Tools of Trade

Question 1

Mechanism behind CXR

Answer 1

1) Tissue decr radiation penetration

2) Tissue = white
air = black

Question 2

what is white on CXR

what is black on CXR

Answer 2

white = tissue
black = air

Question 3

Mechanism of echo

Answer 3

1) US sent to body and return to transducer

Question 4

Returned ultrasound forms:

M mode

Answer 4

moving location of transducer at varying angles to capture image

Question 5

Returned ultrasound forms:

color doppler map of blood flow

Answer 5

blue = flow away

red = flow toward

Question 6

Mechanism of micro-bubbles

Answer 6

1) micro bubbles <10um pass thru pulm capillaries

2) creates micro-bubbles ~16 um

Question 7

Where can micro-bubbles not pass thru?

Answer 7

1) can’t pass thru pulm capill b/c too big

2) not in left heart unless you have R–> L communication + flow

Question 8

Examples of when agitated saline and micro bubbles can appear in left heart

Answer 8

1) intra cardiac shunt

2) intra pulm shunt

Question 9

when do you see bidirectional flow (bidirectional intra-cardiac shunt)

Answer 9

atrial septal defect

Question 10

Diseases you can tell from echo

Answer 10

1) shunts
2) murmurs
3) intracardiac masses
4) bacterial endocarditis
5) pericardial disease/fluid

Question 11

Examples of CAD

Answer 11

1) asymptomatic/non-obstructive CAD

2) ischemia
- stable, exertional angina
- unstable angina

3) MI, cellular necrosis

Question 12

a

Answer 12

a

Question 13

Mechanism behind stress testing

Answer 13

1) precipitate ischemia by incr myocardial O2 demand (stress)

Question 14

How do you identify ischemia from stress testing?

Answer 14

find ischemia by changes in

1) BP
2) ECG
3) sx
4) perfusion (flow) imaging
5) echo (wall motion) imaging

Question 15

types of stress tests

Answer 15

1) exercise treadmill

2) imaging stres
- echo
- radionuclide (nuclear)

Question 16

indications for exercise treadmill test

Answer 16

1) CAD screening
2) chest pain
3) exercise capacity
4) prognosis (exercise duration best)
5) evaluate after revasc

Question 17

Contraindications for exercise treadmill test

Answer 17

1) unstable angina
2) life threatening arrhythmias
3) uncompensated HF
4) advanced AV block
5) acute myocarditis/pericarditis
6) critical aortic stenosis
7) significant HOCM
8) uncontrolled HTN

Question 18

what is exercise treadmill stress test best designed for

Answer 18

good at Identifying left main or 3 vessel CAD

sensitivity decr with 1 vessel CAD

Question 19

possible results from exercise treadmill stress test

Answer 19

1) HR response
2) BP response (systolic incr >20)
3) duration
4) ecg
5) sx

Question 20

pharmacologic agents for imaging stress test

Answer 20

vasodilator- HR independent bc HR not increasing

1) dipyridamole
2) adenosine
3) regadenosen

dobutamine- make heart exercise w/o pt exercising

Question 21

indications for imaging stress test

Answer 21

1) abnormal baseline ECG, WPW
2) incr sensitivity
3) localization
4) preop cardiac risk assessment
5) myocardial viability

Question 22

contraindications for imaging stress test

Answer 22

same as exercise stress test

Question 23

important patient prep for imaging stress test

Answer 23

1) no significant RAD –> bronchospasm with drug
(regadenoson most specificity for pulm so least side effect)

2) no caffeine/theophylline –> counteracts effect of adenosine

Question 24

a

Answer 24

a

Question 25

Mechanism behind radionuclide perfusion

what causes relative decr perfusion?

Answer 25

imbalance btwn supply and demand

Question 26

Mechanism behind radionuclide perfusion

goals

Answer 26

compare perfusion during incr demand (stress) and decr demand (rest)

Question 27

Mechanism behind radionuclide perfusion

what is REVERSIBLE PERFUSION defects indicate?

Answer 27

reversible ischemia

decr blood flow w/ incr demands NOT AT REST

Question 28

Mechanism behind radionuclide perfusion

what does FIXED PERFUSION indicate?

Answer 28

infarction/scar

decr blood flow w/ incr demand and AT REST

Question 29

what are radionuclide perfusion imaging agents

describe thallium-201

Answer 29

init accum prop to blood flow

continuous exch across cell membrane

Question 30

what are radionuclide perfusion imaging agents

describe cardiolite

Answer 30

hepatic accum

biliary clearance

ONE PASS

better with more obese people

Question 31

what are radionuclide perfusion imaging agents

what does cardiolite tell you?

Answer 31

gating-LV ejection fraction and wall motion

Question 32

results of radionuclide perfusion stress test

Answer 32

rest and stress perfusion imaging

Question 33

Stress echo goals

Answer 33

1) can tell wall tension abnormality based on imbalance btwn supply and demand
2) LV should beat faster/thicken with exercise or dobutamine

Question 34

pros of MRI

Answer 34

no ionizing radiation

Question 35

contraindications for MRI

Answer 35

metallic implant

kidney dysfunction with gadolinium contrast

Question 36

what should stress echo be normally

Answer 36

1) cavity size decr

2) myocardium and all heart contract to make cavity smaller

Question 37

what is noninvasive cardiac imaging

Answer 37

cardiac CTA

Question 38

what can cardiac cath/coronary angiography measure?

Answer 38

measure

1) pressure
2) gradients
3) saturation
4) intracardiac shunt

Question 39

difference btwn cardiac cath/coronary angiography

Answer 39

contrast for angography

Question 40

where to cath for right heart

where to cath for left heart

Answer 40

1) intenral jugular or femoral vein –> IVC/SVC

2) radial or femoral artery –> pulmonary

Question 41

if RA = 85% O2 and RV 75% O2

what does that suggest

Answer 41

ASD from left –> right

Question 42

if vena cava and RA = 75% O2 and RV = 85% O2

what does that suggest

Answer 42

VSD from left –> right