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Flashcards in CAD: Diagnosis Deck (56):
0

type I errors = ?

false positives

1

type II error

false negative

2

Target HR in stress test

85% of age predicted HR (220-age)

3

Rate Pressure Product

peak HR x SBP

(measures myocardial workload)

4

Sn and Sp of ETT

both around 70%

5

on ETT does ST elevation or depression localize ischemia?

ST elevation does

6

ECG changes prognostic on ETT

- max ST depression
- # leads involved
-time to ST shift
- recovery time
- inducible ventricular arrhythmias

7

Hemodynamic changes prognostic on ETT?

-peak HR (Chronotropic incompetence)
-BP (exercise induced hypotension)
- rate pressure product

8

what does exercise induced hypotension on ETT mean?

LM or 3VD

9

Are HOCM, high degree AVB, severe HTN absolute contraindications to ETT?

no

10

at what high BP do you stop a ETT?

250/115

11

absolute reasons to stop an ETT (7)

1- ischemia w/ SBP dec by 10mm Hg
2- mod-sev angina
3- CNS sxs
4- cyanosis/pallor
5- sustained VT
6- >1mm ST elev (other than V1 or aVR)
7- pt requests

12

which conditions obscure ST changes on ETT?

WPW
PPM
ST dep 1mm at rest
LBBB
LVH
Dig

13

ST depression in which leads of an ETT don't matter?

V1, aVR

14

ST Elevation on ETT

Should be in leads without Q waves
Transmural ischemia from coronary spasm or myocardial injury

15

Duke Treadmill Score

Exercise time (mins) - (5 x mm ST dep) - (4 x angina index)

16

Angina index

0- no CP
1- CP
2- CP stops exercise

18

Scores and corresponding mortality for Duke treadmill

Low risk > 5 (0.5%)
Intermediate risk +4 to -10 (.5-5%)
High risk < -11 (>5%)

19

HR reserve and chronotropic incompetence

HR Reserve = 220-age-resting hR
Chron. incomp is inability to inc HR by 80% of HR reserve

20

what is considered a low level of exercise?

HR<70% max HR

21

differences in SN/Sp b/w stress echo and nuclear

similar Sn
stress echo- higher Sn (fewer false +)

22

adenosine stress MOA

A2A receptor agonist--> 4x inc in coronary blood flow

23

adenosine effect on HR and BP

inc HR
modest dec in BP

24

*adenosine side effects by receptor-type

A1 : AVB
A2b: periph vasodilation, bronchospasm
A3: bronchospasm

25

adenosine stress contraindication (5)

asthma/COPD
high degree AVB/SSS w/o PPM
SBP<90
recent dipyridamole/aggrenox
on methyl xanthones (aminophylline, caffeine) w/in 12hrs

26

regadenoson receptors

binds selectively to A2A receptor
- low affinity for A1, A2b, A3 so less side effects

27

persantine (dipyridamole) stress test MOA

indirectly increases adenosine by preventing its reuptake

28

dobuatmine stress dosing

5-10 mcg/kg/min, inc q3min to 20/30/40 mcg/kg/min
atropine .25mg IV q2min upto 1-2mg

29

dobutamine antidote

short acting IV BB

30

Dobutamine stress absolute contraindications

symptomatic severe AS
acute Ao dissection
ACS
HOCM

31

absolute contraindications to atropine

myasthenia gravis
narrow-angle glaucoma
pyloric stenosis

32

does dobuta stress have good PPV or NPV?

NPV

33

what type of contraindications are recent ventricular arrhythmias and high degree AVB for dobuta stress?

relative

34

4 Class I indications for angiography

1- CCS class III/IV angina on meds
2- high risk stress test
3- SCD
4- sustained MONOMORPHIC VT (>30s)
5- non sustained POLYMORPHIC VT (<30s)

35

CCS classification for angina

I- can do normal physical activity (angina only w/ a lot of exertion)
II- slight limitation w/ normal activity (running up stairs, emotional stress/morning hours/uphill)
III- marked limit. 1 flight of stairs.
IV- unable to do activity. Rest angina.

36

intermediate risk Duke treadmill score

-11 to 5

37

what category of risk is inc'd lung uptake on stress test?

high

38

> ? segments on stress echo with low dose dobuta is high risk?

>2 segments

39

if a pt has DM, 2VD + pLAD, is it Appropriate to do PCI?

yes

40

for which of the following is it Appropriate to do CABG in DM: 2VD +pLAD, 3VD, LM Dz, or LM + 1VD?

All

41

in asxs pt's w/ no known CAD, when is it APPROPRIATE to do cardiac CT?

family hx of premature CAD and low to intermediate risk of CHD

42

is it APPROPRIATE to do a cardiac CT on a symptomatic pt. to assess stent patency

no

43

in pt's w/ CM, when is it APPROPRIATE to do a cardiac CT?

low-intermediate CHD risk

44

when is it APPROPRIATE to do a cardiac CT for atrial or ventricular arrhythmias?

never

45

what conditions to use cardiac CT to assess structure and fxn?

congenital heart dz
RV fxn
Arrhythmogenic RV dysplasia
pericardial anatomy
PV anatomy (afib ablation)
localization of CABG grafts pre thoracic Sx

46

what to look for on CMR to assess myocardial viability?

late gadolinium enhancement

47

what is considered a positive EKG on ETT for ischemia if baseline EKG has <1mm ST depression?

>2mm ST depression (horizontal or downsloping)

48

if a patient has ventricular ectopy/bigeminy, etc. on ETT, what is its significance if it happens during a) exercise b) recovery

a) decreased LVEF
b) decreased LVEF and inc'd mortality

49

persantine contraindications are same as adenosine plus what?

liver failure b/c of hepatic metabolism

50

if pt has normal nuclear with strongly positive exercise EKG or angiographic stenosis, what is their cardiac event rate per year?

<1%

51

what is TID due to?

subendocardial ischemia

52

can cardiac CT or MR be used to screen for CAD?

no

53

what perfusion defect percentage at rest or stress is considered high risk (>3% death/MI per yr)?

10%

54

what CAC score is high risk?

>400

55

Class I rec for noninvasive imaging in asymptomatic pt's

none

56

if ETT already done, when is it appropriate to do CTA?

intermediate risk