Non-Invasive Cardiac Diagnosis Flashcards
How is Chest pain Classified?
1) Classical Location
2) With Exertion
3) Relieved with rest or NTG
3 elements= Typical Chest pain
2 elements= atypical
1 element= Noncardiac
What does Baye’s theorum tell us?
A diagnostic test is the most useful when the pre test probablility is near 50%
Only do test if it will change your management.
What is the progression of the Ischemic Cascade?
Flow maldistribution Hypoperfusion Diastolic Dysfunction Systolic Dysfunction ECG Changes Angina
What is the purpose of Dobutamine in Cardiac Diagnosis?
Increases Rate and output of the heart without exercise. In place of a stress test.
What is the 1st line choice for Cardiac Stress test?
Exercise with EKG
When do you stop a Stress test?
Pt Desire ST elevation >1.0 Drop in SBP >10mmHg Mod-severe angina Syncope, dizziness Signs of poor perfusion Sustained VT
What is the procedure in Exercise Echocardiogram?
Bruce Protocol
THR achieved Straight to table to compare exercise echo to rest echo
Decrease in End systolic Volume, Increase in EF
Why do you do a Dobutamine stress test?
Pt unable to exercise
Synthetic Catecholamine
B1 agonist AND B2 agonist
SE? Arrhythmias, Hypotension, CP and Dyspnia
What are the Contraindications to Dobutamine?
UA Recent MI SBP200 Hx of Vent tahyarrhytmias Severe AS HOCM Large Aortic Aneurism or dissection
What are the considerations for Vasodilator Stress test?
.
What are the Contraindications for Vasodilator Stress testing?
.
What are the SE for Vasodilator Stress testing?
.
What is the Protocol for Myocardial Perfusion Imaging?
Inject technicium 99. Imaging will show where there is decrease in perfusion. Will show area of ischemia
What are the Drawbacks to Perfusion imaging?
Lots of possibilities for Artifacts. Fat/breast, GI metabolism will interfere too.
What is the Most sensitive and specific Test for ischemia?
PET scan. But requires a lot of technology and training.
