Patient Care, Exam Set Up & Safety

Question 1

An outpatient is in the Echo Lab for a TEE exam. What position should the patient be in prior to the physician inserting the probe?

Answer 1

For outpatients undergoing a TEE exam the best position is the left lateral decubitus

Question 2

Name four contraindications for stress echocardiograms.

Answer 2

Four contraindications for performing an exercise stress echocardiogram are:

• unstable angina
• recent acute myocardial infarction
• aortic stenosis
• acute aortic dissection

Question 3

How would you position a patient who has aortic stenosis in order to use the PEDOF (nonimaging) probe along the right sternal border?

Answer 3

The patient should be rolled up into the right lateral decubitus position in order to optimize the Doppler spectral trace from the right sternal border

Question 4

What advantage does exercise echocardiography have over regular exercise electrocardiography in detecting coronary artery disease?

Answer 4

In detecting single vessel coronary artery disease, regular exercise electrocardiography (ECG) has a sensitivity of about 60%.

In comparison, exercise echocardiography has a sensitivity and specificity of about 90%. In patients with multivessel coronary disease, this method’s sensitivity is even greater.

Question 5

What are four indications for performing an exercise stress echocardiogram?

Answer 5

Four indications for performing an exercise stress echocardiogram are:

• aid in the diagnosis of chest pain
• determine the severity of coronary disease
• guide post MI rehab
• evaluate exercise induced arrhythmias

Question 6

Is echocardiography the best noninvasive diagnostic technique for evaluating pericardial thickening?

Answer 6

Echocardiography is neither sensitive nor specific in the diagnosis of pericardial thickening. This lack of reliability is due to the brightness and reflectivity of the pericardium.

Moreover, the pericardium lies at a depth of 15 to 20 cm, which is outside the optimal focal zone of most ultrasound systems. Computer axial tomography (CAT scan) or cardiac magnetic
resonance imaging (CMR) is more accurate than echocardiography in determining the pericardial thickness.

Question 7

You just completed an echocardiographic study on a patient who has all the echo and Doppler findings for tamponade. What is your next step?

Answer 7

When you have a patient that you suspect is in tamponade you should find echo physician to do an immediate interpretation and get those results to the patient’s physician

Question 8

How often should sonographers do peer to peer reviews?

Answer 8

Peer to peer reviews between sonographers should be done twice a month.