Stress echo and Contrast imaging Asynchronous Flashcards
What is a stress echo?
Combines echo + ECG with peak/post exercise to detect changes in the heart under stress
What is the primary use of stress echo?2
- Assessment of cardiac perfusion
- Increased workload unmasks ischemia (may be silent at rest)
What do we find with stress echo in terms of assessment of cardiac perfusion?2
- CAD symptoms
- Known CAD
What are some other uses (non-primary) uses for stress echo?3
- Viability of the myocardial muscle tissue after MI
- Valvular studies
- Assessment of cardiac transplants
What kind of valvular studies can we do with stress echo?2
- Low flow, low gradient AS
- Valve disease - asymptomatic, but mod
What are some contraindications for stress echo?3
- Acute problems
- Severe heart problems
- Severe systemic problems
What are some acute problems that are contraindications for stress echo?3
- MI
- PE
- Infection (pericarditis, myocarditis, endocarditis, systemic infection)
What are some severe heart problems that are contraindications for stress echo?4
- Unstable angina/ arrhythmias
- AS
- Dissection
- HF
What are some severe systemic problems that are contraindications for stress echo?4
- DVT
- Syncope
- Seizures
- Pregnancy
What happens in a stress echo?
- Prep the patient
- Take resting heart info
- Stress the patient
- Take stressed heart info
- Monitor patient recovery
What is the bruce protocol?
Every 3 minutes 2% grade and speed increase
What are clinical reasons to stop a stress echo?2
- ECG criteria
- S/S
What are ECG criteria for stopping a stress test?3
- Severe ST segment depression (>2mm)
- New onset of V-tachycardia, Afib, SVT, LBBB, 2nd or 3rd heart block
- Cardiac arrest
What are signs and symptoms that are clinical S/S for stopping a stress echo?3
- Severe fatigue, chest pain, dyspnea, dizziness
- Systolic pressure drops >20mmHg
- Blood pressure increases 200/120 mmhg
What is the treadmill test protocols? 3
- Resting images taken
- Pt runs on treadmill until target HR
- Quick return to scan bed and images take immediately
What is the bicycle stress echo protocol?
Pt. on supine exercise bike, this allows for image at THR
What is the pharmacological Stress test?
Use dobutamine (+/- atrophine) given to provoke ischemia
What is the benefit of pharamacological stress test?2
- Pt can be in optima position
- Good for patients unable to exercise
What is the disadvantage of pharmacological stress test?
Expensive and time consuming
What are views that are looked at in stress echo?4
- PLAX
- PSAX (pap level)
- AP4
- AP2
Stress echo views are displayed in what kind of screen?
Quad screen for comparison
Which portion of the ECG is used for stress test?
Systolic portion beat only, 8-12 frames/ beat are captured
Why is the systolic portion of the stress echo used?
Easily compared even with fluctuating heart rates
How long do we need to wait before scannig?
2 Minutes post test for monitoring
What is the stress test Treadmill steps?3
- Bruce protocol
- Target HR
- IMPOST images immediately within 1 minute
Which protocol is this?
Treadmill Stress test
What does dobutamine do?
Raises HR and contractility
What is dobutamine?
Synthetic catecholamine
What is the most common pharm agent?
Dobutamine
In terms of a pharmacological stress echo, one of the uses of a stress echo is what?
Determine viable, hibernating or stunned myocardium post MI
Fill the chart
What process does this refer to?
Dobutamine stress echo
DSE requires what?4
- A nurse for IV
- Cardiologist for review and possible intervention
- A crash cart nearby
- Dose of Dob increases in phases
What does a stress echo look like?2
- ST depression >1-2mm
- Changes in LV function
What does a ST depression look like?
What is contrast echo?2
- Saline or contrast agent bubbles injected into RA through arm/ hand veins
- Bubbles show up easily as echogenic on ultrasound
What does the Mechanical index need to be for contrast echo?
Low (MI = 0.5)
Why does MI need to be low?
Avoids bursting tiny micro bubbles
Fill the chart
Which side of the heart can contrast be used on?
RT and LT side of the heart
Which patients is contrast used on?
TDS patients
Contrast improves what?5
Endocardial board delineation such as
1. Wall motion + EF
2. Thrombus
3. Aneurysms
4. Doppler signal enhancement
5. Congenital abnormalities
What is shown here?
Standard doppler imaging and Contrast doppler imaging on the right due to contrast
What is agitated saline used to look for?2
- Shunts
- RT heart
What shunts are found with agitated saline?
ASD/PFO
What parts of the right heart is looked at with agitated saline? 3
- Chamber/wall motion
- Valves
- Congenital