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Clinical Medicine II > Cardiology : Diagnostic Modalities > Flashcards

Cardiology : Diagnostic Modalities Flashcards

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1
Q

Indications for 12-Lead EKG

A

acute CP
current palpitations
LV Hypertrophy screening
evaluation of past MI

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2
Q

Contraindications for 12-Lead EKG

A

None

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3
Q

Indications for telemetry

A

hospital admission for CP or possible ACS

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4
Q

12 Lead EKG works by detecting ________ in the heart.

A

electrical activity

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5
Q

What is important when administering 12 lead EKG?

A

serial collection of data.

don’t use as a solitary assessment

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6
Q

Which cardiac enzyme test is preferred to diagnose and provide prognosis of MI?

A

high-sensitivity cardiac troponin

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7
Q

Is cTn I or cTn T more sensitive for cardiac infarct?

A

cTn I

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8
Q

troponin is considered a biomarker of what

A

cardiac injury

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9
Q

When should you expect to see elevated troponin and CK-MB?

A

trauma, surgery, inflammation, infection

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10
Q

what is an important consideration when evaluating both EKG and troponin?

A

must obtain serial enzymes and several EKGs to compare against baseline.

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11
Q

On serial cardiac enzymes, what is indicative of acute ischemia?

A

rise and fall of troponin

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12
Q

CK and troponin both have an onset of 3-12 hrs and a peak at 18-24, but troponin has a duration of ______ while CK’s duration is ______.

A

Troponin duration: 14 days

CK: 36-48 hrs

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13
Q

This is the primary noninvasive modality for quantitative and qualitative evaluation of cardiac anatomy and function….

A

transthoracic echocardiogram (TTE)

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14
Q

What are the indications for TTE?

A

evaluate wall motion, valve structure and function

calculate EF

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15
Q

This imaging modality can detect:

LA clots within the heart

valvular pathology

visualization of vegetations in endocarditis

A

transesophageal echo (TEE)

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16
Q

Who must be present when performing TEE?

A

cardiology and anesthesiology

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17
Q

TEE provides high resolution of what cardiac structures?

A

posterior cardiac structures

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18
Q

What are the indications for cardiac stress tests?

A

exertional chest pain

CHD with new/worsening symptoms

Newly diagnosed CHF or cardiomyopathy

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19
Q

What are the contraindications for cardiac stress testing?

A

acute MI in 48 hours

unstable angina

uncontrolled arrhythmia, heart failure, hypertension

acute aortic dissection

severe pulmonary HTN

acutely ill

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20
Q

This cardiac stress test is:

  • Less expensive
  • helps diagnose CAD in symptomatic patients
  • Useful in assessing functional capacity
A

Exercise EKG

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21
Q

What should a clinician look for during exercise EKG stress test?

A

EKG changes from baseline

Increased HR

Development of Sx

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22
Q

What is the protocol for an EKG stress test?

A
  1. baseline resting EKG
  2. exercise to target HR, Sx, or time
  3. monitor Sx and EKG
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23
Q

This cardiac stress test has the following advantages:

low cost

no radiation

determines exercise capacity

widely available

mimics physiological conditions

A

Exercise EKG

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24
Q

This cardiac stress test has the following disadvantages:

Doesn’t localize ischemia

doesn’t evaluate LV function

Lower sensitivity

Poor specificity in ST-T abnormal pts, digoxin use, LBBB or pacemakers, female population

