Non-invasive cardiac disease Flashcards
how is chest pain classified?
typical vs atypical vs noncardiac
location
with / without exertion
relieved with rest or NTG
3 elements - typical chest pain
2 elements - atypical
1 or less - noncardiac
what is baye’s theorem?
table relating age, sex, and typical / atypical angina, and their probabilities of pretest probability of having disease
what is the goal HR for a stress test?
(220 - age) x 0.85
class Ia ACC/AHA recommendation
standard ECG testing is recommended for patients with an intermediate pretest probability of IHD who have an interpretable ECG and at least moderate physical functioning or no disabling comorbidity
when is a stress test terminated?
patient's desire ST elevation over 1.0 mm drop in SBP over 10 mm Hg moderate-severe angina syncope, dizziness signs of poor perfusion sustained VT
when is the addition of exercise echo indicated?
risk assessment in patients with SIHD who are able to exercise to an adequate workload but have an uninterpretable ECG not due to LBBB or ventricular pacing
what test is the gold standard for patients who can walk?
exercise echo
when is pharmacological (dobutamine) stress indicated?
patients are unable to exercise
what are the side effects for dobutamine stress test?
arryhthmias
hypotension
CP
dyspnea
which agents are used for vasodilator stress test?
adenosine
regadenson
dipyrimidine
what are the contraindications to vasodilator stress test?
severe asthma, COPD
high degree AV block / SSS
what is the antidote for vasodilator stress test side effects?
aminophylline
when are chemical stress tests used?
immobile patients
dobutamine if no arrythmias
EKG, echo, or MPI (myocardial perfusion imaging)
what is the use for myocardial perfusion imaging?
radiotracer that can be added to any of the 3 major modalities to enhance specificity and sensitivity
better for single vessel disease
what is the most specific stress test?
dobutamine stress echo
