Tools of the Trade Flashcards
In a parasternal long axis view of an echocardiogram, which chamber will be closest to the prob (highest)?
Right ventricle
*This is a sagittal view while laying on back
*Right ventricle is farthest anterior
How is the m mode electrocardiogram different than normal?
It picks a single line vector and you look down that line
*Is displayed with an X-axis of time and shows you echoes of a single line below where the probe points
On the doppler feature of an echo, which color signifies blood moving away from probe?
Blue/ white
What is the pathology of this heart?
Mitral regurgitation
What is wrong with this heart? What will happen to the ECG?
Pericardial effusion
ECG: Electrical alternans
=intensity of QRS will vary cuz heart is flopping around in the fluid
What are microbubbles? How are they used diagnostically?
Agitated saline that makes small bubbles that don’t pass through capillaries
*Can be observed with echo to find bidirectional flow from shunts between atria (ie. patent foramen ovale, atrial septal defect)
How could you determine between patent foramen ovale and atrial septal defect with microbubbles?
PFO: only get right > left flow
(flap closes with high ventr. pressures)
Septal defect: get flow both directions
List as many things as you can that you can find through an echo?
(Though we’ve never had a test Q like this so far)
- Chamber size
- Function
- Chamber structure
- Wall motion
- Valves
- Pressure and hemodynamics
- Shunts
- Murmurs
- Intracardiac masses
- Bacterial endocarditis
- Pericardial disease
List steps of progression to cell death caused by CAD
- Asymptomatic, non-obstructive CAD
- Ischemia
–Stable exertional angina
–Unstable angina
- Myocardial infarction (MI), cellular necrosis
**Doesn’t always have to occur like this
Stress testing is used to identify ischemia by increasing myocardial oxygen demand.
What tools do you use during the stress test to identify changes from ischemia?
•Identify ischemia by changes in:
–blood pressure
–ECG
–symptoms
–blood flow (perfusion) imaging
–wall motion (echocardiography) imaging
What is the strongest prognosis indicator of the stress test?
Exercise duration
What things can we evaluate (indications) for using the stress test?
•Indications
–Screening for coronary artery disease (CAD)
–Evaluate chest pain
–Exercise capacity
–Prognosis
–Evaluation after revascularization
You have a patient and you’re trying to decide if you should do a stress test on them. What contraindications would you look for to decide against it?
–Unstable angina
–Untreated life-threatening arrhythmias
–Uncompensated heart failure
–Advanced AV block
*Also respiratory disease
Exercise stress test was used to find CAD in middle aged men. What is the relative sensitivity of the test with the following conditions?
- Left main, 3 vessel disease
- One vessel disease
- RCA
Left main, 3 vessel disease: 75 - 90%
One vessel disease: 25 - 70 %
LAD > RCA > CIRC
How do you know if there’s a problem with the stress test?
Heart becomes abnormal before 85% max exertion or you can never get to 85%
The left lateral (L5,L6) and inferior leads are most helpful with stress test.
This ECG is taken during a stress test. Is there ischemia? Why or why not?
Yes - significant ST depressions
Alright doc, what’s your diagnosis?
Reversible ischemia
*Look at bottom left. At rest it looks good, but at exercise it doesn’t
Alright doc, what’s your diagnosis?
Irreversible ischemia
*Areas don’t get perfusion at rest or exercise
*Indicative of previous infarction
