262.2 📚 國考版

262.2.0.1 必背 — Cardiac CT

262.2.0.1.0.1 CAC Score
  • CAC 0: very low risk → consider deferring statin
  • CAC > 100: high risk → statin + prevention
  • Intermediate ASCVD risk (10-20%): best use of CAC for decision
262.2.0.1.0.2 CCTA
  • High sensitivity (95%+) for CAD
  • High NPV (rules out CAD)
  • First-line low-intermediate risk (2024 ESC)
  • Limited by severe calcification + high HR

262.2.0.2 必背 — Cardiac MRI Indications

  • Cardiomyopathy (DCM, HCM, RCM, ARVC, amyloid, sarcoid, Fabry, hemochromatosis)
  • Myocarditis (Lake Louise criteria)
  • Viability assessment (LGE > 50% = non-viable)
  • Congenital heart disease
  • Cardiac masses
  • Pericardial disease

262.2.0.3 必背 — LGE Patterns

Pattern Disease
Subendocardial CAD-distribution Infarction
Mid-wall septal/lateral DCM
Patchy mid-wall Sarcoidosis
Epicardial / subepicardial Myocarditis
Subendocardial circumferential + atrial + RV Amyloidosis
Septal junction HCM
Sub-tricuspid (free wall) ARVC

262.2.0.4 必背 — Nuclear Cardiology

  • SPECT: stress + rest perfusion; reversible (ischemia) vs fixed (scar) defects
  • PET: higher resolution + coronary flow reserve; better for obese
  • FDG-PET: cardiac sarcoidosis (active inflammation)
  • PYP / HMDP: ATTR amyloidosis (sensitive + specific with negative FLC)

262.2.0.5 必背 — Viability Assessment

  • FDG-PET mismatch (perfusion ↓ + FDG uptake ↑) = hibernating myocardium (will recover with revascularization)
  • Cardiac MRI: LGE > 50% wall thickness = non-viable

262.2.0.6 必背 — Stress Imaging Selection

  • Stress echo: can’t exercise; intermediate-high pretest probability
  • Stress MPI / PET: similar; particularly for obese / specific clinical questions
  • Stress MRI: specific scenarios; no radiation

262.2.0.7 必背 — Modalities for Specific Diseases

  • CAD: stress test (echo, MPI, PET) → coronary angiography
  • Cardiomyopathy: CMR (LGE pattern) + PET for sarcoid + PYP for amyloid
  • Aortic dissection: CTA gold standard
  • PE: CTPA
  • Cardiac mass: CMR
  • Pericardial disease: CMR or echo

262.2.0.8 必背 — 2024 ESC Chest Pain Guidelines

  • Acute / chronic low-intermediate risk: CCTA first-line
  • Higher pretest probability: stress imaging
  • High pretest / refractory: coronary angiography