adjunct diagnostic tests

avatar
Created by
Brenda Lee Ufano

Cards (46)

  • ●      Basically, the diagnostic tests for diagnosing cardiovascular diseases are divided into two:
    →    Noninvasive tests
    →    Invasive tests
  • Non invasive tests
    ●      Electrocardiographic tests are noninvasive tests that uses the electrocardiogram to evaluate the electrical activity generated by the heart at rest and/or with activity
    →    Holter Monitor
    →    EKG/ECG
    →    Exercise Stress Test
  • ambulatory monitors
    ●      Holter monitors
    ●      Loop Recorder
    ●      CardioNet (mobile cardiac outpatient telemetry)
    ●      Transtelephonic transmitter
  • holter monitors
    ●      AKA Ambulatory ECG
    ●      Holter monitors are small, portable electrocardiograph machines that are able to record the heart’s rhythm.
    ●      Used to assess heart rhythm over time
    ●      Correlate symptoms with heart rhythm
    ●      Used to diagnose abnormal heart rhythms:
    →    type, how long they last, and what may cause them to guide appropriate treatment
    ●      Usually worn for 24 hours to monitor the 24-hour electrical activity of the heart during normal activities, including sleeping
  • loop recorder
    ●      AKA Event Recorder
    ●      Worn for a longer period of time compared to the 24-hour holter (can be as long as two weeks)
    ●      It can be removed during showers and baths.
    ●      Used for arrhythmias that occurs less frequently. Sometimes you still cannot see an arrhythmia in a 24-hour holter so you request for loop recorder.
    ●   They press a button and the recorder is activated.
    ●      The monitor records the event for the 60 seconds prior to pushing the button and up to 40 seconds after the arrhythmia is over.
    ●      The loop recorder can store up to three events.
  • B. ecg/ekg
    ●      A device used to record the electrical activity of the myocardium of the heart on graph paper.
    ●      The picture is drawn by a computer from information supplied by the electrodes.
    ●      Used to assess your heart rhythm.
    ●      Can be used to diagnose poor blood flow to the heart muscle (ischemia)
    ●      Diagnose a heart attack, as well as abnormalities of the heart:
    →    Heart chamber enlargement
    →    Abnormal electrical conduction
  • ●      There are different models of ECG machine:
    →    Single Channel – the basic one wherein you have to change the leads as you print the electrical impulses
    →    Three channels
    →    Six channels – the latest
  • C. exercise stress test
    ●      AKA Stress Test, Exercise ECG, Treadmill Test, Graded exercise Test, Stress ECG
    ●      Provide information about how the heart responds to stress.
    ●      Involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while the electrocardiogram, heart rate and blood pressure are monitored.
  • Exercise stress test
    ●      It is used to:
    →    Determine if there is adequate blood flow to your heart during increasing levels of activity
    →    Evaluate the effectiveness of cardiac treatment plan
    →    Determine the likelihood of having coronary artery disease and the need for further testing
  • Exercise stress test
    How it’s done
    ●      The patient begins to exercise by walking on a treadmill or pedaling a stationary cycle.
    ●      The degree of difficulty is gradually increasing.
    ●      Last about 30 minutes, with the actual exercise time usually between 7 and 12 minutes.
  • Exercise stress test
    Absolute Contraindications
    ●      ECG change suggesting recent MI, severe ischemia, or another significant cardiac event
    →    e.g., patient having syncope in a normal activity
    ●      Unstable angina
    ●      Uncontrolled cardiac arrhythmias causing symptoms like dizziness, syncope, etc.
    ●      Severe symptomatic aortic stenosis
  • Exercise stress test
    Absolute contraindications
    ●      Symptomatic heart failure because the patient might collapse during the test
    ●      Pulmonary embolus or pulmonary infarction because of hypoxemia
    ●      Acute myocarditis or pericarditis
    ●      Suspected or known dissecting aneurysm
    ●      Acute systemic infection
  • Exercise stress test
    Relative contraindications
    ●      Left main coronary stenosis
    ●      Moderate stenotic valvular heart disease
    ●      Electrolyte abnormalities
    ●      Hypertension, >200/110 at rest because it might alter the result of the test
    ●      Tachyarrhythmias or bradyarrhythmias
    ●      Hypertrophic cardiomyopathy (other outflow tract obstructions)
    Neuromuscular, musculoskeletal, rheumatoid disorders exacerbated by exercise
  • Exercise stress test
    Relative contraindications
    ●      High-grade AV block
    ●      Ventricular aneurysm
    ●      Uncontrolled metabolic disease (diabetes, thyroid)
    ●      Chronic infectious disease (hepatitis)
    ●      Mental of physical impairment with inability to exercise.
  • D. laboratory Testing
    ●      CBC
    →    to check if patient is tachycardic
    →    check for anemia or any sign of infection
    ●      Lipids
    →    to check for lipidemia
    ●      Electrolytes
    →    for patients having syncope
    ●      BNP (B-type Natriuretic Peptide)
    →    for heart failure
    ●      Enzymes and Proteins
  • Cardiac Biomarkers
    • Troponin I
    • CK-MB
  • Troponin I
    ●      Sensitive and specific for cardiac damage.
    ●      Can detect an AMI shortly after onset of symptoms, thereby making it possible to provide a more timely and accurate diagnosis.
     
