Tools of the Trade

Question 1

Cardiology Tests

Answer 1

Chest Radiograph (CXR)
Echocardiogram (Echo)
Cardiac Stress Tests
Cardiac Magnetic Resonance Imaging (CMRI)
Cardiac CT, CT angiography (CTA)
Cardiac Catheterization and coronary angio

Question 2

CXR Standard Views

Answer 2

PA

Lateral

Question 3

Echocardiogram Types

Answer 3

2D Echo: Parsternal Long axis
M-Mode: Multiple Individual tracings of heart anatomical movements
Color Doppler: Blood flow map
Spectral doppler: Blood or tissue velocity map

Question 4

Micro-bubbles: definition and use

Answer 4

-Agitated saline creates micro-bubbles of ~16um in diameter
-Do NOT pass through pulmonary capillaries
-ONLY show up in left heart if there right to left communication such as:
Intra-cardiac shunt or
Intra-pulmonary shunt

Question 5

Methods of identifying ischemia during stress testing:

Answer 5

blood pressure
ECG
symptoms
blood flow (perfusion) imaging
wall motion (echocardiography) imaging

Question 6

Types of Stress Tests

Answer 6

Exercise Treadmill Test (ETT)
Echocardiography
Nuclear (Radionuclide)
       Thallium-201
       Technetium-99m-Sestamibi (Cardiolite)

Question 7

ETT Indications

Answer 7

Screening for coronary artery disease (CAD)
Evaluate chest pain
Exercise capacity
Prognosis
Evaluation after revascularization

Question 8

ETT Contraindications

Answer 8

Unstable Angina
Untreated life-threatening arrhythmias
Uncompensated Heart Failure
Advanced AV block
Acute myocarditis, pericarditis
Critical Aortic Stenosis

Question 9

Best Use for ETT

Answer 9

Left Main and 3 vessel CAD

Question 10

Indications for Imaging Stress Tests

Answer 10

Abnormal baseline ECG, digoxin, Wolf-Parkinson-White
Increase sensitivity
Localization
Preoperative cardiac risk assessment
Myocardial viability

Question 11

Contraindications for Imaging Stress Tests

Answer 11

Unstable Angina
Untreated life-threatening arrhythmias
Uncompensated Heart Failure
Advanced AV block
Acute myocarditis, pericarditis
Critical Aortic Stenosis

Question 12

Radionuclide Perfusion Imaging

Answer 12

Imbalance between supply and demand leads to decreased radionuclide perfusion.
Compare stress to rest images.
Fixed perfusion defects indicate infarction or scar

Question 13

Stress Echocardiography

Answer 13

Imbalance between supply and demand results in wall motion abnormality. Compare wall motion during stress to rest.
Normally left ventricle should beat faster and thicken more with exercise or dobutamine