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Clin Med Exam 1(Lauren) > Cardiology Diagnostics > Flashcards

Cardiology Diagnostics Flashcards

(75 cards)

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1
Q

What is the first test you’re going to do when someone complains of chest pain?

A

ECG

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2
Q

What are the risk factors for CAD?

A

Age

Gender

Hypertension

Hyperlipidemia

Diabetes

Smoking

Family history

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3
Q

Does ECG measure cardiac events directly or indirectly?

A

Indirectly

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4
Q

True or false:

ECGs can be quite subjective

A

True

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5
Q

Is it a good idea to have a baseline ECG to compare to?

A

Yes, because ECGs can be very subjective

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6
Q

True or false:

ECGs are commonly used as a solitary assessment

A

False, almost never used as solitary assessment for chest pain

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7
Q

What are the 3 cardiac enzymes discussed in lecture?

A

Creatinine Kinase

CK-MB

Troponins

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8
Q

Is creatine kinase specific for cardiac muscle?

A

No, it is found in many muscles throughout the body

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9
Q

Is CK-MB more or less specific for cardiac muscle than Creatine Kinase?

A

More specific

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10
Q

Which cardiac enzyme is the most specific for cardiac tissue, and is the most useful enzyme to measure?

A

Troponins

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11
Q

What are the two 3 types of troponin that can be measured, depending on the specific lab/hospital you’re at?

A

Troponin T (larger)

Troponin I (smaller)

High-sensitivity Troponin-T

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12
Q

How long after a cardiac event would you expect to see the ONSET of elevated enzymes?

(CK or troponin)

A

3-12 hours

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13
Q

How long after a cardiac event would you expect to see the PEAK of elevated cardiac enzymes?

A

18-24 hrs

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14
Q

How long after a cardiac event will elevated CK enzymes stick around?

A

36-48 hours

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15
Q

How long after a cardiac event will elevated troponin stick around?

A

Up to 10 days

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16
Q

If someone had chest pain 2 hours ago, but their enzymes are normal, does that mean they’re OK?

A

No, you wouldn’t expect to see an onset of elevated enzymes until 3-12 hours after the event

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17
Q

If someone comes in and says they had chest pain 2 days ago, and their troponin is not elevated at all, should you be suspicious that they had a heart attack?

A

No, because elevated troponin will stick around for up to 10 days

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18
Q

What is the point of obtaining serial enzymes?

A

To check for a CHANGE in values

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19
Q

What is a normal High-sensitivity Troponin T for men and women?

A

Men: 15ng

Women: 10ng

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20
Q

When comparing High-sensitivity troponin from time 0 to 2h, what level of change would indicate that a heart attack happened?

A

Delta 10 or higher

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21
Q

When comparing high-sensitivity troponin measurements from time 0 to 6h, what level of change would indicate that a heart attack happened?

A

Delta 12 or higher

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22
Q

When comparing high sensitivity troponins from time 0 to 2h, what change would indicate that nothing happened?

A

Delta 3 or less

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23
Q

When comparing high sensitivity troponins from time 0 to 2h, what change would indicate an intermediate risk for an acute myocardial injury?

A

Delta 4-9

Proceed to check hsT at 6h

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24
Q

Why would we do a CXR when someone comes in with chest pain?

