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ECHO 325 > Stress And Contrast Echo > Flashcards

Stress And Contrast Echo Flashcards

1
Q

Define angiography vs angioplasty:

A

Angiography: Dye injected into the artery to display luminal contour of the artery

Angioplasty: Balloon and stent to treat a blocked artery

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2
Q

What is the stage of sensitivity for stress ECG?

A

Initial stage of detection of exercise induced ECG changes

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3
Q

What is the statistical sensitivity and specificity for stress ECG?

A 
Se = 51-63%
Sp = 62-74%
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4
Q

What is the stage of sensitivity for stress echo?

A

Able to identify segmental wall motion abnormalities due to exercise-induced ischemia

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5
Q

What is the statistical sensitivity and specificity for stress echo?

A 
Se = 74-97%
Sp = 64-100%
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6
Q

What is the stage of sensitivity for nuclear stress?

A

Detects perfusion changes during exercise using radioactive dye

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7
Q

What is the statistical sensitivity and specificity for nuclear stress?

A 
Se = 61-94%
Sp = 81%
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8
Q

What is the stress ECG test also known as?

A

ETT (Exercise tolerance test)

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9
Q

What is the principle of an ETT?

A

Physical stress induces ischemia of the myocardium

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10
Q

Target HR is what percent of the max HR with a stress ECG?

A

85-90%

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11
Q

How is max HR calculated with a stress ECG test?

A

Max HR = 220-age

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12
Q

How is target HR calculated with a stress ECG test?

A

Target HR = 220 - age X 0.85

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13
Q

As the duration of ischemia persists, a chain of events then follow. List them:

A
  • Myocardial O2 supply/demand imbalance
  • Perfusion abnormalities
  • Diastolic Dysfunction
  • Systolic Dysfunction
  • Increase LV filling pressures
  • ECG changes
  • Angina
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14
Q

Where can echo detect ischemia in the chain of events leading to angina?

A

Middle of the chain

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15
Q

Describe stage 1 of the Bruce Protocol:

A

Speed: 1.5 mph
Grade: 10%
Cumulative time: 3 mins
METs: 5

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16
Q

What does METs stand for?

A

Metabolic equivalent of task

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17
Q

Describe stage 2 of the Bruce Protocol:

A

Speed: 2.7 mph
Grade: 12%
Cumulative time: 6 mins
METs: 7

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18
Q

Describe stage 3 of the Bruce Protocol:

A

Speed: 3.4 mph
Grade: 14%
Cumulative time: 9 mins
METs: 10

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19
Q

Describe stage 4 of the Bruce Protocol:

A

Speed: 4.2 mph
Grade: 16%
Cumulative time: 12 mins
METs: 13

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20
Q

Describe stage 5 of the Bruce Protocol:

A

Speed: 5.0 mph
Grade: 18%
Cumulative time: 15 mins
METs: 15

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21
Q

Describe stage 6 of the Bruce Protocol:

A

Speed: 5.5 mph
Grade: 20%
Cumulative time: 18 mins
METs: 18

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22
Q

Describe stage 7 of the Bruce Protocol:

A

Speed: 6.0 mph
Grade: 22%
Cumulative time: 21 mins
METs: 20

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23
Q

Assessment of workload is measured by what?

A

Metabolic equivalents (METs)

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24
Q

Workload is a reflection of what?

A

Oxygen consumption

25
Q

1 MET is equivalent to what?

A

3.5 ml oxygen/kg per minute (oxygen of an average individual at rest)

26
Q

How many METs are required to carry out the activities of daily living?

A

5 METs

27
Q

Describe the normal electrocardiographic changes during exercise:

A
  • P wave increases in height
  • R wave decreases in height
  • J point becomes depressed
  • ST segment becomes sharply upsloping
  • QT interval shortens
  • T wave decreases in height
28
Q

What are findings suggesting high probability of CAD?

A
  • Horizontal ST segment depression of >2 mm
  • Downsloping ST segment depression
  • Early positive responsive within six minutes
  • Persistence of ST depression for more than six minutes into recovery
  • ST segment depression in five or more leads
  • Exertional hypotension
29
Q

What is the primary use of stress echo?

