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Spring '24 > Stress Echo Exam #2 > Flashcards

Stress Echo Exam #2 Flashcards

1
Q

This has the poorest blood supply of the entire myocardium

A

 sub, endocardial tissue

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2
Q

Most common form of  heart disease in adults is what

A

Coronary artery disease

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3
Q

With atherosclerosis, the arteries lining becomes hardened, stiffen, and swollen with all sorts of “______”

A

 grunge

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4
Q

Describe the blood clotting system

A
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5
Q

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.

A

Single vessel disease, or multi vessel dz

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6
Q

A stenosis, a.k.a.

A

Ischemia

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7
Q

Myocardial ischemia can be reversed, true or false

A

True

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8
Q

With ischemia, what percentage of the luminal cross-sectional area has to be narrowed

A

 70 to 90%

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9
Q

This type of blood flow can help you preserve myocardial function

A

 collateral blood flow

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10
Q

Coronary artery disease factors risk factors:  obviously, being a man and age are two major ones. However, the rift for women increases after

A

Menopause

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11
Q

If your father or brother had CAD before age _____, or  your mother, or sister before age ______,  your risk is highest for CAD

A

55, 65

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12
Q

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?

A

20! cigarettes a day, risk is six times that

Men is 3x

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13
Q

Radiation therapy to the chest can be a risk factor for coronary artery disease true or false

A

True

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14
Q

Type a personality types are how many times more likely to exhibit coronary artery disease

A

2x

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15
Q

What relieves stable angina

A

Rest and or nitroglycerin

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16
Q

What is unstable angina? And is it an emergency?

A

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.

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17
Q

Syndrome, X, or metabolic syndrome is a cluster of cardiac risk factors that result from what

A

Insulin resistance

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18
Q

Metabolic syndrome, risk factors need three of the following five:

A

elevated waist circumference,  elevated serum, triglycerides,  reduced high density, lipoprotein, cholesterol, elevated blood pressure, elevated fasting glucose

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19
Q

Women or men  are more likely to suffer from syndrome, X or metabolic syndrome

A

Women

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20
Q

Why are women more prone to suffer from syndrome X metabolic syndrome

A

 their blood vessels are exposed to varying levels of estrogen

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21
Q

Medical treatment for coronary artery disease (4)

A

 Aspirin, anti-platelet therapy - nitroglycerin, statins - which are cholesterol lowering medication, or beta blockers / calcium channel blockers which are blood pressure medication

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22
Q

More spurious treatment for coronary artery disease

A

Angioplasty stent in plantation, artery bypass grafting, or CABG, which stands for coronary artery bypass surgery

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23
Q

Ischemic cascade

A

 Perfusion defect, metabolic disorder, diastolic dysfunction, systolic dysfunction, ECG changes, chest pain, myocardial infarction

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24
Q

Two types of infarction

A

Transmural, and non-transmural

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25
Q

With a transmural infarct, the result is

A

A complete occlusion of the areas blood supply, a definite area of akinesis and wall thinning will be present

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26
Q

Non-transmural in a.k.a.

A

Subendocardial infarction

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27
Q

Between a transmural and non-transmural and which one would you prefer?

A

A non-transmural!  may result in a lesser degree of walk thinning, and hypokinesis, rather than akinesis

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28
Q

In the presence of chest pain and EKG changes, What is direct evidence of myocardial ischemia

A

Wall motion abnormality

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29
Q

With an acute MI, what is present at rest

A

 Wall motion, abnormality..  with acute infarction wall sign is normal but systolic wall, thickening and endocardial motion are reduced or absent

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30
Q

Approximately what percentage of all myocardial infarction are silent

A

25% or 1/4

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31
Q

Women experienced less symptoms than men for myocardial infarction true or false

A

True..  usually shortness of breath, weakness, a feeling of indigestion, fatigue

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32
Q

A myocardial infarction can be transmural, or non-transmural, or

A

STEMI / NONSTEMI

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33
Q

The more heart muscle have been damaged, the greater the amount of what  two proteins will be in the blood

A

Troponin T and troponin I (both sensitive and specific)

34
Q

Even a slight increase in troponin

A

There has been some damage to the heart

35
Q

Troponin level

A

 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.

36
Q

CK levels will what if you had a heart attack

A

Double

37
Q

CK not the best biomarker because

A

It can go up in many other condition, it is not specific

38
Q

CK MB is what and what can it tell you

A

 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

39
Q

What small protein is occasionally measured with troponin

A

Myoglobin

40
Q

Complications of an MI

A

 Pericarditis Dresslers, my true regurgitation, VSD, ventricular rupture with pseudo aneurysms, pericardial effusion, RV infarction, LV aneurysm, LV thrombus

41
Q

What is Dressler’s syndrome?

