Guide for Week 3 Quiz – Study the following:
1) Women and assessing by procedures for CAD - ACC guidelines do not recommend stress tests
for asymptomatic patients unless women are 55 years> , is sedentary & wishes to begin
exercising aggressively; For women who are symptomatic but who have a normal resting ECG
recording, good exercise tolerance, and no coronary risk factors, an exercise stress test is
appropriate; diagnostic imaging is not recommended for low-risk women who are
asymptomatic; For women who are symptomatic and have known CAD, an abnormal resting
ECG recording, questionable exercise tolerance, or coronary risk factors such as diabetes or
peripheral arterial disease, stress test imaging is recommended.
The burden of coronary artery disease (CAD) in women is significant. In spite of increasing uses of
noninvasive testing, coronary angiography remains the gold standard in the diagnosis and assessment of
CAD. Since gender differences exist in the clinical presentation of CAD and in the sensitivity and
specificity of noninvasive testing, coronary angiography remains an invaluable tool in providing diagnostic
and prognostic information in women.
2) Changes that occur in an ECG that demonstrate ischemia late in the ischemic cascade - Typical
ECG changes of ischemia result, although the ST-segment and T-wave changes that are central
to demonstration of ischemia occur relatively late in the ischemic cascade; The hypoperfusion
produces first diastolic, and then systolic dysfunction, with characteristic signs and symptoms of
chest pain; Various imaging modalities that can be used as adjuncts to the graded exercise test
can be viewed in the context of the ischemic cascade.
3) Understand the terms: Specificity and Sensitivity and an exercise echocardiography 2DE -
Current data suggest that adjunctive echocardiographic imaging enhances the sensitivity and
specificity of CAD detection to an extent comparable to that provided by nuclear techniques.
Another study found the sensitivity of dobutamine stress 2DE to be comparable to that
of dobutamine single-photon emission CT (85% versus 80%, respectively). The
specificity of the two techniques was also comparable (82% versus 74%, respectively), as
were the predictive values.
Sensitivity – percentage of people with disease who test positive
Spcificity – percentage of people without disease who test negative
4) What part of Medicare covers inpatient hospital services - Part A – paid through federal payroll
taxes – Covers inpatient hospital services as well as some post-hospital nursing care & home
health care
, 5) Stress-induced ischemia – ETT increase workload incrementally to induce ischemia or until a
predetermined workload is reached
Recent evidence, particularly from the Women's Ischemia Syndrome Evaluation study, a
multicenter study sponsored by the National Heart, Lung, and Blood Institute, has
demonstrated that many women without obstructive CAD continue to have symptoms and a
poor quality of life. Many of these women have evidence of stress-induced ischemia, which is
likely to be related to endothelial dysfunction of the microvasculature.
6) How does an echocardiogram enhance a standard ETT - The ETT is typically adequate as a
means of observing disease progression for purposes of prognostication and timing of
revascularization procedures. However, with respect to the delineation of damaged myocardial
regions and residual myocardial viability in zones of prior injury, it has become clear that
adjunctive radiopharmaceutical or cardiac ultrasound imaging substantially improves test
sensitivity and specificity. The 2DE (Two-Dimensional Exercise Echocardiography)
evidence for ischemia includes an abnormal left ventricular ejection fraction (LVEF)
response to exercise or the development of regional wall motion abnormalities. The
exercise is performed with a bicycle or treadmill, and dobutamine is the most common
pharmacologic agent used simultaneously with the echocardiography imaging. The
image quality may be enhanced by the injection of echogenic microbubbles.
7) Term used for the encouragement of patients to be active in their own healthcare - Patients are
empowered to research their disorders, to ask questions, and to dialogue with others
about their symptoms and possible treatments. This empowerment has engaged
patients in their own health, enabling a partnership with their primary care provider.
8) Women and symptoms of CAD - Women have different patterns of CAD and different
responses to cardiac testing. This disorder is not diagnosed expeditiously; Women are more
likely to have non-obstructive or single-vessel disease which decreased diagnostic accuracy of
stress testing; Single-photon emission CT imaging is technically limited in women because
breast tissue and smaller coronary artery size; Many of these women have evidence of stress-
induced ischemia, which is likely to be related to endothelial dysfunction of the
microvasculature; if the woman has diabetes and peripheral arterial disease are CAD risk
equivalents
9) A negative ETT - when 85% of age predicted maximum heart without inducible ischemic –
Maximum heart rate = 220-age
10) Physiological changes that occur during a routine ETT - The primary goal of the ETT is to
increase workload incrementally to induce ischemia or until a predetermined workload is
reached.
