24 Questions
What defines myocardial injury in the context of acute coronary syndrome?
Troponin level above the 99th percentile without evidence of myocardial ischemia
What characterizes Type 2 myocardial infarction?
Supply-demand mismatch that is not atherothrombosis
What is the most common cause of Type 2 myocardial infarction?
Sepsis/infection
What is the purpose of rotating the probe 90° in the 5-chamber view?
To visualize the inferior vena cava (IVC) and assess volume status and right atrial (RA) pressure
What does the LV internal diameter in diastole (LVIDd) measure?
LV internal diameter at rest
What does an abnormal septal motion indicate?
Constrictive pericarditis
What does the diameter and respiratory variation of the IVC provide an estimate of?
Volume status and right atrial (RA) pressure
What is the preferred treatment approach for STEMI without cardiogenic shock?
Complete revascularization strategy
Which condition warrants culprit-lesion only PCI for STEMI?
STEMI with cardiogenic shock
What is the preferred treatment for 3VD, L main disease, 2VD with prox LAD stenosis or EF<40%?
CABG
What is assessed during Left Heart Catheterization?
Coronary anatomy/lesions and performs PCI
What does Right Heart Catheterization assess?
Hemodynamics, cardiac biopsies, and CO
What should be the approach for intermediate risk patients in terms of invasive procedures?
Delayed invasive approach within 72h
Which modality is preferred over pharmacologic testing if the patient can reach goal exertion?
Exercise Tolerance Test (ETT)
What diagnostic criteria are used for exercise stress testing?
Reaching >85% max-predict HR, peak double product >20k, and HR recovery >12
Which imaging modality is used to determine the viability of ischemic myocardial tissue?
SPECT
What is the indicated use of Coronary CTA?
To evaluate the presence and extent of CAD
What do Cardiac MRI assess primarily?
The functional and tissue properties of the heart
What are the stress testing modalities mentioned in the text?
Exercise, vasodilator, inotropy
Which diagnostic criteria are used for exercise stress testing?
>85% max-predict HR, peak double product >20k, HR recovery >12
What is the preferred stress testing modality if the patient can reach goal exertion?
Exercise Tolerance Test (ETT)
Which modality is used for viability testing to determine the viability of ischemic myocardial tissue?
SPECT
What does rest imaging include for evaluating the presence and extent of CAD?
Coronary CTA
What is indicated for low to moderate risk patients to evaluate the presence and extent of CAD?
Coronary CTA
Study Notes
Non-Invasive Cardiac Testing Overview
- Stress testing modalities include exercise (treadmill), vasodilator (adenosine, regadenoson), and inotropy (dobutamine).
- Imaging modalities for stress testing include ECG, TTE, SPECT, PET, and MRI.
- Exercise Tolerance Test (ETT) is preferred over pharmacologic testing if the patient can reach goal exertion.
- Diagnostic criteria for exercise stress testing include reaching >85% max-predict HR, peak double product >20k, and HR recovery >12.
- Pharmacologic stress tests are used for imaging only and involve choosing agents like adenosine/regadenoson or dobutamine.
- Viability testing is used to determine the viability of ischemic myocardial tissue and involves SPECT, PET, TTE, or MRI.
- Rest imaging includes the use of coronary CTA to evaluate the presence and extent of CAD.
- Coronary CTA should not be used to screen asymptomatic patients and is indicated for low to moderate risk patients.
- Coronary Artery Calcium (CAC) scans provide risk assessment scores for CAD and ASCVD risk stratification.
- Cardiac MRI is the modality of choice for assessing the functional and tissue properties of the heart.
- Different echocardiography views, such as parasternal long axis, apical 4 chamber, and parasternal short axis, are used to assess various aspects of cardiac function and anatomy.
- Echocardiography helps in assessing LV size, function, wall thickness, MV/AoV function/flow, RV/LV size, function, thrombus, septal size/motion, and pericardial effusion.
Test your knowledge of cardiology and cardiac catheterization with this summary quiz covering topics such as chest pain evaluation, cardiac catheterization procedures, and non-invasive cardiac testing modalities.
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