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Clin Med II > L1: Diagnostics in Cardiology > Flashcards

L1: Diagnostics in Cardiology Flashcards

1
Q

What are the 2 types of electrocardiography tests?

A

12-Lead EKG

Telemetry

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2
Q

What does an EKG detect?

A

-The electrical activity occurring in the heart (series of upward + and downward - deflections)

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3
Q

When is the use of an EKG indicated?

A
  • Most helpful in acute setting, especially ACUTE CHEST PAIN (Angina and MI)
  • Palpitations
  • Screening for left ventricular hypertrophy
  • Can evaluate for past myocardial infarction
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4
Q

What are the contraindications for EKG?

A

None

but can be subjective so best to have a baseline for comparison

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5
Q

How does Telemetry work?

A

Continuous EKG monitoring in an inpatient setting

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6
Q

What are the indications for telemetry?

A

Hospital admission for chest pain or possible acute coronary syndrome

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7
Q

Name the cardiac enzymes.

A
  • Troponin

- CK, CK-MB

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8
Q

How are we able to detect cardiac enzymes?

A

Cardiac injury results in disruption of myocyte membrane, therefore cardiac enzymes are measurable biomarkers of cardiac injury

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9
Q

What does troponin do in the heart?

A
  • Regulates muscle contraction

- Cardiac regulatory protein complex that controls the calcium-mediated interaction of actin and myosin

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10
Q

What are the 2 types of cardiac troponin enzymes?

A

cTn I and cTn II

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11
Q

What are the indications for Troponin measurement?

A
  • Preferred method of dx and prognosis in ACUTE MI

- Biomarker of cardiac injury

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12
Q

Which cardiac enzyme is most sensitive and more specific?

A

Troponin&raquo_space;» CK-MB

*If available, high-sensitivity cardiac troponin is preferred

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13
Q

In what situations would troponin levels increase?

A

Cardiac injury:

  • Trauma
  • Surgery
  • Inflammation
  • Infection
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14
Q

What is important to remember when measuring troponin levels in regards to detecting acute ischemia?

A

Always obtain serial enzymes to monitor the rise and fall (remember some pts may have consistently elevated levels)

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15
Q

What does Creatine Kinase do in the body? Where is it found?

A
  • Facilitates movement of high-energy phosphates into and out of the mitochondria
  • Found in a number of tissues (heart, brain, SM)
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16
Q

Is CK or CK-MB more specific to the heart?

A

CK-MB

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17
Q

What is the onset, peak, and duration of CK (total and MB) levels following cardiac injury?

A

Onset: 3-12 hours
Peak: 18-24 hours
Duration: 36-48 hours

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18
Q

What is the onset, peak, and duration of Troponin levels following cardiac injury?

A

Onset: 3-12 hours
Peak: 18-24 hours
Duration*: Up to 14 days (in system longer which is better for testing compared to CK-MB)

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19
Q

What are the 2 kinds of echocardiography?

A
  • Transthoracic echocardiogram (TTE)

- Transesophageal Echocardiogram (TEE)

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20
Q

How does ultrasound work (electrocardiography)?

A
  • High frequency sound pulses travel into tissues and sound waves are reflected back to crystal probe (provides 2D image)
  • Gives apical (upside down) view of 4 chamber heart
21
Q

What is the primary indication for a TTE? What are some other indications?

A

-Primary noninvasive modality for quantitative/qualitative EVAL OF CARDIAC ANATOMY AND FUNCTION

Can also assess for:

  • Wall motion (during or after an MI)***
  • Calculate ejection fraction/systolic function***
  • Eval size of heart chambers
  • Assess diastolic function
  • Evaluate valve structure and function***
  • Detect tumors, masses, or clots in heart
22
Q

List some factors that affect the results of a TTE (7)

A
  • Chest wall abnormalities/trauma
  • COPD
  • Thick chest wall
  • Excessive movement during exam
  • Obesity
  • Large breasts
  • Posterior cardiac structure view
23
Q

When is the most appropriate situation to utilize a TEE?

A

When higher resolution images of the POSTERIOR CARDIAC STRUCTURES are necessary

24
Q

What is a TEE able to detect? (6)

A
  • Clots (left atrial thrombi in pts with afib)***
  • Septal defects or patent foramen ovale
  • Ascending aortic atherosclerosis
  • Aortic dissection
  • Valvular pathology, such as vegetations in endocarditis***
  • Better myocardial motion without as much interference
25
Q

What are the contraindications for performing a TEE?

A
  • Overall test has increased complications (requires cardiology and gas man team)
  • Altered mental status
  • Compromised cardiorespiratory status
  • Recent or active esophageal tear or hemorrhage
  • Coagulopathies
  • Thrombocytopenia
  • Esophageal stricture
26
Q

What is the purpose of a cardiac stress test?

