Stress & Contrast

Question 1

What is the Bruce Protocol?

Answer 1

Increase the speed and the incline (2%) every 3 minutes

Question 2

Stress test vs stress echo

Answer 2

Stress Test (ETT): ECG only
Stress Echo: stress test & echo

Question 3

What is the target HR and how is this calculated?

Answer 3

85-90% max HR
Target HR= 220 - age x 85%

Question 4

How do ischemic changes with increased workload affect the ECG?

Answer 4

ST will become depressed.

Question 5

What ST measurement is positive for ischemia?

Answer 5

>1mm

Question 6

What are the 3 primary uses of stress echo?

Answer 6

1. Assessment of cardiac perfusion
2. Assessment of CAD
3. Increased workload may uncover ischemia that is silent at rest

Question 7

What are 3 other uses of stress echo?

Answer 7

1. Viability of the heart after MI
2. Valvular studies (time to replace?)
3. Assessment of cardiac transplants
4. functional capacity

Question 8

What is the protocol for treadmill stress echo?

Answer 8

Resting images taken, then the patient goes back and forth from the treadmill to bed. Keep at target HR for one minute once reached

Question 9

What is the protocol for using the bicycle in stress echo?

Answer 9

Patient is supine on the bike, less back and forth, but image quality decreases since they’re supine.

Question 10

What is the protocol for using pharmacological stress echo?

Answer 10

Drugs are given to provoke ischemia. Used to delineate viable vs. non-viable myocardium. Good for patients who cannot tolerate exercise

Question 11

What drug is typically used to provoke ischemia? How does it achieve this?

Answer 11

Dobutamine: raises HR and contractility

Question 12

What 3 factors are a high probability of CAD?

Answer 12

1. ST depression (>1-2mm)
2. early positive response (within 6 mins)
3. Exertional hypotension

Question 13

Name 4 contraindications to stress echo

Answer 13

1. Acute or severe heart problems
2. acute systemic infection
3. DVT
4. syncope
5. seizures
6. pregnancy

Question 14

WMSI=

Answer 14

sum of all wall scores/# of segments visualized

Question 15

Name 3 points for using pharmacological stress echo

Answer 15

• patient can stay in optimal position
• good for those who are unable to exercise
• more time for each image
• determines viable (hibernating or stunned) and non-viable myocardium after an MI
• requires a nurse for IV and cardiologist nearby

Question 16

Name 5 criteria for stopping a stress echo

Answer 16

• Severe ST depression >3mm
• New arrhythmia
• increase or decrease in BP
• Severe: fatigue, chest pain, dizziness
• reaching max Dob dose
• ST elevation (dob stress)
• reaching 85% of max HR

Question 17

How are contrast agents helpful?

Answer 17

• improve borders on TDS (wall motion, EF, thrombus, aneurysm
• aids in assessing shunts/abnormalities

Question 18

How does contrast differ for RT and LT sides

Answer 18

LT: small bubbles to help the borders pop
RT: large bubbles big enough that they can’t pass through the lungs

Question 19

Answer 19

Quad screen for dobutamine stress echo

Question 20

Answer 20

Quad screen for bicycle stress echo

Question 21

Answer 21

Quad screen for treadmill stress test