Lecture 1: Diagnostic Studies Flashcards
when is exercize ECG testing not useful
- patient can’t exercize 2. baseline ECG is abnormal (LVH, LBBB, paced rhythm, WPW syndrome, >1 mm ST-segment depression
contraindications to dobutamine
Dobutamine contraindications are severe baseline hypertension, unstable angina, and arrhythmia
contraindications to adenosine stress
bronchospastic airway disease, theophylline use, sick sinus syndrome, and high-degree AV block
best test for LBBB
vasodilator stress (septal perfusion abnormality that may occur with exercise)
adequate work load for exercise stress
- rate pressure product (heart rate × systolic blood
essure) of at least 25,000 - 85% of PMHR
- (5 metabolic equivalents [METs on Bruce Protocol
CAC utility
Coronary calcium scores greater than 400 are associated with a higher incidence of abnormal perfusion on SPECT imaging
used in framhingam intermediate 10-20%
wide aortic knob
aortic dissection
water bottle heart
pericardial effusion
skull heart
constrictive pericarditis
nephrogenic sclerosis eGFR
< 30
when should you not do an echo
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
features of coarctation of aorta
- lack of aortic knob + rib notching
- hypertension, radiofemoral delay
- bicuspid aortic valve
- associated with turner’s syndrome
when to treat coarcation
- Hypertension
- Heart failure
- peak to peak gradient > 20
cardiac extramanifestation coartcation
berry anyeursms
surveilllance timing of echo in valve
mild - q 3 years
daily symptoms arrythmia
Holter
infrequent but lasting 1-2 minutes
patient triger event
infrequent, < 1 minute or syncope
looping event
very infequent
implanted loop
medication that need to be held when doing stress ehco
- BB
- nitrates
- non-pyradamine CCB
- digoxin
ECG changes that are considered positive
> 1 mm ST depression in contingous leads or elevation
primary cardiac tumors
- atrial myxoma
- papillary fibroelastoma (papillary fronds)
- atrial septal lipomas (thickening of septum)
RA-angiosarcoma - malignant
arrytjhmia monitor for syncope
looping event recorder is useful for recording episodes of palpitations that are accompanied by syncope or presyncope
Attrituble risk factors
Cholesterol, smoking, stressors, diabetes, hypertension, obesity, alcohol, exercise, fruits and vegetables
Moderate intensity Staten and diabetics
40 to 75 years old, risk less than 7.5.
HSCRP
Elevated level may used to restart a phi intermediate risk score a.k.a. 10 to 20.
Low-dose aspirin guidelines
50 to 59, 10 year CVD risk greater than 10%. And have a life expectancy at least 10 years.
equalization of diastolic pressures
cardiac tamponade and constrictive pericarditis
normal RA pressure
5
normal RV pressure
20
normal PCWP pressure
10
physiologically split
A-P slightly seperated during inspiration
widely split S2
early closure A valve -severe mitral valve stenosi or P2 late - pulmonary stenosis
fixed slpit
ASD
reasons to fix ASD
RV enalrgement without PAH
> 2:1 L-shunt
symptoms
HYPER FAT HIP
physiological S3 hyperdynamic states F: Fever A: anemia/AV fistual T: Thiamine (wet berry berry) Hyperthyroidism Infection Pagets/Pregnancy
Louder murmors with valsalva
MVP, HCM (Valsalva+ Amyl nitrate + Standing)
Pulsus paradoxus -
inspiratory fall in systolic in pressure, > 10 mmHg CAAT: Cardiac tamponade Constrictive perist Asthma Tension
Beck’s triad
pulsus paradoxus, heart sounds muffled, and hypotension, elevated JVD
RCRI risk variables
- Ischemic heart Disease
- Congestive Heart Failure
- Cerebrovascular Disease
- Diabetes Mellitus (Use of Insulin Therapy)
- Renal Insufficiency (Serum Cr >2.0mg/dL)
2 or more varaibles gets you > 1%.
preoperative risk testing
emergency or urgent surgery - go ahead
if elective, then >1% risk and poor METS (< 4 aka symptoms with aDLS), then preoperative testing
tx angioedema related to ACE
~ aCE inhibitor to ARB
