Non-invasive tests Flashcards
A 55-year-old man has undergone a TMET. He has a normal resting ECG. He walked 7 minutes on the Bruce protocol, achieving 8 METs, 77% predicted func-tional aerobic capacity. The test was stopped due to angina. The stress ECG showed + 1 mm ST depression in leads V4–V6.
The patient’s Duke treadmill score is:
-6
Baseline ECG which are contraindicated for exercise ECG test include:
- Pre-excitation ECG
- Resting ST depression > 1 mm
- LBBB
- Paced rhythm
A 65-year-old female presents for evaluation of DOE. She has NYHA class II functional limitation. As part of the evaluation a TTE is obtained. This shows the LV EF = 55% and the following data:
■ LVOT diameter 2.0 cm
■ Mitral annulus diameter 4.0 cm
■ LVOT TVI (pulsed wave Doppler) 20 cm
■ Peak aortic velocity (continuous wave Doppler) 1.2 m/sec
■ Mitral valve TVI (pulsed wave Doppler) 10 cm
Based on these facts, you would recommend:
MV SV = 125.7 mL
AV SV = 62.8 mL
MV regurgitant volume = 62.9 mL
Severe MR –> MV repair or replacement
A 45-year-old male with fatigue presents for an echocardiogram. The LV end diastolic dimension is 60 mm and the end systolic dimension is 40 mm. What is the EF?
55.5%
Which of the following statements is true concerning SPECT MPI?
a. A stress perfusion defect reflects a focal stenosis rather than diffuse atherosclerosis
b. A mild perfusion defect on a SPECT myocardial perfusion study denotes an increased risk for future cardiac mortality
c. SPECT MPI has been shown in women to have incremental prognostic value over clinical and exercise variables
d. The occurrence of post stress dilation of the LV denotes multivessel coronary dis-ease, even if the perfusion defect is localized only to one coronary distribution
e. Adenosine stress is preferred in women undergoing SPECT MPI to reduce the incidence of breast artifacts observed with exercise stress SPECT
c. SPECT MPI has been shown in women to have incremental prognostic value over clinical and exercise variables
A patient is referred to your practice for review of a TMET. On review of the rest-ing exercise, you notice that LV hypertrophy by voltage criteria is present. You then evaluate the stress ECG that has been performed.
Which of the following statements is not correct?
a. The stress ECG is positive for ischemia if 2 mm or more of horizontal or downsloping ST-segment depression is present at 0.08 sec after the J point
b. The stress ECG is positive for ischemia if 1 to 2 mm of additional horizontal or downsloping ST-segment depression is present 0.08 sec after the J point
c. The stress ECG is negative for ischemia if less than 1 mm of additional ST-segment depression is noted
d. The stress ECG is negative for ischemia if there is pseudonormalization of an inverted T wave which occurs without ST-segment depression
e. The stress ECG is nondiagnostic for ischemia if 1 mm or more of ST-segment elevation occurs in a lead in which there are preexisting pathologic Q waves present
b. The stress ECG is positive for ischemia if 1 to 2 mm of additional horizontal or downsloping ST-segment depression is present 0.08 sec after the J point
The most important cardiac properties to determine when assessing LV diastolic function are:
a. LV contractility and LV relaxation
b. LV and LA compliance
c. LV relaxation and LA compliance
d. LV compliance and LV viscoelastic properties
e. LV contractility and LA compliance
d. LV compliance and LV viscoelastic properties
Based on the pretest probability of CAD, noninvasive stress imaging is best indicated for the diagnosis of obstructive CAD in which patient?
a. A 45-year-old man with typical angina and a LBBB on ECG
b. A 50-year-old asymptomatic woman with an LDL of 140 mg/dL on digoxin
c. A 45-year-old woman with atypical anginal chest pain and a normal resting ECG
d. A 30-year-old woman with typical angina and 1 mm resting lateral ST segment depression
e. A 75-year-old woman with typical angina and a pacemaker
d. A 30-year-old woman with typical angina and 1 mm resting lateral ST segment depression
Which of the following statements regarding radionuclide angiography is correct?
a. Diastolic function can not be assessed since ECG gating is required
b. Heparin can interfere with radionuclide imaging
c. Pharmacological stress testing combined with radionuclide angiography is preferred in patients with LBBB over MPI
d. The presence of a pacemaker precludes the use of radionuclide angiography
e. Exercise radionuclide angiography presents all coronary artery territories equally
b. Heparin can interfere with radionuclide imaging
A 45-year-old female (156 cm, 82 kg) undergoes radionuclide testing. She reports chest pain lasting for 45 to 80 min, constant, non-radiating. She is uncertain about the relationship of her symptoms to exercise but has experienced episodes at rest.