11) The agent is most commonly used to administer an ETT - bicycle & treadmill
12) The meaning of an ST segment elevation during an exercise stress test - + for L. coronary artery
or reflects acute thrombotic coronary stenosis occlusion; ST elevated after MI – terminate
exercise
1) Women and assessing by procedures for CAD - ACC guidelines do not recommend stress tests
for asymptomatic patients unless women are 55 years> , is sedentary & wishes to begin
exercising aggressively; For women who are symptomatic but who have a normal resting ECG
recording, good exercise tolerance, and no coronary risk factors, an exercise stress test is
appropriate; diagnostic imaging is not recommended for low-risk women who are
asymptomatic; For women who are symptomatic and have known CAD, an abnormal resting
ECG recording, questionable exercise tolerance, or coronary risk factors such as diabetes or
peripheral arterial disease, stress test imaging is recommended.
The burden of coronary artery disease (CAD) in women is significant. In spite of increasing uses of
noninvasive testing, coronary angiography remains the gold standard in the diagnosis and assessment of
CAD. Since gender differences exist in the clinical presentation of CAD and in the sensitivity and
specificity of noninvasive testing, coronary angiography remains an invaluable tool in providing diagnostic
and prognostic information in women.
2) Changes that occur in an ECG that demonstrate ischemia late in the ischemic cascade - Typical
ECG changes of ischemia result, although the ST-segment and T-wave changes that are central
to demonstration of ischemia occur relatively late in the ischemic cascade; The hypoperfusion
produces first diastolic, and then systolic dysfunction, with characteristic signs and symptoms of
chest pain; Various imaging modalities that can be used as adjuncts to the graded exercise test
can be viewed in the context of the ischemic cascade.
3) Understand the terms: Specificity and Sensitivity and an exercise echocardiography 2DE -
Current data suggest that adjunctive echocardiographic imaging enhances the sensitivity and
specificity of CAD detection to an extent comparable to that provided by nuclear techniques.
Another study found the sensitivity of dobutamine stress 2DE to be comparable to that
of dobutamine single-photon emission CT (85% versus 80%, respectively). The
specificity of the two techniques was also comparable (82% versus 74%, respectively), as
were the predictive values.
Sensitivity – percentage of people with disease who test positive
Spcificity – percentage of people without disease who test negative
4) What part of Medicare covers inpatient hospital services - Part A – paid through federal payroll
taxes – Covers inpatient hospital services as well as some post-hospital nursing care & home
health care
, 5) Stress-induced ischemia – ETT increase workload incrementally to induce ischemia or until a
predetermined workload is reached
Recent evidence, particularly from the Women's Ischemia Syndrome Evaluation study, a
multicenter study sponsored by the National Heart, Lung, and Blood Institute, has
demonstrated that many women without obstructive CAD continue to have symptoms and a
poor quality of life. Many of these women have evidence of stress-induced ischemia, which is
likely to be related to endothelial dysfunction of the microvasculature.
6) How does an echocardiogram enhance a standard ETT - The ETT is typically adequate as a
means of observing disease progression for purposes of prognostication and timing of
revascularization procedures. However, with respect to the delineation of damaged myocardial
regions and residual myocardial viability in zones of prior injury, it has become clear that
adjunctive radiopharmaceutical or cardiac ultrasound imaging substantially improves test
sensitivity and specificity. The 2DE (Two-Dimensional Exercise Echocardiography)
evidence for ischemia includes an abnormal left ventricular ejection fraction (LVEF)
response to exercise or the development of regional wall motion abnormalities. The
exercise is performed with a bicycle or treadmill, and dobutamine is the most common
pharmacologic agent used simultaneously with the echocardiography imaging. The
image quality may be enhanced by the injection of echogenic microbubbles.
7) Term used for the encouragement of patients to be active in their own healthcare - Patients are
empowered to research their disorders, to ask questions, and to dialogue with others
about their symptoms and possible treatments. This empowerment has engaged
patients in their own health, enabling a partnership with their primary care provider.
8) Women and symptoms of CAD - Women have different patterns of CAD and different
responses to cardiac testing. This disorder is not diagnosed expeditiously; Women are more
likely to have non-obstructive or single-vessel disease which decreased diagnostic accuracy of
stress testing; Single-photon emission CT imaging is technically limited in women because
breast tissue and smaller coronary artery size; Many of these women have evidence of stress-
induced ischemia, which is likely to be related to endothelial dysfunction of the
microvasculature; if the woman has diabetes and peripheral arterial disease are CAD risk
equivalents
9) A negative ETT - when 85% of age predicted maximum heart without inducible ischemic –
Maximum heart rate = 220-age
10) Physiological changes that occur during a routine ETT - The primary goal of the ETT is to
increase workload incrementally to induce ischemia or until a predetermined workload is
reached.
11) The agent is most commonly used to administer an ETT - bicycle & treadmill
12) The meaning of an ST segment elevation during an exercise stress test - + for L. coronary artery
or reflects acute thrombotic coronary stenosis occlusion; ST elevated after MI – terminate
exercise
