ECHO- Hemodynamic Stress Echo for Structural Heart Disease Flashcards
Use of stress echo in native valve disease
- Asymptomatic AS
- low flow, low gradient AS on DSE
- mitral stenois
-MR (organic./ischemia)
SAM Mediated/LVOTO - Aortic Regurgitation
- multivalvular heart disease
Indication for Stress echo in valve disease
see pic
Methods in Stress echo in VHD?
Exercise (treadmill, semi recumbent bicycle
Preferred Method in Stress echo in VHD?
(treadmill, semi recumbent bicycle, pharmacologic)
treadmill - HCM, diastolic dysfunction and constriction
semi-recumbent bicycle - for valve except for LFLG AS
pharmacologic - LFLG AS
reason for doing stress echo in high gradient AS
to unmask symptoms
reason for doing stress echo in LFLG AS
to differentiate true vs pseudo-severe AS
assess contractile reserve
preferred method: bicycl e
reason for doing stress echo in paradoxical LFLG AS and preserved EF
to differentiate true vs pseudo-severe AS
What do we look for in stress echo in asymptomatic severe AS?
- increase MG ≥18-20mmHG
- decrease LV systolic function
- lack of LV functional reserve
- SPAP > 60mmHg
high risk maker to develop cardiac event
Effect of dobutamine stress echo in LFLG AS if it is true or pseudo-severe AS?
in TRUE AS
- increase in SV by ≥20%
- increase in transvalvular gradient
- no change in calculated AVA or AVA remains in severe range
in Pseudo-severe AS
- increase in SV by ≥20%
- increase of AVA above 1.0
- no significant change in transvalvular gradient
what if DSE is inconclusive/indeterminate in LFLG AS?
suggest noncontrast Aortic valve calcium assessment
what is paradoxical LFLG AS?
see pic
Role of DSE in Severe AS: HG AS, LFLF AS, equivocal DSE
see pic
Indication of stress echo in hemodynamically significant Mitral stenosis
three indications in MS
stress echo findings/change in significant MS:
stress echo findings/change in significant MS:
MVA remains the same but there is increase transmitral gradient -> increase LAP -> increase PAP
cut off:
exercise MG > 18mmHg (>20mmHg in dobutamine)
exercise SPAP >60 mmHg
(+) Pulmonary edema on Lung USD
Indication for stress echo in HCM
Class IIa - in symptomatic patients if bedside maneuvers (Valsalva) fail to induce LVOTO ≥50 mmHG.
exercise method if preferred
what to look in stress echo in HCM?
see pic
how many repetitions in Squat-to-stand maneuvers in stress echo for HCM?
5-10 repititions
stress echo for HCM, better in postprandial or on NPO?
better in postprandial, there is pooling of blood in splanchnic circulation -> decrease CO->easy to provoke gradient
stress echo cut off values associated with clinical significance, outcomes or limited response to therapy?
see pic
