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Cardiology IPAP > Slide set 4 > Flashcards

Slide set 4 Flashcards

1
Q

Invasive Dx testing

A

Echo (TEE) Cardiac stress testing (IV medications) Cardiac catheterization Electrophysiologic studies Implantable monitor

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2
Q

What views to obtain on CXR

A

PA and lateral

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3
Q

What can you visualize on CXR (7)

A

Cardiac silhouette Cardiac configuration Calcifications Artificial Devices G

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4
Q

What view is best to view Cardiomegaly

A

PA view (AP distorts heart)

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5
Q

CT can eval

A

Great vessels Pericardium Myocardium Coronary arteries

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6
Q

CT primary indications are

A

Great vessel issues (AA or disection) Pericardial ABNLs (Pericarditis)

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7
Q

TOC for pericardial diseases

A

EBCT

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8
Q

EBCT and MSCT abbreviation is

A

Electron beam CT Multislice CT

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9
Q

Is CT coronary angiography invasive?

A

No (EBCT/MSCT)

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10
Q

What kind of score can we obtain from CT and for what purpose?

A

Agatstan score for Coronary artery calcification risk factor

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11
Q

What are the limitations of CT

A

Contrast dye Rad exposure Artifact from pt motion

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12
Q

Cardiac cath is great for

A

Identifying problem AND fixing it (therapeutic)

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13
Q

MRI of the heart is also known as

A

Cardiovascular magnetic resonance

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14
Q

CMR advantages

A

No radiation, Evals almost everything cardiac

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15
Q

CMR disadvantages

A

Expensive

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16
Q

CMR can eval

A

Function Perfusion Viability Tissue characterization

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17
Q

CMRA is an abbreviation for

A

Cardiovascular magnetic resonance angiography

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18
Q

CMRA advantages are

A

Noninvasive Contrast free High Sensitivity for CAD or congenital ABNLs of the coronary arteries

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19
Q

Gandolinium contrast in an MRI is used for

A

Distinguish between impaired and infarcted (irrev) tissue

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20
Q

Echocardiogram primarily focuses on

A

Suspected murmurs Cardiac function assessment Other suspected structural heart DZ

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21
Q

Echo U/S modes

A

M-mode, 2-D, 3-D, Doppler

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22
Q

Echo M-mode is useful for

A

measuring wall thickness or chamber diameters

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23
Q

Echo 2D-mode is useful for

A

Defines cardiac structures relative to another

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24
Q

Echo Doppler-mode is useful for

A

eval blood flow, velocity, turbulence

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25
Q

What are the two types of echocardiogram

A

TTE - Trans-Thoracic Echo TEE - Trans-Esophageal Echo

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26
Q

TTE echo transducer is placed where

A

On the chest

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27
Q

TTE echo is CI in

A

Heavy people

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28
Q

TTE echo is useful for

A

EF calculation Ventricle Dilation Left Atrium size Paradoxical septal motion

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29
Q

TEE Echo transducer is placed where

A

In the esophagus via endoscopy and posterior to the heart

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30
Q

TEE Echo can help rule out what

A

Aortic Dissection Endocarditis Prosthetic valve dysfx Left atrium thrombus prior to cardiversion

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31
Q

TEE Bubble study concept

A

Sterile saline with bubbles are injected- Bubbles should be seen on R-side but no L-side to to lungs filtering them out.

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32
Q

TEE bubble study is useful for ID of

A

VSD/ASD

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33
Q

Types of nuclear cardiology tests

A

MUGA and PET

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34
Q

MUGA stands for

A

Multi-unit gated acquisition

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35
Q

PET scan stands for

A

Positron Emission Tomography

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36
Q

MUGA is useful for

A

Assessment of Left-Ventricular function

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37
Q

PET scan is useful for

A

Assessment of myocardial perfusion

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38
Q

Another name for MUGA

A

RVG or Radionuclide ventriulography

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39
Q

Concept of MUGA

A

Radiolabels RBCs w/ technetium 99m to determine Left and Right Ventricle EF’s

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40
Q

MUGA (RVG) advantages are

A

Highly accurate providing RV/LV info at the same time Not limited by body habitus Done in 30m

