Cardiac Diagnostic Studies Lecture Powerpoint

Question 1

Most important tool in evaluating cardiac patient

Answer 1

History and physical

Question 2

10 year old experiencing palpitations suddenly, what are the 5 big tests would you order for diagnosis?

Answer 2

• EKG #1
• Echocardiogram
• Holter monitor
• Event recording
• Symptom diary and pulse checks

Question 3

Holter Monitor definition and one big disadvantage

Answer 3

5 lead EKG recording that records every heartbeat up to 48 hours, provides avg heart rate as well as minimum and max heart rate, patients should self record symptomatic moments to correlate to the arrhythmia

-Disadvantage: short time frame relatively speaking so many patients will not have symptoms

Question 4

Holter Monitor indications

Answer 4

-Evaluate symptoms such as palpitations, chest pain, syncope caused by dysrythmia, or evaluate medical therapy being used to suppress dysrhythmia

Question 5

Event recorders definition and one big disadvantage

Answer 5

• Devices that continously monitor ECGs for 30-60 days, device has a memory that will store a triggered event (regardlss of if patient is aware or if patient triggers device manually) as well as the previous 10 minutes
• Disadvantage is that patient must wear for a month and change patches

Question 6

Event recorders indications

Answer 6

Suspected dysrhythmia not occurring on a daily basis

Question 7

Implantable cardiac monitor

Answer 7

Implanted on upper chest wall subcutaneously, hand held device activator placed over device to mark and save rhythms before, during, and after event, new models can automatically send transmission to physician

Question 8

Tilt table test

Answer 8

Older test that is used for evaluation of vasovagal syncope opposed to a cardiac syncope, thru strapping patient to table that moves from horizontal to vertical position while monitoring heart rate and blood pressure and assessing for syncope

Question 9

65 year old presenting to cardiologist complaining of intermittent dyspnea related to activity, what are 4 tests you would order?

Answer 9

• EKG
• Echocardiogram
• Stress Test
• Chest X ray

Question 10

Echocardiography and 3 subtypes

Answer 10

• 2D mapping allows for evaluation of anatomy, hemodynamics, function of cardiac structures, assessment for clot presence, tumor, or pericardial effusion
• Transthoracic echo, transesophageal echo, or doppler

Question 11

White on an echocardiogram represents ____ and black represents ___

Answer 11

muscle, lumen

Question 12

Doppler imaging

Answer 12

A continuous wave doppler that can measure the velocity of the fluid in the heart helpful in diagnosing stenosis or other conditions (color flow mapping)

Question 13

Benefits and limitations of echocardiography

Answer 13

Benefits - non invasive, inexpesnive, mobile

Limitations - poor windows, technologist dependent, subjective interpretations by physicians

Question 14

Poor windows

Answer 14

Refers to when there is extra tissue (adipose, muscle, etc) that makes it difficult to obtain clear echocardiogram images

Question 15

65 male with mildly elevated cholesterol presents with chest tightness when walking, what 4 tests do you order?

Answer 15

• EKG
• echocardiogram
• exercise stress test
• Holter monitor

Question 16

Cardiac stress testing and 2 ways to enhance the study

Answer 16

Goal is to evaluate perfusion/function of myocardium at times of stress (exercise induced or pharmacologically induced) that can evaluate exercise intolerance or rhythm abnormalities, can evaluate for ST segment changes, BP response, maximum achieved predicted HR

-enhanced with imaging studies such as echocardiogram or nuclear imaging

Question 17

Stress test indications (4)

Answer 17

• Evaluate patients with known or suspected CHD
• assess therapeutic effects of drugs
• post MI
• Preop risk assessment

Question 18

Exercise stress tests without imaging advantages and disadvantages

Answer 18

Advantages - assessment of ischemia, equipment widely available
Disadvantages - Sensitivity lower than that of stress imaging techniques, female population not as accurate

Question 19

Absolute and relative contraindications for exercise testing

Answer 19

Absolute - recent MI, unstable angina, acute aortic dissection or PE
Relative - Left coronary artery stenosis, electrolyte abnormalities, mental or physical impairment

Question 20

Stress test Echocardiography advantages and disadvantages

Answer 20

Advantages - Useful for diagnosing CAD, provides immediate results
Disadvantages - interpretation subjective and not standardized, images may be nondiagnostic

Question 21

Pharmacological alternatives to treadmill for stress testing (3)

Answer 21

• Dobutamine
• Adenosine
• Persantine

Question 22

Dobutamine stress testing function

Answer 22

Prominent inoropic and less prominent chronotropic effects on myocardium that increases heart rate, blood pressure, and contractility closely simulating exercise, up titrated as infusion to achieve max acheived predicted HR

Question 23

Adenosine stress testing function

Answer 23

Coronary vasodilator that decreases blood pressure but has no effect on HR, can cause transient heart block or induce bronchospasm, can accurately assess CAD in patients unable to exercise and is relatively safe with side effects that can be rapidly reversed

Question 24

Nuclear stress test (perfusion imaging)

Answer 24

Involves nuclear isotope with an affinity for the heart is injected, ischemic areas will have decreased uptake and infarcted will have none, highly sensitive for coronary artery disease as it directly measures PERFUSION

Question 25

Interpreting nuclear stress test

Answer 25

Compare rest image with stress image, if defect present at stress and rest then that indicates previous MI in the artery of the region

Question 26

Cardiac catheterization

Answer 26

Angiogram that allows for location of stenosis or aneurysm in blood vessels, allows to assess hemodynamics, pressure in heart and lungs, biopsy, and identify congenital heart defects

Question 27

Cardiac catheterization risks (4)

Answer 27

• bruising
• stroke
• arrhythmia
• dye can have allergic rxn

Question 28

Cardiac MRI

Answer 28

Examines size of heart chambers and thickness of the wall and other anatomy, determines extent of damage caused by heart attack or progressive heart disease, detects plaque buildup, assesses a patients recovery following treatment

Question 29

Teens with chest pain and elevated troponin levels indicates ____ for which the study of choice to image is ____

Answer 29

Viral myocarditis, cardiac MRI

Question 30

Benefits and drawbacks of cardiac MRI

Answer 30

Benefits - 3D analysis, non invasive, no radiation

Drawbacks - no pacemakers, only diagnostic not therapeutic

Question 31

Nuclear stress test is directly measuring ____

Answer 31

perfusion

Question 32

Cardiac CT angiogram

Answer 32

Uses CT and IV contrast to obtain 3D images of heart and great vessels, enable visualization of plaque or ca2+ deposits on artery walls, noninvasive method to detect blockages

Question 33

Cardiac CT angiogram benefits and drawbacks

Answer 33

Benefits - 3D, noninvasive analysis, superior to catheter angiography
Drawbacks - Radiation exposure, diagnostic not therapeutic, risk of contrast allergy

Question 34

Electrophysiology study

Answer 34

Tests function of heart’s electrical system, can be useful in identifying an arrhythmia and helping decide best therapy for it especially when there is risk for future cardiac events

Question 35

Risks and benefits of electrophysiology study

Answer 35

Benefits - may be able to cure arrhythmia via ablation

Risks - bleeding, infection, injury

Question 36

Calcium score screening CT

Answer 36

Method for predicting risk for CAD in asymptomatic patient by detecting Ca2+ buildup, quick screening tool but may miss some plaques and gives radiation exposure