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2nd Year Echo > Stress Echo > Flashcards

Stress Echo Flashcards

1
Q

What are the classic signs of MI in men?

A 
very specific
pain spreading through neck and shoulders
pressure or tightness in the chest
chest discomfort
nausea 
sob
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2
Q

what are the common triggers for MI in men?

A

physical exertion

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3
Q

what are the common triggers of MI in women?

A

emotional stress

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4
Q

what are the classic signs of MI in women?

A 
more vague
SOB
Nausea
back or jaw pain
anxiety
flu like symptoms
palpitations
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5
Q

what are some contra-indications for treadmil stress echo?

A

CHF
Unstable Angina
HTN

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6
Q

what are some indications for the stress echo?

A

history of MI, recent or old
patients with known CAD
surgery clearance
AS/LVOT obstruction (dobutamine)

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7
Q

what is the purpose of the stress test?

A

to evaluate the myocardium for possibility of functional recovery and viability.

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8
Q

what are the possible states of myocardium?

A

health viable myocardium
hybernating myocardium (chronic ischemia)
stunned myocardium
unviable dead myocardial tissue

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9
Q

what is the response of healthy myocardium to the stress test?

A

LV chamber dimensions become smaller as a result of demand

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10
Q

what is the response of compromised myocardium to stress testing?

A

Regional wall motion abnormalities

LV chamber dilation lacking response to increased demand.

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11
Q

what are the elements of the ischemic cascade from least to greatest over time?

A 
hypoperfusion
metabolic disturbances
diastolic dysfunction
systolic dysfunction
EKG changes
chest Pain
myocardial necrosis
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12
Q

what are some contra-indications for stress echo?

A 
CHF
Unstable Angina
severe HTN
AS with a mean gradient of 50mmHg
Acute MI
EF
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13
Q

what are the elements of the ischemic cascade from least to greatest over time?

A 
hypoperfusion
metabolic disturbances
diastolic dysfunction
systolic dysfunction
EKG changes
chest Pain
myocardial necrosis
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14
Q

These wall motion changes indicate?
Rest = Normal
Exercise = Normal

A

Wall Motion

Normal

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15
Q

These wall motion changes indicate?
Rest = Normal
Exercise = Abnormal

A

Wall Motion

Ischemia

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16
Q

These wall motion changes indicate?
Rest = abnormal (thin myocardium)
Exercise = fixed/no change

A

Wall Motion

infarction

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17
Q

These wall motion changes indicate?
Rest = abnormal (thin, scarred)
Exercise = dyskinetic

A

Wall Motion

infarction

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18
Q

These wall motion changes indicate?
Rest = abnormal, akinetic
Exercise = Wall motion improves or gets worse

A

Wall Motion

hybernating

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19
Q

These wall motion changes indicate?
Rest = abnormal, akinetic
Exercise = Wall motion improves or gets worse

A

Wall Motion

hybernating

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20
Q

What are the score values for wall motion?

A 
1 = normal wall motion
2 = hypokinetic (reduced motion and thickening in systole)
3 = akinesis (no wall motion, no thickening)
4= dyskinetic
5= aneurysmic
0= hyperkinetic
21
Q

What are the score values for wall motion?

A 
1 = normal wall motion
2 = hypokinetic (reduced motion and thickening in systole)
3 = akinesis (no wall motion, no thickening)
22
Q

What is the calculation for wall motion score?

A

sum of segmental scores / number of segments visualized.

23
Q

What is are the grades for wall motion score?

A

1.0 is normal

>/= 2.0 is abnormal

24
Q

EKG Changes in the Lateral Wall indicate which Coronary Artery?

A

CX

25
Q

EKG Changes in the Inferior Wall indicate which Coronary Artery?

A

RCA, LAD

26
Q

EKG Changes in the Anterior Wall indicate which Coronary Artery?

A

LAD

27
Q

Which EKG Lead will change with ischemia to the lateral wall?

