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ADV DIAG > exam 2 CVD > Flashcards

exam 2 CVD Flashcards

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1
Q

risk factors for heart disease

A

hypertension, hyperlipidemia, smoking, diabetes, obesity, poor diet, inactivity, excessive alcohol, family history of early onset of CAD or sudden death

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2
Q

TTE is what

A

noninvasive US of heart
done with probe outside anterior chest
harmless, high freq waves emitted from transducer penetrate the heart and reflect back as series of echos

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3
Q

TTE gives info about what

A

structure and fx of heart

dx pericardial effusion, valve disease, wall motion abnormalities, CM, aneurysm, congenital heat disease

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4
Q

color flow doppler TTE

A

direction of blood flow across regurgitant or stenosed valves

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5
Q

TEE

A

high freq ultrasound transducer placed in distal esophagus behind heart

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6
Q

TEE avoids interference from what

A

subcutaneous tissue, bony thorax, and lungs

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7
Q

TEE shows better visualization of what

A

MV, masses on valves, thoracic aorta, endocarditis

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8
Q

risk of TEE

A

esophageal perforation or bleeding

CI in pts with liver varices

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9
Q

ECG detects what

A

electrical activity of heart displayed in ECG tracings

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10
Q

ECG uses

A

Evaluate arrhythmias
Conduction defects (heart blocks)
Myocardial injury (ischemic events), damage, hypertrophy,
Pericardial disease (ie pericarditis)
Adverse reaction to medications (ie dig tox)
Electrolyte abnormalities (like hypo- or hyper- kalemia)

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11
Q

II, III, aVF

A

inferior leads

give info about RCA

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12
Q

aVL, I, V5, V6

A

lateral leads

LCx

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13
Q

V2, V3, V4

A

anterior leads

LAD

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14
Q

V1 and V2

A

septal

RCA, LAD, posterior wall

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15
Q

acute myocardial damage on ECG shown as

A

STE or inverted T waves

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16
Q

old MI on ECG

A

deep q waves

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17
Q

pericarditis on ECG

A

diffuse STE

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18
Q

how many leads show STEMI on ECG

A

2 leads

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19
Q

interfering factors of ECG

A

inaccurate placement of electrodes, tremors, e-lyte imbalances, meds (ie dig)

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20
Q

Why is an ECG ordered for a patient with CHF?

A

To check for dysrhythmias, and to assess for ischemia and scarring. The ECG may also point to another diagnosis like pericarditis or pericardial effusion.

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21
Q

List all the abnormalities that might be found on an echocardiogram study done on a patient with CHF.

A

left ventricular enlargement, little or no movement of some parts of the heart wall or septum, thinning of the myocardium, leaking of heart valves, low ejection fraction

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22
Q

What is the best echocardiogram test for an obese patient and why?

A

TEE because there is less tissue for the sound waves to penetrate and the images will be more complete and accurate.

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23
Q

Why would an ECG be ordered for a patient with suspected acute or chronic coronary artery disease?

A

To check for arrhythmia, acute ischemia and evidence of chronic scarring.

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24
Q

Does a normal ECG in the ED rule-out cardiac chest pain?

A

No. The ECG maybe normal in the ED when the patient has acute coronary insufficiency. The likelihood ratio for a negative test is close to 1 so the odds of having acute insufficiency are not changed much by a normal EKG.