A

Assessment of cardiac perfusion

30
Q

In stress echo, increased cardiac workload is used to unmask what?

A

Perfusion defects (ischemia) that may be silent at rest

31
Q

Maximum workload equation:

A

Maximum workload = max HR X max BP

32
Q

List the acquisition of a baseline set of images for stress echo:

A
  1. PLAX
  2. PSAX (pap)
  3. Apical 4
  4. Apical 2
33
Q

What are some technical points for stress echo?

A
  • Optimal endocardial definition needed
  • Acquire images quickly after exercise (workload declines rapidly)
  • Use 3D/4D
34
Q

How long do you have to obtain all 4 cine clips post treadmill test?

A
  1. Long axis: PLAX/A3C
  2. PSAX (mid)
  3. A4C
  4. A2C
35
Q

What is the equation for wall motion score index?

A

WMSI = sum of all wall scores / # of segments visualized

36
Q

What is the score and definition of normal/hyperkinesis wall motion?

A

Score: 1

Systolic wall thickening: >40%

37
Q

What is the score and definition of hypokinetic wall motion?

A

Score: 2

Systolic wall thickening: 10-40%

38
Q

What is the score and definition of akinetic wall motion?

A

Score: 3

Systolic wall thickening: <10%

39
Q

What is the score and definition of dyskinetic wall motion?

A

Score: 4
Definition: Wall thinning and moving outward in systole

40
Q

What is dobutamine?

A

A synthetic catecholamine

41
Q

Who is dobutamine used for with stress echo?

A

Patients who cannot exercise or for viability tissue studies

42
Q

What are the effects of dobutamine?

A

Increases HR and inotropy. Increases O2 demand which can trigger ischemia

43
Q

What data is recorded in a dobutamine stress test protocol?

A

HR, BP, symptoms (CP, SOB, syncope), ECG, echo images

44
Q

Which does dobutamine affect more, contractility or HR?

A

Contractility

45
Q

Why may atropine be given to augment the HR to reach target?

A

If peripheral vasodilation occurs or if patient was on beta blockers

46
Q

What are endpoints for stopping a dobutamine stress echo?

A
  1. Reaching the maximum protocol dose
  2. Patient discomfort
  3. A definite wall motion abnormality involving two or more adjacent segments
  4. ST segment elevation on ECG
  5. Reaching 85% of max predicted heart rate for age
  6. A systolic BP >200 mmHg or a diastolic BP >120 mmHg
  7. Significant ventricular arrhythmias
47
Q

Contrast echo improves endocardial border delineation to assess what 4 things:

A
  1. Wall motion
  2. Thrombus
  3. Aneurysms
  4. TDS patients
48
Q

Which contrast is injected for the right heart?

A

Agitated saline

49
Q

Which contrast is injected for the left heart?

A

Difinity contrast

50
Q

What should you look for with agitated saline?

A

ASD, PFO, rt to lt shunts

51
Q

What does a tissue viability study detect?

A

Stunned or hibernating myocardium

52
Q

Describe a stunned myocardium at rest, and with low and high doses of dobutamine:

A

At rest: impaired wall motion
Low dose: increases wall thickening
High dose: further increase in wall thickening

53
Q

Myocardium may come back to near normal function after what?

A

Reperfusion intervention

54
Q

Describe a hibernating myocardium at rest, and with low and high doses of dobutamine:

A

At rest: impaired wall motion
Low dose: increased wall thickening
High dose: reduction in wall thickening

55
Q

Describe infarcted myocardium at rest, and with low and high dose of dobutamine:

A

At rest: impaired wall motion
Low dose: no change in wall thickening
High dose: no change in wall thickening

56
Q

What does MIBI stand for?

A

Methoxy IsoButyl Isonitrile

57
Q

What is a MIBI?

A

Nuclear scan where radioactive tracers display where they end up in the heart

58
Q

What can a cardiac MRI reliably image?

A

Coronary arteries

ECHO 325 (19 decks)

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