    Laboratory Findings
    →    Earliest increase: 4-6 hours
    →    Peak hours; 10-24 hours
    →    Duration of increase:4-7 days
    →    Sensitivity at peak >98%, Specificity: 95%
  • CK Total
    Laboratory Findings
    ●      Earliest increase: 4-8 hours
    ●      Peak hours: 24-36 hours
    ●      Duration of Increase: 36-48 hours
    ●      Specificity: 57-88%
    ●      Sensitivity at peak: 93-100%
  • CK-MB
    ●      Prior to the introduction of cardiac troponins, the biochemical marker of choice for the diagnosis of AMI was the Creatine Kinase-MB (CK-MB).
    ●      2 serial elevations above the diagnostic cut-off level or a single result more than twice the upper limit of normal.
    ●      Also exists in skeletal muscles
    ●      Fasle-positive elevations:
    →    Trauma
    →    Heavy
    →    Myopathy
  • CK-MB
    Laboratory Findings
    ●      Earliest increase: 3-4 hours
    ●      Peak hours: 15-24
    ●      Duration of Increase: 24-36 hours
    ●      Specificity- 93-100%
    Sensitivity at peak: 94-100
  • . ultrasound
    ●      Ultrasound tests are noninvasive tests which use ultrasound, or high frequency sound wave, to create graphic images of the heart's structures, pumping action, and direction of blood flow.
    ●      Ultrasound studies:
    →    Echocardiogram
    →    Dobutamine Stress Echo
    →    Transesophageal Echo (TEE)
    →    Exercise Stress Echo
  • ECHOCARDIOGRAM
    ●      An echocardiogram (often called "echo” or “2D-echo”) is a graphic outline of the heart's movement.
    ●      High frequency sound waves coming from a hand-held probe placed on the chest is used to provide images of the heart’s valves and chambers
    ●      It is used to evaluate myocardial contractility
    ●      Echo is often combined with Doppler ultrasound and color Doppler to evaluate blood flow across the heart’s valves.
  • ●      An echocardiogram is used to:
    →    assess the heart’s function
    →    determine the presence of disease of the heart muscle, valves and pericardium, heart tumors, and congenital heart disease
    →    evaluate the effectiveness of medical or surgical treatments
    →    follow the progress of valve disease
  • DOBUTAMINE STRESS ECHOCARDIOGRAM
    ●      aka Dobutamine Echo, Pharmacological Echocardiogram
    ●      The dobutamine stress echo test involves infusing a medication through an intravenous (IV) line, called dobutamine.
    ●      The dobutamine stimulates the heart and makes it “think” it is exercising.
    ●      The test is used to evaluate the heart and valvular function when the patient is unable to exercise on a treadmill or stationary cycle
  • ●      A dobutamine stress echo is used to:
    →    Determine how well the heart tolerates stress or exertion
    →    Evaluate the function of your heart and valves
    →    Evaluate the effectiveness of your cardiac treatment plan
    →    Determine the likelihood of having coronary artery disease and the need for further testing
     
