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Echo > Stress Echo > Flashcards

Stress Echo Flashcards

1
Q

________ infusion mimics the effect of exercise on your heart

A

Dobutamine

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2
Q

Common reasons to have Dobutamine stress test:

A
  • to determine if CAD is present and if further studies and/or treatment are required
  • To evaluate progress following a major cardiac event, such as MI or heart surgery
  • to investigate the effect of stress on heart valve function
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3
Q

Patients are asked NPO or smoke for at least _____

A

3 hrs

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4
Q

Patients can take usual medication with a small amount of water unless instructed by the doctor or nurse.

T or F ?

A

T

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5
Q

diabetic patients who use insulin or glucose lowering agents may need to adjust dosage.

T or F ?

A

T

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6
Q

patients should inform the nurse if experience the followings:

A
  • CP
  • dizziness
  • lightheadness
  • SOB
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7
Q

stress test is very safe. the likelihood of a serious complication, such as MI or death, is less than________

A

1/10,000

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8
Q

Transient side effects can occur with Dobutamine infusion.

Major side effect is ______, and occasionally, patients may notice _____. Neither of these effects causes any harm, and both go away shortly after the discontinuation of the drug infusion.

A

heart ponding

shake or shiver

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9
Q

complications related to diagnostic ultrasound have not been reported.

T or F ?

A

T

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10
Q

*Stress Echo directly assesses the presence of coronary or myocardial ischemia which results in an oxygen supply demand mismatch.

T or F ?

A

F

SE indirectly assesses the presence of coronary or myocardial ischemia which results in an oxygen supply demand mismatch

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11
Q

*1979 marked the first use of cross sectional echocardiography with bicycle exercise to describe ______________.

A

reversible segmental pathology

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12
Q

*Describe “Ischemic Cascade” in 30 words or more.

A

progressive myocardial oxygen supply–demand mismatch causes a consistent sequence of events:

  1. metabolic abnormality
  2. perfusion abnormality
  3. diastolic abnormality
  4. systolic dysfunction by strain
  5. visible systolic dysfunction
  6. hemodynamic changes
  7. ECG changes (ST segment elevation)
  8. angina
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13
Q

*List four (4) responsibilities of a cardiac sonographer during the staging and performance of a stress echocardiogram.

A
  • Explain procedure in its entirety
  • Patient signs the consent form
  • inquire about the patient’s allergies
  • Patient changes into gown and is prepped with 12 lead ECG
  • Prepare Ultrasound unit (name, data etc.)
  • Take REST images
  • Take post images
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14
Q

*Vasodilators (dipyridamole, adenosine, regadenosen) used to ____1_____, cause ___2___and increase ____3____.

A

decrease BP

tachycardia

myocardial function

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15
Q

*SE used to induce ___1___ and to predict ___2____ and __3_____.

A

regional myocardial ischemia

viability (ability to function/survive)

prognosis

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16
Q

*The two most common pharmacological stress agents are: _____and _____

A

dobutamine

atropine - Atropine increases the heart rate and improves the atrioventricular conduction by blocking the parasympathetic influences on the heart.

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17
Q

*Bruce protocol depends on a target rate during a stress test. For adults, the maximum predicted heart rate is _________ minus age.

A

220

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18
Q

*A vasodilator that exhibits an extremely short half-life and increases blood flow in coronary territories utilized during a Pharmacological Stress Echo is _____________ (similar to adenosine).

A

dipyridamole

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19
Q

*Stress Echocardiography is a noninvasive imaging technique that provides baseline sonographic images of the heart followed by images during or after exercise or pharmacologic stress induction to evaluate changes in myocardial performance and valvular hemodynamics.

T or F ?

A

T

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20
Q

*Digital Echo facilitated enhanced visualized imaging and replayed side by side: ______ and _______.

A

rest

exercise

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21
Q

*Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease is published by the ______________________.

A

American Society of Echocardiography

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22
Q

*What does SBSE stand for?

