Lecture 6: CV Outcome Measures and Diagnostics Flashcards
validity
does test measure what It intends to
reliability
how repeatable is test
sensitivity to change
ability to statistically detect change over a period of time
responsiveness to change
detection of clinically relevant change
minimal detectible change
amount of change that exceeds measurement error
minimal clinically important difference
amount of change needed to determine if clinical change can be achieved
purpose/benefits of gait speed with CV patients
almost perfect measure for CV pts
pts with chronic HF
- < 0.65m/s = increase risk of all cause mortality
- <0.8 m/s = increase risk of all cause hospital admission
MCID = 0.05-0.12 m/s
6 minute walk test relevance with CV patients and average values for HF pts
submax
can easily convert to METs and VO2 max
average distance for pt with chronic HF = 310-427m
- less that 300m indicates poor prognosis
- less than 200m predicts hospital/mortality
30-50m improvement = positive effect on mortality
80m = QOL benefit
MCID = 54m
TUG normal values/interpretation
stand in chair, walk 3 m, turn and return to sit
normal = 8.2s
> 13.5 sec = increased fall risk
reliable and valid with HF
slower speeds associated with increased mortality and CVD risk
5x STS or 30 sec STS values for further assessment of fall risk
> 12 seconds for 5xSTS = need further fall risk assessment
what is short physical performance battery test and important values
combines balance, STS, and gait speed
better for lower functioning pts
MCID = 1 point
<10/12 predicts increased mortality
what is Activity Measure for Post Acute Care (AMPAC “6 clicks”)
widely used in acute care settings to predict discharge destinations and functional impairment levels
medicare uses for approval/denial
<17/24 = might need post acute rehab
health related quality of life measures
medial outcomes study short form (SF-36)
Minnesota Living with Heart Failure Questionnaire (LHFQ)
Seattle Angina Questionnaire (SAQ)
Kansas City Cardiomyopathy Questionnaire (KCCQ)
indications for ECG
cardiac arrhythmias
ischemia
structural damage
heart failure
pre-op clearance
medication adjustments/interactions
following device placement/procedures
what is a Holter monitor
continuous ambulatory 24 hr monitor of heart activity
can be work for up to 30 days
various options for recording in correlation with S&S
event recording button
indications for Holter Monitor
arrhythmia
palpations
unexplained dizziness/syncope
assessment of ICD function
purpose of chest X-ray
cannot see internal structures
good way to view fluid accumulation
indications for chest X-ray
heart failure
pulmonary edema
cardiomegaly
post-op CT sx
device placement
post extubation
what is an echocardiogram
US of heart to assess structure and function
can detect atrial and ventricular size, cardiac mm function, valve function, heart chamber thickness, and movement
real time images of beating heart
estimates EF, SV, and flow rates
indications for echocardiogram
valve conditions, congenital heart disease, thrombus, ischemia, cardiac mm dysfunction, cardiomyopathy, aortic dissection
transthoracic echo (TTE) vs transesophageal echo (TEE)
TTE
- noninvasive
- anterior superior view of heart
TEE
- invasive
- requires anesthesia
- posterior and inferior view of heart
- used for more accurate and closer view of cardiac structures
contrast echo
injected contrast allows for improved resolution and more accurate cardiac blood flow
helps detect cardiac effects
can look closely at coronary blood flow without more invasive diagnostics
MRI
evaluates cardiac form and structure, cardiac blood flow and myocardial contractility
similar diagnostic accuracy as PET imaging but less expensive and more available
higher chance of contraindications
MRA
magnetic resonance angiogram
MRI imaging with IV contrast to evaluate vasculature
CT
used to identify structural defects of heart, aorta, and other large vessels
can be performed with or without IV contrast depending on indication and comorbidities
PET scan
positron emission tomography
nuclear imaging that can detect glucose uptakes, blood flow, and cardiac metabolism
noninvasive, can assess jeopardized but viable myocardium without exercise
not as accessible, expensive, requires equipment
cardiac catheterization
invasive
diagnosis or management of cardiac disease
femoral or radial arterial access
he’s identify further medical management interventions needed
typically performed pre CT sx
indications for cardiac Cath
CAD
heart failure
cardiac arrest
valve disease
angina
worsening of exercise tolerance
pending organ donation
how does a cardiac Cath work
IV contrast injected into heart chambers and coronary arteries
fluoroscopy used to view and measure pressures, blood flow, chambers, vessels, and valves
stents can be placed during same procedure
information that can be obtained from cardiac Cath
presence of/severity of CAD, % stenosis or block
valvular heart disease and severity of dysfunction
pericardial disease
cardiac output, ejection fraction
shunts, structural heart defects
chamber pressures
pulmonary artery pressures
what does cardiac Cath predict well
greater predictive accuracy in assessment of CAD than exercise testing
Riley to be on bedrest for 4-6 hours after procedure
what is an endocardial biopsy
samples of endocardium can be obtained at time of cardiac Cath
usually taken from ventricle or at intraventricular septum
determines myocardial rejection in pts with heart transplant
indications for endocardial biopsy
cardiac transplant
sarcoidosis
amyloidosis
myocarditis
cardiomyopathy
tumors
genetic conditions
ankle brachial index
compares BP in posterior tibialis or dorsalis pedis to brachial artery
represents % of blood reaching feet
used to diagnose degree of PAD, determine likelihood of tissue healing
doppler ultrasound
sound waves used to determine degree of blood flow
especially useful in small or diseased vessels
various variations of device
indications = DVT, endothelial injury, arterial occlusion, aneurysm, venous insufficiency
carotid ultrasound
used to detect ischemia or measure blood flow to brain
indications: new CVA, PAD, cardiac arrest, syncope