  • transesophageal echocardiogram
    ●      aka TEE
    ●      The ultrasound transducer is positioned on an endoscope.
    ●      The endoscope is placed into the mouth and passed into the esophagus to provide a close look at the heart's valves and chambers without interference from the ribs or lungs.
  • ●      TEE is often combined with Doppler ultrasound and color Doppler to evaluate blood flow across the heart’s valves.
    ●      TEE is often used when the results from standard echo studies were insufficient.
  • ●      TEE is used to:
    →    Assess the overall function of the heart's chambers and valves
    →    Determine the presence of many types of heart disease (I.e. valvular/myocardial heart disease, pericardial disease, cardiac masses and congenital heart disease)
    →    Evaluate the effectiveness of medical or surgical treatments
    →    Evaluate abnormalities of the left atrium
  • exercise stress echo
    ●      The exercise stress echo test involves exercising on a treadmill or stationary cycle.
    ●      The test is used to evaluate heart and valve function at rest and with exertion
    ●      Three echo tests are obtained: baseline, during exercise, and post exercise (after resting)
    ●      An exercise stress echo is used to:
    →    Determine how well the heart tolerates activity
    →    Evaluate the function of the heart and valves
    →    Determine the likelihood of coronary artery disease
    →    Evaluate the effectiveness of a cardiac treatment plan
  • Exercise stress echo
    How it is done:
    ●      A resting ECG, resting heart rate and BP will be recorded before exercise.
    ●      A resting echo will also be performed.
    ●       The patient will exercise either on a treadmill or stationary bicycle - gradually increasing the rate of exercise.
    ●     
  • exercise stress echo
    If the patient was exercising on a bike, the echo test may be performed while the patient is still pedaling. Another echocardiogram after exercising may also be performed.
    ●      If exercise was on a treadmill, the patient will return to the table to lie down for another echo.
    ●      The appointment takes about 60 minutes.
    ●      The actual exercise time is usually between 7 and 12 minutes.
  • radiographic tests
    ●      Radiographic tests are noninvasive tests which use x-ray machines or specialized equipment with computer technology to create pictures of the internal structures of the chest.
    ●      Radiographic studies:
    →    Calcium-score screening
    →    Cardiac CT
    →    Chest x-ray
    →    MRI
  • Calcium-score screening heart scan
    ●      A test used to detect calcium deposits found in atherosclerotic plaque in the coronary arteries.
    ●      CT methods are the most sensitive approaches to detecting coronary calcification from atherosclerosis, before symptoms develop.
    ●      Higher coronary calcium means more coronary atherosclerosis, suggesting a greater likelihood of significant narrowing somewhere in the coronary system and a higher risk of future cardiovascular events
  • invasive tests
    ●      Invasive tests involve inserting catheters into the blood vessels of the heart in order to get a closer look at the coronary arteries or to stimulate and test the electrical system of the heart.
    ●      Invasive tests:
    →    Carotid Angiography
    →    Cardiac Catheterization
    →    Electrophysiology Study
    →    Intravascular Ultrasound
    →    Myocardial Biopsy
  • Contrast dye is injected through the catheter and radiographic images of the carotid arteries are taken and evaluated.
  • ●      Carotid angiography is used to:
    →    evaluate or confirm the presence of narrowing or blockage in carotid arteries
    →    determine risk for future stroke
    →    determine the need for further treatment (angioplasty or surgery)
  • carotid angiography
    How it is done:
    ●      A plastic introducer sheath (a short, hollow tube through which the catheter is placed) is inserted in a blood vessel in the arm or groin. A catheter is inserted through the sheath and threaded to the arteries of the neck (right and left carotid artery).
    ●      When the catheter is in place, contrast material will be injected. The contrast material outlines the vessels.
  • B. CARDIAC CATHETERIZATION
    ●      An invasive imaging procedure that involves inserting a catheter into a blood vessel in the arm or leg, and guiding it to the heart with the aid of a radiographic imaging machine.
    ●      Contrast dye is injected through the catheter so that the valves, coronary arteries and heart chambers are can be visualized.
  • ●      Cardiac catheterization is used to:
    →    evaluate or confirm the presence of heart disease (such as coronary artery disease, valve disease or disease of the aorta)
    →    evaluate heart muscle function
    →    determine the need for further treatment (angioplasty or bypass surgery)
     
  • INTRAVASCULAR ULTRASOUND (IVUS)
    ●      An invasive procedure, performed along with cardiac catheterization.
    ●      A miniature sound probe (transducer) on the tip of a coronary catheter is threaded through the coronary arteries and, using high-frequency sound waves, produces detailed images of the interior walls of the arteries.