Other cardiac diagnostics

Question 1

echocardiogram indication in CHF

Answer 1

• All pts with suspected new dx of HF need an echo,
• EF determined by measuring left ventricular EDV and ESV on echo and calculating
  • EF = (EDV – ESV) / EDV x 100%
  • Normal EF is ≥ 50% at rest (50 to 70% is normal range)
• Pts with lower than normal EF have HF due to “systolic dysfunction,” ,” also known as “HF with reduced EF” – a poor pump / “failure of the LV as a pump” / a “baggy” LV
• Pts with normal to high EF have HF due to “diastolic dysfunction,” also known as “HF with preserved EF” – “a failure of the LV to relax adequately” / a “stiff” LV

Question 2

echocardiogram important findings in CHF

Answer 2

• Echo determines LV size and function
• regional wall motion abnormalities suggest ischemia (CAD)
• marked ventricular hypertrophy suggests longstanding HTN, AS, or, much less commonly, infiltrative diseases such as amyloidosis or sarcoidosis
• focal LV hypertrophy that occurs in the absence of conditions that increase afterload suggests hypertrophic obstructive cardiomyopathy (HOCM)
• valvular abnormalities suggests valvular dz J e.g. AS

Question 3

echocardiogram indication in pericardial dz

Answer 3

• Abnormal collection of fluid in pericardial space
• Usually part of an underlying diagnosis of infectious pericarditis (usually viral), some related to underlying rheumatic diseases (e.g. SLE), uremia, profound hypothyroidism, and some are “idiopathic”

Question 4

echocardiogram important findings in pericardial dz

Answer 4

• Echo provides information regarding the size, location (circumferential vs. loculated), and any hemodynamic consequences of the pericardial effusion suggesting tamponade
• Can be used to guide pericardiocentesis

Question 5

echo indications in valvular dz

Answer 5

• as the valvular condition worsens, echos are performed more frequently, trying to optimally time the need for surgical valve repair or replacement. Ideally, would want to repair prior to patient symptom development or irreversible LV dysfunction (“decompensation”)
• Echo is always indicated for symptomatic pts, those with a ≥ 3/6 systolic murmur, or those with a diastolic murmur

Question 6

echo important findings in valvular dz

Answer 6

• Leaflet thickness and mobility, valve calcification, and the appearance of subvalvular and supravalvular structures can be assessed

Question 7

EKG ambulatory monitoring testing

Answer 7

• Allows for evaluation over an extended time period to detect electrical abnormalities that may be brief or transient
• Pts utilizes diary to monitor symptoms and see if there is symptom / EKG abnormality correlation
• Types
  
  • Holter Monitor
  • Event Recorder
  • Implantable Loop Recorder

Question 8

indications for holter monitor

Answer 8

• EKG tracing from 2 or 3 surface leads are stored on a tape recorder that the pt wears for 1-2 days
• Recorders have patient activated event markers and time markers so that abnormalities can be correlated with pt’s symptoms

Question 9

indications for event recorder

Answer 9

• For less frequent symptoms, can use an event recorder for several weeks (typically ordered / rented for 30 days)
• Several systems available, common system does continuous loop storage of several minutes of EKG data from one lead, when patient activates system the EKG data preceding the event and thru the event are recorded and stored for further analysis, can be transmitted to interpreting center over the phone

Question 10

indications for implantable loop recorder

Answer 10

• Small device placed subcutaneously
• Can record EKG information to capture data from infrequent events over several months