Focused/ED/Miscellaneous Flashcards
Focused Cardiac Ultrasound (FCU)
List 4 goals of a focused cardiac ultrasound.
- identify reduced LV systolic function
- determine volume status measured by RAP (more accurate & feasible than physical examination)
- identify marked RV enlargement
- identify significant pericardial effusion
Image recording is not mandatory for handheld ultrasound.
True or False ?
True
Image recording is not mandatory
Initial evaluation when there is a reasonable suspicion of valvular heart disease scores a 1 on the AUC.
True or False ?
False
*indication #34: initial evaluation when there is a reasonable suspicion of valvular heart disease (AUC score = 9)
Sustained or nonsustained atrial fibrillation, SVT, or VT scores a 9 on the AUC.
True or False ?
True
*note:
SVT - Supraventricular tachycardia begins in the upper portion of the heart, usually the atria
VT - Ventricular tachycardia begins in the heart’s lower chambers, the ventricles
Because VTs occur in the ventricles, they make the heart extremely inefficient and are more serious than SVTs.
The symptoms of VTs are usually more severe, and have a much greater tendency to be fatal.
While SVTs are not usually life-threatening, they can cause both emotional and physical problems. It is cause for concern if a patient experiences frequent SVTs or if the episodes are lengthy.
List at least 4 things suitable for a handheld ultrasound system.
LV systolic dysfunction
- LA enlargement
- LVH
- aortic root aneurysm
- AV calcification
- MVP/MS
- pulmonary edema
- pleural effusion
- pneumothorax
LV aneurysm
pericardial effusion
isolated RV enlargement
The last structural change that can be detected in atherosclerosis is an increase in IMT.
True or False ?
False
*The first structural change that can be detected in atherosclerosis is an increase in IMT
A __________________ with level 2 or 3 training performs a limited cardiac echocardiogram.
sonographer
FoCUS is done by ＿＿＿＿＿
physician with FCU training
“Appropriate Use Criteria” was developed as a result of the over use of echocardiograms.
True and False ?
True
*rational approach to prevent unnecessary use of TTE
Atherosclerosis most often develops gradually and slowly, starting from childhood and proceeding into adulthood with varying velocity and susceptibility to complications.
True or False ?
True
A limited Echocardiogram has a formal report meeting ________ standards and has a billing code ________.
IAC
93308
A handheld ultrasound exam is usually less than ___ minutes.
5
*physician performs imaging during physical examination. Procedure needs short, specific explanation to patient
Most Common Indications for TTE in a Clinical Setting is:
Indication #1: Symptoms or conditions potentially related to a cardiac etiology, including but not limited to chest pain, shortness of breath, palpitations, TIA, stroke, or peripheral embolic event (AUC score = 9)
Symptoms or conditions potentially related to a cardiac etiology, including but not limited to chest pain, shortness of breath, palpitations, TIA, stroke, or peripheral embolic event AUC score = 9).
True or False?
True
Coronary Flow Imaging has a reported specificity of 90%.
True or False ?
True
- Coronary flow imaging has a potential for noninvasive assessment of significant stenosis during routine echocardiography.*
- Indications are reported that there is a 90% specificity*
- *note: specificity -* the percentage of people who test negative for a specific disease among a group of people who do not have the disease
_______________ is an important atherosclerotic risk marker.
Intima-media thickness (IMT) is an important atherosclerotic risk marker.
Coronary flow imaging has no potential for noninvasive assessment of significant stenosis during routine echocardiography.
True or False ?
False
It has a potential for noninvasive assessment
Significant stenosis in the LAD is usually located in the ____ segment of the artery
proximal
A FCU as full function: M-mode, 2D, color Doppler, spectral Doppler, TDI, contrast, and is ECG - gated.
True or False?
False
FCU - 2D minimum
limited echo - Full function (M-mode, 2D, color Doppler, spectral Doppler, TDI, contrast), ECG-gated
Significant stenosis in the LAD is usually located in the proximal segment of the artery.
True or False?
True
Based on the AUC, routine surveillance (< 1 year) of heart failure (systolic or diastolic) when there is no change in clinical status or cardiac examination would be considered ok.
True or False?
False
Indication # 74:** Routine surveillance (< 1 year) of heart failure (systolic or diastolic) when there is no change in clinical status or cardiac examination (**AUC score = 2)
List 4 risk factors for carotid intima media thickness.
1.
2.
3.
4.
aging
HLD
HTN
smoking
DM
obesity
sedentary lifestyle
A hand held Ultrasound system is the new stethoscope for a physiscian.
True or False?
True
- Physician with a stethoscope – former
- Physician with Hand held ultrasound
List 4 limitations of FCU.