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41
Q

MUGA (RVG) disadvantages are

A

Radiation exposure Not for pts with arrythmias No info on valvular structures

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42
Q

PET scan is the fallback for what

A

Stress test for patients who have L-BBB, ventricular pacing, or A-fib

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43
Q

PET scan is essentially

A

A CT with nuclear sugar solution (dead cells don’t uptake sugar)

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44
Q

PET scan is not counterindicated but what

A

Vasodilaters like dobutamine

45
Q

Holter monitor is

A

Ambulatory EKG monitoring for 1-2D

46
Q

Holter monitor is useful for

A

Suspected frequent recurrent arrythmias

47
Q

Continuous EKG monitoring is also known as

A

Telemetry

48
Q

Event monitor (Loop monitor) is used for

A

Extended EKG monitoring (3D-3Wks) and records per pt as symptoms occur

49
Q

Event monitoring is indicated for

A

Infrequent arrythmia-type symptoms

50
Q

An implanted event monitor (loop recorder) is reserved for

A

Infrequent but concerning symptoms of a pathologic arrythmia (Unexplained syncope)

51
Q

Types of cardiac stress tests

A

Treadmill EKG Treadmill stress imaging (Echo/Nuclear) Pharmocologic stress test

52
Q

The HR goal of a stress test is

A

85% of their max HR

53
Q

IF they have an ST seg elevation during the stress test what happens?

A

Go straight to the cath lab

54
Q

Primary goal of a stress test is to

A

Determine likelihood of underlying CAD

55
Q

What is most important when determing probablity during stress test?

A

Bayes Theorem - Pre-test probability (Clinical picture)

56
Q

CI to all stress test modalities

A

Recent STEMI <2Ds High Risk for acute coronary syndrome Active heart failure Severe Aortic stenosis Symptomatic HOCM

57
Q

Stress testing works best for who

A

Intermediate pre-test probability

58
Q

High probability of CAD

A

> 85% Angina in older patients with multiple risk factors (DM, Tob, Hyperlipidemia)

59
Q

Intermediate probability of CAD

A

15-85% and younger <40/<60F with angina/risk factors present/not present

60
Q

Low probability of CAD

A

<15% young patients with possible angina

61
Q

EKG ABNLs that will make stress test EKG hard

A

L-BBB Paced rhythm, any ST depression >1mm, LVH,

62
Q

CI for exercise stress test (3)

A

Pre-existing ST-T wave changes Pacemakers ST depression already

63
Q

Most common treadmill stress protocol is

A

Bruce protocol

64
Q

When do you stop Standard exercise stress test

A

Angina EKG signs of myocardial ischemia Max HR achieved (85% MHR) Pt fatigued

65
Q

ABNL stress testing is defined by

A

Clinical parameters (index) Electrical paramaters (ST seg depress >1mm)

66
Q

Markedly positive POS stress test means

A

Ischemic EKG seen w/in 3m or persist 5m after exercise stopped ST depression >2mm SBP drops during exercise High grade Ventricular arrythmias occur Pt

67
Q

What score is used for prognosis using a treadmill stress test

A

Duke prognostic score

68
Q

What three variables go into a Duke prognostic score

A

Exercise time Max ST segment deviation Exercise Angina

69
Q

What is Duke prognostic score risk values

A

Low risk - (>5) Mod risk - (-11 to +4) High risk - (

70
Q

Besides Duke prognostic score what other findings suggest poor prognosis

A

Early ST depression or severe angina <6m ST depression >2mm in >5 leads ST segment rise w/out prior Q waves Sustained BP decrease >10mmHg HR <12bpm w/in 1m (strong indicator) Arrythmias - Persist VT or Complex PV