A

exercise EKG

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25
What radioactive tracers are used for the nuclear stress test? Where do these concentrate?
Technitium-99m or Thallium concentrate in myocardium with adequate blood flow
26
Does a nuclear stress test utilize exercise or pharmacologic stressors?
pharmacologic
27
What drugs are used in nuclear stress testing to cause cardiac stress?
Vasodilators: adenosine, dypyridamole
28
What causes more dilation and by what degree: Exercise or pharmacologic intervention?
pharmacologic intervention by 3-5x
29
Nuclear Stress Test Protocol:
Inject tracer wait 20-40 mins Scan at rest Induce stress w/ adenosine/dypyridamole to achieve target HR/Sx Inject tracer 2nd time wait 20-40 min 2nd Scan Compare scans
30
With a nuclear stress test, reversible ischemia would be found with what results?
good perfusion at rest, ischemia under stress
31
With a nuclear stress test, non-reversible ischemia (infarction) would be found with what results?
ischemia at rest and during stress
32
This cardiac stress test has the following indications: abnormal resting EKG To asses areas of myocardial ischemia to determine location and size of injured muscle after MI Dx coronary artery stenosis evaluate function of grafted vessels after bypass
Nuclear stress test
33
This cardiac stress test has the following indications: known or suspected CAD evaluation of CP, SOB, DOE Evaluation of valvular abnormalities preop risk assessment
stress echo
34
Which drug is used to cause stress in a stress echo?
dobutamine
35
This stress test can evaluate ischemia related to wall motion abnormalities when stressed
stress echo
36
When should a stress echo be avoided?
afib and LBBB
37
What is the protocol for a stress echo?
TTE at rest administer dobutamine reach target HR, administer stress echo compare baseline and stress images
38
When wearing a Holter Monitor, a patient's cardiac electrical events are recorded over ________
24-48 hours
39
What are the indications for a Holter Monitor?
syncope, palpitations
40
What is a major limitation of Holter Monitor?
79% of patients are asymptomatic during the 24-48 hour period
41
How long can an event monitor be worn?
30-60 days
42
What is a major difference between an event monitor and a holter monitor?
Holter is continuously recording
43
How does a patient record a cardiac event when wearing an event monitor?
patient pushes button to capture previous 2-5 minutes to present.
44
For how long does an implantable cardiac monitor record?
3 years
45
What activates an implantable cardiac monitor?
automatically activated, or patient activated
46
indictions for implantable cardiac monitor?
infrequent sxs suspected arrhythmia with inconclusive non-invasive testing
47
What is a fingertip monitor used for?
monitoring afib and other symptomatic arrhythmias
48
What are the two main forms of cardiac CT?
coronary CT angiography coronary CT calcium scan
49
This cardiac imaging modality: assesses presence and extent of coronary artery occlusion given with contrast
CCTA
50
This cardiac imaging modality: assesses for calcium deposits in coronary arteries/MI risk Given without contrast
Coronary CT calcium scan
51
This imaging modality is the following major applications: detection of aortic dissection detection of coronary artery calcium deposition/atherosclerosis detection for presence and extend of CAD
Cardiac Computerized Tomography
52
The indications for cardiac CT scan:
Aortic dissection stable angina r/o CAD
53
What are the contraindications for cardiac CT scan?
allergy to contrast dye severe renal insufficiency
54
This imaging modality has the following characteristics: assessment of functional and tissue properties of heart highlights atrial and ventricular anatomy highlights myocardial tissue composition
Cardiac MRI
55
Cardiac MRI is typically used for what patients?
complicated patients after 1st line testing/echo
56
Indications for cardiac MRI:
myocardial, pericardial, or valvular disease cardiac tumor CAD myocardial perfusion
57
What are the contraindications for cardiac MRI?
metal or electrical implants, devices or foreign bodies
58
What is the gold standard to diagnose CAD, but is often not 1st line test?
cardiac catheterization/coronary angiography
59
What is the protocol for cardiac catheterization?
Thread catheter through groin, arm, neck inject radiopaque dye view patency of coronary arteries via fluoroscopy
60
What risks accompany cardiac catheterization?
bleeding, arrythmia, vessel injury
61
Indications for cardiac catheterization?
known/suspected CAD Atypical chest pain before valve surgery in CP patients
62
What conditions would make you suspect CAD, and therefore order cardiac cath?
unstable angina angina and (+) exercise stress test history of MI w/ EKG changes post-resus from cardiac arrest
63
What are two methods of percutaneous coronary intervention?
balloon angioplasty cardiac stenting

Clinical Medicine II (31 decks)

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