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cardiac diagnostics
cardiac diagnostics
93
Anatomy
Graduate
05/23/2012

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Cards

Term
what are cardiac diagnostic tools
Definition
lab tests, chest xray, EKG, EP studies, holter and loop monitoring, echocardiogram, cardiac catheterization, nuclear studies, MRI, CT scan
Term
what does EKG stand for
Definition
electrocardiogram
Term
what does EP studies stand for
Definition
electrophysiologic studies
Term
what are goals of cardiac diagnostic studies
Definition
identify type, size, and location of pathology, determine disease progression with serial testing, formulate best treatment, determine effectiveness of treatment
Term
how to choose type of cardiac diagnostic test
Definition
minimally invasive, risk to benefit ratio, specificity and sensitivity, timeliness of results, cost
Term
what are 2 types of lab tests for cardiac diagnostics
Definition
serum, urine
Term
what do serum studies show in cardiac diagnostics
Definition
cardiac enzymes, lipids, complete blood count, coagulation, electrolytes, glucose
Term
are lab studies invasive
Definition
no
Term
what are lipids
Definition
cholesterol levels
Term
what to look for in CBC
Definition
infection, hemoglobin
Term
what to look for in coagulation studies
Definition
how well does the blood clot
Term
how do we know that cardiac muscle is damaged vs. skeletal muscle
Definition
damaged cardiac muscle myocytes release specific isomers of enzymes LDH, CKP, and tropnonin T and I
Term
as cell injury continues, how does the number of isoenzymes in the blood change
Definition
increases
Term
how long does the release of isoenzymes into the blood continue
Definition
until the infarct is completed
Term
when are the various cardiac isoenzymes released
Definition
at different times during cellular destruction. Each isoenzyme peaks at a different time.
Term
by what time after MI have all cardiac isoenzymes peaked
Definition
36h after MI
Term
what does serial monitoring of isoenzymes show
Definition
evolution of MI
Term
what is the total serum concentration of isoenzymes proportional to
Definition
extent of myocardial injury
Term
for how long does an MI evolve
Definition
36 hours
Term
how quickly do cardiac enzymes become present in the blood following MI
Definition
<30 minutes
Term
why is it relevant that cardiac enzyme testing can be done within 30 minutes following MI
Definition
thrombolytic treatment must occur within 6 hours after MI and is best within 3h
Term
is cardiac enzyme testing expensive
Definition
no. $40-50
Term
what is the risk of cardiac enzyme testing
Definition
low. Needle stick
Term
if a patient presents to ED with possible MI, what tests will be done first
Definition
vital signs, EKG, bloodwork including cardiac enzyme panel
Term
how often is bloodwork taken with suspected MI
Definition
every 3 hours, total of 4 times to see if there is atrend of myocardial damage.
Term
do you want the ratio of total cholestrol:HDL to be high or low to have a lower risk of heart disease
Definition
low, around 4 or less
Term
what are the components of the complete blood count
Definition
WBC, RBC, Hg, Hct, platelets
Term
what does Hg relfect
Definition
oxygen carrying capacity
Term
what does WBC indicate
Definition
immune status: presence of infection, immune suppression
Term
which patients experience immune suppression
Definition
cancer, transplants
Term
what do platelets reflect
Definition
clotting ability
Term
what are some other lab values besides CBC
Definition
coagulants, glucose, electrolytes
Term
what do coagulants represent
Definition
bleeding time
Term
why would coagulants be manipulated
Definition
to dissolve/prevent clot formulation
Term
wh ywould glucose be abnormally elevated
Definition
type II diabetes
Term
what electrolytes are measured in lab values
Definition
sodium, potassium, chloride, carbon dioxide, BUN, creatine, Anion gap, BUN/Cr
Term
what can happen if there are abnormalities in sodium, potassium, calcium
Definition
triger arrhythmias
Term
what can BUN, Cr give you information about
Definition
kidney function
Term
what does CHF stand for
Definition
congestive heart failure
Term
what lab changes occur with chronic diagnosis
Definition
BUN elevated with CHF and renal insufficiency; sodium elevated with CHF; loop diuretics can deplete K
Term
what are benefits of chest xray
Definition
noninvasive, can betaken serially, verifies line/lead placement of a chest tube
Term
what are common cardiac related findings
Definition
cardiomegaly, pulmonary edema, pleural effusion, widened mediastinum
Term
what is cardiomegaly
Definition
fluid around pericardial sac.
Term
how is cardiomegaly detected by chest xray
Definition
borders of heart are unusually enlarged
Term
can chest xray show early cancer
Definition
no. by the time cancer appears o chest xray, it's advanced.
