Flashcards in CARDIAC DIAGNOSTICS AND INVASIVE THERAPIES Deck (54)
What are the different kinds of Echos?
Transthoracic echo includes
2D cardiac images
Color flow Doppler (checks flow)
Pulse wave Doppler measurements are shown of the aortic valve. High flow rates can be seen during _____ with little flow during ______.
Echo provides valuable information about cardiac structure and function
1. Chamber size,
2. muscle thickness
1. Ejection fraction,
2. wall motion
What other things will an echo be used for?
1. Aortic root size (ascending aortic aneurysm)
2. Valve structure and function
3. Intracardiac blood flow (shunts, pressures)
4. Portable (mini) used in the ED for screening for tamponade, effusion, etc.
Transesophageal echo is used for more detailed evaluation of:
1. How to we use it for Intracardiac thrombus with an Transesophageal echo? 1
2. For valve function?2
3. For endocarditis? 1
1. Prior to direct current cardioversion
-For further evaluation beyond TTE
-For use in the operating room during valve replacement
3. Looking for vegetations
What are the three different technologies for abnormal rhythms?
1. Holter monitor
2. Event monitor
3. Electrophysiology Studies (EPS)
What are the two kinds of ambulatory cardiac monitors?
Holter and Event
Holter vs Event:
1. How long is it worn for?
2. What is the patients role?
3. What will the monitor usually tell us?
1. Worn for 24 hours
2. Patient records a diary of activities and symptoms
3. Many times asymptomatic during that time period
1. Worn for a month
2. Patient triggers the monitor to record during symptoms
3. Newer devices will detect significant arrhythmias without patient triggering device to record
Ambulatory cardiac monitors are useful to investigate the following:
2. To assess rate control or determine percent of atrial fibrillation
4. Intermittent dizziness or lightheadedness that does not seem to be orthostatic
5. Suspected bradycardia (shortness of breath or fatigue)
6. Evaluate for suspected or known arrhythmias
Electrophysiologic Studies (EPS)
are done how?
Use multipolar electrode catheters placed in the venous and/or arterial circulation and advanced to various positions in the heart
1. What does it record?
2. What kind of disease does it define?
3. What does it attempt to do?
4. What does it measure?
1. Records an internal EKG
2. Defines conduction system disease
3. Attempts to induce arrhythmias (SVT and VT)
4. Measure response to pharmacologic and/or pacing device intervention
Indications for EPS?
1. Unexplained syncope
2. Survivors of sudden cardiac death that was not related to an ischemic event
3. Palpitations preceding syncope
4. Poorly tolerated episodes of SVT
5. Many others…related to uncovering or treating arrhythmias
Therapy for advanced heart failure
3. Bi-Ventricular pacing
What does a Pacemaker?
Provides electrical stimuli to cause cardiac contraction when intrinsic cardiac activity is inappropriately slow or absent
Pacemakers are the only treatment for what?
What are the different kinds?
1. External Pacemaker (Transcutaneous pacemaker)
2. Permanent Pacemaker
3. Biventricular Pacemaker
1. External pacemakers are used best when?
2. Transcutaneous pacing (TCP) recommended for what?
3. Place two pacing pads on the patient's chest. In what two positions?
4. Short term until what?
1. in emergencies as a bridge to therapy
2. the initial stabilization of hemodynamically significant bradycardia
3. either in the anterior/lateral position or the anterior/posterior position (this is painful)
4. transvenous pacing or
other therapies can be applied
Placement of a permanent pacemaker involves placement of what?
Where is each connected?
What are the kinds? 2
of one or more pacing wires within the chambers of the heart.
One end of each wire is attached to the muscle of the heart. The other end is screwed into the pacemaker generator.
1. Single lead (paces in the ventricle)
2. Dual Chamber (can pace in the right atrium or right ventricle)
Where is the generator placed in the pt for a permanent pacemaker?
The generator is placed below the subcutaneous fat of the chest wall
Absolute Pacemaker indications?
1. Sick sinus syndrome
2. Symptomatic sinus bradycardia
3. Tachy-brady syndrome
4. Afib with slow ventricular response
5. 3rd degree heart block
6. Chronotropic incompetence
--Inability to increase heart rate to match exercise
7. Prolonged QT syndrome
Pacemakers usually have multiple functions such as? 2
1. Sensing (listening) to the heart's native electrical rhythm
2. Pacing the device will stimulate the ventricles of heart with a set amount of energy, measured in joules at whatever heart rate the device is set at
What is pacemaker syndrome?
1. Patient feels worse after pacemaker placement
2. Presents with progressive worsening of CHF symptoms
3. Due to loss of atrioventricular synchrony, pathway now reversed and ventricular origin of beat
Biventricular pacing is reserved for therapy for what?
advanced heart failure
The biventricular pacing devices have added a third lead (to position B) that is designed to what?
The combination of all three leads creates a synchronized pumping of the ventricles. How does this help? 2
conduct signals directly into the left ventricle
1. Gets rid of the asynchrony between ventricles
2. May increase EF
What is ICD therapy?
What controls the different functions of this?
1. ICD Therapy consists of pacing, cardioversion, and defibrillation therapies to treat brady and tachy arrhythmias.
2. An external programmer is used to monitor and access the device parameters and therapies for each patient.
1. Used in cases where there was a previous cardiac arrest
2. Patients with undetermined origin or continued VT or VF despite medical interventions
3. Cardiomyopathy (EF
ICDs prevent what?
sudden cardiac death
1. What are ICDs designed to treat? (most commonly)
2. What can they also perform?
1. Designed to treat cardiac tachyarrythmias
Most commonly in patient’s with cardiomyopathy
2. Performs cardioversion/defibrillation
If ventricular rate exceeds programmed cut-off rate