S2 L2.6: General Diagnostic Approaches for CAD Flashcards
Tells us if there is injury (ischemia, old or new
Myocardial Infarction and what vessels are affected)
12L ECG
Determins the heart size
CXR
Give me the five (5) biochemical tests that we could do for AMI
○ Lipid profile
○ FBS
○ Homocysteine
○ CRP (for inflammation)
○ Cardiac markers (for injuries)
■ Troponin I or T
■ CKMB
■ Others
Use to detect ischemia when pt does physical
activity
Stress Testing
What are the four (4) examples of stress testing?
○ Treadmill - For pts who can ambulate on the treadmill
○ Dobutamine (Pharmacological; for those unable to perform physical stress test) - Increases myocardial function = makes heart go
faster - Sign of coronary disease = if heart goes weak
(tachycardia)
○ Echocardiography
○ Nuclear Scintigraphy - Visualization of heart using nuclear energy; safe
T/F about stress testing as a diagnositc approach
- Dobutamine is pharmacological and is used for those unable to perform physical stress test
- Dopamine increases myocardial function and makes heart go faster
- In taking dopamine, there is a sign of coronary disease if heart goes weak (bradycardia)
- Nuclear Scintigraphy is the visualization of heart using nuclear energy; safe
- T
- F. Dobutamine not dopamine
- F. In taking DOBUTAMINE, there is a sign of coronary disease if heart goes weak (TACHYCARDIA)
- T
GENERAL DIAGNOSTIC APPROACH
Separate in itself, but can be used in Stress Testing and Most widely used imaging technique
Echocardiography
GENERAL DIAGNOSTIC APPROACH
Hearing from patients
Myocardial perfusion Imaging/Nuclear Scintigraphy
GENERAL DIAGNOSTIC APPROACH
Ct scan of heart
CT angiography
GENERAL DIAGNOSTIC APPROACH
Can be inserted to coronary arteries
Intravascular Ultrasound
Give me the three (3) missing components of the different general diagnostic approcahes in this list:
1. 12L ECG
2. CXR
3. Biochemical TEsts
4. Stress Testing
5. Echocardiography
6. Myocardial perfusion Imaging/Nuclear Scintigraphy
7. CT angiography
8. Intravascular Ultrasound
- MRI
- PET
- Coronary Angiography
Modified T/F
In the outdated version in diagnosing cardiac diseases, HR and BP is monitored and there are different rules for strong or weak patient
MD is not always required to be present and is not required to be within the area
TF
MD is not always required to be present but should be within the area
In what test is the following required?
Heart scanning before and after the stress
Myocardial Perfusion Imaging/Nuclear Scintigraphy
In Myocardial Perfusion Imaging/Nuclear Scintigraphy, the following are true, EXCEPT:
A. Radionuclear material is injected into the vein
B. If the scan lights up completely then it is normal
C. If not lighted up completely then the heart is
diseased (posterior portion; R top image)
D. Good sensitivity and specificity at 98.5%
E. None of the above
D. Good sensitivity and specificity at 98% NOT 98.5%
Very expensive; usually used only for metastatic cancers or rare diseases of the heart
PET
What diagnostic tool looks into the calcification of
the coronary arteries?
CT Angiography
If scores are high in this test, there is
significant obstruction in
coronary arteries
CT Angiography
In this case, the pt might need
coronary angiogram
In CT Angiography, presence of calcium depositions means presence of what?
atheroma burden
Done by puncturing
the artery similar to
coronary angiogram
Intravascular Ultrasound
Measures the
burden of plaque
Intravascular Ultrasound
X-ray examination of the vessels and chambers of the heart
Diagnostic Coronary Angiography/Cardiac Catheterization
Done to identify narrowed or clogged coronary arteries that are preventing blood to reach heart muscles
Diagnostic Coronary Angiography/Cardiac Catheterization
Used to measure the size and function of the heart
valves
Diagnostic Coronary Angiography/Cardiac Catheterization
T/F about Diagnostic Coronary Angiography/Cardiac Catheterization
- Before the procedure, IV line, heart monitor, and oral or IV sedative are needed
- Lasts betweem 2 - 3 hrs
- Pt will be placed in a table c the fluoroscope (x-ray imaging device) which will move around the chest in one directions to to record pictures of the heart and coronary arteries from multiple angles
- Most cardiac catheterization take place in the femoral artery of the groin since it cannot be done in the artery of the arm
- True
- False. It only lasts between 1 - 2 hours
- Pt will be placed in a table c the fluoroscope (x-ray imaging device) which will move around the chest in ALL DIRECTIONSto to record pictures of the heart and coronary arteries from multiple angles
- False. Most cardiac catheterization take place in the femoral artery of the groin but CAN BE DONE in the artery of the arm
Arrange the following from 1 to 6 in accordance with the sequence of steps in diagnostic coronary angiography/cardiac catheterization
MD will numb the area where a needle will be placed, a wire is placed and is gently guided through the arterial system to the heart
A soft flexible catheter will be slipped over the wire
through the sheath and threaded up to the heart
MD will watch the movement of the catheter on the fluoroscope (pt may feel the pressure as the wire and sheath is inserted but no movement will be felt)
The needle will be withdrawn and exchanged for a
small flexible tube called a sheath that permits access to the femoral artery
Evaluation of coronary arteries happens when guide wire is removed and positions the tip of the catheter just inside the arteries one at a time and inject a special dye
The dye will allow the fluoroscope to take x-ray images cut angiograms of the arteries interior
1.MD will numb the area where a needle will be placed, a wire is placed and is gently guided through the arterial system to the heart
- The needle will be withdrawn and exchanged for a small flexible tube called a sheath that permits access to the femoral artery
- A soft flexible catheter will be slipped over the wire through the sheath and threaded up to the heart
- MD will watch the movement of the catheter on the fluoroscope (pt may feel the pressure as the wire and sheath is inserted but no movement will be felt)
- Evaluation of coronary arteries happens when guide wire is removed and positions the tip of the catheter just inside the arteries one at a time and inject a special dye
- The dye will allow the fluoroscope to take x-ray images cut angiograms of the arteries interior
T/F about Diagnostic Coronary Angiography/Cardiac Catheterization
- Any blockages will be clearly identified as arteries are filled with dye
- Pt may feel flushed or slightly nauseated when dye is injected
- After sufficient images of the coronary arteries and its tributaries have been taken, catheter will be removed through the groin without any precautionary measures
- Monitored in recovery room for 60 - 80 minutes
- Pt is only allowed to sit for several hours with pressure bandage in place over the insertion site
- Discharge within a week
- True
- True
- False
- False. After sufficient images of the coronary arteries and its tributaries have been taken, catheter will be removed through the groin & PRESSURE MUST BE APPLIED OVER THE FEMORAL ARTERY TO PREVENT BLEEDING
- False. Pt LIES ON BACK for several hours with pressure bandage in place over the insertion site
- False. Discharge SAME DAY OR STAY OVERNIGHT NOT WITHIN A WEEK
Done by puncturing the artery just like the coronary angiogram
Intravascular Ultrasound
Takes note of the atheroma burden
Intravascular Ultrasound
This measures the burden of plaque
Intravascular Ultrasound
