EXAM #2: NON-INVASIVE CARDIAC DIAGNOSIS Flashcards
What are the three elements of typical chest pain? What differentiates between typical, atypical, and non-cardiac chest pain?
1) Location
2) With exertion
3) Relieved with rest of NTG
3x= typical
2x= atypical
1 or less= non-cardiac
What is the target pre-test probability to order a stress-test?
50% - 70%
What is the goal of a stress test?
To mimic the ischemic cascade
What is the purpose of a nuclear stress test?
This is a sensitive test to evaluate for hypoperfsion
What is gold standard stress test for a patient that can exercise?
Treadmill ECG
What is a drawback to exercise stress test?
Lowest sensitivity and specificity, especially in women
What ST changes indicate a positive exercise stress test?
1) Horizontal ST depression
2) Downsloping ST depression
*Note that the ST depression cannot be localized to a specific coronary artery
What makes an uninterpertable ECG?
Baseline abnormal ECG i.e.
- Paced
- WPW
- LBBB
- LVH
….etc.
What do “mets” tell you about a patient?
Can the patient exercise enough to induce a positive stress test
What is the target heart rate in an exercise ECG?
85% of (220-age)
What is the basic process for an exercise Echo?
1) Achieve THR on treadmill
2) Immediate ECHO
What is the most specific type of stress test?
Exercise echo
How does the exercise echo compare to treadmill?
1) More specific
2) Can localize
3) Determine EF
*EF is the most determinant of prognosis
Who should get a pharmacological stress test?
Patients that cannot exercise
What patients should NOT get dobutamine?
1) Recent MI
2) Hypotension
3) HTN
4) Arrhythmia
5) AS
6) HCM
7) Aortic dissection
