Clinical Test 3

Front 1

a special type of x-ray that allows a blockage in the coronary arteries to be viewed and recorded on film.

Back 1

Coronary angiography

Front 2

Salt that is a source of nitric oxide. It is injected into the artery and then measure arterial diameter to check for coronary artery endothelial dysfunction in a coronary angiography

Back 2

Sodium nitroprusside

Front 3

Particular procedure for coronary angiography in which acetylcholine is injected into artery and arterial diameter is then measured. If vasodilation occurs, endothelium normal. If vasoconstriction occurs, dysfunction present

Back 3

Endothelial dependent testing

Front 4

Surgery in which a balloon is inserted into the coronary artery to enlarge the lumen of the sclerotic artery. The balloon is inserted via a catheter that enters through the arm or groin region. The balloon is deflated and often replaced with a stent to hold the lumen open

Back 4

Percutaneous Transluminal Coronary Angioplasty (PTCA)

Front 5

Technique for measuring peripheral endothelial function in which conduit arteries such as the brachial, radial, or femoral are measured for changes in diameter following reactive hyperemia

Back 5

high resolution vascular ultrasound

Front 6

Technique for measuring peripheral endothelial function in which resistance arteries' vasodilation is measured

Back 6

Venous occlusion (strain gauge) plethysmography

Front 7

A device used to measure change in volume in a blood vessel

Back 7

plethysmograph

Front 8

Procedure in which a BP cuff in inflated to 200 mmHg for 5 minutes and then released, causing an increase in flow. Endothelium dependent vasodilation is then measured using high resolution ultrasound of the brachial artery

Back 8

Reactive hyperemia/ Flow mediated dilation

Front 9

Potent vasodilator used also as an explosive.

Back 9

nitroglycerin

Front 10

Increase in blood flow

Back 10

hyperemia

Front 11

(Peak diameter-baseline diameter)/ (baseline diameter). Measure of the change in blood vessel diameter after allowing occluded blood vessel to flow again. Over 10% change is healthy, below ten may indicate CV disease

Back 11

Flow-mediated dilation

Front 12

Non-invasive technique in which hyperemia (return blood flow) in forearm is measured when upper arm is occluded with a BP cuff. Hyperemia is measured with a mercury strain-gauge that via electricity monitors minute changes in forearm and forearm blood vessel diameter. This process indirectly can show hypertension (those with HP have slower hyperemia)

Back 12

Venous occlusion plethysmography (VOP)

Front 13

Endothelial function in peripheral arteries and coronary arteries correlate ____.

Back 13

modestly (r=.36)

Front 14

Non-invasive administration of this NO donor is performed in endothelium-independent testing

Back 14

Nitroglycerin, which is given sublingually

Front 15

Does FMD predict future CV events?

Back 15

Yes- those with low FMD are at an increased risk

Front 16

Two things that New England J.O.M found that exercise helped improve. These were in response to acetylcholine injection.

Back 16

Coronary vessel diameter and blood flow velocity

Front 17

____, _____, ____ increased while ___ decreased in exercise group but not in control group after 12 weeks of exercise in men with coronary artery disease.

Back 17

Flow Mediated Dilation (FMD), NO, SOD activity; Oxidative stress

Front 18

Non-invasive procedure that measures arterial stiffness by measuring radial artery pulse waveform. The central aortic BP waveform is synthesized from the measured radial artery using a generalized transfer function

Back 18

Applanation Tonometry

Front 19

Applanation tonometry of the radial pulse measures arterial stiffness. High arterial stiffness is correlated with high risks of: (3 things)

Back 19

LV hypertrophy, myocardial ischemia due to reduced coronary infusion due to low diastolic BP, and increased stroke risk

Front 20

The pressure wave found from applanation tonometry ____ with age.

Back 20

Increases

Front 21

Measuring _______ between 2 locations in the arterial tree helps determine regional arterial stiffness.

Back 21

Pulse wave velocity

Front 22

The pressure waveform in applanation tomography is a composite of which two waves?

Back 22

Incident from the heart and reflected from the arteriole beds (particularly in the lower limbs and trunk)

Front 23

Higher pressure wave velocity indicates (higher/lower) aortic stiffness?

Back 23

higher

Front 24

Does exercise reduce or increase pulse wave velocity?

