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45 Cards in this Set
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- Back
- 3rd side (hint)
What are the 2 types of CT Angiography?
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MDCT (multidetector CT) & EBCT ( Electron Beam)
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What are the disadvantages of MDCT?
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5x rad dose compared with reg angiography, req contrast, accuracy dependent on reader experience, HR must be < 60, patient must hold breath for > 15sec
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What are the advantages of MDCT?
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> 90% spec & sens
triple r/oCAD, PE, & Dissection MDCT evolving rapidly |
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What are the advantages of EBCT?
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gated to concurrent ECG less radiation
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What are the disadvantages of EBCT
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Less sens & specific than MDCT
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What does PCWP measure?
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dampened LA pressure which reflects LVEDP which in turn reflects LVED volume
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What are the normal PCWP pressures? mmHg
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RA < 7
RV = 30/7 PCWP < 12 |
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What does an elevated RA pressure indicate?
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RV Failure > 7
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accompanied by JVD
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What does and elevated PCWP indicate?
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LVF
LVH Mitral Stenosis AR/MR Tamponande Constrictive Pericarditis |
6 causes
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What PCWP measure does DOE start?
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> 15 -18
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What does PCWP measure?
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dampened LA pressure which reflects LVEDP which in turn reflects LVED volume
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What are the normal PCWP pressures? mmHg
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RA < 7
RV = 30/7 PCWP < 12 |
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Dyspnea at rest, Orthopnea, & intersitial edema occur at what PCWP?
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25-35
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Pulmonary edema is assoc. with what PCWP level
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> 35
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What are the normal RA, PA, PCWP and BP measurements
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RA 0-5 <7
PA (13-28)/(3-13) 30/7 PCWP 3-11 <12 BP 110/70 |
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RA 18
PA 32/18 PCWP 19 BP 70/50 Diagnosis? |
Diastolic pressures are equal in all chambers indicating pericardial tamponade or constrictive pericarditis
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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 |
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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 |
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Diagnosis
RA 18 PA 90/32 PCWP 30 BP 110/70 |
Mitral stenosis with secondary RV failure
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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 |
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In what cases is myocardial biopsy useful? When is it not?
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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 - |
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What are the two types of cardiac stress tests
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Exercise stress test
Exercise Imaging tests 1. Stress echo 2. Exercise myoperfusion imaging (MPI) |
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When should stress test be used
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Low sensitivity should be used in groups with high prevelence
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List benefits and drawbacks of EET?
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less sensitive than imaging stress tests
good for testing for ischemia, functional capacity, & prognosis. Not good for localizing ischemia or determing myocaridal viability. |
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Contraindications for EET
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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
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What is a positive EET
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Flat or downsloping ST seg > 1mm & longer than 80 msec following j-poinnt
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Reasons to stop EET
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>2 mm ST depression
decrease in systolic BP > 15 CP, SOB, VT |
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What does reversible ST segment elevation on an EET mean?
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Coronary spasm
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What are the reasons to do an imaging stress test?
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Determine area of ischemia, if it is reversible, EF% and myocardial viability
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4 reasons
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In what patients can you use an imaging stress test and not an EET
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Resting ST changes
Patient on Digoxin WPW Still cannot use with LBBB or paced rhythm |
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Describe diagnosic changes in an MPI
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Ischemic areas take up less radionuclide but show same distribution at rest.
Infarct or aneursyms are underperfused both during exercise and rest |
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When is TEE used
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LA, Mitral Valve, intracardiac masses, ASD, endocarditis, aortic dissection
LA thrombi prosthetic valve function vegetations on valves decending aortic dissection |
4
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Cancer patient presenting with new cardiax sx and a cardiac echo
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Think pericardial effusion or tamponade
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Equation for peak gradient across a valve
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Gradient=4*(velocity)2
121 gradient=4*(5.5m/s)(5.5m/s) |
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Describe normal, moderate, & severe stenotic gradients
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<30
30-70 >70 |
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Draw pulmonary cathertierization
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Describe nml pressures in each chamber
RA 0-5, PA (13-28)/(3-13), PCWP 3-11, BP 110/70 |
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What test should be used in a pt with LBBB? or a paced rhytm?
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MPI with adenosine
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When are stress imaging done instead of ETT?
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Need to determine area of ischemia and if it is reversible
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What is the key question to ask in picking the correct cardiac stress test?
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Can the pt exercise? is the resting ECG nml? if yes ETT if resting ECG abnml use perfusion imaging
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Pt needs stress test and has asthma and cannot exercise what should be used?
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Do not use adenosine in pts with bronchospasm
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Pt needs stress test but has episode of prior V-Tach what test should be used
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Do not use dobutamine
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What can a MDCT r/o in the ER?
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Triple r/o CAD, PE, dissection
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What are negatives of MDCT?
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2x rad dose
operator experience needed in reading iodinated contrast exposure HR > 60 & regular pt must be able to hold breath |
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Diagnosis?
PCWP 11 Low BP High CO |
Septic shock
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When is PCWP increased?
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LVF, LVH, Mitral Stenosis, AR/MR, tamponade, constrictive pericarditis
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