Term
| Giving epinpehrine to a pt would increase __ and __. |
|
Definition
afterload via alpha receptors
contractility via beta receptors |
|
|
Term
Imaging techniques used to investigate chest pathology include:
Plain film
Computed Tomography
Ultrasound
MUGA
MPI
Angiography |
|
Definition
|
|
Term
| Penetration of the x-ray beam is dependent on tissue density. The denser the object the __ penetration and __ absorption there is, this means there is less beam striking the film, so the object appears __. |
|
Definition
- less penetration
- more absorption
- whiter |
|
|
Term
| An object that is not very dense, will have __ penetration and __ absorption and will appear __ on a film. |
|
Definition
- more penetration
- less absorption
- blacker |
|
|
Term
| In order from least dense (blackest) to most dense (whitest): |
|
Definition
|
|
Term
| air (lungs/trachea/outside of body)> fat (perirenal fat/fascial plane)> water (muscle/organs)> bone (bone/plaque)> Metal (fillings/markers/ortho devices) |
|
Definition
|
|
Term
Adjacent structures of similar densities are not visualized
Kidney (water density) against liver (water density) |
|
Definition
|
|
Term
Adjacent structures of different densities are visualized
Liver (water density) next to Bowel (air density) |
|
Definition
|
|
Term
| Minimum diagnsotic X-ray series: |
|
Definition
|
|
Term
| Normally want them to have full inspiration before chest film done. |
|
Definition
|
|
Term
| Expiration studies help visualize __ __, __ __ __ like __, and __ __. |
|
Definition
- small pneumothorax
- air trapping disease like emphysema
- bronchial obstruction |
|
|
Term
ABCs
Abdomen
Bone
Chest
Soft tissues
ATMLL
Abdomen
Thorax
Mediastium
Lung
Lung |
|
Definition
| 2 main ways to search chest xrays |
|
|
Term
| ATMLL KNOW THIS SEARCH PATTERN: |
|
Definition
A = Abdomen
T = Thorax
M = Mediastinum
L = Lungs (unilaterally)
L = Lungs (bilaterally) |
|
|
Term
| When searching the abdomen scan across it many times. Evaluate normal gas containing structures: __, __ __ of colon, __ __ of colon. Evaluate the liver and spleen if possible. |
|
Definition
- stomach
- hepatic flexure
- splenic flexure |
|
|
Term
| Abdominal diseases that can mimic lung disease include: |
|
Definition
- Subphrenic abscess
- Diaphragmatic hernia
- Hiatal hernia |
|
|
Term
| Posterior ribs descend __ to __. Anterior ribs descend __ to __. |
|
Definition
- medial to lateral (PML)
- lateral to medial
just remember PuMLe (PML) |
|
|
Term
| PA view is most common. When would you do an AP? For bedside emergency situations. Bedridden patients. |
|
Definition
|
|
Term
| With a PA view, the pts __ is against the film and the x-ray beams go through their __ first. |
|
Definition
|
|
Term
| Thorax cage diseases that may mimic chest dz: |
|
Definition
- bony metastasis
- rib/clavicle fracture |
|
|
Term
| Three searches of the mediastinum: |
|
Definition
1. Trachea and carina
2. Aorta and heart
3. Hilum |
|
|
Term
| On chest x-rays, the __ are evaluated last. |
|
Definition
|
|
Term
| With a left lateral chest film, the pts __ side is against the film, and the x-ray beams go through their __ side first. |
|
Definition
|
|
Term
| Left Lateral chest films are better for __ __ and allows you to visualize __ __ and __ __. |
|
Definition
- localizing lesions
- overlapping tissue
- hidden pathology |
|
|
Term
| What is the pattern for searching the left lateral film? |
|
Definition
same as other: ATMLL
- abdomen
- thorax
- mediastinum
- lung
- lungs |
|
|
Term
| b/c the recurrent laryngeal nerve runs over aorta> so enlarged mediastinum> stretches and compresses recurrent laryngeal nerve> hoarseness |
|
Definition
|
|
Term
| The __ method is used to determine cadiac output by looking at __. |
|
Definition
|
|
Term
| According to the Fick method, what does Flow equal? |
|
Definition
Flow= rate added/concentration
(10 beads per minute/ 2 beads per liter)= 5 liters/min flow |
|
|
Term
| Fick method Can do this with a radioactive tag, temperature modifications with thermodilution method, oxygen, bead, etc. |
|
Definition
|
|
Term
| formula for blood prssure: |
|
Definition
|
|
Term
| Fick method formula for oxygen flow: |
|
Definition
| Flow= oxygen consumption rate/ (concentration of O2 leaving-concentration of O2 entering) |
|
|
Term
