot exercise

Question 15

What patients should NOT get dobutamine?

Answer 15

1) Recent MI
2) Hypotension
3) HTN
4) Arrhythmia
5) AS
6) HCM
7) Aortic dissection

Question 16

What is the mechanism of a vasodilator stress test?

Answer 16

• Induction of vasodilation and hyperemia

- Compare regional differences in blood flow

Question 17

What are the contraindications to vasodilator stress test?

Answer 17

1) Asthma
2) COPD
3) Hypotension
4) HR less than 40
5) Xanthines within 24 hours
6) High degree AV block
7) Less than 2 days post MI

Question 18

What is the antidote to vasodilator stress test?

Answer 18

Aminophylline

Question 19

What is myocardial perfusion imaging?

Answer 19

Radiotracer added to any stress test to increase specificity and sensitivity

Question 20

In a patient with known CAD, what should you do?

Answer 20

Add echo or myocardial perfusion to increase sensitivity/ specificity

Question 21

In a patient with known CAD, how do you know when to stress test them again?

Answer 21

Change or progression in symptoms