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Flashcards in CV testing lecture Deck (22):
1

2 ECG leads are monitored and recorded by a device (cassette recorder) that patient wears for extended period of time. Provides continuous recording of ECG for 24 hours. Useful for detection of cardiac arrhythmias and determination if their presence correlates with patient symptoms.

Ambulatory monitoring (AKA Holter Monitor)

2

External event recorders can monitor for...

weeks

3

Implantable loop recorders: monitoring for up to

3 years

4

What is used to determine pretest probability for CHD

Age
Gender
Character of chest pain

5

Is CP substernal?
Is CP brought on by exertion?
Is CP relieved by rest or NTG?

(Character of chest pain)
0/3=Asymptomatic
1/3=Nonanginal CP
2/3=Atypical angina
3/3=Typical (classical) angina

6

Asymptomatic men/woman of all ages.
Woman under 50 yrs with atypical CP

Avoid stress testing in this group. Hi incidence of false positives.

*low pretest probability, under 10%

7

Intermediate pretest probability is ____ to ____%

10 to 90%

8

Men of all ages with atypical angina
Woman ≥50 yrs with atypical angina
Woman 30-60 yrs with typical angina

Intermediate pretest probability

**STRESS TEST!

9

Stress test may confirm Dx but negative test does not exclude Dx.
Stress testing may provide prognostic valued in this group.
Some of these patients will benefit from coronary angiography.

High pretest probability group (over 90%)

10

Men ≥40 yrs with typical angina
Women ≥60 yrs with typical angina

High pretest probability (over 90%)

11

Exercise increases CO and coronary flow up to...

5 times

12

1 met: resting O2 consumption= ____ml/min/kg.

3.5

13

Adenosine and Dipyridamole
Dobutamine

Pharmacologic stress testing

14

Reproduce symptoms and/or diagnostic evidence of ischemia (ECG).
Achieve target heart rate: 85-90% of PMHR if no ischemic changes.

Goals of exercise stress testing

15

If BP decreases during stress test...

STOP IT!

16

Stress echocardiography overall SENSITIVITY?

SPECIFICITY?

sensitivity: 60-70%

specificity: 80-85%

17

Single vessel CAD stress echo sensitivity

50%

18

2 vessel CAD stress echo sensitivity?
3 vessel CAD?

2 vessel: 65%
3 vessel: 85%

19

predicted max HR men:
predicted max HR women:

men: 220-age
women: 210-age

20

For patients without symptoms/ECG changes, need to achieve 85-90% PMHR before concluding...

negative test or ischemia

21

Stress echoes have a high incidence of false positives in..

young, healthy women

22

Stress echocardiography have decreased ______ in women with documented CHD.

sensitivity

(bc women usually have single vessel dz)