Back 24

Reduce

Front 25

Patients with the following two conditions are not supposed to undergo angioplasty (PTCA)

Back 25

Left main Coronary Artery Lesions or Coronary Vasospasms

Front 26

Advantages of using a stent in PTCA

Back 26

Decreased restenosis rate (~15% vs. ~30% without) and decreased thrombus rate

Front 27

Migration and proliferation of SMC's and production of extracellular matrix in subintimal space. It is a response to endothelial injury from balloon/stent and a significant cause of restenosis and recurrent symptoms

Back 27

Neointimal proliferation

Front 28

Disadvantages of using stent versus just balloon PTCA

Back 28

More neointimal proliferation

Front 29

PTCA with stent or without stent has lower restenosis rate and higher survival rate?

Back 29

W/ stent

Front 30

Process of blocking an already stented or angioplastied artery

Back 30

Restenosis

Front 31

Form of angioplasty in which a radioactive stent is temporarily or permanently placed at the lesion site with the hopes of preventing SMC (neointimal) proliferation and resulting restenosis

Back 31

Brachytherapy (Intra-coronary radiation)

Front 32

Procedure that uses a tiny rotating cutting blade coated with diamond tips to open a narrowed artery and improve blood flow to or from the heart. Often a stent—a small tube made of metal mesh—is put in the artery to prevent it from re-narrowing.

Back 32

Rotational Atherectomy

Front 33

Surgically sawing through the sternum. It is performed during coronary bypass surgery

Back 33

Median sternotomy

Front 34

Highly invasive Surgical procedure that involves re-routing blood flow around a blocked artery. This is done by using a graft of another blood vessel (typically Saphenous veins or internal mammary artery)

Back 34

Coronary Artery Bypass Graft Surgery (CABG)

Front 35

Type of graft in coronary bypass surgery that involves using the saphenous vein from the leg

Back 35

Free Venous Graft

Front 36

A transfusion or transplant using the patients own tissue

Back 36

Autologous

Front 37

Type of graft in coronary bypass surgery in which an artery from inside the chest wall is rerouted to the blocked coronary artery to help restore blood flow to the area

Back 37

IN SITU Arterial graft

Front 38

Type of IN SITU graft in which the Internal Mammary artery is used to reroute blood flow to the affected area

Back 38

LIMA graft

Front 39

Type of graft in coronary bypass surgery that involves using the radial artery

Back 39

Free Arterial graft

Front 40

Patients with the following two conditions are not supposed to undergo angioplasty (PTCA)

Back 40

Left main Coronary Artery Lesions or Coronary Vasospasms

Front 41

Advantages of using a stent in PTCA

Back 41

Decreased restenosis rate (~15% vs. ~30% without) and decreased thrombus rate

Front 42

Migration and proliferation of SMC's and production of extracellular matrix in subintimal space. It is a response to endothelial injury from balloon/stent and a significant cause of restenosis and recurrent symptoms

Back 42

Neointimal proliferation

Front 43

Disadvantages of using stent versus just balloon PTCA

Back 43

More neointimal proliferation

Front 44

PTCA with stent or without stent has lower restenosis rate and higher survival rate?

Back 44

W/ stent

Front 45

Process of blocking an already stented or angioplastied artery

Back 45

Restenosis

Front 46

Form of angioplasty in which a radioactive stent is temporarily or permanently placed at the lesion site with the hopes of preventing SMC (neointimal) proliferation and resulting restenosis

Back 46

Brachytherapy (Intra-coronary radiation)

Front 47

Procedure that uses a tiny rotating cutting blade coated with diamond tips to open a narrowed artery and improve blood flow to or from the heart. Often a stent—a small tube made of metal mesh—is put in the artery to prevent it from re-narrowing.

Back 47

Rotational Atherectomy

Front 48

Surgically sawing through the sternum. It is performed during coronary bypass surgery

Back 48

Median sternotomy

Front 49

Highly invasive Surgical procedure that involves re-routing blood flow around a blocked artery. This is done by using a graft of another blood vessel (typically Saphenous veins or internal mammary artery)

Back 49

Coronary Artery Bypass Graft Surgery (CABG)

Front 50

Type of graft in coronary bypass surgery that involves using the saphenous vein from the leg

Back 50

Free Venous Graft

Front 51

A transfusion or transplant using the patients own tissue

Back 51

Autologous

Front 52

Type of graft in coronary bypass surgery in which an artery from inside the chest wall is rerouted to the blocked coronary artery to help restore blood flow to the area

Back 52

IN SITU Arterial graft

Front 53

Type of IN SITU graft in which the Internal Mammary artery is used to reroute blood flow to the affected area

Back 53

LIMA graft

Front 54

Type of graft in coronary bypass surgery that involves using the radial artery

Back 54

Free Arterial graft

Front 55

Type of graft that uses a donor vein or artery (typically vein) from a bank

Back 55

Cryo-preserved grafts

Front 56

[Arteries/veins] grafts have better long-term potency (non-obstruction) due to their ability to better withstand pulsatile flow, better barrier between blood and SMC, and better vasodilator production (NO and prostacyclin)