1.
2.
3.
4.
- transducer quality/selection
- devices used to image: smaller screens, fewer imaging modes, less image processing
- lack of ECG gating
- typically not quantitative
- imaging protocols from limited windows
- limited experience of user - obtaining images/interpreting images
A focused cardiac ultrasound does not have a defined scope of practice and can be performed anywhere, anytime.
True or False?
False
FCU: location of imaging - defined scope of practice
*Scope of practice is broadly defined as healthcare services that a physician or other healthcare practitioner is authorized to perform. Responsibilities are based on education, training, experience, and demonstrated clinical competency.
Intima-media thickness values of more than ___ (ESC) or over the 75th percentile (ASE) should be considered abnormal.
- Intima-media thickness values of more than 0.9 mm (ESC) or over the 75th percentile (ASE) should be considered abnormal.*
- *note: ESC - The European Society of Cardiology*
A ____________ with FCU training typically is the person performing a FCU.
physician
FCU acquisition: Physician with FCU training
FCU interpretation: Physician with FCU training defined, limited scope
When the need for clinical evaluation is emergent or urgent and echocardiography is not immediately available, FCU may be used. List 4 pathologies that might be assessed in the ED or at the seen of trauma.
hemodynamic instability or shock
chest trauma
clinical suspicion of pericardial tamponade
cardiac arrest
acute heart failure
What is FOCUS ?
Focused cardiac ultrasound (FOCUS) refers to the use of ultrasound to evaluate cardiac pathophysiology at the point of care, by providers actively managing a patient.
*limited exam
Limited Echocardiogram vs. Focused Cardiac US
- image protocol?
- equipment (function)?
- measurement?
- acquisition by?
- interpretation by?
- image storage?
- documentation?
- billing?
Hand Held Ultrasound
functions (4)
Basic 2D imaging – measurements
Color Doppler – lesions
High Frequency – atherosclerosis
Assess diastolic filling patterns
Hand Held Ultrasound Technique
patient position?
gel application?
risk?
study interpretation?
documentation?
- Patient is supine or in semi-Fowler position*
- Minimize gel reapplications, preferably use only a single dollop*
- Device drop, misplacement, and contamination risks*
- Study interpreted on the spot, while imaging*
- Document subjective findings, preferably as a component of physical examination*
- Recharge device battery every 1-2 days*
Applications of Focused Cardiac Ultrasound
Most Common Indications for TTE in a Clinical Setting
Indication #2: Prior testing that is concerning for heart disease or structural abnormality, including but not limited to chest X-ray, baseline scout images for stress echocardiogram, ECG, or cardiac biomarkers (AUC score ?)
9
Most Common Indications for TTE in a Clinical Setting
Indication #9: Syncope when there are no other signs of cardiovascular disease (AUC score = ? )
7
Most Common Indications for TTE in a Clinical Setting
Indication #58: Suspected cardiovascular source of embolus (AUC score = ?)
9
Most Common Indications for TTE in a Clinical Setting
Indication #71: Re-evaluation of known HF (systolic or diastolic) with a change in clinical status or
cardiac exam without a clear precipitating change in medication or diet (AUC score = ? )
8
Most Common Indications for TTE in a Clinical Setting
Indication #73: Re-evaluation of known HF (systolic or diastolic) to guide therapy (AUC score = ? )
9
Most Common Indications for TTE in a Clinical Setting
Indication #1: Symptoms or conditions potentially related to a cardiac etiology, including but not limited to chest pain, shortness of breath, palpitations, TIA, stroke, or peripheral embolic event (AUC score = ?)
9
Most Common Indications for TTE in a Clinical Setting
Indication #5: Sustained or nonsustained atrial fibrillation, SVT, or VT (AUC score = ?)
9
Most Common Indications for TTE in a Clinical Setting
Indication #34: Initial evaluation when there is a reasonable suspicion of valvular heart disease (AUC score = ?)
9
“Rarely Appropriate” indications for TTE
- Intima-media thickness is an important atherosclerotic risk marker. However, this increase is not synonymous with subclinical atherosclerosis, but is related to it. Indeed, increase in IMT is also the result of nonatherosclerotic processes.*
- T or F ?*
T
The ______________is a measure used to diagnose the extent of carotid atherosclerotic vascular disease. The test measures the thickness of the inner two layers of the carotid artery—the intima and media—and alerts physicians to any thickening when patients are still asymptomatic.
carotid intima-media thickness test (CIMT)
Coronary Flow Imaging
PoCUS is the test of choice in the ED for… (2)
cardiac arrest and emergency triage
UAPE stands for?
ultrasound augmented physical examination
