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CAD: Diagnosis Flashcards

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1
Q

type II error

A

false negative

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2
Q

Target HR in stress test

A

85% of age predicted HR (220-age)

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3
Q

Rate Pressure Product

A

peak HR x SBP

measures myocardial workload

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4
Q

Sn and Sp of ETT

A

both around 70%

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5
Q

on ETT does ST elevation or depression localize ischemia?

A

ST elevation does

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6
Q

ECG changes prognostic on ETT

A
  • max ST depression
  • # leads involved
  • time to ST shift
  • recovery time
  • inducible ventricular arrhythmias
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7
Q

Hemodynamic changes prognostic on ETT?

A
  • peak HR (Chronotropic incompetence)
  • BP (exercise induced hypotension)
  • rate pressure product
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8
Q

what does exercise induced hypotension on ETT mean?

A

LM or 3VD

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9
Q

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

A

no

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10
Q

at what high BP do you stop a ETT?

A

250/115

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11
Q

absolute reasons to stop an ETT (7)

A 
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
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12
Q

which conditions obscure ST changes on ETT?

A 
WPW
PPM
ST dep 1mm at rest
LBBB
LVH
Dig
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13
Q

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

A

V1, aVR

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14
Q

ST Elevation on ETT

A

Should be in leads without Q waves

Transmural ischemia from coronary spasm or myocardial injury

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15
Q

Duke Treadmill Score

A

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

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16
Q

Angina index

A

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

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17
Q

type I errors = ?

A

false positives

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18
Q

Scores and corresponding mortality for Duke treadmill

A

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

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19
Q

HR reserve and chronotropic incompetence

A

HR Reserve = 220-age-resting hR

Chron. incomp is inability to inc HR by 80% of HR reserve

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20
Q

what is considered a low level of exercise?

A

HR<70% max HR

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21
Q

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

A

similar Sn

stress echo- higher Sn (fewer false +)

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22
Q

adenosine stress MOA

A

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

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23
Q

adenosine effect on HR and BP

Study These Flashcards
A

inc HR

modest dec in BP

24
Q

*adenosine side effects by receptor-type

Study These Flashcards
A

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

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