Diagnostic Tests

Question 1

Holter Monitor

Answer 1

• Patient Activated monitor:
  – Hit button when feel Sx
• Indication: pt with syncope, dizziness, intermittent symptoms
• Pt keeps a 24 hr diary
  – 1-3 days duration
• Diagnosis and manage symptomatic arrhythmias
  – Rest and with Ex
• ECG for entire length of time

Question 2

How is a resting ECG different from a 12 lead exercise ECG?

Answer 2

The Right and Left Foot are in different places.
Resting ECG: On actual eet
Exercise: On the ribs

Question 3

What abnormalities might someone see on a resting ECG?

Answer 3

• Identify Ischemia
  – ST depression
• Identify injury
• MI
• Arrhythmias
  – Afib; SVT; Vtach; Vfib
  – Aflutter; AV blocks

Question 4

What is a GXT?

Answer 4

• Incremental exercise test
• Treadmill or bike/cycle
• 12 lead ECG
• HR, BP, RPE monitored at each stage
• Maximal or Symptom limited
• Sub-max

Question 5

What is the GXT used for?

Answer 5

• Evaluate cardiac symptoms
• Evaluate effects of medical / surgical intervention
• Evaluate arrhythmias & hemodynamic response to ex
• Determine Exercise prescription

Question 6

What is done in an electrophysiological study?

Answer 6

• Catheter inserted groin, up to the heart
• Electrical signals are sent to the heart; evaluate the SA node and the conduction pathways
• Dysrhythmia may be induced
  – Meds given to stop & evaluate effectiveness of the meds
• Mapping to locate the spot where a dysrhythmia starts
  – If found an ablation (freezing or radiofrequency) can be done

Question 7

When is an ablation indicated?

Answer 7

• SVT, A fib and A flutter
• Goal is to remove ectopic foci (scar tissue doesn’t allow signal)
• Radiofrequency ablation

Question 8

What tests can be done to test for ischemia?

Answer 8

• Resting ECG
• Exercise ECG (stress test)
• Angiography
• Radioactive Nuclide Perfusion testing
• Pharmacological stress testing
• MRI

Question 9

What can cause ischemia?

Answer 9

Vasospasm or artherosclerosis

Question 10

What is an angiogram and what does it look at?

Answer 10

• A long thin flexible catheter is inserted through femoral artery up to heart (Sometimes brachial artery is used)
• Goal: establish or confirm Dx of CAD
• X-rays are taken of heart chambers and coronary arteries
• Data on R coronary, L main, LAD & Circumflex circulation
• Radio-opaque contrast material is injected into heart chamber or coronary arteries

Question 11

What is a Thallium Stress Test?

Answer 11

• Use isotope Thallium to evaluate coronary artery perfusion (blood flow)
• EKG and treadmill
• Two phases: Pre and during exercise (isotope injected near peak)
• Evaluate perfusion of the heart = IPE

Question 12

A Thallium Stress Test is performed, an area of the heart perfused at rest but not during exercise (IPE), what does that tell you

IPE: Immediate post exercise

Answer 12

It is transient ischemia

Question 13

A Thallium Stress Test is performed, no areas of the heart perfused at rest nor during exercise (IPE). What does that mean?

Answer 13

MI with scarring

Question 14

What is the alternative test to Thallium Stress Test for those that cannot exercise? What does it do?

Answer 14

Persantine-Thallium Stress Test

Persantine helps to expand the coronary arteries (similar to exercise)

Question 15

How is the Thallium Stress Test and GXT Stress Test different?

Answer 15

Thallium is similar but also uses additional information by using the isotope Thallium to evaluate coronary blood flow.

Question 16

What is an echocardiography?

Answer 16

• Noninvasive
• Ultrasound of heart through the intercostal space
• Looks at the size, struture and function of the heart, chambers and valves

Question 17

What is a Transesophageal Echo and how is it different than ultrasound?

Answer 17

• Thin flexible tube (special tip) inserted down throat. Anethetic applied to inhibit gag reflex. Tip sends out an ultrasound wave
• It is different because of location and you get a much clearer image

Question 18

What is a stress echo?

Answer 18

• Echo and Treadmill Stress Test
• Echo done at rest and again at peak heart rate
• Looking at wall motion, chamber size, wall thickness and valves

Question 19

What is a Dobutamine Stress Echo?

Answer 19

• Evaluate heart movement, valves and chambers for those who can’t exercise on treadmill
• Dobutamine – medication to increase HR and BP similar to ex

Question 20

What is a carotid ultrasound measure?