A

To monitor the heart’s ability to respond to external stress in a controlled environment

27
Q

What are the 3 types of stress tests? Are they typically exercise or pharmacologically induced?a

A
  1. EKG stress test (exercise)
  2. Nuclear stress test (pharmacologic)
  3. Stress echocardiogram (pharmacologic)
28
Q

What are the indications for cardiac stress tests? (3 main)

A
  • Eval of exertional chest pain***
  • Known CHD with new/worsening sx***
  • Newly diagnosed heart failure or cardiomyopathy***
  • Risk stratification of ischemic heart disease
  • Determine exercise capacity
  • Patients with prior coronary revascularization
  • Pts with valvular heart disease
  • Surgical clearance (non-cardiac)
29
Q

What are the contraindications for any form of cardiac stress testing?

A
  • Uncontrolled cardiac or vascular issue
  • Aortic dissection
  • Acutely ill
  • Uncontrolled hypertension
30
Q

Describe an exercise EKG stress test.

A
  • EKG obtained at rest and monitored during exercise

- Patient exercises within protocol to achieve: target heart rate, symptoms, or time limit

31
Q

What kind of stress testing can localize ischemia?

A

Cardiac stress testing with Imaging (exercise EKG unable to do this)

32
Q

What are the 2 kinds of radioactive tracers used for nuclear stress testing? Where do they concentrate?

A
  • Technetium-99m agents*** or Thallium
  • Concentrate in areas of the myocardium with adequate blood flow and living myocardial cells (defect seen w/ hypoperfusion)
33
Q

Name the 2 vasodilators and 1 inotrope used in nuclear stress testing.

A

Vasodilators:

  • Adenosine
  • Dipyridamole

Ionotropes:
-Dobutamine

34
Q

What are indications for nuclear stress testing? (5)

A
  • Pt has abnormal resting EKG (EKG stress test nondiagnostic for ischemia)
  • Assess areas of myocardial ischemia
  • Determine location and size of injured muscle after MI (1-2 months post MI)
  • Diagnose coronary artery stenosis
  • Eval how grafted vessels work post bypass surgery
35
Q

What are the indications for a stress echocardiogram?

A
  • Used in the dx of ischemia related to development of WALL MOTION ABNORMALITY with exercise/stress
  • Known or suspected CAD
  • Eval of CP, SOB, DOE
  • Eval of valvular abnormalities
  • Preoperative risk assessment prior to major surgery
36
Q

What pharmacologic agent is often used with a stress echocardiogram?

A

Dobutamine (increases contractility and HR)

37
Q

What are the indications for a Holter Monitor (ambulatory EKG)?

A
  • Eval of syncope, PALPITATIONS
  • Rhythm record
  • Heart rate variability
  • ST segment monitoring
38
Q

What is the difference between a holter monitor and event monitor?

A

Both are ambulatory EKG monitors but holter monitors are continuous recordings while an event monitor is not (pt activates device indicating an event)

39
Q

List the length of times a holter monitor, event monitor, and implantable monitor are typically used for.

A

Holter: 24-48 hours (best when they’re having daily sx)
Event: 30-60 days (best when sx are weekly-monthly)
Implantable: Up to 3 years (best for infrequent sx)

40
Q

What is are the indications for use of an implantable cardiac monitor

A
  • Pts with infrequent symptoms

- Pts with suspected arrhythmia but non-invasive testing has been negative or inconclusive

41
Q

What is the primary indication for use of a fingertip monitor?

A

Best for monitoring arrhythmias (such as afib) that are symptomatic (essentially an at home EKG test for pts)

42
Q

What are the 2 types of cardiac CT scanning and what are they used to detect?

A
  1. Coronary CT angiography (CCTA): Pt given contrast dye + CT; evaluates presence and extent of CORONARY ARTERY OCCLUSION
  2. Coronary CT calcium scan: No IV contrast given; assess for Ca2+ DEPOSITS IN CORONARY ARTERIES and therefore risk of MI
43
Q

What are the major applications of a cardiac CT scan (in general)?

A
  • Useful for evaluation of less mobile structures (like the thoracic aorta and pericardium as opposed to heart structures)
  • Detection of AORTIC DISSECTION
  • Detection of CORONARY ARTERY CALCIUM deposition (atherosclerosis)
  • Detection of presence and extent of CAD
44
Q

What are the contraindications for a cardiac CT scan?

A
  • Allergy to contrast dye

- Severe renal insufficiency

45
Q

What is the modality of choice for assessment of the functional and tissue properties of the heart?

A

Cardiac MRI
-Typically used for complicated and advanced disease patients, after eval with first-line testing, such as echocardiography

46
Q

What are the indications for a cardiac MRI?

A
  • Myocardial disease
  • Valvular disease
  • Pericardial disease
  • Cardiac tumor
  • CAD
  • Myocardial perfusion
47
Q

What are the contraindications for a cardiac MRI?

A

-Metal or electrical implants, devices, or foreign bodies

48
Q

What is the gold standard for diagnosing CAD?

A

Cardiac catheterization/coronary angiography (pinpoints location and extent of occlusion)

49
Q

What are the indications for use of cardiac catheterization/coronary angiography?

A
  • Known/suspected CAD
  • Atypical chest pain
  • Before valve surgery in patient with chest pain or EKG changes

*Docs use this to put in balloons/stents

Clin Med II (9 decks)

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