A

spine (upright) bicycle stress echo

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23
Q

*_______________= Heart Rate x Systolic BP / 100

A

double product

Pressure Rate Product (PRP), also known as the double product (DB), is used in exercise physiology to measure the stress put on the cardiac muscle based on the number of times the heart needs to beat per minute and the arterial blood pressure that pumps against.

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24
Q

*List four (4) indications that a physician might have to order a stress echocardiogram.

1.

2.

3.

4.

A
  • CAD screening
  • assess perfusion pre/post revascularization
  • risk stratification (an assessment used to evaluate a patient’s risk of developing cardiovascular disease (CVD)
  • evaluate heart valvular disease
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25
Q

*List four (4) contraindications for ordering a stress echocardiogram.

A
  • acute MI
  • unstable angina
  • uncontrolled arrhythmia
  • symptomatic valvular stenosis
  • acute PE
  • acute aortic dissection
  • pregnancy
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26
Q

*For patients with a permanent pacemaker, the __________ can be increased to demonstrate regional wall motion abnormalities

A

HR

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27
Q

*Stress Echocardiography provides a method of comparison of cardiac function in both _____and _____ induced cardiac states.

A

resting

exercised

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28
Q

*If an adequate heart rate is not achieved during a DSE, an additional drug may be given. This drug is ________.

A

atropine

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29
Q

*List four (4) advantages of performing a stress echocardiogram.

1.

2.

3.

4.

A
  • noninvasive
  • no exposure to radioactive material, dye, or radiation
  • relatively inexpensive
  • quick and reliable with immediate feedback
  • more sensitive/specific than 12 ECG stress test
  • provides live, visual connection between symptoms, cardiac function, WMA
30
Q

*Beta blockers, also known as beta-adrenergic blocking agents, are medications that reduce _______. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenline. Beta blockers cause the heart to beat more slowly and with less force, which lowers _______.

A

BP

BP

31
Q

*List 5 items necessary to perform a Pharmacological stress echocardiogram.

A
  • infusion pump
  • 12-lead-ECG system with modified lead placement
  • BP device
  • emergency crash cart
  • pharmacological stress agents
32
Q

*What does TMSE stand for?

A

treadmill SE

33
Q

*The Bruce protocol is a standard test in cardiology and is comprised of multiple exercises stages of ________ minutes each.

A

3

34
Q

*Dobutamine decreases heart rate and contractility.

T or F ?

A

F

*increase

35
Q

What is stress echo?

A

Noninvasive imaging technique that provides baseline sonographic images of the heart followed by images during or after exercise or pharmacologic stress induction to evaluate changes in myocardial performance and valvular hemodynamics.

36
Q

In SE, all stressors cause __________

A
  • hemodynamic effects
37
Q

SE is able to induce (4)…

A
  • myocardial supply and demand issue
  • ischemia
  • WMA
  • valvular abnormality
38
Q

What does pharmacological stress agents do ?

A
  • stimulate myocytes
  • mimic effects of actual physical exercise
  • increase O2 demand by increasing contractility (inotropy) and HR (chronotropy)
39
Q

what is the agent similar to dobutamine; provides balanced inotropic and chronotropic simulation?

A

arbutamine

40
Q

________ may be given in conjunction with dobutamine to achieve target HR

A

atropine

41
Q

SBSE usually has a lower heart rate and higher BP response than TMSE

T or F ?

A

T

42
Q

Pharmacologic SE indications:

A
  • same indication as SE
    • CAD screening
    • assess perfusion pre/post revascularization
    • risk stratification (an assessment used to evaluate a patient’s risk of developing cardiovascular disease (CVD)
    • evaluate heart valvular disease
  • individuals with impaired walking ability
43
Q

Pharmacologic SE contraindications:

A

patients with reactive airway obstruction or significant conduction defects against Adenosine and dipyridamole

44
Q

For pharmacologic SE, patient may consider holding ________ unless test is being performed for therapy assessment

A

beta blocker therapy

45
Q

Infusion pump

starting rate is ___ mcg/kg/min

at 3 min increased to ___ mcg/kg/min

at 6 mim increase to ____ mcg/kg/min

at 12 min increase ___ mcg/kg/min

A

5

10

20

40

46
Q

Infusion Pump

If endpoint is not reached, ___ mg of _____ may be administered every minute up to ____ mg

A

0.5

atropine sulfate

2.0

47
Q

Pharmacologic Stress Echocardiography Endpoint

A
  • Clinical ischemia
  • Blood pressure (hyper/hypotension)
  • Sustained tachycardia
  • WMA involving 2 or more segments
  • Predicted rate reached
48
Q

what is pacing SE ?

