Stress Echo Exam #2 Flashcards
This has the poorest blood supply of the entire myocardium
 sub, endocardial tissue
Most common form of  heart disease in adults is what
Coronary artery disease
With atherosclerosis, the arteries lining becomes hardened, stiffen, and swollen with all sorts of “______”
 grunge
Describe the blood clotting system
Patient might have just one or two plaque or might have dozen distributed throughout their coronary arteries. This would be known as this disease or that disease.
Single vessel disease, or multi vessel dz
A stenosis, a.k.a.
Ischemia
Myocardial ischemia can be reversed, true or false
True
With ischemia, what percentage of the luminal cross-sectional area has to be narrowed
 70 to 90%
This type of blood flow can help you preserve myocardial function
 collateral blood flow
Coronary artery disease factors risk factors:  obviously, being a man and age are two major ones. However, the rift for women increases after
Menopause
If your father or brother had CAD before age _____, or  your mother, or sister before age ______,  your risk is highest for CAD
55, 65
The incident of heart attack in women who smoke at least how many cigarettes a day is, how many times that of women who have never smoked?
20! cigarettes a day, risk is six times that
Men is 3x
Radiation therapy to the chest can be a risk factor for coronary artery disease true or false
True
Type a personality types are how many times more likely to exhibit coronary artery disease
2x
What relieves stable angina
Rest and or nitroglycerin
What is unstable angina? And is it an emergency?
It refers to unexpected chest pain and usually occurs at rest. It is more severe and prolonged and is a acute coronary syndrome and should be treated as an emergency.
Syndrome, X, or metabolic syndrome is a cluster of cardiac risk factors that result from what
Insulin resistance
Metabolic syndrome, risk factors need three of the following five:
elevated waist circumference,  elevated serum, triglycerides,  reduced high density, lipoprotein, cholesterol, elevated blood pressure, elevated fasting glucose
Women or men  are more likely to suffer from syndrome, X or metabolic syndrome
Women
Why are women more prone to suffer from syndrome X metabolic syndrome
 their blood vessels are exposed to varying levels of estrogen
Medical treatment for coronary artery disease (4)
 Aspirin, anti-platelet therapy - nitroglycerin, statins - which are cholesterol lowering medication, or beta blockers / calcium channel blockers which are blood pressure medication
More spurious treatment for coronary artery disease
Angioplasty stent in plantation, artery bypass grafting, or CABG, which stands for coronary artery bypass surgery
Ischemic cascade
 Perfusion defect, metabolic disorder, diastolic dysfunction, systolic dysfunction, ECG changes, chest pain, myocardial infarction
Two types of infarction
Transmural, and non-transmural
With a transmural infarct, the result is
A complete occlusion of the areas blood supply, a definite area of akinesis and wall thinning will be present
Non-transmural in a.k.a.
Subendocardial infarction
Between a transmural and non-transmural and which one would you prefer?
A non-transmural!  may result in a lesser degree of walk thinning, and hypokinesis, rather than akinesis
In the presence of chest pain and EKG changes, What is direct evidence of myocardial ischemia
Wall motion abnormality
With an acute MI, what is present at rest
 Wall motion, abnormality..  with acute infarction wall sign is normal but systolic wall, thickening and endocardial motion are reduced or absent
Approximately what percentage of all myocardial infarction are silent
25% or 1/4
Women experienced less symptoms than men for myocardial infarction true or false
True..  usually shortness of breath, weakness, a feeling of indigestion, fatigue
A myocardial infarction can be transmural, or non-transmural, or
STEMI / NONSTEMI
The more heart muscle have been damaged, the greater the amount of what  two proteins will be in the blood
Troponin T and troponin I (both sensitive and specific)
Even a slight increase in troponin
There has been some damage to the heart
Troponin level
 increased within six hours of a heart attack, may remain high for one to two weeks after a heart attack. This is the best bio marker.
CK levels will what if you had a heart attack
Double
CK not the best biomarker because
It can go up in many other condition, it is not specific
CK MB is what and what can it tell you
 it is a type of CK, it can help differentiate between heart damage or damage to other muscles, can tell Dr, if clot dissolving drugs are working, it will rise. If it is, more sensitive for finding heart damage from a heart attack, levels rise 4 to 6 hours after MI, back to normal after a day or 2
What small protein is occasionally measured with troponin
Myoglobin
Complications of an MI
 Pericarditis Dresslers, my true regurgitation, VSD, ventricular rupture with pseudo aneurysms, pericardial effusion, RV infarction, LV aneurysm, LV thrombus
What is Dressler’s syndrome?