| Gold standard for measuring CO: |
|
Definition
Fick Method
very accurate, but invasive and discontinuous |
|
|
Term
| Fick Method is easy to get representative __ sample, but difficult to get __ sample. |
|
Definition
|
|
Term
| To determine CO with Fick method, get arterial blood sample from the __ or __ artery and get venous sample from the __ _ or __ __. The venous sample needs be mixed blood from renal venous system and coronary venous system. |
|
Definition
- femoral or brachial artery
- pulmonary trunk or right ventricle |
|
|
Term
| With thermodilution the indicator is __ __ injected into the __ __ using a catheter. The temperature change in the blood is measured in the __ __ using a __. The temperature change is __ __ to the amount of blood flowing through the __ __. |
|
Definition
- cold-saline
- right atrium
- pulmonary artery
- thermistor
- inversely proportional
- pulmonary artery |
|
|
Term
| Several methods of measuring cardiac output In the Fick method, the indicator is O2; consumption is measured by a spirometer. The arterial-venous concentration difference is measure by drawing simples through catheters placed in an artery and in the pulmonary artery. In the dye-dilution method, dye is injected into the pulmonary artery and samples are taken from an artery. In the thermodilution method, cold saline is injected into the right atrium and temperature is measured in the pulmonary artery. |
|
Definition
|
|
Term
| The __ __ is the standard echocardiogram. It is painless and similar to an x-ray, but without radiation. |
|
Definition
| Transthoracic Echocardiogram |
|
|
Term
| Transesophageal Echocardiogram (TEE): |
|
Definition
| This test requires that the transducer be inserted down the throat into the esophagus (the swallowing tube that connects the mouth to the stomach). Because the esophagus is located close to the heart, clear images of the heart structures can be obtained without the interference of the lungs and chest. |
|
|
Term
|
Definition
| This is an echocardiogram that is performed while the person exercises on a treadmill or stationary bicycle (also chemical induced stress echos). This test can be used to visualize the motion of the heart's walls and pumping action when the heart is stressed. The echocardiogram is performed just prior and just after the exercise. |
|
|
Term
| __ __ is a form of echocardiogram performed during cardiac catheterization. |
|
Definition
| Intravascular ultrasound (IVUS) |
|
|
Term
| Echocardiography uses __ __ __ imaging to evaluate the heart and surrounding structures. __ technology is also used to see the __ and __ of blood flow in the heart. Echocardiograms are non-invasive and give lots of information. |
|
Definition
- real-time ultrasound
- Doppler
- direction and velocity |
|
|
Term
| Echo provides an excellent way to determine __ and __ function, if __ is present, to evaluate __ __ and __ __. |
|
Definition
- systolic and diastolic function
- LVH is present
- cardiac valves
- pericardial effusion |
|
|
Term
Possible indcations for ultrasound (echo):
KNOW THIS |
|
Definition
- chest pain
- SOB
- dyspnea on exertion
- code/arrest situations such as pulseless electrical activity (PEA)
- left/right sided heart failure suspected
- pulmonary embolism suspected
- cardiac tamponade suspected
- unexplained hypotension
- assessment of central venous pressure and volume status |
|
|
Term
| Echo can detect wall motion abnormalities (WMA) which indicate dead or dysfunctional myocardium. Myocardium can be hypokinetic, dyskinetic, or akinetic, or normal. During exercise/cardiac stress, if myocardium becomes __ or __ when it was previously normal, a significant __ __ is present and the stress test is considered ___. |
|
Definition
- hypokinetic or akinetic
- coronary obstruction |
|
|
Term
| Echocardiogram is a type of __ that uses __ __ sound waves to produce an image of the heart. The sound waves are sent via a transducer and are reflected off the heart. There is no special prep for the test. |
|
Definition
- ultrasound
- high pitched |
|
|
Term
Ultrasound gel is applied to the transducer to allow transmission of the sound waves from the transducer to the skin
The transducer transforms the echo (mechanical energy) into an electrical signal which is processed and displayed as an image on the screen.