A

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

42
Q

Ischemic MR is a complication that occurs in patients with a prior myocardial infarction typically resolves after

A

The ischemia resolves

43
Q

A better term for a ischemic MR may be

A

 post infarction mitral regurgitation

44
Q

The leaflets in a patient with ischemic MR cannot reach the

A

Annulus level when coapting

45
Q

The most dramatic complication of acute ST elevation, myocardial infarction involved

A

VSD or tearing or rupture of acutely infarcted myocardial tissue

46
Q

If there is a new systolic murmur, accompanied by signs of hypo perfusion, after an acute myocardial infarction, you must

A

Investigate !! could be a ventricular septal defect/rupture

Look at septum and apex if patient had MI and is presenting with hypoperfusion

47
Q

An LV  aneurysm may form at the site of

A

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

48
Q

Pseudoaneurysm can be seen when

A

Usually post, recent, MI, cardiac trauma, myocarditis, infective endocarditis, cardiac surgery

49
Q

Apical thrombus most often occurs with what

A

Large anterior ST elevation myocardial infarction

It is an important complication

50
Q

This is a common complication of acute or recent MI, and can occur and cause MR or flail leaflet

A

Papillary muscle rupture

RARE AND CAN BE FATAL!! Results in severe MR, cardiogenic shock, pulmonary edema

51
Q

In papillary muscle rupture, which muscle is the most commonly injured and why

A

The Postero medial muscle is the most commonly injured due to its single blood supply from the posterior, descending coronary artery

52
Q

What is coronary artery spasm?

A

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.

53
Q

Coronary artery spasm can be triggered by what

A

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

54
Q

Coronary artery spasms are due to what

A

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

55
Q

Main symptom of coronary arteries spasm is

A

 Angina typically felt under the sternum or left side of the chest, described as constricting, crushing, pressure, squeezing, tightness

56
Q

This type of pain occurs at odd hours

A

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

57
Q

 Secondary MR is due to this… not leaflet abnormality

A

Dz of left ventricle

58
Q

Myocardial tethering refers to

A

Impact that an abnormal segment has a normal adjacent border segment

Occurs horizontally and vertically

59
Q

Symmetric tethering is global and asymmetric tethering is

A

Local

60
Q

Tenting area is measured at what part of the cardiac cycle

A

Mid systole

61
Q

Normal wall motion is

A

Normal endocardial inward motion, and wall thickening in systole

62
Q

Dyskinesis

A

Outward motion or bulging of the segment in systole usu associated with thin, scarred myocardium

63
Q

Hyperkinesis is

A

Increased endocardial inward motion

64
Q

This is what

A

Thinning of myocardial wall due to prior MI

65
Q

Wall motion scoring ASE how many segments

A

17

66
Q

Most common non ischemic wall motion abnormality is

A

LBBB, abnormal motion after cardiac surgery

67
Q

5 characteristics that a wall motion abnormality is due to LBBB

A
  1. Early systolic beaking of IVS followed by transient paradoxical motion
  2. Preserved wall thickening of IVS
  3. Wall motion abnormality restricted to basal and mid segments, Will not extend into apical segments
  4. Intersegmental temporal dyschrony
  5. No area of wall thinning
68
Q

What’s this

A

Septal Beaking Left bundle branch block

69
Q

Abnormality with postoperative cardiac procedure in which pericardium is opened, the motion abnormality is global or local

A

Global

70
Q

PVC results in wall motion abnormality for the beat in which

A

The left ventricle is activated by the PVC

71
Q

After a PVC there is a compensatory pause and the subsequent left ventricular contraction is

A

Normally hyper dynamic

72
Q

When evaluating echoes for ischemic wall motion abnormality, it is important to quickly assess the what

A

Left ventricular geometry bc it provides a very rapid clue to the presence of abnormal regional function

73
Q

Ventricle more spherical in what cardiomyopathy

A

Dilated

74
Q

In Simpsons you obtain a 4 and 2 chamber view and measure in both systole and diastole true or false?

A

TRUE

75
Q

The difference in turning angle between the base and Apex is called the… or …

A

Net twist angle
Net torsion angle

76
Q

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

A suction force that is the key mechanism that drives early diastolic filling

77
Q

Myocardial deformation on echo described in form of 3 principle strains

A

Longitudinal - shortening of LV along long axis
Radial - thickening of LV wall along radius
circumferential - reduction in LV circumference

78
Q

Strain measures for

A

Myocardial deformation
Better than EF measurement
Early indicator of myocardial dysfunction

79
Q

Strain rate defined

A

Rate of change in velocity between these two points

80
Q

In strain, a negative value indicates____ and a positive value indicates ______

A

Negative - contraction
Positive - relaxation

81
Q

Which type of strain usu is first to be compromised

A

Longitudinal strain

Spring '24 (9 decks)

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