Procedures: Cardiac (12.5%)

ARRT-N · 37 questions

• A patient with heart failure and a reduced ejection fraction is scheduled for Tc-99m PYP imaging to evaluate for transthyretin cardiac amyloidosis. The cardiologist wants myocardial retention graded about one hour after injection, and department protocol requires cross-sectional imaging to keep blood pool activity out of that grade. The patient has eaten breakfast and taken the usual morning medications. Which acquisition plan best completes this amyloid study?
• A 66-year-old scheduled for a same-day Tc-99m sestamibi rest and stress study cannot walk a treadmill because of hip pain and takes theophylline daily for asthma. The protocol requires a higher activity at stress than at rest. Which stress agent and injection pattern fits this patient?
• A patient with severe persistent asthma has suspected coronary artery disease, cannot exercise because of severe osteoarthritis, and the department stocks only Tc-99m perfusion agents. Which stress agent and radiopharmaceutical pairing should be selected?
• A technologist starts a gated SPECT myocardial perfusion acquisition and sees the cycle-length histogram spread widely instead of clustering around one R-R interval; the chest leads were applied over lotion, and the study must finish before the stress lab opens. Which correction should the technologist make before restarting the gated acquisition?
• On a rest and stress myocardial perfusion study, the inferior wall shows reduced tracer uptake on both acquisitions, all frames passed the motion check, and the gated frames show that same segment contracting poorly. Which pathophysiologic explanation best accounts for this pattern?
• A patient with a fixed perfusion defect on rest sestamibi images is being evaluated for revascularization, so cardiology orders FDG viability imaging for the afternoon. The patient's last meal was at noon and blood glucose was drawn then. Which preparation should the technologist arrange before the FDG injection to judge myocardial viability?
• A patient checks in for a vasodilator stress myocardial perfusion study at an outpatient clinic. The patient had caffeinated coffee at breakfast, uses an albuterol inhaler for mild asthma, and takes metformin for type 2 diabetes. The order specifies regadenoson as the stress agent. Which preparation step must be completed before the regadenoson injection proceeds?
• An outpatient scheduled for rest and stress myocardial perfusion imaging cannot use the treadmill because of severe leg pain, and the nurse hears audible wheezing before the stress phase begins. The patient is otherwise stable and ready to proceed today. Which stress approach should the team use for this study?
• A patient with an old anterior infarct, an ejection fraction of 35% and recurring chest pain is being considered for revascularization. The team must distinguish hibernating muscle from scar, compare flow and metabolism in the same walls, and use a controlled myocardial FDG preparation with a documented glucose value. Which myocardial viability plan meets those requirements?
• Myocardial tracer uptake rises with regional coronary blood flow, so perfusion imaging compares stress uptake with rest uptake. A defect with reduced stress uptake and normal rest uptake in the anterior septum and apex, with the inferior and lateral walls normal, is reversible. Which pathophysiology statement best explains that pattern?
• A cardiologist requests noninvasive confirmation of cardiac transthyretin amyloidosis in an older adult with heart failure and preserved ejection fraction. The report must grade myocardial uptake against rib uptake while separating activity from overlying bone and blood pool, and the visit must use the right patient preparation. Which amyloid imaging plan best satisfies these requirements?
• A patient arrives for adenosine stress myocardial perfusion imaging after drinking coffee this morning. Rest images are complete, the patient feels well, and vital signs are normal. Which step best handles the caffeine before the pharmacologic stress phase?
• A patient arrives for a vasodilator stress myocardial perfusion study having just finished a caffeinated drink, and the rhythm review shows frequent premature beats. The final data set has to support both perfusion images and gated volumes with an ejection fraction. Which combined preparation and gating plan keeps both parts of the study valid?
• On a myocardial perfusion study the reduced tracer uptake sits in the inferior wall of the left ventricle on both stress and rest images, while the other walls fill normally. Which coronary artery most commonly supplies the territory where the uptake is reduced?
• A patient with a calcified, narrowed aortic valve and worsening exertional dyspnea is scheduled for stress myocardial perfusion imaging. Cardiology documents pressure overload across the valve. Which left ventricular geometry is the expected adaptation to that load?
• A patient with severe left ventricular dysfunction is referred for F-18 FDG myocardial viability imaging after a fixed defect appeared on a perfusion study. The protocol requires an overnight fast, a glucose check, and glucose loading before injection. Which patient preparation plan best supports this viability protocol?
• A 59-year-old with severe persistent asthma is referred for myocardial perfusion imaging after exertional chest tightness. He cannot reach the target heart rate on the treadmill, and the study will be a gated rest and stress SPECT. Which stress agent paired with Tc-99m sestamibi best fits this patient?
• A 69-year-old with heart failure and suspected cardiac amyloidosis is injected with Tc-99m PYP. At 1 hour, planar images show activity over the left heart with blood pool, sternum, and ribs overlapping, plus a bright liver. The reader must rule out blood pool before calling the study cardiac. Which acquisition best proves the uptake is truly myocardial?
• A patient with an akinetic inferior wall after an old infarction is being evaluated for revascularization. The cardiologist wants resting perfusion and myocardial metabolism compared within a single session so hibernating tissue can be identified, and the metabolic preparation has already started. Which viability protocol plan best meets those requirements?
