Stress Echo

Question 1

Stress echo assesses the areas of ____ that develop while the heart is under stress.

Answer 1

Ischemia (WMA)

Question 2

What are some stress indications?

Answer 2

• Chest pain of unknown origin
• Shortness of breath
• Abnormal EKG
• Exercise related dysrhythmias
• Previous non-diagnostic EKG stress tests
• Presence of risk factors (age, sex, etc.)
• Pre-operative clearance

Question 3

LBBB, hypertension, paced rhythm, infarction, and cardiomyopathy are causes of ____ at rest.

Answer 3

WMA

Question 4

What are considered absolute contraindictions?

Answer 4

• Acute MI (within 2 days)
• Unstable angina (pain > 6)
• Uncontrolled arrhythmias
• Severe AS (symptomatic >50mmHg)
• Acute PE
• Acute aortic dissection
• Acute myocarditis/pericarditis
• Pregnancy

Question 5

What are considered relative contraindictions?

Answer 5

• Moderate AS
• Severe hypertension
• HOCM
• High Degree of atrioventricular block
• Tachyarrhythmias/Bradyarrhythmias

Question 6

What is the sequence of ischemic response?

Answer 6

1. Decrease perfusion
2. Decrease LV compliance
3. Increase LVEDP
4. Decrease LV contractility
5. ECG changes
6. Symptoms

Question 7

The goal of the Bruce protocol is to get the patient to a ____% predicted target heart rate.

Answer 7

90%

Question 8

____ is a synthetic catecholamine (inotropic) which causes the heart to contract harder at low dose and beat faster at higher doses.

Answer 8

Dobutamine

Question 9

If a blockage causes reduced blood flow, myocardial oxygen demands will eventually exceed supply and ____ will develop.

Answer 9

Ischemia

Question 10

In a dobutamine stress echo, dobutamine is infused every ____-____ minutes.

Answer 10

3-5 minutes

Question 11

In a dobutamine stress echo, images are taken at ____, ____, ____, and ____.

Answer 11

Rest, low dose, peak, and recovery

Question 12

____ can be given to increase H.R. (used often if patient is taking a beta-blocker)

Answer 12

Atropine

Question 13

Most stress echoes are analyzed based on ____ ____ ____, comparing wall thickening and endocardial excursion at baseline and during stress.

Answer 13

Regional wall motion

Question 14

The presence of baseline WMA suggests previous ____.

Answer 14

MI

Question 15

The normal response to stress is the development of ____ wall motion.

Answer 15

Hyperdynamic

Question 16

In a stress echo, lack of hyperkinesis is ____.

Answer 16

Abnormal

Question 17

If wall motion response is normal during rest and hyperkinetic during stress, that is considered ____.

Answer 17

Normal

Question 18

If wall motion response is normal during rest and hypokinetic/akinetic during stress, that is considered ____.

Answer 18

Ischemic

Question 19

If wall motion response is akinetic during rest and akinetic during stress, that is considered ____.

Answer 19

Infarction

Question 20

If wall motion response is hypokinetic during rest and akinetic/duskinetic during stress, that is considered ____.

Answer 20

Infarction and/or ischemic

Question 21

If wall motion response is hypokinetic during rest and normal during stress, that is considered ____.

Answer 21

Viable - do a different test, something is wrong.

Question 22

____ is the mildest form of abnormal wall motion and is defined as less than 5 mm of endocardial excursion.

Answer 22

Hypokinesis

Question 23

____ is the most extreme form of a wall motion abnormality

Answer 23

Dyskinesis

Question 24

Dyskinesis is defined as ____ thinning and outward motion or bulging of the myocardium during ____.

Answer 24

Systolic; systole

Question 25

What is the WMA category table?

Answer 25

X – Not visualized
0 – Hyperkinetic
1 - Normal
2 – Hypokinetic
S – Severe Hypokinesis
3 – Akinetic
4 – Dyskinetic
5 – Aneurysmal
6 – Akinetic/Scar
7 – Dyskinetic/Scar

Question 26

Stress testing after MI is used to predict the location and extent of ____ ____.

Answer 26

Coronary disease

Question 27

Most patients with coronary artery disease will have resting ____.

Answer 27

WMA’s