Tools of the Trade Flashcards
- Recognize basic concepts and discuss uses of the following tests in evaluation of patients with known or suspected cardiac disease: chest x-ray, echocardiogram, cardiac stress tests, cardiac magnetic resonance imaging (MRI), cardiac CT/CT angiography, and cardiac catheterization and coronary angiography.
- Differentiate and recognize indications and contraindications for cardiac stress testing, including exercise ECG, echocardiography stress test and radionuclide stress test.
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What is a chest xray?
- Radiation used
- Tissue decreases radiation penetration to film
- Tissue = white (denser the tissue, the whiter it will be)
- Air = black
- Two standard views: posterior-anterior & laternal
What an echocardiogram?
- ultrasound!
- Sounds waves reflects by the tissues
- Blood/fluid = dark
Can be transformed into:
- 2-D “motion picture”
- M-mode
- Color doppler of blood flow
- Spectral doppler map of blood or tissue velocity
What is an m-mode echo?
- earliest forms of echo
- like poking a straw through the chest and only seeing what’s in it
- go look at the ppt
- it has the funky graph view
What do the colors mean in a color doppler echo?
- Red/yellow = towards the transducer
- Blue/white = away from the transducer
What general info is obtained from an echo?
- Chamber size/structure
- Function
- Wall motion
- Valves
- Pressure/hemodynamics
What pathologic info is obtained from an echo?
- Shunts
- Murmurs
- Intracardiac masses
- Bacterial endocarditis
- Pericardial disease
What are micro-bubbles used for?
- to determine if there are problems w/ right-to-left communication/flow
- you should not see them in the LV b/c they do not pass through the pulm capillaries (b/c they are too big)
- this is agitated saline
What do you suspect if you see microbubbles in the LV?
- Intra-cardiac shunt
- Intra-pulm shunt
e.g. anteroseptal shunt
What are the uses for exercise treadmill test (ETT)?
- Screening for CAD
- Evaluate chest pain
- Exercise capacity
- Prognosis
- Eval after revascularization
What are the contraindications for an ETT?
- Unstable angina
- Untreated life-threatening arrhythmias
- Uncompensated HF
- Advanced AV block
- Acute myo/pericarditis
- Critical aortic stenosis
- Significant HOCM
- Uncontrolled HTN
- Acute systemic illness
What is a cardiac MI?
- Strong magnet field
- 3D
- No ionizing radiation
- Anatomic imaging (spin echo)
- Functional imaging (cine CMRI)
Better for overweight/obese pts than ultrasound (w/ US you cannot penetrate the tissue completely)
What are contraindications for MRI?
- Metallic implants
- Kidney dysfunction
what are cardiac caths used for?
Measures:
- Pressure
- Gradients
- Saturation
- Intracardiac shunt
Inserted into artery/vein => moved to heart/coronary arteries
What is added to the cath for an angiogram?
Contrast
