Other Cardiac Diagnostic Tests

Question 1

What is Holter Monitoring?

Answer 1

1. Continuous 24 hr EKG monitoring
2. Ordered for detecting and assessing arrhythmias and for evaluating effectiveness of antiarrhythmic therapy
3. used in both inpatient and outpatient

Question 2

PT implications for Holter Monitoring

Answer 2

1. know the pt is using one
2. know the results and change treatment plan accordingly

Question 3

What is an electrocardiogram?

Answer 3

provides ultrasound images of the heart

allows visualization of abnormal cardiac anatomy and determination of abnormal cardiac function/physiology

Question 4

List things that an electrocardiogram will provide images for

Answer 4

1. size of the ventricular cavities
2. thickness and integrity of interartial and intraventricular septa
3. function of the valves
4. motions of individual segments of ventricular wall
5. volumes of the L ventricles
6. assessment of performance of the heart muscle itself
7. estimates SV and EF
8. allows analysis of motion of valves and heart muscle

Question 5

T/F: echocardiograms provide a real time image of a beating heart?

Answer 5

TRUE

can also provide info about blood flow

Question 6

List and briefly describe the types of echocardiography

Answer 6

1. Surface or transthoracic
   
   • echo transducer is moved on the skin over the heart
2. Transesophageal
   
   • echo transducer is swallowed
   • provides a very clear image of those heart structures and valves
3. Stress
   
   • imaging done while the pt is exercising or immediately afterwards (or both)

Question 7

when is a transesophageal echo used?

Answer 7

aka TEE

• used when image quality is confounded by obesity, chest deformities, pulmonary disease
• invasive, contraindicated for those with dysphagia.
  
  • may cause breathing problems or bleeds

Question 8

list additional types of echocardiographs

Answer 8

1. 3D echocardiography
   
   • newest form
   • displays intracardiac anatomy
2. Contrast echocardiograph
   
   • provides an assessment of aortic stenosis, pulmonary vein flow analysis
   • improved diagnostic accuracy in assessing myocardial perfusion and ventricular chambers

Question 9

echo report abbreviations

Answer 9

1. IVS → interventricular septum thickness
2. PW → posterior wall thickness
3. LVID → LV inside diameter
4. RWT → Relative wall thickness
5. FS → fractional shortening
   
   • relationship between LV dimensions and EF

Question 10

Describe what PET is

Answer 10

Positron Emission Tomography

• measures cardiac metabolism (glucose, FFA) and blood flow of heart
• requires specialized equipment, highly trained personnel, very expensive
• uses a radioactive labeled glucose
• imaging allows for quantification and qualification of regional myocardial tracer distribution
  
  • blood flow/areas of underperfusion
• detects tissue viability, and function

Question 11

what is the gold standard assessment for blood flow measurement and metabolic assessment of the heart?

Answer 11

PET

Question 12

List types of imaging of the heart

Answer 12

1. PET
2. Radionuclide perfusion imaging
3. Thallium stress test
4. MRI
5. Coronary angiography
6. CT
7. CAT angiography
8. Cardiac calcium scan
9. Doppler ultrasound
10. MUGA scan

Question 13

what is radionuclide perfusion imaging?

Answer 13

1. evaluates cardiac perfusion and function at rest and during dynamic exercise and global and regional L ventricular systolic function
   
   • commonly used Thallium-201
   • follow radioactive labels as they move into cardiac tissue
   • taken up by cardiac tissue based on coronary blood flow
   • assesses blood flow and cell membrane intregity
   • cells must be perfused and metabolic to be “hot”

Question 14

describe a thallium stress test

Answer 14

1. cardiac or nuclear stress test
   
   • nuclear imaging stress test shows how well blood flows in the heart while exercises or at rest

Question 15

what is an MRI?

Answer 15

Magnetic Resonance Imaging

• uses the movement of water molecules in a magnetic field to create an image
• originally used for assessing cardiac anatomy and congenital malformations and to ID masses/thrombi

Question 16

what can an MRI currently be used for pertaining to cardiac disease?

Answer 16

1. Currently evaluates:
   
   • valvular disease
   • cardiac shunts
   • cardiac flow
   • coronary artery anatomy
2. evaluates morphology, blood flow, and contractility

Question 17

what is a coronary angiogram?

Answer 17

1. an X-ray examination of the blood vessels or chambers of the heart that have been perfused with a special dye (cardiac cath.)
   
   • this fluid is visible via X-ray and the pictures obtained are called angiograms

Question 18

what can a coronary angiogram help detect?

Answer 18

1. Presence and severity of:
   
   • CAD
   • LV, atrial, pulmonary vein, CA dysfunctions
   • valvular heart disease

Question 19

PT implications of left heart cathererization

Answer 19

1. due to the arterial incision site (femoral artery), bed rest is recommended for 6-8 hours with involved LE straight
2. knee immobilizer to minimize hip flexion
3. monitor for groin hematomas and pain

Question 20

PT implications of right heart catheterization

Answer 20

1. used to dx right ventricular, atrial, and pulmonary artery impairments
2. the incision site is generally via the external jugular vein and there are no activity restrictions

Question 21

what is a CT scan?

Answer 21

Computer Tomography

1. combine series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels, and soft tissues inside your body
   
   • provides more detail than plan X-rays do
   • same as CAT scan

Question 22

what is a CAT angiogram?

Answer 22

1. A CT coronary angiogram is an imaging test that looks at the arteries that supply blood to your heart
2. used to dx and treat blood vessel diseases and conditions
3. invovles the use of contrast material

Question 23

a CAT angiogram can be used to dx what conditions?

Answer 23

1. aneurysms
2. blockages
3. blood clots
4. congenital (birth-related) abnormalities of the cardiovascular system, including the heart
5. disorganized blood vessels, such as vascular malformations
6. vessel rupture or tears

Question 24

what are cardiac calcium scans?

Answer 24

1. uses special X-ray equipment to produce pictures of the coronary arteries to determine if they are blocked or narrowed by the buildup of plaque
2. x-ray beam is sensitive to different intracellular Ca2+ content
3. when calcium is present, the higher the score, the higher one’s risk of heart disease

Question 25

interpretation of cardiac calcium scans

Answer 25

* zero = no plaque * 1-10 = small amount of plaque * 11-100 = some plaque * 101-400 = moderate amount of plaque

Question 26

what is a doppler ultrasound?

Answer 26

a noninvasive test that can be used to estimate the blood flow through your blood vessels by bouncing high-frequency soundwaves (ultrasound) off circulating RBCs. It turns sound waves into images

Question 27

what can a doppler ultrasound show

Answer 27

1. DVT 2. blockage in arteries 3. check blood flow in your veins, arteries, and heart 4. locate aneurysms

Question 28

what are MUGA scans?

Answer 28

1. Creates video images of the lower chambers of the heart to check whether they are pumping blood properly 2. it shows any abnormalities in the size of the chambers and in the movement of blood through the heart 3. involves the use of a radioactive tracer