• During a myocardial perfusion study, the stress images show reduced tracer uptake limited to the anterior wall, and the rest images taken the next day show that same wall taking up tracer normally. Which combination of coronary supply and flow physiology explains this stress-to-rest difference?
• A 61-year-old with exertional chest pressure is booked for a one-day rest and stress myocardial perfusion study with Tc-99m sestamibi, because the cardiology clinic can see the patient only once this week. Rest images are acquired first, and the patient returns the same afternoon for a treadmill stress stage with a second injection. Which injection sequence and relative activity fits this one-day sestamibi protocol?
• A 74-year-old with fatigue, a history of bilateral carpal tunnel release, and preserved ejection fraction is scheduled for Tc-99m PYP imaging to evaluate suspected cardiac amyloidosis. Renal clearance and background activity both influence how clearly myocardial uptake appears. Which preparation instruction matches current published guidance for this study?
• A patient with a markedly reduced ejection fraction and a large prior infarct is being evaluated for revascularization, and the cardiologist needs proof that the poorly contracting territory still holds living muscle. The patient cannot complete treadmill exercise. Which viability protocol should be planned?
• A patient is booked for a vasodilator-stress myocardial perfusion SPECT study to evaluate chest pain, with ECG gating planned for both rest and stress acquisitions. The patient fasted as instructed but mentions having a cup of coffee shortly before arriving. Which preparation decision keeps the stress portion of the study valid?
• A patient with heart failure and a healed anterior infarct is scheduled for Tc-99m PYP scintigraphy for suspected ATTR cardiac amyloidosis. The protocol already includes planar imaging plus SPECT, but the requisition arrives without any laboratory studies and orders an overnight fast with insulin held for a same-day FDG comparison. Which preparation is required before this PYP study can be interpreted as supporting ATTR cardiac amyloidosis?
• A 74-year-old with HFpEF and concentric LV wall thickening is referred for Tc-99m PYP imaging to evaluate suspected ATTR cardiac amyloidosis. Serum and urine monoclonal studies are negative and kidney function is stable. The laboratory's protocol starts with a 1-hour acquisition. Which acquisition plan best separates true myocardial retention from residual blood-pool activity?
• An outpatient arrives for an equilibrium gated blood pool study to evaluate ventricular function. The department uses the modified in vivo-in vitro red blood cell labeling method (stannous pyrophosphate pretreatment, then blood withdrawn for ex vivo technetium incubation), and the patient is at the first step of the prep sequence. Which preparatory step must be completed before the blood sample is drawn for labeling?
• A 64-year-old with new exertional chest pain completes a two-day stress myocardial perfusion study. The raw data show sharp motion-free frames, and the lateral wall takes up less tracer at peak stress but fills in completely on the next morning's resting images. The cardiologist asks what that change means for the muscle. Which myocardial pathophysiology best explains the pattern?
• A patient with severe COPD but no active wheezing reaches only a low heart rate on the treadmill and wants to avoid a long infusion, so the cardiologist plans vasodilator pharmacologic stress with Tc-99m sestamibi imaging. Which stress agent and administration plan best fits this patient?
• A patient with severe left ventricular dysfunction after an anterior infarction is being evaluated for bypass surgery, and the heart team must separate hibernating myocardium from dense scar. The patient cannot exercise, and the study must supply perfusion and metabolic information in the same session so the mismatch pattern can be read. Which viability protocol should be planned?
• A patient with severe asthma after a recent wheezy flare needs a rest and stress myocardial perfusion study, and a painful hip rules out treadmill exercise. The department runs a one-day Tc-99m sestamibi protocol in which stress activity exceeds rest activity. Which combination of radiopharmaceutical, activity pattern and stress agent best fits this patient?
• A gated rest SPECT reports that most beats were rejected and gives an implausible ejection fraction. The patient has frequent premature contractions, caffeine abstention was followed, and the cardiologist needs a dependable ejection fraction. Which acquisition change best improves this gated study?
• A patient is lying still for a gated blood pool study, but the acquisition display shows most heartbeats being rejected, and the ECG trace on the monitor looks small and noisy. The detector is centered over the heart and the patient has removed all jewelry from the chest. Which action will most likely produce a properly synchronized gated acquisition?
• A 58-year-old with exertional chest discomfort undergoes gated myocardial perfusion SPECT. The rest study shows a fixed perfusion defect with akinesis of the anterior wall and mid septum, while the lateral and inferior walls show normal uptake and normal thickening. Which coronary artery territory best explains this regional wall abnormality?
• A patient with stable angina is scheduled for myocardial perfusion imaging today. Severe knee osteoarthritis rules out walking on a treadmill, and the chart documents physician-diagnosed asthma with active wheezing today. Resting rhythm is sinus with normal blood pressure. Which stress agent best fits this perfusion study?
• A 68-year-old with heart failure and suspected cardiac amyloidosis shows clear myocardial tracer uptake on Tc-99m PYP imaging, and SPECT confirms that the uptake sits in the myocardium rather than in the blood pool at one hour. The cardiology team wants a noninvasive confirmation of the amyloid type before therapy starts. Which evaluation must be completed before the study is attributed to ATTR?
• A patient with an akinetic inferior wall and a severely reduced ejection fraction is being evaluated for revascularization, and the cardiology team needs to know whether the resting defect is scar or hibernating myocardium. The nuclear medicine staff must pick a protocol that answers that viability question during a single visit. Which single-visit imaging protocol best answers the viability question?