A
  • Performed on patients with a permanent pacemaker
  • Target heart rate can be achieved by increasing the pacing rate
  • May be performed with or without Dobutamine
  • May be performed using transesophageal echocardiography
49
Q

Pacing Stress Echocardiogram

Pacing is started a ____beats per minute (bpm)above the patient’s baseline heart rate.

A

10

50
Q

Pacing Stress Echocardiogram

The heart rate is increased to___ at 2 minutes and ___ during the next 2 minutes.

A

85%

100%

51
Q

Pacing Stress Echocardiogram

Imaging is performed at ___, ____, ____ and ____ heart rate.

(4 stages)

A

rest

first stage

pre-peak

peak

52
Q

Pacing stress testing is terminated when____ age-predicted heart rate is reached.

A

maximal

53
Q

Advantage of pacing is rapid restoration of baseline conditions and heart rate on termination of atrial stimulus

T or F ?

A

T

54
Q

Corresponding Perfusion Zones of the Major Coronary Arteries

LAD

A

Apex

Anterior

Anteroseptal

Apical Septal

ApicalAnterior

55
Q

Corresponding Perfusion Zones of the Major Coronary Arteries

CX

A

Apical lateral

Anterolateral

Inferolateral

56
Q

Corresponding Perfusion Zones of the Major Coronary Arteries

RCA

A

inferior
inferoseptal

57
Q

Exercise stress – ___% of maximum heart rate sustained for 1 minute

A

90

58
Q

Pharmacologic stress- ___% of maximal heart rate sustained for 1 minute.

A

85

59
Q

Pre-stress image clip views

A

PLAX

PSAX

A4C

A2C

60
Q

Images should be obtained within first ___seconds after exercise (same 4 images as taken for the baseline exam)

A

Images should be obtained within first 60 seconds after exercise (same 4 images as taken for the baseline exam)

61
Q

Digital image acquisition – Triggered by _________

A

QRS complex

62
Q

____________should be used to enhance endocardial border definition

A

Tissue harmonic imaging

63
Q

SE

False negative can occur if:

A

Maximum heart rate is not achieved

Mild CAD is present

Collateral vessels are

present

Inadequate exercise, especially in the elderly

64
Q

SE

False positive can occur if:

A

Cardiomyopathy (HCM needs more myocardial perfusion

High blood pressure may cause myocardial underperfusion

65
Q

risk factors for SE

A

heredity
men
post-menopausal women
age
smoking
HTN
HLD
DM
obesity
stress
alcohol abuse

66
Q

Advantages of Stress Echocardiography

A
  • Shorter imaging time
  • Lack of ionizing radiation
  • Portability
  • Immediate availability of results
  • Cost effective
  • Ancillary (providing necessary support to the primary activities or operation of an organization, institution, industry, or system) information
    • 1. Chamber size and function
    • 2. Valves
    • 3. Pericardial effusion
    • 4. Aortic root disease
    • 5. Wall thickness
67
Q

Pitfalls of SE

A

Sonographer dependent – sonographer should be adequately educated with proficient scan technique

Interpreter dependent – interpreter should be adequately educated

68
Q

During DSE, if the THR is not achieved, a sixth dose of up to 50 mcg/kg/min can be administered with _____.

Additional doses of 0.25-0.5 mg of _____ may be repeated 1 minute interval (max 2.0 mg)

A

atropine sulfate 0.5 mg

atropine

69
Q

During DSE, when should the “low dose” images be acquired ?

A

stage 1 or 2

70
Q

WMSI equation

A

WMSI (wall motion score index) = sum of all wall motion scores/number of segments visualized

71
Q
A

Echo (35 decks)

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