A

To rule out things like pneumonia, pericarditis, pneumothorax, etc etc

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25
Are males or females at higher risk of CAD?
Males
26
Does CAD risk increase with age?
Yes duh
27
What are the indications for doing a stress test?
Evaluation of CP on exertion Assess significance of known CAD Determine exercise capacity Risk calculation for ischemic heart disease
28
What are the two ways we can “stress” the heart during a stress test?
Exercise Pharmacologic
29
What are the 3 drugs used to stress the heart for an ECG stress test?
Adenosine Dipyridamole Dobutamine
30
Is exercise ECG stress test expensive?
No
31
Is exercise ECG stress test good for low risk patients?
Yes
32
What can exercise ECG stress test be used for?
Diagnose CAD in symptomatic pts Assess functional capacity
33
Why would we do a stress test?
The stress increases cardiac oxygen demand and the test will reveal areas of hypoperfusion due to blocked coronary arteries
34
When doing a stress test, should you take an ECG before they start exercising/take drugs?
Yes duh
35
When doing an exercise ECG stress test, how long should the pt exercise for?
Until they reach: Target HR Symptoms develop Time limit
36
What are the absolute contraindications to doing an exercise ECG stress test?
Heart attack in last 2 days Ongoing unstable angina Uncontrolled arrhythmia with hemodynamic compromise Endocarditis Symptomatic aortic stenosis Decompensated heart failure Pulmonary Embolism/DVT Myocarditis Aortic dissection Physical disability (Sorry for this atrocity of a card, i just didn’t really know what to focus on)
37
What are the RELATIVE contraindications to exercise ECG stress test?
Obstructive left coronary artery stenosis Aortic stenosis Tachyarrythmias Advanced heart block Hypertrophic obstructive cardiomyopathy Recent stroke/TIA Mental impairment/can’t cooperate BP > 200/110 Uncorrected medical conditions like significant anemia, electrolyte imbalance, hyperthyroidism (Sorry for this card)
38
Will an exercise ECG stress test localize ischemia?
No
39
Does exercise ECG stress test evaluate LV function?
No
40
What are some circumstances where an exercise ECG stress test would have poor sensitivity?
ST-T abnormalities on their resting ECG Digoxin use LBBB Pacemaker Female population
41
What are the common tracers used for nuclear medicine imaging?
Thallium-201 Technetium-99m agents (sestamibi, teboroxime)
42
When doing a nuclear medicine imaging stress test, where does the thallium concentrate?
Areas with adequate blood flow and living myocardial cells
43
When doing a nuclear imaging stress test, should we take resting images before we shoot em up with the stressful drugs?
Yes
44
How do you tell that someone has a perfusion defect when doing a nuclear imaging stress test/scan?
You compare the areas of perfusion on the resting scan to the stressed scan. They should match
45
Will nuclear medicine imaging tell us the location, size, and which artery is affected in an MI?
Yes
46
Can we diagnose narrowed arteries and evaluate function of grafted vessels using nuclear medicine imaging?
Yes
47
What are the 3 types of echocardiogram discussed?
Transthoracic Trans esophageal Stress echo
48
What are some of the indications for a transthoracic echocardiogram?
Evaluate wall motion Calculate ejection fraction Determine diastolic filling Evaluate size of chambers Evaluate valves Detect tumors, masses, or clots Evaluate size of IVC
49
Is a transthoracic echocardiogram considered to be invasive?
No
50
What will Doppler echocardiogram help you evaluate?
Valves
51
What kinds of things can affect the results of a transthoracic echocardiogram?
Chest wall abnormalities COPD (barrel chest) Thick chest wall/morbidly obese Excessive movement Large breasts
52
If you suspect endocarditis or an infected valve, what kind of echocardiogram should you do?
Transesophageal
53
Is your patient wide awake when you do a transesophargeal echo?
No, this procedure requires sedation from an anesthesiologist (As well as a cardiologist because you will not actually be doing this proceure)
54
What are some of the things that a transesophageal echocardiogram can detect?
Clots Septal defects/patent foramen ovale****** Ascending aortic atherosclerosis Aortic dissection Valvular pathology, including vegetations AKA endocarditis*** Myocardial motion with less interference than TTE
55
Is transesophageal echocardiogram an invasive procedure?
Yes
56
What drug do we give to induce stress during an echocardiogram?
Dobutamine
57
What are vegetations?
Lesions caused by endocarditis
58
What two conditions make a pt unsuitable for stress echocardiogram?
AFib LBBB (Nuclear stress test would be better)
59
What are the indications for a stress echocardiogram?
Known/suspected CAD Evaluation of chest pain, SOB, dyspnea on exertion Evaluation of valvular abnormalities Pre-op risk assessment before major surgery
60
If someone has afib, what stress-inducing drug must we avoid?
Dobutamine
61
When doing a stress echocardiogram, at what % of max HR should we take peak-stress images?
85%
62
If someone has ST-elevation, what should we do?
Send them straight to the cath lab lol
63
What is the gold standard for diagnosing CAD?
Cardiac catheterization/angiogram
64
What are the indications for cardiac catheterization/angiogram?
Known/suspected CAD (unstable angina, angina and + exercise test, history of MI with ECG changes, post resuscitation from cardiac arrest) Atypical chest pain Before valve surgery in pt with chest pain/ECG changes
65
What is percutaneous coronary intervention?
Balloon angioplasty +/- stent placement
66
How long does a patient wear a Holter monitor?
24-48 hrs, while keeping a diary of symptoms
67
What is a common reason we would put a pt on a Holter monitor?
Evaluation of dizziness, syncope, palpitations
68
Does a Holter monitor record continuously?
Yes
69
Does an event “loop” recorder record continuously?
No. Pt presses a button if they experience an event and the previous 5 minutes and subsequent few minutes will be recorded which can then be transmitted via phone to an interpreting center.
70
How long does a pt wear an event “loop” recorder?
30-60 days
71
Who would an implantable loop recorder be good for?
Someone with infrequent symptoms (like they pass out twice a year) Someone in whom you suspect an arrhythmia but other testing has been inconclusive
72
Does an implantable loop recorder record continuously?
No. Records according to “programmed criteria” or when patient presses a button
73
What kinds of cardiac things would we use a CT for?
Thoracic aorta Pericardium Aortic dissection Calcium depositions on coronary arteries Pulmonary embolism
74
If you think someone is having an aortic dissection, should you send them to CT or MRI?
CT, much faster
75
What is MRI good for evaluating?
Aorta Pericardium Myocardium Valves Cardiac abscesses/masses Myocardial perfusion with contrast during adenosine stress

Clin Med Exam 1(Lauren) (8 decks)

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