Which of the following is correct?
a. A positive MPI stress test would not establish the diagnosis of CAD
b. Thallium is preferred over technetium because of its superior imaging char-acteristics
c. A pharmacological MPI stress test versus an exercise MPI stress test would make the test more specific
d. A test should be terminated when the patient has exercised to 85% of her maximal predicted HR
e. The test should be terminated if the ECG shows >|= 2 mm ST depression in the absence of symptoms
a. A positive MPI stress test would not establish the diagnosis of CAD
A patient with known idiopathic cardiomyopathy is referred to you for assess-ment of LV function. An echocardiogram and a radionuclide angiogram at rest had been performed as part of a study with an LV EF by echo of 17% and by radionuclide angiography of 20%. A year later, a repeat echocardiogram and radionuclide angiogram on follow-up exam are done. An echocardiographic LV EF of 25% is now reported and a radionuclide angiogram LV EF of 15%. You are asked to comment on these findings.
Which of the following conclusions is correct?
a. There is significant improvement in his LV function
b. The LV function is about the same
c. Further deterioration of his LV function has occurred
d. The presence of regional wall motion abnormalities would refute the diagno-sis of idiopathic dilated cardiomyopathy
e. Additional parameters would not be helpful in further risk stratification
c. Further deterioration of his LV function has occurred
A 52-year-old patient (168 cm, 131 kg) is referred with symptoms of Class III dyspnea. The patient is a smoker, sedentary, and has significant COPD and hyperlipidemia. You want to assess the LV function to distinguish between a pos-sible respiratory or cardiac reason for his dyspnea.
Which of the following statements is not correct in this setting?
a. TTE will probably yield unsatisfactory images
b. First-pass sestamibi is helpful, especially if 30 mCi are used to improve photon statistics
c. The heart volumes measured and images by radionuclide angiography are affected by body habitus and are likely to be smaller than in a normal-weight person
d. Radionuclide angiography is challenging because of the patient’s COPD
e. EBCT would be the imaging modality of choice in this patient
c. The heart volumes measured and images by radionuclide angiography are affected by body habitus and are likely to be smaller than in a normal-weight person
Which of the following is true when MPI using thallium-201 is compared with PET?
a. They provide images of similar quality in all patients
b. They provide for quantification of absolute regional myocardial blood flow
c. They have similar applicability in defining myocardial viability
d. Imaging can be done without the need for an on-site cyclotron
e. Unlike Tc-99 m sestamibi, thallium provides equivalent imaging quality to PET in obese patients
d. Imaging can be done without the need for an on-site cyclotron
A 45-year-old patient with diabetes who weighs 330 pounds and has an EF of 24% and known three-vessel CAD by coronary angiography presents to you complaining of shortness of breath despite intensive medical treatment. The car-diac surgeon is skeptical that LV function would improve after CABG because a non-exercise 24-hour thallium study showed predominantly fixed perfusion defects.
Which of the following studies would you order to pursue the possibility of myocardial viability further?
a. Low-dose dobutamine echocardiography
b. PET with 18F FDG
c. PET with FDG and nitrogen-13-labeled ammonia
d. PET with carbon-11-palmitate
e. None of above; if 24-hour thallium imaging does not demonstrate myocardial viability, none of these tests are likely to be helpful
c. PET with FDG and nitrogen-13-labeled ammonia
The following findings on stress ECG are considered nondiagnostic for MI except:
a. >|= 1 mm of ST-segment elevation in the presence of existing Q wave
b. >|= 2 mm of ST-segment depression in the presence of LV hypertrophy by Sokoloff (voltage) criteria
c. >|= 1 mm of ST-segment depression in leads V1–V3 in the presence of right bundle branch block
d. >|= 1 mm of ST-segment depression in the presence of digitalis
e. >|= 1 mm of ST-segment depression in the presence of Wolff-Parkinson-White syndrome
b. >|= 2 mm of ST-segment depression in the presence of LV hypertrophy by Sokoloff (voltage) criteria
