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Cardiovascular > Heart Investigations > Flashcards

Heart Investigations Flashcards

1
Q

DDx for left axis deviation

A 
Left anterior hemiblock
Inferior MI 
WPW
RV pacing
Normal variant 
Elevated diaphragm 
Lead misplacement 
Endocardial cushion defect
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2
Q

DDx for right axis deviation

A 
RVH 
Left posterior hemiblock 
PE
COPD 
Lateral MI 
WPW
Dextrocardia 
Septal defects
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3
Q

What are the types of pacemakers + how do they appear on ECG?

A

Demand = discharge (vertical spike) prior to widened QRS
Atrial = discharge prior to P wave
Triggered = discharge following P wave, prior to QRS
Atrial + ventricular = discharge before P + QRS

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4
Q

What are the SE of digitalis?

A

Palpitations, fatigue, visual changes (yellow vision), decreased appetite, hallucinations, confusion, depression

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5
Q

DDx for ST elevation

A 
I HELP A PAL 
Ischemia 
Hypothermia (osborne waves)
Early repolarisation 
LBBB
Post-MI
Acute STEMI
Prinzmetal's angina 
Acute pericarditis 
Left/ right ventricular aneurysm
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6
Q

DDx for ST depression

A 
WAR SHIP 
WPW
Acute NSTEMI
RBBB/ LBBB
STEMI w/ reciprocal changes 
Hypertrophy 
Ischemia 
Post MI
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7
Q

When does troponin peak, how long is it elevated for + what causes it to rise?

A

1-2 days = peak
Elevated for 2 weeks
MI, CHF, PE, AFib, myocarditis, CKD, sepsis, hypovolemia

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8
Q

When does CK-MB peak, how long is it elevated for + what causes it to rise?

A

1 day = peak
Elevated for 3 days
MI, myocarditis, pericarditis, muscular dystrophy, cardiac defibrillation, CKD

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9
Q

What is TTE + what is it used for?

A

Transthoracic Echo

Used to evaluate chamber size, LVEF, myocardial ischemia, valve morphology, wall thickness

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10
Q

What is TEE + what is it used for?

A

Transoesophageal Echo
Invasive procedure, US probe into oesophagus
Better visualisation of posterior structures (left atrium, mitral + aortic valves)

Used 1st line for aortic dissection
Evaluating aortic + mitral valve

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11
Q

What is a stress echo + what are the indications?

A

Using exercise or dobutamine as stress mechanism

Post ACS to decide on efficacy of revascularisation
Evaluate significancy of valve disease or heart disease

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12
Q

What is a contrast echo with agitated saline?

A

Improves resolution + provides real-time assessment of intracardiac blood flow
Allows visualisation of right heart + shunts, ie PFO

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13
Q

What is a contrast echo with transpulmonary contrast agents?

A

Agents cross pulmonary bed - improves visualisation of endocardial borders + enhance evaluation of LVEF

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14
Q

What is the Bruce protocol?

A

7 stage test with each stage = 3 mins

Treadmill increases in speed + grade with each stage

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15
Q

What is exercise testing + what are the indications?

A

ECG + BP monitoring during exercise
Pts with intermediate (10-90%) probability of CAD
ST depression <1mm at rest, no LBBB, no digoxin or estrogen use

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16
Q

How do the results of exercise testing affect the pt?

A

Low risk = can be treated medically w/o invasive testing
Intermediate risk = may need additional testing (exercise imaging studies or cardiac catheterisation)
High risk = cardiac catheterisation

17
Q

What are the CI to exercise testing?

A

Acute MI, aortic dissection, pericarditis, myocarditis, PE
Severe AS, arterial HTN
Inability to exercise adequately

18
Q

ECG changes in hypothermia

A

Sinus bradycardia
Prolonged QRS + QT
AFib with slow ventricular response
Osborne J waves = hump like waves at junction of J point + ST segment

19
Q

ECG changes in pericarditis

A 
Early = diffuse ST segment elevation + PR segment depression, upright T waves
Later = isoelectric ST segment, flat or inverted T waves
20
Q

What is nuclear cardiology?

A

Myocardial perfusion imaging with ECG gated CT

Evaluates myocardial perfusion, function + any ischemia

21
Q

What is right heart catheterisation?

A

Swan-Ganz catheter used to obtain measurements of pulmonary arteries
Can estimate cardiac output, systemic vascular resistance, O2 delivery + uptake

22
Q

What is cardiac index?

A

CO/ body surface area

Measure of cardiac function

23
Q

What is pulmonary capillary wedge pressure?

A

Obtained by advancing catheter to wedge distal pulmonary artery
Records pressure in pulmonary venous system
Reflects LA pressure

24
Q

Indications for right heart catheterization

A

Unexplained volume status in shock
Severe cardiogenic shock
Suspected pulmonary HTN

25
Q

What is left heart catheterisation?

A

Catheter introduced into brachial or femoral arteries + advanced into LV
Evaluates aortic + mitral valve defects + myocardial disease
Measures LV size + EF by injecting contrast into LV

26
Q

What is coronary angiography?

A

Radiographic visualisation of coronary vessels after injection of contrast media

27
Q

Indications for coronary angiography

A

Disabling stable angina despite medical therapy
High risk criteria
Severe ventricular arrhythmia or CHF

28
Q

What is contrast enhanced angiography?

A

ECG synchronised CT image of heat

29
Q

Indications for a pacemaker

A

SA node dysfunction =
Symptomatic bradycardia + hemodynamic instability
Mobitz 2 or complete heart block

30
Q

Complications of a pacemaker

A

Surgery = pneumothoraz, hemothorax, air embolism, perforation or malposition of leads, infection
Failure to pace, failure to sense, pulse generator failure, pacemaker syndrome

31
Q

Types of pacemaker techniques

A

Transvenous (temporary)

Transvenous (permanent) into RA or RV

32
Q

What are ICDs?

A

Implantable cardioverter defibrillators

Detect VT + VF + provide shock

33
Q

What pts are eligible for ICD?

A

Cardiomyopathy, depressed LVEF, prolonged QRS

34
Q

Indications for catheter ablation

A 
SVT (AVNRT) 
Accessory pathways (AVRT)
Atrial flutter (in RA)
AF (pulmonary vein ablation) 
VT
35
Q

Complications of catheter ablation

A 
Death 
High grade AV block requiring permanent pacemaker 
Tamponade 
Pericarditis 
PE
TIA/ stroke
36
Q

What does digitalis toxicity look like on ECG?

A

Gradual downward curve of ST

37
Q

What ECG changes do you get with Brugada syndrome?

A

RBBB with ST elevation in V1, V2 + V3

38
Q

What ECG changes do you get with Wellens syndrome?

A

Marked T wave inversion in V2 + V3

Cardiovascular (15 decks)

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