Cardiac Diagnosis

Question 1

Cardiac Enzymes include? (3)

Answer 1

CK
CK-MB
Troponins

Question 2

CK:

Order why?

Answer 2

(Creatine Kinase, general mm enzyme)

suspect acute coronary synd (chest pains, etc)

Question 3

CK:

Order when?

Answer 3

order serially (every 6 hrs inpatient)
Onset = 3-12hrs

Peak = 18-24hrs

Duration = 36-48hrs

Question 4

CK:

Results mean?

Answer 4

High levels indicate:
cardiac mm injury/exertion,
skeletal mm injury/exertion
NOT conclusive for MI

Question 5

CK-MB:

Order why?

Answer 5

If CK is ↑ and suspect acute coronary synd:

More indicative of heart mm vs skeletal

Question 6

CK-MB:

Order when?

Answer 6

Serially:
Onset = 3-12hrs

Peak = 18-24hrs

Duration = 36-48hrs

Question 7

Troponins:

Order why?

Answer 7

Cardiac regulatory protein for actin/myosin interaction,

levels ↑ w/ heart damage

Question 8

Troponins:

Order when?

Answer 8

suspect ACS

Onset = 3-12hrs

Peak = 18-24hrs

Duration = up to 10 days

Question 9

Troponins:

Results mean?

Answer 9

High sensitivity and specificity for heart damage

Question 10

Telemetry is?

Answer 10

continuous ECG monitoring

Question 11

Exercise ECG Stress Test:

Order when?

Answer 11

Stable pt w/ low risk factors

Question 12

Stress Tests:

Order why?

Answer 12

Eval exert chest pain
Diag CAD in sympt pts
Assess functional capacity (during and after exercise)

Question 13

Stress Tests:

Results mean?

Answer 13

Reveals imbalance b/w myocardial O2 demand and supply to diseased coronary arteries:

ST ↓
↑ HR
sxs develop (chest pain, SOB, etc)

Question 14

Contraindications to Stress Test? (6)

Answer 14

Acute phase of uncomplicated MI/ACS
Acute myo or pericarditis
Rapid arrhythmias
Severe aortic stenosis, anemia, infection
Hyperthyroidism
Acute aortic dissection

Question 15

Stress Test does NOT tell me?

Answer 15

Site or extent of ischemia
LV fxn
(P) incorrect abnormal results

Question 16

Nuclear Medicine Imaging is?

Answer 16

Radioactive tracers for better imaging,

Obtained at rest and exercise

Question 17

Nuclear Medicine Imaging:

Order when?

Answer 17

myocardial ischemia present

Question 18

Nuclear Medicine Imaging:

Order why?

Answer 18

Locate injured cardiac mm

Eval effectiveness of vessel surgeries

Question 19

Nuclear Medicine Imaging:

Results mean?

Answer 19

Thallium visible in healthy mm w/ adequate blood flow

Question 20

Transthoracic Echocardiogram (TTE) is?

Answer 20

US of heart

Question 21

TTE:

Order why?

Answer 21

Eval wall motion at or post MI
Calc EF (65% = normal)
Measure heart chambers
Eval valves
Find masses, infection

Question 22

TTE detractors?

Answer 22

Chest wall abnormality
Obesity
Movement
Boobs

Question 23

Transesophageal Echocardiogram (TEE) is?

Answer 23

US probe down esophagus, behind heart

Question 24

TEE:

Order when?

Answer 24

Need better clarity or access to heart

Question 25

TEE: | Order why?

Answer 25

``` TTE findings + Septal defects Foramen ovale patency AAA Aortic Dissection ```

Question 26

Stress Echocardiogram: | Ordered when?

Answer 26

Pt has stenosis | Reg ECG ST undiagnostic

Question 27

Stress Echo: | Ordered why?

Answer 27

Preop eval Conduction/repol abnormalities undiag on ECG ST Eval valves or EF

Question 28

Stress Echo: | Results mean?

Answer 28

Wall motion abnorm w/ stress = ischemia

Question 29

Cardiac Cath/Angiogram is?

Answer 29

Gold for CAD diagnosis Cath and dye threaded into heart See patency of coronary arteries

Question 30

Cardiac Cath/Angiogram: | Order when?

Answer 30

Known or suspected CAD Atypical chest pain Pre valve surgery if chest pain or ECG Δs

Question 31

Cardiac Cath/Angiogram: | Order why?

Answer 31

locate lesions | Can stent or balloon right then

Question 32

Holter monitor is?

Answer 32

ambulatory ECG

Question 33

Holter monitory ordered when/why?

Answer 33

Correlate activity and symptoms Eval syncope, palp Variable HR Find silent ischemia (ST seg monitoring) NOT for infrequent events

Question 34

Event Loop Recorder?

Answer 34

Similar to Holter but longer Pt activates at event Signal immediately transmitted

Question 35

CT ordered when/why?

Answer 35

Detect aortic dissection Detect coronary artery Ca2+ deposits NOT good if movement

Question 36

MRI ordered when/why?

Answer 36

``` Eval of: Aorta Pericardium Myocardium Valves Abscess/mass Myo perfusion ```