2B: Cardiac Testing

Question 1

What is the typical hematocrit value for women?

Answer 1

37-47%

Question 2

What is the typical hematocrit value for men?

Answer 2

40-54%

Question 3

What is normal hemoglobin for women?

Answer 3

12-16 g/dL

Question 4

What is normal hemoglobin for men?

Answer 4

14-18 g/dL

Question 5

What is normal WBC count?

Answer 5

4,500 - 11,000 uL

Question 6

What electrolytes are most important for cardiac function?

Answer 6

Potassium, sodium, calcium, CO2

Question 7

What value is considered hyperkalemia?

Answer 7

Potassium > 5.9 mmol/L

Question 8

What value is considered hypokalemia?

Answer 8

Potassium < 3.5 mmol/L

Question 9

What happens with hyperkalemia?

Answer 9

Na cannot come in, bradycardia, decreased ability for myocardial contractility

Question 10

What happens with hypokalemia?

Answer 10

K influx, life threatening arrhythmias with tachycardia

Question 11

What is the normal range for Na2+?

Answer 11

136-143 mmol/L

Question 12

What is the normal range for Ca+?

Answer 12

4.5-5.3 gm/dL

Question 13

What value is considered high CO2, and what is the effect?

Answer 13

> 30 mmHg, can result in alkalytic state of muscle weakness

Question 14

What is an EKG used to diagnosis?

Answer 14

Specific arrhythmias that can be causing symptoms, measure disease progression, and effectiveness of treatment

Question 15

When is a holter monitor used?

Answer 15

After syncope or repeated arrhythmias - 24 hrs of up to 2 weeks long

Question 16

Describe a graded exercise stress test?

Answer 16

Testing with either a treadmill or bike to assess exercise tolerance and ischemia

Question 17

What is the most common graded exercise stress test?

Answer 17

Bruce protocol

Question 18

When is a stress test indicated?

Answer 18

Chest pain with activity, severe dyspnea, suspicion of CAD and ischemia, risk assessment

Question 19

What will the results of a stress test be used for?

Answer 19

Determine the need for further testing, location of ischemia, exercise prescription

Question 20

What are the three reasons why a stress test will be stopped?

Answer 20

1. EKG changes
2. Angina symptoms
3. Extreme dyspnea

Question 21

What three EKG changes indicate terminating a stress test?

Answer 21

1. > 2mm ST segment depression
2. Inverted T wave
3. Significant Q wave

Question 22

Describe dyspnea that would cause a stress test to be terminated?

Answer 22

3-4 on dyspnea scale with LE fatigue

Question 23

What is echocardiography?

Answer 23

Ultrasound of the heart, measure of wall motion

Question 24

What information does an echo provide?

Answer 24

Valve function, size of ventricle, thickness, integrity of interatrrial and interventricular septums. Also gives value of EF

Question 25

What are the limitations of an echo?

Answer 25

Posterior wall structure and motion due to interference from spinal bone

Question 26

When is an echo indicated?

Answer 26

After MI, CHF, unstable angina, syncope episode, cardiomyopathy

Question 27

What is a Thallium stress test?

Answer 27

Uses a radioactive nuclear marker to detect myocardial perfusion

Question 28

What does a Thallium stress test look at?

Answer 28

Ischemia by assessing Thallium in blood flow trough the myocardial tissue

Question 29

What is the risk associated with coronary angiography?

Answer 29

2% risk of stroke

Question 30

Coronary angiography is a definitive diagnosis for what?

Answer 30

CAD, valvular disease, congenital defects

Question 31

Describe how a cardio cath is placed

Answer 31

Threaded through femoral or radial artery into coronary artery and injects dye

Question 32

When is a cardiac catheter used?

Answer 32

Unstable angina, acute MI, positive stress test, positive echo

Question 33

CAD blockages up to what % are considered mild?

Answer 33

70%

Question 34

What is indicated with blockages of > 90%?

Answer 34

Conservative management unless risk of MI is imminent, surgical

Question 35

What are the precautions for cardiac cath with femoral artery entry?

Answer 35

6-12 hours of bedrest with sandbag or compression to prevent bleeding

Question 36

What are the precautions for cardiac cath with radial artery entry?

Answer 36

Nothing major, can ask MD about use of AT

Question 37

What does TEE stand for?

Answer 37

Trans Esophageal Echocardiogram

Question 38

What is a TEE?

Answer 38

Ultrasound head is fiber optic and threaded down the esophagus to give improved visualization of heart structures and function

Question 39

When is a TEE indicated?

Answer 39

Posterior views

Question 40

Describe PET

Answer 40

Nuclear technique, provides visualization

Question 41

What information will PET provide?

Answer 41

Metabolic functions: glucose and fatty acid metabolism, blood flow to the heart Dynamic functioning of myocardium without exercise

Question 42

What are draw backs of a PET?

Answer 42

Very expensive, not readily available

Question 43

What goes MUGA stand for?

Answer 43

Multigated Acquisition Imaging or Gated Pool Imaging

Question 44

What is a MUGA?

Answer 44

Non-invasive technique to calculate left ventricular ejection fraction - uses multiple EKG views

Question 45

What is the advantage of a MUGA?

Answer 45

Less expensive than PET

Question 46

What information does a CT provide?

Answer 46

Cardiac structures and ventricular function

Question 47

When is a CT indicated?

Answer 47

Pts with probable coronary stenosis