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PCM III Final > Cardiovascular Imaging > Flashcards

Flashcards in Cardiovascular Imaging Deck (19)
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1

You suspect a pt of having a paradoxical embolus stemming from recent knee replacement surgery. The following labs have been ordered: CBC w/ diff, CMP, fasting lipid panel, EKG, CT w/o contrast with f/u MRI of brain for CVA-like event. In addition, another appropriate test would include:

A. D-dimer to assess for PE
B. MRI w/ contrast of R knee
C. CTA of pulmonary vasculature
D. Duplex R popliteal a. and v.
E. Nerve conduction study of RLE

D. Duplex R popliteal a. and v.

2

What is a duplex?

Combination of traditional US (sound waves that bounce off blood vessels) and doppler US (records sound waves reflecting off moving objects, such as blood, to measure their speed and flow)

3

Most common use of doppler US?

Fetal heart sounds

4

You suspect a pt of having a paradoxical embolus stemming from recent knee replacement surgery. Head CT reveals a right-sided embolic CVA. MRI to follow. The patient has confirmed thrombus of the R popliteal v. What is an appropriate additional test to confirm how this CVA event occurred?

A. Transesophageal echocardiogram
B. D-dimer lab q4 hours
C. Transthoracic echocardiogram with EF measurement
D. Transthoracic echocardiogram with bubble study
E. Pulmonary angiography

D. Transthoracic echocardiogram with bubble study

5

4 routes of embolism

1. Venous system — PE

2. Arterial system — systemic embolism effects

3. Portal vein embolism — hepatic embolism

4. Paradoxical embolism

6

What is the difference between a provoked and unprovoked DVT?

Provoked is something we can logistically say that initiated formation of the clot

Unprovoked is something inherent in patient — underlying coagulopathy, cancer, etc.

7

What is a bubble study?

Real time assessment of intracardiac blood flow

Requires venous access, saline, concerted effort to capture results, transthoracic echocardiogram

8

Clinical applications for a bubble study

R—>L shunts in atrium or ventricle

PFO

Arteriovenous shunts in pulmonary vasculature

9

low voltage and Electrical alternans seen on ECG in the setting of trauma may indicated what?

Cardiac tamponade

10

What is a FAST exam?

Focused Assessment with Sonography in Trauma

Goal is to detect hemoperitoneum and pericardial effusion using four views:
-Pericardiac
-Perihepatic
-Perisplenic
-Peripelvic

11

Dx and tx of cardiac tamponade

Dx: pt hx, presentation, CXR, EKG, and echo findings — Beck’s triad = increased JVP, muffled heart sounds, low BP (weak pulse or narrow pulse pressure)

Tx: pericardiocentesis, surgical drainage, thoracotamy

12

Initial test of choice to use US to evaluate cardiac anatomy and function

Transthoracic echocardiogram

13

Indications of transthoracic echocardiogram

Evaluate pericardium

Evaluate ventricles/septa/atria

Evaluate cardiac valves

Determine EF

14

A healthy abdominal aorta is about 2 cm. It is considered an aneurysm when it is >3cm, most are palpable at 5cm. AAA is usually asymptomatic, and risk factors include M>F, smoking, ages 64-74.

What is the screening test if AAA is suspected?

Abdominal aortic ultrasound

Once confirmed, if >5cm — requires CTA of abdominal aorta

[refer to vascular specialist if >4cm]

15

You diagnose a pt with acute inferior wall MI and immediately give 324 mg chewable aspirin, place him on O2 via nasal cannula, order cardiac troponins, and would need to include which of the following?

A. Portable CXR, place on cardiac monitor, review CXR, send to cath lab
B. CTA of pulmonary vasculature, review CT, place on cardiac monitor, consult specialist
C. Portable CXR, obtain blood cultures, begin IV abx
D. Provide pt reassurance and discharge with instructions for f/u

A. Portable CXR, place on cardiac monitor, review CXR, send to cath lab

16

Cardiac cath procedure

1. Doc places catheter into either femoral or radial a.

2. Guides catheter into aorta to reach coronary vasculature

3. Uses fluoroscopy to visualize coronary aa. (Uses contrast!)

4. Depending on what is found, intervention may/may not be performed

17

Risks vs. benefits of coronary angiography

Risks:
Bruising/bleeding
MI
Infection
CVA
Arterial damage
Arrhythmias
Kidney damage (contrast)
Allergic rxn

Benefits:
Diagnostic with benefit of immediate intervention; potentially life saving

18

Invasive procedure involving use of US via esophagus to evaluate structural integrity of the heart

Transesophageal echocardiogram

19

Uses for transesophageal echocardiogram

LA thrombus in atrial fibrillation

Infective endocarditis

Prosthetic valve evaluation

Acute aortic pathology (dissection, etc.)

If transthoracic echo is unrevealing