Cardiac and Pulmonary Testing Module 1

What consists of a medical workup?

Patient Interview
Physical Examination
Chest X-ray
ECG
Echocardiogram
Lab Tests

What are some examples of Non-Invasive Imaging?

CT
MRI
ECHO (TTE)
Holter Monitoring
Event Monitoring
ECG
Exercise Stress Test
Carotid Ultrasound

What are the two types of ECHO?

Transthoracic Echo (TTE)
Transesophageal Echo (TEE)

What is a Holter Monitor?

A small chest device that continuously monitors heart rate and rhythm. Patients keep a journal of symptoms to correlate with the recorded data

How does a Holter Monitor help clinicians?

Clinicians interrogate the monitor and compare readings to the patient’s symptom log to identify abnormal heart rhythms

What is an Event Monitor?

A device that is patient-activated to record heart rhythm only when symptoms occur

What is a limitation of Event Monitors?

They wont capture asymptomatic events, such as silent arrhythmias and showering can disrupt the device

Where are Holter and Event Monitors typically used?

In outpatients settings or at home, for periods ranging from 24-48 hours up to a week, as recommended by a cardiologist

What is an Electrocardiogram (ECG)?

A test where electrodes on the chest record heart’s electrical activity, commonly using 3, 5 or 12 leads

What can an ECG diagnose?

Arrhythmias, myocardial infarctions, or previous MI’s

What is an exercise stress test?

Outpatient test where the patient is hooked to an ECG and exercises to assess heart function under stress

What is the purpose of a stress test?

To see how heart rhythm or ECG changes with activity and detect exercise-induced ischemia or arrhythmias

What is a carotid ultrasound used for?

To examine blood flow through the carotid arteries, especially after stroke, TIA or syncopal episodes

How does a carotid ultrasound inform treatment?

Helps determine if a patient needs surgery, medication or further monitoring

What are some examples of Nuclear Imaging?

Contrast Dye Injected
SPECT
PET Scan

What does a SPECT do?

Test that creates 3D pictures of blood flow and function inside organs, helping to evaluate myocardial perfusion

What is a PET Scan?

Test that shows how cell activity of living tissue

What is a Transthoracic Echocardiogram (TTE)?

Non-invasive ultrasound test where gel is applied to the chest wall to visualize the heart and lungs

What cardiac functions can TTE assess?

Valve function, ventricular performance, filling pressures, ejection fraction, stroke volume and cardiac output

How does TTE evaluate myocardial structure?

Measures wall thickness, ventricular size and wall motion, and can detect thrombi in the heart

Why is identifying a thrombus important in TTE?

Determines whether the thrombus is stable or unstable, influences return-to-work decisions, and guides intervention or medication management

What is a Transesophageal Echocardiogram (TEE)?

A minimally invasive echocardiogram performed with light sedation that provides better visualization of heart structures, especially valves

When is a TEE typically used?

To visualize valve vegetation, monitor post-valve replacement, or evaluate areas not well seen on TTE

What is the main advantage of TEE over TTE?

Better imaging resolution for structures like the mitral valve and areas difficult to see via TTE

What is a CT Angiography?

A non-invasive CT scan using contrast dye to create detailed images of blood vessels to reveal blockages of coronary arteries, or other abnormalities

True or False: A CT Angiography is suitable for kidney patients?

False; the contrast dye can worsen pre-existing kidney issues

What is a Cardiac Catheterization (Angiogram)?

Invasive procedure where a catheter is passed into the heart to diagnose and treat heart problems

What is the Gold standard test for evaluating perfusions?

Cardiac Catheterization (Angiogram)

For a Cardiac Catheterization (Angiogram), what are some entry points for the catheter? Right vs Left Side Heart.

Right-sided through Subclavian vein
Left-sided through femoral artery, brachial artery or radial artery

After an Angiogram catheterization, what steps are done for the patient?

Immediate pressure to the site for 20 minutes (sandbag), then the patient is on bedrest for 4-6 hours after. The extremity must remain straight and motionless. The bed is placed at reverse Trendelenburg at 30 degrees

What are some reasons a CT may be ordered?

PE
Masses, tumors, cysts
Pneumonia
Bronchiectasis

What are some reasons a PET Scan may be ordered?

Stage tumors
Identify COPD, ARDS, and IPF

What is the first-line test in diagnosis for pulmonary hypertension

TTE

What side of the heart does a TTE evaluate?

Right side

What are some things a TTE evaluates?

Pulmonary artery enlargement
Respiratory muscle function
Diaphragm thickness

What does a Ventilation-Perfusion (V/Q) scan or SPECT Imaging diagnose?

Pulmonary Embolism

What is a Ventilation Perfusion?

Injection of radioactive tracer

What is a Ventilation Scan?

Inhalation of radioactive gas

What is a Dynamic MRI used for?

To study the biomechanical function of the diaphragm and chest wall

What is a Perfusion MRI used for?

Checking perfusion of the lungs

What is an MR Angiography used for?

Contrast agent to diagnose a PE

Why is a CT Angiography often better than an MR Angiography?

A CTA provides anatomical information much quicker than an MRA

What is the Gold Standard for diagnosis of PE and Pulmonary Hypertension?

Catheter Pulmonary Angiography

How is a Catheter Pulmonary Angiography placed into the R heart?

Through the pulmonary artery

What is a Bronchoscopy?

Invasive test where a tube is inserted into the trachea to allow for direct visualization of the trachea and the subdivisions. Secretions can also be removed for evaluation.