Tools of the trade Flashcards
List tests that can be used for cardiology
Chest X ray, echo, cardiac stress test, cardiac MRI, cardiac CT, CT angiography, cardiac catheterization and coronary angiography
List ways that ultrasound can be interpreted
2-D motion picture, M-mode, color doppler of blood flow, spectral doppler of blood/tissue velocity
What are microbubbles
<10um bubbles that pass through pulmonary capillaries. Agitated saline creates micro-bubbles ~ 16 µm in diameter. Do not pass through pulmonary capillaries, Do not show up in left heart unless right to left communication and flow via Intra-cardiac shunt or Intra-pulmonary shunt
What information is gained from an echo
- Chamber size, Function, Chamber structure, Wall motion, Valves, Pressure and hemodynamics, Shunts, Murmurs, Intracardiac masses, Bacterial endocarditis, Pericardial disease
- Chamber size, Function, Chamber structure, Wall motion, Valves, Pressure and hemodynamics, Shunts, Murmurs, Intracardiac masses, Bacterial endocarditis, Pericardial disease
How does stress testing work? Ie. How is it measured
Identifies ischemia by changes in BP, ECG, symptoms, blood flow imaging, wall motion (echo) imaging. Ischemia is precipitated by increasing myocardial oxygen demand (stress)
What are the types of stress tests?
Exercise treadmill test or imaging stress tests (echo, radionuclide)
When is a treadmill test used
–Screening for coronary artery disease (CAD), Evaluate chest pain, Exercise capacity, Prognosis, Evaluation after revascularization
–Screening for coronary artery disease (CAD), Evaluate chest pain, Exercise capacity, Prognosis, Evaluation after revascularization
Contraindications to exercise treadmill test
–Unstable angina, Untreated life-threatening arrhythmias, Uncompensated heart failure, Advanced AV block, Acute myocarditis, pericarditis, Critical aortic stenosis, Significant HOCM, Uncontrolled HTN, Acute systemic illness
Exercise treadmill test is best for identifying what?
left main, 3 vessel CAD
What is monitored during an exercise treadmill test? And what results are concerning?
ECG, BP(increased more than 20mmHg), HR (>85% predicted maximal HR for age)
What are the imaging stress tests?
radionuclide or echo used during exercise or pharmacologic agents (vasodilators or Dobutamine)
Indications for imaging stress tests
–Abnormal baseline ECG, digoxin, Wolf-Parkinson-White, Increase sensitivity, Localization, Preoperative cardiac risk assessment, Myocardial viability
–Abnormal baseline ECG, digoxin, Wolf-Parkinson-White, Increase sensitivity, Localization, Preoperative cardiac risk assessment, Myocardial viability
Contraindications for imaging stress tests
–Unstable angina, Untreated life-threatening arrhythmias, Uncompensated heart failure, Advanced AV block, Acute myocarditis, pericarditis, Critical aortic stenosis, Significant HOCM, Uncontrolled HTN, Acute systemic illness
concept of radionuclide perfusion imaging
•Tracer deposited based on blood flow. Imbalance between supply and demand results in relative decreased perfusion.
Compare perfusion during increased demand (stress) and decreased demand (rest). Reversible perfusion defects indicate reversible ischemia. Fixed perfusion defects indicate infarction, scar•Tracer deposited based on blood flow. Imbalance between supply and demand results in relative decreased perfusion.
Compare perfusion during increased demand (stress) and decreased demand (rest). Reversible perfusion defects indicate reversible ischemia. Fixed perfusion defects indicate infarction, scar
Agents used in radionuclide perfusion imaging
•Thallium-201: Potassium analog,Continuous exchange across cell membrane. Technetium-99m-Sestamibi (Cardiolite): Lipophilic monovalent cation. Rapid hepatic accumulation. Biliary clearance. One pass. Gating – LV ejection fraction and wall motion
