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Flashcards in Cardiac Diagnostics Deck (21)
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1

4 Etiological considerations in diagnosing cardiac problems

"Cardiac Chii"

Is the problem - in origin

Congenital
Hypertensive
Ischemic
Inflammatory

2

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?

3

Physiological disturbances to consider in diagnosing cardiac problems

(Is an arrhythmia present?)

Is there evidence of congestive heart failure or myocardial ischemia?

4

How to consider degree of functional disability in cardiac problems -
Class I - Class IV

How strenuous is the physical activity required to elicit symptoms?


5

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.

Myoglobin

6

Lab that rises 3-6 hours after event, peaks in 12-24 hours. Helpful to assess onset and size of AMI.

CKMB

7

MB percentage of CK that is diagnostic of AMI

If MB >5% of total CK

8

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.

TnI, TnT

9

Lab which measures a neuroendocrine peptide that is released in response to stretch of ventricular walls.

BNP

Useful for determining CHF disease severity and mortality

10

Physiological effects of BNP

Vasodilation, aldosterone inhibition from adrenals, and inhibits renin from kidneys. Naturesis- excess Na excreted with H20.

11

What level of BNP is associated with dyspnea from CHF?

>100ng/L

12

What might be used to evaluated an arrhythmia which doesn't show on the EKG?

Holter Monitor

Worn for at least 24 hours

13

Second most commonly used cardiac diagnostic

Shows velocity, direction, and turbulence of blood flow in cardiac chambers, great vessels, and across valves

Echocardiogram

14

When might a transesophageal echo be indicated?

To evaluate posterior cardiac structures:
Left atria / appendage
Mitral Valve
Aortic Valve
Distal Aortic root
Interatrial Septum
**Signs of infective endocarditis**

15

Indications for stress testing

Chest pain evaluation
Cardiac rehab
Effectiveness of medical therapy (angina)
Detect exercise induced HTN

16

EKG changes to be noted during stress test

> 1mm

Depression = ischemia
Elevation = injury

17

Meds used in chemical cardiac stress testing

Dobutamine - inotropic and chronotropic

**normal myocardium has increased contractility, ischemic myocardium does not**

18

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

19

PET / SPECT results

Decreased uptake during stress = ischemia
Decreased uptake during rest and stress = old MI "fixed defect"

20

Other uses for PET

Myocardial Viability

glucose uptake / metabolism to assess whether there is "hibernating" viable myocardium, which would benefit from REVASCULARIZATION

**PET IS GOLD STANDARD FOR THIS**

21

"Gold Standard" for diagnosing vaso-occlusive CAD

Second most common operative procedure in US

Cardiac Catheterization