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98 Cards in this Set

  • Front
  • Back
pacemaker of the heart
SA node
Depolarization
heart contracts
Recovery of heart called
Repolarization
which wave is atrial depolarizatoin
P wave
Which wave is ventricular repolarization
t wave
Which wave is ventricular depolarization
QRS
each block on EKG paper repersents ? seconds
0.04 seconds
most popular treadmill stress test protocol in North America
Bruce
a 24hr Tl delay scan done for ?
Viability
3 images for MPI
Ant, 45 degree LAO, L lat
A false positive septal defect frm treadmill testing is associated with?
Left bundle branch block
Undesirable images from tomographic reconstruction via backprojection is ?
Star artifact
Reconstruction method that is most common?
Backprojection
Sagittal cut is what view (3 letters)
VLA
Transverse cut is what view (3 letters)
HLA
Coronal cut is what view (2 letters)
SA
Which body position is used to reduce attenuation artifacts by breast or gut
Decubitus
a single horizontal profile of SPECT to detect motion
Sinogram
What % of Tl goes to the heart?
3-5%
Is Tl active or passive localization
Active
Which are RP is a K analog?
Tl
Which RP is best to test viability?
Tl
Tc-RP's are taken up actively or passively?
Passive
Which RP redistributes?
Tl
2 chemical classes of Tc?
isonitriles- Sestamibi
diphosphones- Tetrofosmin
Defect seen in stress, but fill in during rest
Ischemia
Reversible blood perfusion loss
Ischemia
Myocardial Infarct
Heart muscle permamnently scarred, non reversible
what % stenosis will reduce blood flow during stress test? How much to see defect at rest?
50%.
90%
Cardiolite also called?
Sestamibi or MIBI
How is Tc localized?
hepatobiliary system, that's why we sait so long
Another name for Myoview? This does or does not remain fixed in myocardium?
tetrofosmin
does remain fixed
85% HR max calculation
220-age= x times .85
3 pharmacological stress drugs
adenosine
dipyridamole
dobutamine
If pt is not stressed to 85% max HR what can happen?
Cannot rule out ischemia
Why not do treadmill test? 2 reasons
pt cant perform exercise
heart med limit HR
2 heart meds that limit HR
Beta blockers
Ca channel blockers
Adenosine:
direct/indirect vasodilator
Biologic T1/2
infusion time
dose
max vasodilation time
Direct
T1/2=15 sec
Inf time= 4 min
140ug/kg/min
max=60s
contraindications for Adenosine
Caffiene
Xanthine meds (theo/aminophylline)
Dypridamole
AKA
direct/indirect vasodilator
T1/2
injection time
dose
reversal med
AKA- persantine
indirect vasodilator
T1/2- 20min
Injection time-4min
dose- 0.56mg/kg
med- animophylline
Dobutamine
T1/2
reason it's used
T1/2- 2 min
use- COPD
reduced perfusion on R/S
reduced contractility
called?
hibernating myocardium
artery is reopened. Perfusion improved, but reduced onctractility called?
Stunned myocardium
Greater deficit of blood flow on rest than stress? 2 names for it
Reverse redistribution or excessive washout
Enlarged heart known as and it seen more common on which ventricle?
Myocardial hypertrophy
Left ventricle
Right ventricle activity normal is it is (greater, less) than left ventricle
Less than left
Lung:Heart ratio only done with which RP?
Tl
Greater than 35% lung:heart ratio indicates?
LV dysfunction
Multi-vessel disease
What % of CABG are occluded after 1 year/ by 10 years?
10-20% at 1 year;
50% at 10 years
Can an MPI be ordered because of an abnormal EKG?
Yes
4 MPI procedures
1 day Tl
1 day Tc
2 day Tc
Dual isotope
Pt prep for all MPI procedures
stop ca channel & beta blockers
stop nitro drip
NPO
NPO time for exercise MPI?Caffiene stop for exercise/drug test?
4-6h
4-6h/24h
Doses for 1 day Tl
4mci
3mci @ stress/ 1mCi @ rest
Why do you not need to reinject for Tl?
Redistribution properties
If you image before 10min (w/Tl) heart is seen 1" higher on stress than rest. This is called?
Cadiac creep
1 day Tc dose stress/rest
20-30mCi stress
10mci rest
2 day Tc doses
30mci stress
30mci rest @24h
In dual isotope which is the rest RP?
Tl
Doses for Tl and Tc for dual isotope
4mci Tl-rest
30mCi Tc-stress
Why use SPECT instead of planar?
Higher sensitive and specificity
Coronal =? axis
Sagittal= ? axis
Transvers= ? axis
short
verticle
horizontal
how does heart sit in body?
points down, left and anterior
4 walls of the heart
Anterior
lateral
inferior
septal
How many views must a defect be seen on to verify a defect?
2
3 main arteries in heart
Left ant descending (LAD)
Left circumflex (LCx)
;eft coronary artery (LCA)
Determines patency of myocardium; heart is opened up and flattened out
Bull's Eye
or
Polor map
On a polar map what part of the heart is the outside ring?
Base
(defects here tend to be overemphasized)
Which RP can be used with gating and why?
Tc- because Tl doesn't provide enough counts
stress images are synchronized to EKG cycle
Gating
Gating frames/cycle for:
MUGA
MPI
MUGA: 8-16 frames/cycle
MPI: 16-32 frames/cycle
Amount of blood pumped out in one cycle is?
Ejection fraction
Amount of blood pumped out by LV in 1 minute?
cardiac output
Amount of blood pumped by a single beat?
Stroke volume
Diastolic is ?
systolic?
relaxation
contraction
What EF is considered normal for MPI?
greater than 50%
Gating uses what kind of trigger?
R wave trigger
T or F? The septal wall is usually shorter than the lateral wall
True
2 ways cardiac function can be imaged without MPI?
First pass
Equilibrium (MUGA)
First pass bolus RP's?
(if MUGA?)
dose
Bolus Tc-SC or Tc-DTPA
(if MUGA Tc PYP/RBC's)
10mCi
First pass ventriculogram body position/camera angle?
Time to complete?
Supine/30 degree RAO
60 seconds
What info is taken from First pass?
Wall motion
EF, Ejection rate, cardiac output, stroke volume, end diastolic/systolic volume
Dose of Tc-PYP/RBC's for MUGA?
Wait time?
20mCi,
wait 20 minutes
Is MUGA a gated study?
Yes
3 vies for MUGA
ANT, 45 LAO, 70 LAO
Which angle shows best seperation of ventricles?
45 degree LAO
RP used in myocardial infarct avid imaging? Dose
Why do this?
Tc-PYP 10-20mCi
taken up by dead tissue-shows bright in infarcted tissue
Best time frame to image infarct?
1-3 days post MI
Infarct images taken
ANT/RAO/LAO/ L lat
Positive MI scan grades
0- normal study
1- heart act < ribs
2- heart activity = ribs
3- heart act. > ribs
0.56mg/kg which drug uses this?
Dipryridamole
T 1/2 Adenosine
15 sec
Infusion rate Adenosine
4 minutes
Dose Adenosine
140ug/kg
Dipryridamole T1/2
20 min
Dipryridamole injection time
4 minutes
Dobutamine T 1/2
2 minutes
Dose of dobutamine?
5ug/kg/min forst 3 minutes
increase 5 ug every 3 minutes until target HR