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CMT > Cardiac Diagnostics > Flashcards

Cardiac Diagnostics Flashcards

1
Q

what does GDMT stand for

A

guideline directed medical therapy

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2
Q

what does OMT stand for

A

optimal medical therapy

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3
Q

what does EF stand for

A

ejection fraction

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4
Q

what does HFrEF stand for

A

Heart failure with reduced left ventricular ejection fraction (EF < 0.4)

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5
Q

what does HFpEF stand for

A

heart failure with preserved left ventricular ejection fracture (> 0.5)

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6
Q

what does HFmEF stand for

A

heart failure with midrange ejection fraction (EF < 0.5 but > 0.4)

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7
Q

what does RVSP stand for

A

right ventricular systolic pressure

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8
Q

5 tests of perfusion

A
  1. treadmill (Bruce Protocol)
  2. treadmill (MPS)
  3. stress echo
  4. PET
  5. arteriogram
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9
Q

Describe components of a stress test

A
  1. Protocol: Bruce vs Lexiscan vs Dobutamine
  2. +/- imaging or Myoview
  3. gives information about perfusion, chroncotropic competence, METs, arrhythmia, exercise tolerance
  4. Instructions to pt: hold BB/CCB 48 hrs, no caffeine 24 hrs
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10
Q

pros of a stress test

4

A
  1. relatively inexpensive
  2. gain info about METs, ischemia, arrhythmia, exercise tolerance
  3. easy to get insurance approval
  4. different modailities
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11
Q

cons of a stress test

A
  1. affected by body habitus
  2. false +/-
  3. equal balanced ischemia
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12
Q

downsloping of what more than what is an indication for termination of a stress test?

A
  1. ST segment
  2. 2mm
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13
Q

Absolute contraindications for stress test

9

A
  1. active endocarditis
  2. acute aortic dissection
  3. acute myocarditis/pericarditis
  4. decomponsated heart failure
  5. inability to exercise
  6. MI within 2 d
  7. ongoing unstable angina
  8. uncontrolled arrhythmias with hemodynamic compromise
  9. sx severe aortic stenosis
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14
Q

Relative Contraindications for stress tests

A
  1. Acquired complete heart block (LBBB)
  2. hypertrophic obstructive cardiomyopathy w/ severe resting gradient
  3. known L main CAD
  4. recent stroke or transient ischemic attack
  5. resting systolic blood pressure > 200 or diastolic > 110
  6. tachyarrhythmia w/ uncontrolled ventricular rate
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15
Q

pros of a stress echo

4

A
  1. quick interpretation at bedwisde
  2. less expensive than MPS
  3. info about heart valves, estimate RVSP
  4. can look for ASD/VSDs (bubble study)
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16
Q

cons for stress echo

4

A
  1. limited by body habitus
  2. need good tech
  3. more challenging if they have underlying wall abnormalities (LBBB/RBBB)
  4. prefer patient to be in NSR/SB

normal sinus rhythm/sinus brady

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17
Q

6 tests for heart anatomy

A
  1. cardiac CTA
  2. heart catheterization
  3. cardiac MRI
  4. 2-d echo
  5. transesophageal echo (TEE)
  6. cardiac MRA
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18
Q

pros of cardiac CTA

2

A
  1. high specificity
  2. leads to diagnosis of +/- ASCVD thus prossible interventional strategies
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19
Q

cons of Cardiac CTA

8

A
  1. dye and radiation exp
  2. weight restrictions
  3. must be brady
  4. hold breath for 20s
  5. can be difficult to get approval by insurance
  6. “blooming artifact”
  7. limiting imaging if hx CABG
  8. know your facility/readers
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20
Q

heart cath overview

5

A
  1. right vs left
  2. flow wire (FFR)
  3. intravascular ultrasound (IVUS)
  4. w/ or w/out LV gram
  5. Dye exposure
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21
Q

pros of left heart cath

4

A
  1. 99.9% accurate
  2. can evaluate anatomy and perfusion
  3. quick turn around/immediate interpretation
  4. final stop: can determine +/- fix while there
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22
Q

cons of heart cath

A
  1. invasive procedure w/ associated risk
  2. $$$
  3. dye/rad exposure
23
Q

how to order a heart cath

A
  • “Right +/- Left heart cath w (w/out) LV gram; do not use access site blank”
  • Hold DOAC tx 48 hours (if INR < 2.0 do not hold anti-platelets)
  • hold nephrotoxic agents 48 hrs (ACE, ARB, ARNI, metformin, Loops)
24
Q

when to order left heart cath (LHC)

5

A
  1. (-)STEMI/ACS
  2. (+) ischemia on stress test
  3. (+) >80% lesion on CTA
  4. pre-valve work-up
  5. high suspicion for blockage
25
Q

where does right heart cath measure pressures in the heart?

