Lecture 6: CV Outcome Measures and Diagnostics Flashcards

1
Q

validity

A

does test measure what It intends to

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2
Q

reliability

A

how repeatable is test

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3
Q

sensitivity to change

A

ability to statistically detect change over a period of time

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4
Q

responsiveness to change

A

detection of clinically relevant change

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5
Q

minimal detectible change

A

amount of change that exceeds measurement error

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6
Q

minimal clinically important difference

A

amount of change needed to determine if clinical change can be achieved

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7
Q

purpose/benefits of gait speed with CV patients

A

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

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8
Q

6 minute walk test relevance with CV patients and average values for HF pts

A

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

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9
Q

TUG normal values/interpretation

A

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

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10
Q

5x STS or 30 sec STS values for further assessment of fall risk

A

> 12 seconds for 5xSTS = need further fall risk assessment

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11
Q

what is short physical performance battery test and important values

A

combines balance, STS, and gait speed

better for lower functioning pts

MCID = 1 point

<10/12 predicts increased mortality

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12
Q

what is Activity Measure for Post Acute Care (AMPAC “6 clicks”)

A

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

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13
Q

health related quality of life measures

A

medial outcomes study short form (SF-36)

Minnesota Living with Heart Failure Questionnaire (LHFQ)

Seattle Angina Questionnaire (SAQ)

Kansas City Cardiomyopathy Questionnaire (KCCQ)

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14
Q

indications for ECG

A

cardiac arrhythmias
ischemia
structural damage
heart failure
pre-op clearance
medication adjustments/interactions
following device placement/procedures

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15
Q

what is a Holter monitor

A

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

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16
Q

indications for Holter Monitor

A

arrhythmia
palpations
unexplained dizziness/syncope
assessment of ICD function

17
Q

purpose of chest X-ray

A

cannot see internal structures

good way to view fluid accumulation

18
Q

indications for chest X-ray

A

heart failure
pulmonary edema
cardiomegaly
post-op CT sx
device placement
post extubation

19
Q

what is an echocardiogram

A

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

20
Q

indications for echocardiogram

A

valve conditions, congenital heart disease, thrombus, ischemia, cardiac mm dysfunction, cardiomyopathy, aortic dissection

21
Q

transthoracic echo (TTE) vs transesophageal echo (TEE)

A

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

22
Q

contrast echo

A

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

23
Q

MRI

A

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

24
Q

MRA

A

magnetic resonance angiogram

MRI imaging with IV contrast to evaluate vasculature

25
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
26
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
27
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
28
indications for cardiac Cath
CAD heart failure cardiac arrest valve disease angina worsening of exercise tolerance pending organ donation
29
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
30
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
31
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
32
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
33
indications for endocardial biopsy
cardiac transplant sarcoidosis amyloidosis myocarditis cardiomyopathy tumors genetic conditions
34
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
35
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
36
carotid ultrasound
used to detect ischemia or measure blood flow to brain indications: new CVA, PAD, cardiac arrest, syncope