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25 Cards in this Set
- Front
- Back
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Transthoracic Echo
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• Safe
• Generally good images • Readily available |
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Transesophageal Echo
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• Relatively safe
• Excellent pictures • More detail |
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Echo applications
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• Wall motion/thickness
• Chamber size • Valvular structure and motion • Masses or thrombi in chabers • Aortic root dissection • Septal defects • Pericardial effusion |
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clinical use for Echo
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• Chamber Size: cardiomyopathy LVH
• Wall Motion abnormalities: ischemia or infaction • Anatomic wall defects: ASD, VSD • Cardiac tumors or vegetations |
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clinical use for Doppler Echo
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• Murmur assessment
• Detecting regurgitant lesions •Detect and quantify shunts •Quantify stenoses •Quantify regurgitant volume |
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Stress Echo
- methods to induce ischemia |
• Exercise (bike, treadmill, arm ergometry)
• Pacing • Dobatamine infusion • Vasodilator infusion • Vasoconstrictor |
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stress Echo
-disadvantage |
•Subjectiveness of wall motion abnormality
•Image quality •Side effects of drugs if used |
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Stress Echo
-advantages |
•Improves sensitivity and specificity of standard treadmill stress test
•Detects viable myocardium |
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Stress Echo Applications
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•Detect ischemic myocardium
•Detect viable myocardium |
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Stress Echo look for
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•Local ischemia
•Abnormal diastolic performance •Regional systolic dysfunction •Wall motion abnormality |
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absolute contraindications for stress testing
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• Acute MI
• Acute myo- or pericarditis • Progressive unstable angina • Uncontrolled CHF • Severe aortic Stenosis • Uncontrolled arrhythmia |
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relative contraindications for stress testing
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• IHSS with significant obstruction
• Severe Hypertension • Physical limitations • Acute non-cardiac illness |
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indications for stress testing
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•Evaluate chest pain and Dyspnea
•Evluate arrhythmias •MI risk stratification •Rehabilitation evaluation •Post angioplasty evaluation |
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end points for stress testing
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• Angina
• Fatigue • Heart block • Advanced arrhythmia • Dropping BP • Severe hypertension • Reaching target |
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False Positives for Stress Tests
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•Women
•Electrolyte imbalance •Autonomic dystonia •Respiratory variation •LV aneurysm •Early repolarization (normal) •Drugs (digoxin) |
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False Negatives for Stress Tests
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•Women
•Poor exercise tolerance •Nitrate therapy •Beta blocker therapy •Antiarrhythmic medications |
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nuclear med. clinical advantages
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•Increase sensitivity
•Asses quantity of ischemia •Useful where pt. unable to exercise •To asses LV and RV function |
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nuclear med. agents used:
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• Technetium
• Thallium • Gallium |
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nuclear med Hot spot imaging
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• Technetium pyrophosphate taken up by inflammatory cells in infarct zone
• Localizes and quantifies amount of damage • Gallium is similar, but less frequently used |
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nuclear med cold spot imaging
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• Thallium and technetium are taken up by viable myocardium
• Cold spot seen in areas of ischemia or scar • Amount of uptake correlates with blood flow to area |
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Long Term ambulatory Monitoring (Holter)
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• Records all beats over 24 hour period
• Able to detect arrhythmias causing symptoms • Able to detect ischemia • Useful only if problem occurs very frequently |
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Long Term Ambulatory Monitoring
(Event Recorder) |
• Records only when activated by patient
• Can be used for 30 days • Useful for intermittent symptoms • Not useful for syncope because patient must activate |
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Long Term Ambulatory Monitoring (Continuous loop)
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•Device may be worn externally for 30 days
•Records only when activated •Has a memory, so can be activated after symptomatic event •Useful for syncope •May be implanted under prepectoral skin •Continuous recording and memory •Externally interrogated for information retrieval •Useful for syncope and a broad range of symptomatic and asymptomatic arrhythmias |
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CT Angiography
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• Multislce (64) CT imaging reconstructs cardiac structure
• With contrast, epicardial vessels are outlined in 3D image • Determines degree of coronary calcification • Correlates well with coronary events • Not effective in determining lesion flow limitations |
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Cardiac MRI
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• Excellent reconstruction of all cardiac structures in 3D format
• With contrast, able to identify ischemic or injured myocardium • Identifies structural cardiac anomalies • Less effective in visualizing coronary vessel lesions now, but soon will surpass CTA in quality |