Back 56

Arteries

Front 57

[Arterial/Venous] grafts have lower angina 7 yrs after CABG, higher survival rates years later, and lower reoperation and infarction

Back 57

Arterial

Front 58

Last resort procedure used in patients that are unable to do PTCA or CABG in which cuffs are placed around the lower limbs and buttocks and rhytmically contracted at the onset of diastole and rapidly released at the onset of systole in order to increase diastolic pressure and aortic counterpulsation as well as decrease systolic pressure.
This helps return blood to the coronary arteries

Back 58

Enhanced External Counterpulsation (EECP)

Front 59

Most commonly used diagnostic test for CAD the employs relatively large increments (ie. MET's per stage) every 3 minutes. It is best suited for screening younger people or more physically active adults

Back 59

Bruce Treadmill Protocol

Front 60

CAD diagnostic tests with similar protocols to the Bruce Treadmill Protocol but with smaller incremental increases. It is best for older or deconditioned individuals and those with CV or respiratory diseases

Back 60

Naughton and Balke Treadmill protocols

Front 61

Diagnostic test for CAD performed on a bike. RPM is increased in stages. It is best for elderly, deconditioned, and diseased individuals

Back 61

Cycle Ergometer Ramp Protocol

Front 62

Anginal pain that meets two of three requirements for angina, but the third requirement is off. Requirements: substernal chest pain with or w/o radiation to neck, jaw, L arm; pain comes w/ exertion or stress; pain relieves slowly within <10 min

Back 62

Atypical chest pain

Front 63

Chest pain that is sharp, stabbing and localized. It is not exacerbated by exercise or reproducible with movement, by palpation, or deep breath, and lasts less than 1 min (few seconds usually). It is not relieved with rest or nitroglycerin (but may be by things such as antacid)

Back 63

Non-anginal chest pain

Front 64

EKG reading during GXT that indicates subendocardial ischemia. Its extent, distribution (# of leads) and slope is important clinically.

Back 64

ST segment depression

Front 65

EKG reading during GXT that indicates transmural ischemia or onset of MI, as well as high grade (>90%) stenosis of coronary artery.

Back 65

ST segment elevation

Front 66

EKG reading during GXT that has no diagnostic value during exercise testing but may indicate ischemia or recent non-Q-wave MI on resting EKG

Back 66

T-wave inversion

Front 67

Guidelines for this include no ST depression or typical angina, indicating that no follow-up work is necessary

Back 67

Low probability of ischemia

Front 68

Guidelines for this include greater than or equal to 1 mm ST depression or typical angina. This indicates that the individual needs further tests with imaging modalities

Back 68

Intermediate probability of ischemia

Front 69

Guidelines for this include greater than or equal to 1 mm and typical angina, indicating the person needs immediate treatment, including PTCA or CABG

Back 69

High probability of ischemia

Front 70

Inability to maintain cardiac output during exercise that can lead to pailor, diaphoresis (excessive sweating), or dizziness. It is typically a result or artery stenosis or multi-vessel CAD. It is an indicator of MI.

Back 70

Exertional Hypotension

Front 71

Medical term for probability of survival. It may also mean probability of freedom from MI

Back 71

Prognosis

Front 72

Poor LV function (ejection fraction <40%), poor exercise capacity, increased # of diseased coronary vessels, recent coronary plaque rupture (MI), and presence of ventricular arrythmia

Back 72

Indicators of poor prognosis in CAD patients

Front 73

Study showed that longer duration of Bruce protocol had a ___ correlation with 5 yr survival in those with 2 mm ST depression on exercise EKG

Back 73

Positive

Front 74

Exercise duration during Bruce protocol [does| does not] predict non-fatal MI or unstable angina events

Back 74

Does not

Front 75

Score of +5 or greater on Duke treadmill protocol indicates ___ risk of mortality, whereas a score of <-10 indicates ___ risk of mortality

Back 75

low; high

Front 76

Poor HR recovery after exercise, which is defined as less than 12 bpm drop from peak HR 1 min post-exercise, is or is not an indicator of mortality risk

Back 76

IS

Front 77

An ultrasound of the heart that can be used post-MI to assess for wall movement abnormalities both before and after a GXT

Back 77

Echocardiogram

Front 78

Chemical that can be administered intravenously to patients who cannot perform a GXT due to exercise contraindications or who have LV hypertrophy. The drug will mimic the effects of a GXT, allowing clinicians to perform an echocardiogram

Back 78

Dobutamine

Front 79

Radioactive compound that binds to O2 and can reach cardiac flow and myocardium. It allows clinicans to distinguish between types of myocardium- viable (healthy), stunned (reduce flow), hibernating (very reduced flow), and necrotic (dead)- by showing up or not showing up on a gamma counter image

Back 79

Thallium 201

Front 80

Some degree of ST depression and an abnormal resting EKG indicates which test should be performed?