Answer 20

Diameter and velocity

Question 21

Tilt Table Test

Answer 21

• Done with pt’s with syncope
• Point is to cause symptoms they were having before
• Increase to 80 degrees
• If they can get to 80 degrees will be given glyceryl trinitrate to drop BP and more likely to have symptoms

Question 22

Oximetry - Values

Answer 22

• Normal 98-100%
• If drops below 90% with exercise – evaluate situation
• PaO2 >80 mm Hg ~ SpO2 >93 - 95%
• PaO2 <60 mm Hg ~ SpO2 <88 - 90%

NEED TO KNOW; REALIZE RELATIONSHIP BETWEEN PRESSURE AND O2 SAT

Question 23

What is a PCI?

Answer 23

• Percutaneous Coronary Innervention
• Performed when stenotic lesion is not too large (~>70%) occluded
• Catheterization; Change tip on catheter with balloon and inflate the balloon where the obstruction is to try to push the atherosclerosis along the line of flow

Question 24

How common is restenosis after a PCI?

Answer 24

Within the first 6 months:
* Restenosis of 32-42% with no Stent
* Restenosis less than 10% with Stent

Question 25

What is a post surgery restriction with PCI patients?

Answer 25

* Can't bend at the hip for 6-8 hours post procedure * Due to a whole in the artery; Arteries have such a high pressure proper clotting takes longer.

Question 26

What is an Atherectomy

Answer 26

* Percutaneous innervention * Cut out plaque * Break off plaque and suck it up

Question 27

What is a stent and what is it used for?

Answer 27

* Tiny spring like device * Placed at stenotic lesion following angioplasty

Question 28

What does CABG stand for? What is it done for?

Answer 28

* Coronary Artery Bypass Graft * Bypass a stenosis * Graft comes from saphenous vein (leg) or internal mammary artery * Attach on aorta and distal to stenosis

Question 29

CABG Surgery Techniques (3)

Answer 29

* Traditional: Heart-Lung Machine; Heart is stopped * Minimally invasive direct coronary bypass (MIDCAB); Tiny incision NO cutting of ribs * Off-Pump Coronary Artery Bypass (OPCAB); heart is beating, no machine, cut and stitch

Question 30

What happens to the hearts electrical system with a heart transplant?

Answer 30

* Herat is denervated and lacks autonomic control * Wihtout sympathetic control results in HR to be 100-115 bpm being controlled by AV Node * Only way to stimulate the HR is from catecholamines (This is why a long warm up and cool down is crucial)

Question 31

What are the types of heart transplants?

Answer 31

* Orthotropic and Heterotopic * Orthotopic: Old heart out, new donor heart in * Heterotopic: Sick heart stays and donor heart is connected if there is enough space

Question 32

What does an assistive device do for the heart?

Answer 32

Improves the ability of the ventrical to eject blood Ex: Ventricular Assist Device: Improves the function of L ventricle

Question 33

What is an Intra-Aortic Balloon Counterpulsation?

Answer 33

* Hemodynamically unstable patients -- Acute conditions post surgery * Augment diastolic BP * Increase coronary blood flow * **Balloon inflates – early diastole** * Keep hip angle less than 70 degrees * **In bed activities**

Question 34

What stage of a heart beat are the coronaries fed?

Answer 34

During diastole!

Question 35

Carotid Endarerectomy

Answer 35

Catheter up through carotid to cut and suck plaque

Question 36

Emboli Capture Device for Angioplasty

Answer 36

Large Veins to catch large clots

Question 37

How can you test for Heart Valve Integrity?

Answer 37

Echocardiography Contrast echo Cathiterization

Question 38

What are some Vascular Diagnostic Tests

Answer 38

1. ABI 2. Ex ABI - Dec ABI by .2 or more - Decrease SBP by 20% or more 3. Segmental limb pressure

Question 39

Chest Radiographs are ____ sensitive for diagnosis of ____

Answer 39

1. NOT 2. COPD Can see disease progression if taken at different stages of disease May be able to see thoracic hyperinflation with flattening diapraham???

Question 40

What is a distinguishing characterisitc of COPD on plain films?

Answer 40

Increased AP diameter of the chest, and increased retrosternal airspace, as seen in green arrow

Question 41

What is a V/Q scan? What values are important?

Answer 41

* Ventiltion/Purfusion Scan; Performed seperately or together * Ventilation scan (V): scanning the lungs while having the person **inhale radioactive gas**. * Perfusion scan: performed by **injecting radioactive albumin** into the vein. The lungs are scanned to detect the location of the radioactive particles as blood flows through the lungs Normal: 0.8-0.9 <0.8 blocked on pulmonary side >0.9 blocked on vesicle side (Ex: PE) ## Footnote NEED TO KNOW VALUES