A form of secondary pericarditis, with or without a pericardial effusion, that occurs as a result of injury to the heart or pericardium.. should be considered in all patients presenting with persistent Malays or fatigue following a MI or cardiac surgery, especially if symptoms present greater than two weeks following the event
Ischemic MR is a complication that occurs in patients with a prior myocardial infarction typically resolves after
The ischemia resolves
A better term for a ischemic MR may be
 post infarction mitral regurgitation
The leaflets in a patient with ischemic MR cannot reach the
Annulus level when coapting
The most dramatic complication of acute ST elevation, myocardial infarction involved
VSD or tearing or rupture of acutely infarcted myocardial tissue
If there is a new systolic murmur, accompanied by signs of hypo perfusion, after an acute myocardial infarction, you must
Investigate !! could be a ventricular septal defect/rupture
Look at septum and apex if patient had MI and is presenting with hypoperfusion
An LV  aneurysm may form at the site of
Infarction
Most commonly involved are anterior wall and Apex
Rhombus frequently forms, thrombus, more likely to be seen in the area of aneurysm look for the hinge point that will tell you where the infarct zone is
Pseudoaneurysm can be seen when
Usually post, recent, MI, cardiac trauma, myocarditis, infective endocarditis, cardiac surgery
Apical thrombus most often occurs with what
Large anterior ST elevation myocardial infarction
It is an important complication
This is a common complication of acute or recent MI, and can occur and cause MR or flail leaflet
Papillary muscle rupture
RARE AND CAN BE FATAL!! Results in severe MR, cardiogenic shock, pulmonary edema
In papillary muscle rupture, which muscle is the most commonly injured and why
The Postero medial muscle is the most commonly injured due to its single blood supply from the posterior, descending coronary artery
What is coronary artery spasm?
It is a temporary sudden narrowing of one of the coronary arteries, slowing or stopping blood flow. They can occur in arteries with or without hardening due to plaque buildup.
Coronary artery spasm can be triggered by what
Alcohol withdrawal, emotional stress, exposure to cold, vasoconstriction medication’s, stimulant drugs, such as cocaine
Occurs commonly in people who smoke or have high cholesterol or high blood pressure
Coronary artery spasms are due to what
Squeezing of muscles of the arteries wall, it may appear normal during testing, but it does not function normally about 2% of patients with angina have coronary arteries spasm
Main symptom of coronary arteries spasm is
 Angina typically felt under the sternum or left side of the chest, described as constricting, crushing, pressure, squeezing, tightness
This type of pain occurs at odd hours
Coronary artery spasm often occurs at rest, may occur at the same time each day usually between midnight and 8 AM, last from 5 to 30 minutes, person may pass out
Not on exertion! Can usu exercise and walk and no pain!! Remember non exertional pain is more dangerous
 Secondary MR is due to this… not leaflet abnormality
Dz of left ventricle
Myocardial tethering refers to
Impact that an abnormal segment has a normal adjacent border segment
Occurs horizontally and vertically
Symmetric tethering is global and asymmetric tethering is
Local
Tenting area is measured at what part of the cardiac cycle
Mid systole
Normal wall motion is
Normal endocardial inward motion, and wall thickening in systole
Dyskinesis
Outward motion or bulging of the segment in systole usu associated with thin, scarred myocardium
Hyperkinesis is
Increased endocardial inward motion
This is what
Thinning of myocardial wall due to prior MI
Wall motion scoring ASE how many segments
17
Most common non ischemic wall motion abnormality is
LBBB, abnormal motion after cardiac surgery
5 characteristics that a wall motion abnormality is due to LBBB
- Early systolic beaking of IVS followed by transient paradoxical motion
- Preserved wall thickening of IVS
- Wall motion abnormality restricted to basal and mid segments, Will not extend into apical segments
- Intersegmental temporal dyschrony
- No area of wall thinning
What’s this
Septal Beaking Left bundle branch block
Abnormality with postoperative cardiac procedure in which pericardium is opened, the motion abnormality is global or local
Global
PVC results in wall motion abnormality for the beat in which
The left ventricle is activated by the PVC
After a PVC there is a compensatory pause and the subsequent left ventricular contraction is
Normally hyper dynamic
When evaluating echoes for ischemic wall motion abnormality, it is important to quickly assess the what
Left ventricular geometry bc it provides a very rapid clue to the presence of abnormal regional function
Ventricle more spherical in what cardiomyopathy
Dilated
In Simpsons you obtain a 4 and 2 chamber view and measure in both systole and diastole true or false?
TRUE
The difference in turning angle between the base and Apex is called the… or …
Net twist angle
Net torsion angle
With the wringing motion or twist of the LV (apex counterclockwise or anti clockwise and base is clockwise)… the subsequent untwist during diastole generates
A suction force that is the key mechanism that drives early diastolic filling
Myocardial deformation on echo described in form of 3 principle strains
Longitudinal - shortening of LV along long axis
Radial - thickening of LV wall along radius
circumferential - reduction in LV circumference
Strain measures for
Myocardial deformation
Better than EF measurement
Early indicator of myocardial dysfunction
Strain rate defined
Rate of change in velocity between these two points
In strain, a negative value indicates____ and a positive value indicates ______
Negative - contraction
Positive - relaxation
Which type of strain usu is first to be compromised
Longitudinal strain