The conversion of sound to electrical energy is called the piezoelectric effect |
|
Definition
|
|
Term
| 4 basic components of ultrasound scanner: |
|
Definition
1. pulse generator: applies high amp voltage to energize crystals
2. Transducer- converts electrical activity to mechanical (ultrasound) energy and vice versa
3. Receiver- detects and amplifies weak signals
4. Display |
|
|
Term
A standard echocardiogram is also known as a transthoracic echocardiogram (TTE), or cardiac ultrasound.
The subject is asked to lie in the semi recumbent position on his or her left side with the head elevated.
The left arm is tucked under the head and the right arm lies along the right side of the body
Standard positions on the chest wall are used for placement of the transducer called “echo windows” |
|
Definition
|
|
Term
In M- mode echocardiogram is not a "picture" of the heart, but a diagram that shows how the positions of its structures change during the course of the cardiac cycle.
It is a good method for studying a structure like a heart valve, but it does not provide information about the spatial relationships of different parts of the heart to each other. |
|
Definition
M- mode= diagram
- good to see valve function
- not good to see spatial relationships |
|
|
Term
Information an Echo provides:
KNOW THIS: |
|
Definition
- Chamber diameter and wall thickness
- Pumping fucntion (estimates EF)
- Assess cardiomyopathy
- Motion of walls
- Clots in atria and ventricles
- Valve function
- Volume status
- Estimates pressures (pulmonary HTN)
- Cardiac infections
- Pericardial fluid
- Pericarditis |
|
|
Term
| A method of nuclear cardiac imaging is __ __ __. It really just shows the __ ventricle, you can't see the right ventricle that well. |
|
Definition
Myocardial Profusion Imaging
left |
|
|
Term
| MPI is a ____ __ imaging technique that uses ___ imaging agents to image the heart. |
|
Definition
- non-invasive nuclear
- radioactive
Thallium-201
Technetium-99 m Sestamibi
Technetium-99 m Tetrofosmin |
|
|
Term
| In a typical MPI, the physician reviews __ __ __ __ and __ ___ ___. |
|
Definition
- static summed perfusion images
- dynamic gated images |
|
|
Term
| Static images on an MPI are viewed in what three orientations? |
|
Definition
- SA: short axis
- VLA: vertical long axis
- HLA: horizontal long axis |
|
|
Term
| Exercise stress also associated with less extensive hepatic and GI uptake improving image quality. Also results in more thorough uptake by myocardium. |
|
Definition
|
|
Term
| Additional information provided by exercise stress test: |
|
Definition
- degree of exercise tolerance
- time to maximal heart rate
- blood pressure response |
|
|
Term
| stress test predictive ability: |
|
Definition
| Predictive ability for man is about 60% for women its about 50%. |
|
|
Term
Target heart rate formula:
KNOW THIS |
|
Definition
|
|
Term
| Pharmacologic stress agents all vasodilate for a stress test: |
|
Definition
- Dipyridamole (Persantine)
- Dobutamine
- Adenosine
- Lexiscan (Regadenoson) |
|
|
Term
| __ is artificial epinephrine. It has less __ effects than epinephrine which allows you to look more specifically at the hearts response. But it is a ___, so if patient is prone to __ do NOT give them Dobutamine. |
|
Definition
- Dobutamine
- less vascular effects
- sympathomimetic
