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CC Jan 2017 Imaging in Ishcemic Heart Disease

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echoecho's version from 2017-03-12 21:50

Section

Question Answer
What disease remains the most common cause of death in the US?Cardiovascular disease
A major focus of care is differentiating patients regarding what?With symptoms suggestive of cardiovascular disease who ACTUALLY have underlying pathology from those who do not
Careful evaluation of patients based on _____ and patient characteristics allows classification of patients int high, intermediate and low risk categories?Symptoms
What is the HEART score for chest pain?It is a validated tool that assists in stratification of the patient into high, intermediate, low risk categories
Explain how the HEART score for chest pain works?1) 0-2 points in 5 categories (hx, ECG findings, age, risk factors and troponin) with higher point values for suspicious hx, significant ST-depression on EKG, older age, 3 or more cardiovascular for risk factors and elevated troponin
The risk of a major adverse cardiac event over the next 6 weeks can be estimated on the HEART score, explain the scores?1) minus 2.5% for score 0-3. 2) 20.3% for score 4-6. 3) 72.7% for score > 7
What is the TIMI score?It is another tool (Thrombolysis in Myocardial Infarction), although it has limited utility in determining who is very low risk and be discharged home w/o additional testing. High risk puts will likely need cardiac catheterization; low risk patients only require risk-factor modification and intermediate risk patients are evaluated w/ non-invasive cardiac testing that includes stress echo and stress myocardial perfusion imaging (MPI)
High risk patients will likely need what?invasive evaluation with cardiac catherization
Low-risk patients will likely only require what?risk-factor modification
Immediate-risk patients are evaluated with what type of cardiac testing? Give examples of this type of cardiac testing?1) non-invasive cardiac testing. 2) stress echocardiography and stress myocardial perfusion imaging (MPI)
Both exercise stress testing with or w/o MPI and stress echo rely on what principle?that dynamic changes indicative of underlying significant coronary artery disease can be elicited during exercise or pharmacologically-induced stress
Why is exercise preferred over pharmacological stress?exercise most closely to mimics a patient's day to day activities and provides additional information such as exercise tolerance and BP response to exercise
memorize
For an exercise stress test, vitals and EKG are obtained at _____. Then patient exercises progressively using an establish treadmill protocol while their EKG tracing, VA, symptoms are monitored
Question Answer
List the reasons why an exercise stress test is terminated?1) if maximum heart rate is achieved and sustained (typically for > 1 minute). 2) EKG changes suggestive of ischemia develops. 3) an arrhythmia develops or symptoms of chest pain ensue
If a stress test produces a positive or equivocal result, what is generally indicated?doing invasive testing
List the contraindications to exercise testing?1) acute MI within 48 hours. 2) unstable angina. 3) uncontrolled arrhythmia. 4) severe valvular stenosis. 5)decompensated heart failure. 6) aortic dissection. 7) acute pulmonary embolism. 8) disorders affecting exercise (COPD, severe OA of the knees or hips, claudication)
An exercise stress test is an option if the patient is able to _____ and has an ________ EKG? 1) exercise 2) interpretable EKG (meaning abnormal findings do NOT interfere with stress test interpretation)
List the conditions that make an EKG uninterpretable?Wolff-Parkinson-White pattern; LBBB; Ventricular paced rhythm; digoxin use with associated ST-T abnormalities; LV hypertrophy with ST-T abnormalities, ST depression > 1mm at rest and hypocalcemia with ST-T abnormalities
Stress MPI involves the addition of an injection of a ______ material that is readily taken by up by the myocardium, such as _____?1) tracer. 2) technetium-99
Regarding stress MPI, what captures image at rest and again immediately following exercise using a standard protocol?SPECT (single-photon-emission computed tomography)
Regarding stress MPI, there is comparison of these pre- and post exercise images allows for 2 defects, list these and their meaning?1) fixed defects (suggests previous MI and nonviable scar tissue. 12) reversible defects (areas with coronary artery stenosis > 50%)
List the limitations of stress MPI?1) motion artifact. 2) inferior wall attenuation artifact with diaphragm or breast tissue 3) radiation exposure
How does stress echocardiography work?transthoracic echo is performed prior to exercise and immediately postexercise
Regarding stress echo, what do resting wall motion abnormalities suggest? How about postexercise abnormalities suggest?1) prior MI but do not conclusively demonstrate nonviable myocardium. 2) presence of coronary artery disease (stenosis > 50%) stress echo, what can be the causes of postexercise abnormalities?1) new or worsening wall motion abnormalities. 2) delayed contraction. 3) development of left ventricular enlargement 4) decreased ejection fraction
Does stress echo relate directly to perfusion of the coronary arteries?no
In addition to contraindications listed for exercise stress testing, accurate stress echo is dependent upon what?1) image quality (some limitation based on body habit us). 2) need for expert reading. 3) interpretation of the images
Is there radiation involved in stress echocardiography?no
*** In comparing the sensitivity and specificity of stress MPI vs. sensitivity and specificity of stress echo?1) stress MPI (sensitivity 75%; specificity 48%). 2) stress echo (sensitivity 94%; specificity 40%)
memorize
More recent comparisons of sensitivity and specificity of these modalities suggest a slight advantage for stress _____, but there are no clear differences in the testing strategies with regard to clinical management or outcomes
Question Answer
*** In a 2012 guideline from the American College of Cardiology Foundation, American College of Physicians and American Heart Association, list the 3 recommendations?1) for patients with an intermediate to high PRETEST probability of ischemic heart disease, an uninterpretable ECG and at least moderate physical functioning, either stress MPI or stress echo is recommended. 2) either stress MPI or stress echo is reasonable in patients with an intermediate to high PRETEST probability of ischemic heart diseased that HAVE an INTERPRETABLE ECG and at least moderate physical functioning. 3) Standard exercise stress testing is recommended for patients with low PRETEST probability of ischemic heart disease who have an INTERPRETABLE EKG and at least moderate physical functioning
List the EKG changes suggestive of ischemic heart disease?1) ST-segment changes. 2) T-wave changes. 3) diagnostic Q waves in 2 contiguous leads 4) new conduction abnormalities
*** SUMMARY = The choice of diagnostic imaging studies for patients with chest pain suspected of having ischemic heart disease depends on what four things?1) presenting signs and symptoms. 2) risk factors. 3) ECG findings. 4) capacity for physical exertion
*** SUMMARY = What two stress tests are commonly used to confirm ischemic causes of chest pain and determine the need for additional cardiac evaluation?1) stress echo. 21) stress myocardial perfusion imaging (MPI)
*** SUMMARY = Whilte the diagnostic accuracy of both procedures is similar, which of the two stress tests mentioned above in the previous question has a better sensitivity for ischemic cardiac events?stress echo
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