Lecture 1: Diagnostic Studies

Question 1

when is exercize ECG testing not useful

Answer 1

1. patient can’t exercize 2. baseline ECG is abnormal (LVH, LBBB, paced rhythm, WPW syndrome, >1 mm ST-segment depression

Question 2

contraindications to dobutamine

Answer 2

Dobutamine contraindications are severe baseline hypertension, unstable angina, and arrhythmia

Question 3

contraindications to adenosine stress

Answer 3

bronchospastic airway disease, theophylline use, sick sinus syndrome, and high-degree AV block

Question 4

best test for LBBB

Answer 4

vasodilator stress (septal perfusion abnormality that may occur with exercise)

Question 5

adequate work load for exercise stress

Answer 5

1. rate pressure product (heart rate × systolic blood
   essure) of at least 25,000
2. 85% of PMHR
3. (5 metabolic equivalents [METs on Bruce Protocol

Question 6

CAC utility

Answer 6

Coronary calcium scores greater than 400 are associated with a higher incidence of abnormal perfusion on SPECT imaging
used in framhingam intermediate 10-20%

Question 7

wide aortic knob

Answer 7

aortic dissection

Question 8

water bottle heart

Answer 8

pericardial effusion

Question 9

skull heart

Answer 9

constrictive pericarditis

Question 10

nephrogenic sclerosis eGFR

Answer 10

< 30

Question 11

when should you not do an echo

Answer 11

Benign murmurs, such as grade 1/6 or 2/6 midsystolic murmurs, are common with pregnancy, anemia, and other high-flow states
continuous flow over breast

Question 12

features of coarctation of aorta

Answer 12

1. lack of aortic knob + rib notching
2. hypertension, radiofemoral delay
3. bicuspid aortic valve
4. associated with turner’s syndrome

Question 13

when to treat coarcation

Answer 13

1. Hypertension
2. Heart failure
3. peak to peak gradient > 20

Question 14

cardiac extramanifestation coartcation

Answer 14

berry anyeursms

Question 15

surveilllance timing of echo in valve

Answer 15

mild - q 3 years

Question 16

daily symptoms arrythmia

Answer 16

Holter

Question 17

infrequent but lasting 1-2 minutes

Answer 17

patient triger event

Question 18

infrequent, < 1 minute or syncope

Answer 18

looping event

Question 19

very infequent

Answer 19

implanted loop

Question 20

medication that need to be held when doing stress ehco

Answer 20

1. BB
2. nitrates
3. non-pyradamine CCB
4. digoxin

Question 21

ECG changes that are considered positive

Answer 21

> 1 mm ST depression in contingous leads or elevation

Question 22

primary cardiac tumors

Answer 22

1. atrial myxoma
2. papillary fibroelastoma (papillary fronds)
3. atrial septal lipomas (thickening of septum)

RA-angiosarcoma - malignant

Question 23

arrytjhmia monitor for syncope

Answer 23

looping event recorder is useful for recording episodes of palpitations that are accompanied by syncope or presyncope

Question 24

Attrituble risk factors

Answer 24

Cholesterol, smoking, stressors, diabetes, hypertension, obesity, alcohol, exercise, fruits and vegetables

Question 25

Moderate intensity Staten and diabetics

Answer 25

40 to 75 years old, risk less than 7.5.

Question 26

HSCRP

Answer 26

Elevated level may used to restart a phi intermediate risk score a.k.a. 10 to 20.

Question 27

Low-dose aspirin guidelines

Answer 27

50 to 59, 10 year CVD risk greater than 10%. And have a life expectancy at least 10 years.

Question 28

equalization of diastolic pressures

Answer 28

cardiac tamponade and constrictive pericarditis

Question 29

normal RA pressure

Answer 29

5

Question 30

normal RV pressure

Answer 30

20

Question 31

normal PCWP pressure

Answer 31

10

Question 32

physiologically split

Answer 32

A-P slightly seperated during inspiration

Question 33

widely split S2

Answer 33

early closure A valve -severe mitral valve stenosi or P2 late - pulmonary stenosis

Question 34

fixed slpit

Answer 34

ASD

Question 35

reasons to fix ASD

Answer 35

RV enalrgement without PAH > 2:1 L-shunt symptoms

Question 36

HYPER FAT HIP

Answer 36

``` physiological S3 hyperdynamic states F: Fever A: anemia/AV fistual T: Thiamine (wet berry berry) Hyperthyroidism Infection Pagets/Pregnancy ```

Question 37

Louder murmors with valsalva

Answer 37

MVP, HCM (Valsalva+ Amyl nitrate + Standing)

Question 38

Pulsus paradoxus -

Answer 38

``` inspiratory fall in systolic in pressure, > 10 mmHg CAAT: Cardiac tamponade Constrictive perist Asthma Tension ```

Question 39

Beck's triad

Answer 39

pulsus paradoxus, heart sounds muffled, and hypotension, elevated JVD

Question 40

RCRI risk variables

Answer 40

1. Ischemic heart Disease 2. Congestive Heart Failure 3. Cerebrovascular Disease 4. Diabetes Mellitus (Use of Insulin Therapy) 5. Renal Insufficiency (Serum Cr >2.0mg/dL) 2 or more varaibles gets you > 1%.

Question 41

preoperative risk testing

Answer 41

emergency or urgent surgery - go ahead | if elective, then >1% risk and poor METS (< 4 aka symptoms with aDLS), then preoperative testing

Question 42

tx angioedema related to ACE

Answer 42

~ aCE inhibitor to ARB