Diagnostic Studies (Lecture 2) Flashcards
With transthoracic (echo) imaging, the patient is positioned to bring the cardiac structures close to the chest wall, usually in a ______ position,
left lateral decubitus
Indications for a ECHO?
Valvular lesions
Ventricular assessment (assess V width and EF)
CAD (every patient with heart attack gets an ECHO)
Cardiomyopathy
Pericardial (but what’s the gold standard)
Implantable monitor Cardiac stress testing (w/ IV meds) Cardiac cath EPS Echo
Invasive studies
How soon shuold a CXR be obtained in patients with suspected cardic issues?
30 mins
In addition to enlargement/cardiomegaly, you can see wht on a CXR?
Ventricular aneuryms (“7 days after an MI”)
also, calcifications, cardiac malconfigurations
CXR in pt w/ COPD might show what?
Flattened diaphragm
Where do you hear aortic regurgitation? What would you see on CXR?
Erb’s point
LV dilation
Dilated aortic
WHere do you hear mitral stenosis? What accompanying sound would you hear?
Apex (5th MCL)
You’d hear an opening snap
Mitral regurgitation is accompanied by?
Pansystolic murmur accompanied by “blowing”
CT use in cardiology is limited. BUt it’s the gold standard for?
chronic obstructive pericarditis
It can also be used to assess great vessel problems in STABLE patients
If creatinine is lower than ___ we shouldn’t do a contrast CT
1
MRI using ____ can help differentiate between impaired (reversible) and infarcted (irreversible) myocardium
gadolinium
EF=(EDV−ESV) / ____
EDV
This can be estimated with a TTE
With stenotic and regurgitant valves, blood flow velocities may be as high as 5 to 6 m/second, requiring the use of the _____.
continuous-wave Doppler mode
_____ uses the Doppler principle to record the velocity of motion of the myocardial wall. _____ recordings of the myocardium adjacent to the mitral annulus are used to evaluate diastolic ventricular function.
Tissue Doppler
A standard echocardiographic study includes pulsed Doppler measurement of antegrade flow velocities (transmitral and transaortic) and evaluation for _____ by continuous-wave and color Doppler modalities
valve regurgitation
With a standard TTE, you probably won’t be able to visualize which ventricle very well?
LV
For definitive/exact EF, use _____; otherwise, TTE can be used for an estimate.
cardiac cath
Transesophageal echocardiography is much more sensitive than transthoracic echocardiography for detection of left atrial thrombus, _____, and prosthetic mitral valve regurgitation/prosthetic valve dysfxn
valvular vegetations
(also highly specific for aortic dissection, endocarditis,
Normal EF is anything > than?
55%
For eval of the aorta or LAA, we’ll probably use?
TEE
_____ is the clinical standard for evaluation of valvular stenosis. Cardiac catheterization is reserved for cases in which _____ is nondiagnostic, clinical data are discrepant with echocardiographic findings, or the coronary anatomy needs to be asses
Echocardiography
Even when transesophageal imaging might be helpful, most clinicians begin with a transthoracic examination; exceptions are for the patient with a possible acute ____, in whom transesophageal echocardiography should be performed as quickly as possible, and in the evaluation of possible _____
aortic dissection
left atrial thrombosis before cardioversion
The recommended scope of practice for point-of-care ultrasound studies includes diagnosis of pericardial effusion and evaluation of global left ventricular systolic function. In contrast, diagnosis of aortic dissection requires transesophageal echocardiographic or computed tomographic or magnetic resonance imaging. Diagnosis of aortic valve stenosis requires continuous-wave Doppler recording of the transvalvular velocity by an experienced sonographer. Acute anterior myocardial infarction results in hypokinesis or akinesis of the anterior wall, which can be visualized by _____, but evaluation of regional myocardial dysfunction is challenging and requires additional training and experience. Papillary muscle rupture might be diagnosed on transthoracic imaging, but transesophageal imaging often is required. Papillary muscle rupture is likely to be missed with current point-of-care ultrasound systems or by less experienced clinicians.
echocardiography