71
Q

ST seg depression is

A

Ischemia

72
Q

ST seg elevation

A

Infarcation

73
Q

What can happen to V-tach during Stress test

A

Can degrade into V-fib

74
Q

If a pt has angina during stress test it means

A

Pt’s CO cant keep up with demand

75
Q

What is a POS on a Stress echocardiogram

A

Wall-motion ABNLs

76
Q

What stress studies can estimate Efs

A

Stress echocardiogram and Stress Nuclear perfusion study

77
Q

For pts who cannot exercise pts can take what

A

A positive inotrope like dobutamine

78
Q

Nuclear stress myocardial perfusion study uses what material

A

Usually Thallium

79
Q

The purpose of a nuclear perfusion study is to

A

Using pre and post exercise images to determine areas of ischemia

80
Q

In a nuclear perfusion stress test when a pt cant exercise you can use

A

Dobutamine (POS inotrope) Adenosine and Dipyridamole (Coronary artery dilation)

81
Q

Which is preferred Chemical or Exercise stress test?

A

Exercise stress test

82
Q

What is a cardiac cath?

A

Fluid filled catheters are introduced into circulation followed by a dye injection

83
Q

Cardiac cath is the gold standard for what

A

Invasive cardiac measurments

84
Q

If we want to assess RA/RV/pulm pressures with cardiac cath use what blood vessels

A

Brachial, femoral, or jugular VEIN

85
Q

If we want to assess Aorta/LV pressures with cardiac cath use what blood vessels

A

Brachial, femoral ARTERY

86
Q

What side cath can indirectly measure CO

A

Right side cath

87
Q

What side cath can directly measure CO and EF

A

Left side cath

88
Q

Is flouroscopic guidance used for L-Heart cath?

A

Yes, It can be

89
Q

Where does L-side cath enter

A

(MC) femoral, brachial, or acillary artery

90
Q

Which type of Cardiac cath is most common?

A

Left heart cath

91
Q

Left heart cath therapeutic indications

A

Treat CAD Treat cardiogenic shock Valvular stenosis Intracardiac shunt closures

92
Q

How to TXT CAD with Left heart cath

A

Ballon angioplasty & stent placement

93
Q

How to TXT Cardiogenic shock with Left heart cath

A

Intra-aortic balloon pump placement

94
Q

How to TXT valvular stenosis with Left heart cath

A

Balloon valvuloplasty

95
Q

Left heart cath diagnostic indications

A

Defining coronary anatomy Assess LV fx Eval proximal aortic DZ Assess hemodynamics with pericardial constriction

96
Q

Where does R-side cath enter

A

Subclavian, internal jugular, brachial, or femoral vein

97
Q

What type of cath is used for R-heart cath

A

Swan-Ganz catheter

98
Q

Is flouroscopic guidance used for R-Heart cath?

A

Not required

99
Q

What concepts should be used when performing a R-Heart cath

A

Pressure waveforms and pulmonary capillary wedge pressure

100
Q

What pressure approximates LA pressure

A

pulmonary capillary wedge pressure

101
Q

Elevated wedge pressure implies

A

Volume overload (wet)

102
Q

Decreased wedge pressure implies

A

Volume depletion (dry)

103
Q

Who is R-Heart cath primarily used for

A

Crticially-ill pts with complex hemodynamic issues

104
Q

R-heart cath indications?

A

Assess HF filling pressures and CO Assess volume status/PVR in septic pts Eval intra-cardiac shunts Eval pericardial disease Peri-operative monitoring for HF

105
Q

Uncommon Complications related to cardiac cath

A

AMI Stroke Bleeding

106
Q

Common Complications related to cardiac cath

A

Allergic reactions to dye Dye induced renal failure

107
Q

Electrophysiology study is

A

Invasive cath procedure using multiple electrodes to directly record/pace heart

108
Q

Electrophysiology diagnostic indication is

A

detailed analysis of difficult to manage arrythmias

109
Q

Electrophysiology therapeutic indication is

A

Asess pharm/impant efficacy Ablation of arrythmia unresponsive to Rx

Cardiology IPAP (20 decks)

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