A

I, AVL, V5, V6
Q Wave
T Wave Inversion
ST Elevation

28
Q

Which EKG Lead will change with ischemia to the Inferior Wall?

A

II, III, AVF
ST Elevation
T Wave Inversion
ST Elevation

29
Q

Which EKG Lead will change with ischemia to the Anterior Wall?

A

V1,V2,V3,V4
ST Elevation
T Wave Inversion
Poor R wave progression

30
Q

Which EKG Lead will change with ischemia to the Posterior Wall?

A

V1, V2,
Increased R Wave
ST depression
T Wave Inversion

31
Q

EKG Changes in the Posterior Wall indicate which Coronary Artery?

A

Posterior Descending

32
Q

Which EKG Lead will change with ischemia to the lateral wall?

A

I, AVL, V5, V6

ST Elevation

33
Q

Which EKG Lead will change with ischemia to the Inferior Wall?

A

II, III, AVF

ST Elevation

34
Q

Which EKG Lead will change with ischemia to the Anterior Wall?

A

V1,V2,V3,V4

ST Elevation

35
Q

Which EKG Lead will change with ischemia to the Posterior Wall?

A

V1, V2,

ST depression

36
Q

Which EKG Lead will change with ischemia to the Posterior Wall?

A

V1, V2,

ST depression

37
Q

What are the Troponin Values and indications

A 
.4 = normal
.4-.6 = suggests MI
.6 - 1.5 = MI
1.5 = Acute MI
(all ng/ml)
38
Q

What are the basic steps of the stress echo?

A

Pre Test Scanning and Screening
Resting Images (LAX, SAX, 4Chmbr, 2Chmbr)
Mark your windows
Exercise to 85% max HR
Post Scan (60-90 secs) (LAX, SAX, 4Chmbr, 2Chmbr)
*Continue scanning until Pt returns to normal.

39
Q

What is Dobutamine?

A

Dobutamine is a synthetic Catecholamine that increases myocardial contractility

40
Q

What are the indications for Dobutamine?

A 
patients who are unable to walk on the treadmill
Unsucessful TM test
Elderly Patients
Transplant clearance
S/P CABG
41
Q

What are the side effects of Dobutamine?

A 
slight tremor
nausea
hypotension
hypertension or headache
chest pain
SOB
42
Q

What is the Dobutamine Stress test Protocol?

A 
Similar to TM Stress Echo:
Pre Screen
Resting Images
Low Dose 10mcg/kg
dosage increased by 10 mcg/kg
increased until 40 or 50 mcg/kg or 85% of Max HR
43
Q

What is the Dobutamine Stress test Protocol?

A 
Similar to TM Stress Echo:
Pre Screen
Resting Images
Low Dose 10mcg/kg
dosage increased by 10 mcg/kg
increased until 40 or 50 mcg/kg or 85% of Max HR
44
Q

What do these wall motion changes indicate in the Dobutamine Stress Test?
Baseline = Normal
Low Dose = Increase
High Dose = Increase

A

Interpretation

Normal

45
Q

What do these wall motion changes indicate in the Dobutamine Stress Test?
Baseline = Normal
Low Dose = Increase
High Dose = Decrease

A

Interpretation

ischemia

46
Q

What do these wall motion changes indicate in the Dobutamine Stress Test?
Baseline = Normal
Low Dose = Decrease
High Dose = Decrease

A

Interpretation

ischemia

47
Q

What do these wall motion changes indicate in the Dobutamine Stress Test?
Baseline = hypo/akinetic
Low Dose = Increase
High Dose = Decrease

A

Interpretation

Viable/Ischemic myocardium

48
Q

What do these wall motion changes indicate in the Dobutamine Stress Test?
Baseline = hypo/akinetic
Low Dose = Increase
High Dose = Increase

A

Interpretation
??? / Ischemic myocardium
Hybernating?

2nd Year Echo (9 decks)

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