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45 Cards in this Set

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What are the 2 types of CT Angiography?
MDCT (multidetector CT) & EBCT ( Electron Beam)
What are the disadvantages of MDCT?
5x rad dose compared with reg angiography, req contrast, accuracy dependent on reader experience, HR must be < 60, patient must hold breath for > 15sec
What are the advantages of MDCT?
> 90% spec & sens
triple r/oCAD, PE, & Dissection
MDCT evolving rapidly
What are the advantages of EBCT?
gated to concurrent ECG less radiation
What are the disadvantages of EBCT
Less sens & specific than MDCT
What does PCWP measure?
dampened LA pressure which reflects LVEDP which in turn reflects LVED volume
What are the normal PCWP pressures? mmHg
RA < 7
RV = 30/7
PCWP < 12
What does an elevated RA pressure indicate?
RV Failure > 7
accompanied by JVD
What does and elevated PCWP indicate?
LVF
LVH
Mitral Stenosis
AR/MR
Tamponande
Constrictive Pericarditis
6 causes
What PCWP measure does DOE start?
> 15 -18
What does PCWP measure?
dampened LA pressure which reflects LVEDP which in turn reflects LVED volume
What are the normal PCWP pressures? mmHg
RA < 7
RV = 30/7
PCWP < 12
Dyspnea at rest, Orthopnea, & intersitial edema occur at what PCWP?
25-35
Pulmonary edema is assoc. with what PCWP level
> 35
What are the normal RA, PA, PCWP and BP measurements
RA 0-5 <7
PA (13-28)/(3-13) 30/7
PCWP 3-11 <12
BP 110/70
RA 18
PA 32/18
PCWP 19
BP 70/50
Diagnosis?
Diastolic pressures are equal in all chambers indicating pericardial tamponade or constrictive pericarditis
Diagnosis
RA 15
PA 21/11
PCWP 10
BP 70/50
Right sided failure
CO and PCWP are decreased possibly in the setting of an acute inferior MI
Diagnosis
RA 18
PA 30/20
PCWP 20
BP 70/50
Biventricular failure
Tx= diuretics, preload and afterload reduction, inotropics. Examples are
nitroprusside, nitro, milirinonone (Primacor), nesirtide (Natrecor) with low dose dpamine or dobutamine for inotropic effect
Diagnosis
RA 18
PA 90/32
PCWP 30
BP 110/70
Mitral stenosis with secondary RV failure
Diagnosis
RA 18
PA 90/32
PCWP 10
BP 110/70
Pulmonary hypertension
Usually the diastolic PA pressure is close to PCWP except in Pulm HTN
In what cases is myocardial biopsy useful? When is it not?
Doxorubicin toxicity
evaluation of cardiac rejection
sarcoidosis is focal and is not useful unless you are lucky. ETOH cardiomyopathy the dx is usually obvious!
2 +
2 -
What are the two types of cardiac stress tests
Exercise stress test
Exercise Imaging tests
1. Stress echo
2. Exercise myoperfusion imaging (MPI)
When should stress test be used
Low sensitivity should be used in groups with high prevelence
List benefits and drawbacks of EET?
less sensitive than imaging stress tests
good for testing for ischemia, functional capacity, & prognosis.
Not good for localizing ischemia or determing myocaridal viability.
Contraindications for EET
Physical incapacity
cannot get up to 85% of age predicted max HR
ECG abnml such as LBBB, LVH, WPW, resting ST changes > 1mm, Digoxin
3 major reasons
What is a positive EET
Flat or downsloping ST seg > 1mm & longer than 80 msec following j-poinnt
Reasons to stop EET
>2 mm ST depression
decrease in systolic BP > 15
CP, SOB, VT
What does reversible ST segment elevation on an EET mean?
Coronary spasm
What are the reasons to do an imaging stress test?
Determine area of ischemia, if it is reversible, EF% and myocardial viability
4 reasons
In what patients can you use an imaging stress test and not an EET
Resting ST changes
Patient on Digoxin
WPW
Still cannot use with LBBB or paced rhythm
Describe diagnosic changes in an MPI
Ischemic areas take up less radionuclide but show same distribution at rest.
Infarct or aneursyms are underperfused both during exercise and rest
When is TEE used
LA, Mitral Valve, intracardiac masses, ASD, endocarditis, aortic dissection
LA thrombi
prosthetic valve function
vegetations on valves
decending aortic dissection
4
Cancer patient presenting with new cardiax sx and a cardiac echo
Think pericardial effusion or tamponade
Equation for peak gradient across a valve
Gradient=4*(velocity)2

121 gradient=4*(5.5m/s)(5.5m/s)
Describe normal, moderate, & severe stenotic gradients
<30
30-70
>70
Draw pulmonary cathertierization
Describe nml pressures in each chamber
RA 0-5, PA (13-28)/(3-13), PCWP 3-11, BP 110/70
What test should be used in a pt with LBBB? or a paced rhytm?
MPI with adenosine
When are stress imaging done instead of ETT?
Need to determine area of ischemia and if it is reversible
What is the key question to ask in picking the correct cardiac stress test?
Can the pt exercise? is the resting ECG nml? if yes ETT if resting ECG abnml use perfusion imaging
Pt needs stress test and has asthma and cannot exercise what should be used?
Do not use adenosine in pts with bronchospasm
Pt needs stress test but has episode of prior V-Tach what test should be used
Do not use dobutamine
What can a MDCT r/o in the ER?
Triple r/o CAD, PE, dissection
What are negatives of MDCT?
2x rad dose
operator experience needed in reading
iodinated contrast exposure
HR > 60 & regular
pt must be able to hold breath
Diagnosis?
PCWP 11 Low BP High CO
Septic shock
When is PCWP increased?
LVF, LVH, Mitral Stenosis, AR/MR, tamponade, constrictive pericarditis