6

A
  1. RA: right atrial pressure
  2. RV: right ventricular pressure
  3. PA: pulm artery pressure
  4. PCW: pulm capillary wedge
  5. LA: left atrial pressure
  6. LV: left ventricular pressure
26
Q

what is an echocardiogram

A

ultrasound to evaluate the heart tissues (muscle/valve) and their movements

27
Q

2 types of echo you could order?

A
  1. trans throacic (TTE)
  2. trans esophageal (TEE)
28
Q

what does echo show?

A
  • muscle abnormalities
  • EJ
  • chamber size
  • valvular disease
  • estimated RVSP
29
Q

pros of echo

4

A
  1. non-invasive, lots of info
  2. low cost
  3. low risk
  4. no rad/dye exp
30
Q

cons of echo

2

A
  1. limited by HR
  2. limited by body habitus
31
Q

what info do you get from cardiac MRI?

A
  1. cardiovascular tissue/muscle defects
  2. muscle function
  3. tumors
32
Q

how can you use cardiac MRI?

A

pre-procedural or pre-surgical mapping

33
Q

pros of cardiac MRI

2

A
  1. very detailed anatomical model of heart/structures
  2. no rad
34
Q

cons of cardiac MRI

3

A
  1. need experienced reader/equipment
  2. difficult to get approval from insurance
  3. contraindicated in pts with metal implants
35
Q

what does MRA stand for

A

magnetic resonance angiography

36
Q

pros of cardiac MRA

4

A
  1. very specific to recreate anatomy of an artery (aneurysm, narrowing, bleeding, plauqe, ect)
  2. used in a lot of stroke protocols
  3. no rad exposure
  4. non-iodine contrast dye (can order w/ or w/out)
37
Q

cons of cardiac MRA

2

A
  1. no metal implants in pts
  2. need good reader/equipment
38
Q

OVERALL

when to order:
1. stress test (treadmill)
2. stress echo
3. RHC
4. LHC
5. Cardiac CTA
6. MRA
7. MRI

A
  1. blockage/perfusion
  2. EF/valves
  3. valve work up
  4. blockage
  5. blockage/anatomy
  6. blockage/anatomy
  7. evaluate restrictive cardiomyopathy
39
Q

5 tests for electrophysiology

A
  1. ECG
  2. telemetry
  3. ambulatory electronic monitoring (AEM)
  4. treadmill
  5. EP study
40
Q

what can ecg show?

4

A
  1. arrhythmia
  2. structural changes to heart
  3. ischemia
  4. drug side effects
41
Q

what is telemetry?

A

continuous tracing, usually 2-5 leads

42
Q

what is telemetry primarily used for?

A

arrhythmia detection

43
Q

overview of ambulatory event monitoring

A
  1. worn by pt for period of time (24hrs-2wks)
  2. can be continuous monitoring or triggered
44
Q

treadmill testing w/ ecg overview

A
  1. tracing during test will show heart rate variability, exercise/rate induced changed
  2. pt terminated vs tech terminated
45
Q

describe EP study

A
  1. advanced invasive testing of electrical system of the heart performed by EP
  2. can perform mapping, induce arrhythmias
  3. requires venous access
46
Q

describe tilt table test

A
  1. monitors BP, HR, rhythm in various positions
  2. used in work up of syncope
  3. may use provocative measures
47
Q

purpose of multigated acquisition (MUGA) & how to do it

A
  • to evaluate cardiac muscle, EF
  • IV injection of dye and placed under scanner
48
Q

describe artery calcium score (CAC)

A
  • give agaston score to quantify plaque burden
  • anything > 0 is abnormal
  • has benefit in decision making on rx for statin +/- ASA
49
Q

describe arterial brachial index

A

looking for peripheral arterial disease

50
Q

when would you use abdominal ultrasound

A

to evaluate the abdominal aorta to rule out an aneurysm

51
Q

what does a cardiac doppler do?

A

ultrasound of cardiac arteries

52
Q

how to measure EF

5 tests

A
  1. best test is echo
  2. MUGA
  3. MRI
  4. LV gram on cath
  5. spect imaging report
53
Q

what to order if echo shows hypertorphy?

A

MRI to r/u infiltrative disease

54
Q

what do you need to order to concretely r/o a blockage?

A

RHC

CMT (72 decks)

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