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DMST 367 Echo 3 > Stress echo and Contrast imaging Asynchronous > Flashcards

Stress echo and Contrast imaging Asynchronous Flashcards

1
Q

What is a stress echo?

A

Combines echo + ECG with peak/post exercise to detect changes in the heart under stress

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2
Q

What is the primary use of stress echo?2

A
  1. Assessment of cardiac perfusion
  2. Increased workload unmasks ischemia (may be silent at rest)
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3
Q

What do we find with stress echo in terms of assessment of cardiac perfusion?2

A
  1. CAD symptoms
  2. Known CAD
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4
Q

What are some other uses (non-primary) uses for stress echo?3

A
  1. Viability of the myocardial muscle tissue after MI
  2. Valvular studies
  3. Assessment of cardiac transplants
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5
Q

What kind of valvular studies can we do with stress echo?2

A
  1. Low flow, low gradient AS
  2. Valve disease - asymptomatic, but mod
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6
Q

What are some contraindications for stress echo?3

A
  1. Acute problems
  2. Severe heart problems
  3. Severe systemic problems
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7
Q

What are some acute problems that are contraindications for stress echo?3

A
  1. MI
  2. PE
  3. Infection (pericarditis, myocarditis, endocarditis, systemic infection)
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8
Q

What are some severe heart problems that are contraindications for stress echo?4

A
  1. Unstable angina/ arrhythmias
  2. AS
  3. Dissection
  4. HF
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9
Q

What are some severe systemic problems that are contraindications for stress echo?4

A
  1. DVT
  2. Syncope
  3. Seizures
  4. Pregnancy
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10
Q

What happens in a stress echo?

A
  1. Prep the patient
  2. Take resting heart info
  3. Stress the patient
  4. Take stressed heart info
  5. Monitor patient recovery
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11
Q

What is the bruce protocol?

A

Every 3 minutes 2% grade and speed increase

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12
Q

What are clinical reasons to stop a stress echo?2

A
  1. ECG criteria
  2. S/S
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13
Q

What are ECG criteria for stopping a stress test?3

A
  1. Severe ST segment depression (>2mm)
  2. New onset of V-tachycardia, Afib, SVT, LBBB, 2nd or 3rd heart block
  3. Cardiac arrest
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14
Q

What are signs and symptoms that are clinical S/S for stopping a stress echo?3

A
  1. Severe fatigue, chest pain, dyspnea, dizziness
  2. Systolic pressure drops >20mmHg
  3. Blood pressure increases 200/120 mmhg
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15
Q

What is the treadmill test protocols? 3

A
  1. Resting images taken
  2. Pt runs on treadmill until target HR
  3. Quick return to scan bed and images take immediately
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16
Q

What is the bicycle stress echo protocol?

A

Pt. on supine exercise bike, this allows for image at THR

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17
Q

What is the pharmacological Stress test?

A

Use dobutamine (+/- atrophine) given to provoke ischemia

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18
Q

What is the benefit of pharamacological stress test?2

A
  1. Pt can be in optima position
  2. Good for patients unable to exercise
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19
Q

What is the disadvantage of pharmacological stress test?

A

Expensive and time consuming

20
Q

What are views that are looked at in stress echo?4

A
  1. PLAX
  2. PSAX (pap level)
  3. AP4
  4. AP2
21
Q

Stress echo views are displayed in what kind of screen?

A

Quad screen for comparison

22
Q

Which portion of the ECG is used for stress test?

A

Systolic portion beat only, 8-12 frames/ beat are captured

23
Q

Why is the systolic portion of the stress echo used?

A

Easily compared even with fluctuating heart rates

24
Q

How long do we need to wait before scannig?

A

2 Minutes post test for monitoring

25
Q

What is the stress test Treadmill steps?3

A
  1. Bruce protocol
  2. Target HR
  3. IMPOST images immediately within 1 minute
26
Q

Which protocol is this?

A

Treadmill Stress test

27
Q

What does dobutamine do?

A

Raises HR and contractility

28
Q

What is dobutamine?

A

Synthetic catecholamine

29
Q

What is the most common pharm agent?

A

Dobutamine

30
Q

In terms of a pharmacological stress echo, one of the uses of a stress echo is what?

A

Determine viable, hibernating or stunned myocardium post MI

31
Q

Fill the chart

32
Q

What process does this refer to?

A

Dobutamine stress echo

33
Q

DSE requires what?4

A
  1. A nurse for IV
  2. Cardiologist for review and possible intervention
  3. A crash cart nearby
  4. Dose of Dob increases in phases
34
Q

What does a stress echo look like?2

A
  1. ST depression >1-2mm
  2. Changes in LV function
35
Q

What does a ST depression look like?

36
Q

What is contrast echo?2

A
  1. Saline or contrast agent bubbles injected into RA through arm/ hand veins
  2. Bubbles show up easily as echogenic on ultrasound
37
Q

What does the Mechanical index need to be for contrast echo?

A

Low (MI = 0.5)

38
Q

Why does MI need to be low?

A

Avoids bursting tiny micro bubbles

39
Q

Fill the chart

40
Q

Which side of the heart can contrast be used on?

A

RT and LT side of the heart

41
Q

Which patients is contrast used on?

A

TDS patients

42
Q

Contrast improves what?5

A

Endocardial board delineation such as
1. Wall motion + EF
2. Thrombus
3. Aneurysms
4. Doppler signal enhancement
5. Congenital abnormalities

43
Q

What is shown here?

A

Standard doppler imaging and Contrast doppler imaging on the right due to contrast

44
Q

What is agitated saline used to look for?2

A
  1. Shunts
  2. RT heart
45
Q

What shunts are found with agitated saline?

46
Q

What parts of the right heart is looked at with agitated saline? 3

A
  1. Chamber/wall motion
  2. Valves
  3. Congenital

DMST 367 Echo 3 (27 decks)

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