Flashcards in Cardiac Diagnostics Deck (21)
4 Etiological considerations in diagnosing cardiac problems
Is the problem - in origin
4 Anatomical considerings in diagnosing cardiac problems
Which chambers are involved?
Are they hypertrophied, dilated, or both?
Which valves are affected?
Are they regurgitant, stenotic, or both?
Is there pericardial involvement?
Has there been a Myocardial Infarction?
Physiological disturbances to consider in diagnosing cardiac problems
(Is an arrhythmia present?)
Is there evidence of congestive heart failure or myocardial ischemia?
How to consider degree of functional disability in cardiac problems -
Class I - Class IV
How strenuous is the physical activity required to elicit symptoms?
Lab that is seldom used to diagnose AMI, but can be used as an early evaluation because it rapidly rises within first 2-3 hours. Not specific.
Lab that rises 3-6 hours after event, peaks in 12-24 hours. Helpful to assess onset and size of AMI.
MB percentage of CK that is diagnostic of AMI
If MB >5% of total CK
Lab which is highly specific to myocardial damage. Elevated in about 3 hours and stays elevated for 7-14 days. May be falsely elevated in renal disease.
Lab which measures a neuroendocrine peptide that is released in response to stretch of ventricular walls.
Useful for determining CHF disease severity and mortality
Physiological effects of BNP
Vasodilation, aldosterone inhibition from adrenals, and inhibits renin from kidneys. Naturesis- excess Na excreted with H20.
What level of BNP is associated with dyspnea from CHF?
What might be used to evaluated an arrhythmia which doesn't show on the EKG?
Worn for at least 24 hours
Second most commonly used cardiac diagnostic
Shows velocity, direction, and turbulence of blood flow in cardiac chambers, great vessels, and across valves
When might a transesophageal echo be indicated?
To evaluate posterior cardiac structures:
Left atria / appendage
Distal Aortic root
**Signs of infective endocarditis**
Indications for stress testing
Chest pain evaluation
Effectiveness of medical therapy (angina)
Detect exercise induced HTN
EKG changes to be noted during stress test
Depression = ischemia
Elevation = injury
Meds used in chemical cardiac stress testing
Dobutamine - inotropic and chronotropic
**normal myocardium has increased contractility, ischemic myocardium does not**
Test used to evaluated suspected CAD or progression of ischemia. Often used with chemical stress testing to obtain rest and stress imaging
PET / SPECT test - Nuclear Imaging
PET / SPECT results
Decreased uptake during stress = ischemia
Decreased uptake during rest and stress = old MI "fixed defect"
Other uses for PET
glucose uptake / metabolism to assess whether there is "hibernating" viable myocardium, which would benefit from REVASCULARIZATION
**PET IS GOLD STANDARD FOR THIS**