- arrythmias |
|
|
Term
| If pt is prone to arrythmias, what pharmacologic agent would you NOT give them for stress test, and what two may you use instead? |
|
Definition
- do NOT give Dobutamine
- can give Adenosine or Dipyridamole |
|
|
Term
| If patient has lung disease like asthma, and you are going to perform an exercise stress test, what two pharmacologic agents would you avoid and which one could you use? |
|
Definition
- avoid Dipyridamole and Adenosine
- can use Dobutamine |
|
|
Term
| __ and __ have lung effects. Dobutamine does not. |
|
Definition
| Dipyridamole and Adenosine |
|
|
Term
| EKG IS NOT GOOD FOR LEFT BUNDLE B/C CAN’T SEE ISCHEMIA, SO DO A NUCLEAR STRESS TEST WITH LBB. |
|
Definition
|
|
Term
| Indications for pharmacological stress testing: |
|
Definition
Inability to perform adequate exercise
Left bundle branch block
Ventricular pacemaker
CCB’s or Beta blockers
Evaluation of patients very early after acute MI (<3 days) or very early after stenting (<2 weeks) |
|
|
Term
| Absolute Contraindications for EXERCISE stress test include: |
|
Definition
- uncontrolled unstable angina
- uncontrolled symptomatic arrhythmias
- decompensated CHF
- acute aortic dissection |
|
|
Term
| Relative Contraindications to EXERCISE stress test include: |
|
Definition
- left main coronary stenosis
- uncontrolled HTN
- tachy/brady arrhythmia
- mental/physical impairement |
|
|
Term
| Summed images on a MPI are used to assess __ __. Rest and Stress images are compared to determine if a region of the heart is __. |
|
Definition
- cardiac perfusion
- ischemic |
|
|
Term
| Gated images of an MPI are used to assess __ __, like __ __ and ___ ___. |
|
Definition
- cardiac function
- wall motion
- ejection fraction |
|
|
Term
A nuclear stress test provides excellent negative predictive value
Patients from the general population with normal MPI scans have <1% annual risk of cardiac events |
|
Definition
|
|
Term
| Best way to measure ejection fraction? |
|
Definition
|
|
Term
| A Multiple Gated Acquisition Scan (MUGA) uses __ __ to assess ___ __, __ __, and __ __. |
|
Definition
- radio-labelled RBCs
- cardiac function
- wall motion
- ejection fraction |
|
|
Term
Cardiac Perfusion Imaging
Stress/Rest Study
Sestimibi
Assesses ischemia and infarction of myocardium |
|
Definition
|
|
Term
| A MUGA and an MPI are both __ imaging techniques. |
|
Definition
|
|
Term
| With MPI, if there is a defect in the stress study, but the rest study is normal, the diagnosis is ___. |
|
Definition
|
|
Term
| With MPI, if there is a defect in the stress and rest studies, the diagnosis is __ ___. |
|
Definition
|
|
Term
| Multislice CT Coronary Angiography is a new form of cardiac imaging. It measures __ similarly to __ __. It is NOT a ___ test. |
|
Definition
- obstruction similarly to cardiac catheterization
- NOT a function test |
|
|
Term
| Coronary Calcium Scoring is calcium scoring for __ __. This is for ___ pts and is not recommended for routine screen. |
|
Definition
- risk assessment
- asymptomatic individuals |
|
|
Term
| Multislice CT scan (64slice CT scan): |
|
Definition
CT images that are used come from mid to end diastole due to relative motion free period. CT scans the entire cardiac cycle but uses ECG after the fact to pull the images from mid to end diastole only.
IV contrast is used.