Back 80

Thallium 201 exercise test

Front 81

Camera used to pick up thallium radioactivity after a thallium exercise test.

Back 81

Gamma camera

Front 82

Chemical that is a potent vasodilator and upregulator of adenosine. It can be used in place of a GXT to help perfuse thallium 201, thereby allowing clinicians to image the heart with a gamma counter in individuals who cannot exercise or who are suspected of giving a poor exercise effort

Back 82

Persantine

Front 83

Term for when blood flows to an unblocked artery instead of a blocked artery, even in the blocked artery is only partially blocked. This can cause confounding results on a persantine thallium scan

Back 83

Coronary steal

Front 84

A procedure in which a thin plastic tube is introduced through an artery in the arm or leg. From there, the tube is advanced into the coronary arteries or heart for diagnostic and/or therapeutic purposes.

Back 84

Cardiac catheterization

Front 85

Imaging of a ventricle of the heart after the injection of a radioactive contrast medium. The technique is less invasive than cardiac catheterization and is used to assess ventricular function. If less dye is seen in the ventricle after systole, that means there is increased cardiac flow.

Back 85

Radionuclide Ventriculogram

Front 86

Most common heart catheterization that involves infusion of a radio-contrast dye, providing planar images to show coronary artery lumen only, showing severity of stenosis. It does not provide information on lesion composition or morphology. The catheter is typically inserted in the arm or groin.

Back 86

Coronary angiography

Front 87

Procedure that can assess coronary blockages to see if they are stable or unstable. It can also assess stent deployment and CAD regression. It is performed by adding a transducer to the tip of a catheter, thereby providing cross-sectional images of the coronary wall and lumen.

Back 87

Intravascular ultrasound (IVUS)

Front 88

Left heart catheterizations are best accessed via __?

Back 88

Arteries

Front 89

Right heart catheterizations are best accessed via ___?

Back 89

Veins

Front 90

It is measured by a Swan-Ganz catheter, and is the pressure measured in a pulmonary artery after occlusion of that artery. Because of the large compliance of the pulmonary circulation, it provides an indirect measure of the left atrial pressure.

Back 90

Pulmonary wedge pressure (PWP)

Front 91

When testing the coronary artery's endothelial function, we test the epicardial conduit for _____ and microvascular resistance for ___ and ____.

Back 91

arterial diameter; velocity and flow

Front 92

When testing peripheral artery's endothelial function, we are trying to find the _____ of the conduit artery.

Back 92

diameter

Front 93

This term describes the different effects Acetylcholine has on arteries who either have normal endothelial function (it causes them to vasodilate) or those who have endothelial dysfunction (it causes them to vasoconstrict)

Back 93

Paradoxical vasoconstriction

Front 94

What are the similarities and differences of Venous occlusion plethysmography and Flow-mediated dilation?

Back 94

Sim: Both use reactive hyperemia technique. DIFF: VOP can also use agonist-mediated method and it uses a mercury strain-gauge to measure changes in arm diameter which measures forearm blood flow; FMD uses ultrasound to assess actual change in brachial, rad, or fem artery diameter

Front 95

What is the difference between the invasive and noninvasive methods of venous occlusion plethysmography?

Back 95

Invasive uses an agonist (typically Ach) which is inserted via a catheter to invoke flow-mediated vasodilation response, whereas noninvasive just uses the reactive hyperemia technique to invoke vasodilation

Front 96

What is the difference between endothelium-dependent methods and endothelium-independent methods?

Back 96

Endothelium dependent uses a chemical or technique that requires the endothelium to go through a series of reactions to create NO (such as Ach to NO). Endothelium independent skips the endothelium and makes NO in SMC's via an NO donor (such as nitroprusside or nitrogylcerin)

Front 97

Brachial FMD [is/is not] predictive of future CV events.

Back 97

Is

Front 98

Affecting the time or rate of the heart

Back 98

Chronotropic

Front 99

effect of a substance that influences the contractility of heart cells. A positive effect improves contractility, a negative effect worsens it.

Back 99

Inotropic

Front 100

Producing physiological effects resembling those caused by the activity or stimulation of the sympathetic nervous system. Ex: dopamine, dobutamine

Back 100

Sympathomimetic