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25
most common CXR views
anterior chest against the digital or film cassette (the PA or posterior anterior view) taken with the cassette close to the side of the chest (the lateral view
26
CXR primary uses - cardiac
to assess heart size ( suspect CHF ) | to check for fluid in the lungs and pleural space (pleural effusion)
27
B-type natriuretic peptide(BNP, NT-Pro BNP)
Neuroendocrine peptides produced by ventricular myocardial cells in response to stretching
28
BNP, NT-pro BNP uses
Most useful as a test to rule out heart failure in an acutely dyspneic patient Helpful prognosticator in patients with episode of decompensated heart failure that have known HF (compare with previous BNP to help guide prognosis)
29
BNP lab values
<100 pg/mL HF is unlikely 100 pg/mL - 400 pg/mL it is indeterminate, use clinical judgement > 400 pg/ml, positive depending on age, sex and presence or absence of obesity
30
NT-Pro BNP (isolated peptide)
< 300 pg/mL HF unlikely < 50 years of age; > 450 pg/mL HF likely 50-75 years; >900 pg/mL HF likely > 75 years; >1800 pg/mL HF likely
31
bnp levels in women
tend to be higher when compared with men
32
bnp levels do what with age
rise | older ppl have higher baseline levels than younger ppl
33
bnp levels in obese ppl
tend to be lower
34
What factors influence the cut-off point for a BNP/NT-Pro BNP to help make a diagnosis of CHF?
age, sex, obesity
35
TLP includes what
``` total cholesterol high density or HDL cholesterol low density or LDL cholesterol Triglycerides (aka fat in the blood) Sometimes very low density or VLDL cholesterol is included ```
36
TLP goal in heart disease/high risk populations
raising HDL, lowering LDL
37
goal for LDL in ppl with minimal risk
130 mg/dL or less
38
goal for LDL in ppl with very high risk
70 mg/dl or less
39
USPSTF screening recommendations for lipid disorders
Men over 35 and women over 45 Start screening earlier if elevated risk Repeat every 5 years if normal age cut-off for screening is uncertain
40
Why would the practitioner order a lipid panel for a patient with coronary artery disease?
Because an elevated LDL and/or a low HDL are risk factors for progression of CAD. It is ordered as a baseline for treatment decisions.
41
stress test w/o imaging
ordered for pt with low probability of CAD Sensitivity: 61-73% (not great), specificity: 59-81% Exercise usually on a treadmill with the patient connected to an ECG machine for continuous monitoring. Goal: get HR elevated When 85% of predicted maximum heart rate is reached, the test is terminated Determined by 220 – pts age x .85 = predicition also terminated if ECG changes are suggestive of ischemia, ST segment variance > 1 mm = positive test.
42
stress test with imaging
Echo and Nuclear scans are done to increase sensitivity of stress testing (Sensitivity 81%, specificity 85-95%)
43
Nuclear: Myocardial Perfusion Imaging
Radiotracer injected, gamma camera used to scan before and after exercise to assess blood flow in the heart. Looking for ST changes Exercise causes the vasodilation
44
nuclear- myocardial perfusion imaging with regadenoson
Pharmacologic agent for those who cannot exercise: Regadenoson which causes vasodilation to coronary vessels. Does not raise HR Resting images are compared to stress images, look at blood flow in heart Safe for ppl with impaired renal fx Does not speed up heart, so it safe for a fib (will not cause RVR)
45
stress echo
Echo performed before and after exercise or infusion of dobutamine if unable to exercise Do not use dobutamine for pt with a fib, will cause RVR Looking for wall motion abnormalities with increase contractility Do not want to see 1 wall that cannot keep up with the other walls w/ exercise
46
stress test recommendations
Performed when there is a possibility of cardiac disease but the chance of coronary artery disease is small enough that it is not necessary to take the patient directly to the cath lab. Performed on low risk pts
47
duplex US
used to detect obstruction in larger arteries carotid, femoral recommended for symptoms of possible vascular obstruction
48
carotid duplex US recommendations
syncope (w/o clear etiology), TIA, frequent strokes, light headedness especially when looking up
49
femoral artery duplex US recommendations
claudication, non-healing foot ulcers in a patient without diabetes
50
holter monitor
continuous recording of a limited number of leads of the ECG usually set for 24 hours and the patient keeps a log during that time recording chest pain or dizziness or other symptoms possibly related to the heart
51
TSH in cardiac disease
thyroid disease freq accompanies dysrhythmias such as tachycardia and a fib
52
hyperthyroidism with cardiac disease
can be correlated with tachycardia, a fib, elevated BP
53
hypothyroidism with cardiac disease
can be correlated with bradycardia, lipid disorders, pericardial effusions
54
CK-MB
enzyme produced by myocardial muscle when there is ischemia
55
CK-MB vs troponin, which is faster
CK-MB rises quickly and is cleared from blood faster than troponin
56
CK-MB can also rise with
shock, hypothermia, myocarditis, severe skeletal injury, myopathy this limits the specificity of test
57
test of choice to dx or r/o myocardial ischemia
troponin
58
troponin is what
biochemical marker for cardiac disease highly specific for myocardial cell injury protein components for striated muscle
59
troponin levels change with time
elevate 2-3 hrs after injury do 2-3 sets (q4-8 hrs) over 24 hrs
60
how long do troponins stay elevated after MI
7-10 days also with cardiac surgery, stents
61
troponin limitations
falsely elevated with HD pts and in severe muscular injury
62
Why are troponins ordered for a patient who may have acute coronary syndrome?
Troponins are released from ischemic cardiac muscle so the concentration rises in the blood with ACS and other conditions that stress the heart such as pulmonary embolism and CHF. They are measured in some situations post coronary artery stenting or surgery to assess reperfusion.
63
What is the usual time-frame for the rise and fall of troponin levels after acute coronary obstruction?
Troponins are elevated as soon as three hours and remain elevated for 1 - 2 weeks after myocardial ischemia.
64
Under what circumstances would a Holter monitor be ordered?
Answer: Holter monitors are useful when the ECG in the office shows no dysrhythmia, but the patient has periodic chest pain, dizziness, palpitations, shortness of breath or syncope.
65
Why would the practitioner order an ECG for a patient with hypertension?
To check for dysrhythmia, cardiac hypertrophy, and evidence of coronary artery disease.
66
why would echo be useful for pt with HTN
to assess for cardiac hypertrophy
67
2nd right interspace
aortic area
68
2nd left interspace
pulmonic area
69
lower left sternal border
tricuspid area
70
apex
mitral area
71
blood flow through the heart
``` Superior and inferior vena cavas Right atrium and the right ventricle Pulmonary arteries Left atrium and left ventricle Aorta and the aortic arch ```
72
systole
ventricles contraction The right ventricle pumps blood into the pulmonary arteries (pulmonic valve is open) The left ventricle pumps blood into the aorta(aortic valve is open)
73
diastole
ventricles relax Blood flows from the right atrium → right ventricle (tricuspid valve is open) Blood flows from the left atrium → left ventricle (mitral valve is open)
74
PMI tapping per palpation
normal
75
PMI sustained during palpation
suggests LV hypertrophy from HTN or aortic stenosis
76
PMI diffuse during palpation
suggests dilated ventricle from CHF or cardiomyopathy
77
Harsh 2/6 medium-pitched holosystolic murmur best heard at the apex describes
mitral regurgitation
78
Soft, blowing 3/6 decrescendo diastolic murmur best heard at the lower left sternal border describes
aortic regurgitation
79
diastolic murmurs
MV stenosis , heard at apex, does not radiate, low pitch ruble with bell of stethoscope
80
systolic murmur
MV regurg | thrill
81
s3
tends to be early diastole, happens with increased ventiruclar filling
82
s4
right before s1, from ventricular stiffness, little laides with prolonged HTN, stiff ventricles
83
blood flow through cardiac valves
TPMA
84
Troponin T normal range
< 0.1 ng/ml
85
troponin I normal range
<0.03 ng/ml

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