Heart rate needs to be less than 70 bpm so beta-blockers are used (protocol). |
|
|
Term
| Multislice CT scanning use __ __ first to get heart rate below __. __ __ is used. A CT scans the entire cardiac cycle, but EKG is used afterward to pull images only from __ to __ __ due to the relative motion free period. |
|
Definition
- beta blocker
- 70 bpm
- IV contrast
- mid to late diastole |
|
|
Term
| CI to mulislice CT scanning; |
|
Definition
Absolute
Rapid heart rate, Atrial fib, frequent PVC’s
Pregnancy
Extensive calcification (often a CCS is done first and if very high, > 1000, the CTA is not done). We do this screen here.
Unable to hold breath for 20 seconds
Contraindication to IV contrast, beta-blocker or nitrates.
Relative
High BMI: for e.g. if BMI < 25 the sens, spec, PPV and NPV are 100%, declines with weight.
Younger patients especially if female due to increased risk of excessive radiation. |
|
|
Term
|
Definition
False positives and negatives
Better rate than most noninvasive stress tests.
Radiation exposure
Comparable to nuc med stress
Risk is highest for young women |
|
|
Term
| Coronary Artery Disease (CAD) is the narrowing of the coronary arteries preventing adequate __ __ to the heart muscle. It is usually caused by __. It can progress to muscle damage resulting in __, __, or __ __. |
|
Definition
- blood supply
- atherosclerosis
- infarction, arrythmia, or heart failure |
|
|
Term
| Coronary Artery Bypass Graft (CABG) is __ rather than vein grafts. This is a way to treat CAD. |
|
Definition
|
|
Term
| Now with CABG a __ incision is made instead of a sternotomy. |
|
Definition
|
|
Term
| With CABG avoid the cardiopulmonary bypass machine |
|
Definition
|
|
Term
|
Definition
|
|
Term
| A stent is an expandable metal mesh tube that buttresses the dilated segment to limit restenosis. |
|
Definition
| start plavix and ASA after |
|
|
Term
|
Definition
Unstable or chronic angina
Acute or post acute MI
Post ACB with post operative angina |
|
|
Term
|
Definition
Left main disease unless protected with bypass
Diffuse disease
Disease distal to area for intervention
Coronary orifice stenosis
Variant angina – spasm
Torturous vessels – some can be PCI without stent |
|
|
Term
| Coronary ___ is one of the most commonly performed imaging tests to evaluate the __ and __ __. |
|
Definition
angiography
heart and great vessels |
|
|
Term
| types of coronary angiography: |
|
Definition
coronary arteriography (coronary arteries),
aortography (aorta), and
pulmonary angiography (pulmonary arteries and lungs). |
|
|
Term
| The purpose of coronary arteriography is to to define degree of __ __ __ usually caused by __. |
|
Definition
- coronary artery obstruction
- atherosclerosis |
|
|
Term
| Coronary angiography can also be performed in the acute setting of suspected coronary occlusion, and a balloon catheter or thrombolytic agent can be placed through the catheter in an attempt to relieve the coronary artery obstruction. |
|
Definition
|
|
Term
Aortography is used primarily to evaluate suspected aortic disease.
Although aortography remains the standard for traumatic injury, CT has largely replaced aortography |
|
Definition
|
|
Term
| Pulmonary angiography is to treat massive __ __ with __ __ or treat __ ___. |
|
Definition
- pulmonary embolism with thrombolytic therapy
- ateriovenous malformations |
|
|
Term
| Pulmonary artery catheterization is also used to measure the __ __ __ in pts with suspected __ __ __. |
|
Definition
- pulmonary artery pressures
- pulmonary arterial hypertension |
|
|
Term
| Possible Complications during angiograms: |
|
Definition
Arrhythmias
Vasovagal reaction
Thromboembolism
Tamponade
MI
Bleeding at puncture site
Coronary artery dissection
Allergy to contrast medium
Pulmonary edema
Pulmonary embolism
Cerebral vascular accident |
|
|