Term
what is the dark part on a chest xray
Definition
airfilled lungs
Term
what is the purpose of electrophysiological studies
Definition
attempts to induce arrhythmias to localize area of pathology
Term
once electrical physiologic stimulation has localized pathology that causes arrhythmias, what can be done
Definition
can ablate area/kill it off so that it can't set off arrhythmia. Can recommend pacemaker or deplantable defibrillator
Term
what is the normal impulse direction of the heart
Definition
normal impluse in the heart goes from SA to AV to bundle of HIS to bundle branches.
Term
what happens with Wolf Parkinson white syndrome
Definition
a patch forms in the AV node that can cause arrhythmias
Term
how can wolf parkinson syndrome be treated
Definition
surgeons can go in and laser out the abnormal pathway so that the arrhythmias aren't as fatal or chronic
Term
what do implantable defibrillators do
Definition
deliver a shock to the patient's heart when it detects an abnormal rhythm
Term
what are holter and loop monitors
Definition
portable EKG monitors that patients wear during normal activities/ADLs
Term
how long does a patient typically wear a holter monitor
Definition
24 hours - 1 month
Term
when to use holter monitor
Definition
for patients with symptoms that aren't effectively documented by an EKG. Patient also keeps a diary so they can see if activity relates to arrhythmia
Term
what is an echocardiogram
Definition
reflected US waves
Term
is an echocardiogram invasive
Definition
no
Term
what are the 2 approaches of echocardiograms
Definition
parasternal, transesophogeal
Term
what is the standard of the 2 echocardiogram approaches
Definition
parasternal
Term
what are limitations of the parasternal approach of the echocardiogram
Definition
pulmonary problems, obesity, chest wall defects
Term
what diagnoses/findings come from the echocardiogram
Definition
ventricular size and ejection fraction; wall motion; valves; septal defects; pericardial effusion; thrombus; neoplasm; anuerysm; areas of ischemia
Term
what is ejection fraction
Definition
heart's ability to pump strongly
Term
what can you correlate with an echocardiogram
Definition
EKG
Term
is cardiac catheterization invasive
Definition
yes
Term
how is cardiac catheterization done
Definition
peripheral line radiographically guided to heart
Term
is cardiac catheterization expensive
Definition
yes, more than $2500
Term
can you assess both sides of the heart with cardiac catheterization
Definition
no, only right or left, not both
Term
how to get to right side of heart with catheter
Definition
venous access
Term
how to get to left side of heart with catheter
Definition
arterial access
Term
what are the two possible entry points for a left heart cath
Definition
radial or femoral artery
Term
what are the protocols following left heart cath with radial or femoral artery entry point
Definition
at least 6h strict bedrest after procedure. Hematoma risk
Term
what is angiography
Definition
dye injected into coronary arteries for mapping
Term
along with coronary angiography, what else is measured in left heart cath
Definition
LV volumes
Term
what are risks of left heart cath
Definition
bleeding, arrhythmias, allergic reactions
Term
what interventions can be performed with left heart cath
Definition
percutaneous transluminal coronary angioplasty; stent placement
Term
what do we call the catheter line that goes to the right heart cath
Definition
swan-ganz catheter
Term
does a right heart cath use venous or artery entrance point
Definition
venous access
Term
which veins are used for right heart cath entry
Definition
femoral or jugular
Term
what is the path of a swan ganz catheter
Definition
femoral or jugular vein to vena cava to R atria to R ventricle to pulmonary artery
Term
how long can a person have a swan ganz catheter
Definition
can remain in for hours or days or weeks
Term
is ambulation allowed for patients with swan ganz
Definition
usually - check with MD first
Term
what is measured by a swan ganz/right heart cath
Definition
heart pressure, temperature, blood pressure, wedge pressure,
Term
what does RNV stand for
Definition
radionucleotide ventriculogram
Term
what does RNV do
Definition
estimates left ventricular ejection fraction
Term
what type of study is an RNV
Definition
nuclear study
Term
what is a pharmacologic stress/perfusion test
Definition
distress patient with adenosine and dobutamine to increase HR and heart contraction. Stimulates exercise stress test
Term
what do adenosine and dobutamine do
Definition
increase HR and strength of contraction
Term
what is positive chronotrope
Definition
increase HR
Term
what is positive ionotrope
Definition
increase strength of contraction
Term
why is thallium given with adenosene or dobutamine in physiologic stress test
Definition
for contrast
Term
what kinds of patients are nuclear studies such as physiologic stress tests good for
Definition
amputees, paraplegics, SCI patients, transplants with poor physical activity, grossly obese, significant leg pain
Term
what are other cardiac diagnostic tests that are expensive
Definition
MRI, CT Scan, PET scan
Term
what are PET scans good for
Definition
detecting tumors in the heart or lungs
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