Echocardiography Stress Testing

Question 1

What are the four types of Echocardiography?

Answer 1

• Tranthoracic Echo (TTE)
• Transesophageal Echo (TEE)
• Exercise stress echo
• Pharmacologic (dobutamine) stress echo

Question 2

• noninvasive imaging modality that uses ultrasound to evaluate cardiac anatomy, physiology and function
• the patient lies on an exam table while a cardiac sonographer uses an ultrasound transducer to obtain different views of the heart

Answer 2

Transthoracic Echocardiogram (TTE)

Question 3

what are indications for an echocardiogram?

Answer 3

• Evaluate cardiac anatomy (size, structure and anatomical positions of the chambers and valves, aorta, pericardium)
• evaluate ventricular function and wall motion
• evaluate valve structure and function
• evaluate the cause of symptoms (i.e, dyspnea) or clinical findings (i.e, murmur or arrythmia)
• assess volume status (inferior vena cava)

Question 4

what are indications of TEE?

Answer 4

• evaluate for valvular vegetations with suspected endocarditis
• evaluate native and prostethic valve disease
  -stenosis or regurgitation, in preparation for possible valve surgery
  -3D imaging is used to help plan surgical repair
• evaluate for intracardiac thrombus
  -prior to cardioversion for atrial fibrillation
• evaluate congential abnormalities
• Acute aortic pathology
  -Thoracic aortic dissection

Question 5

what are signs of infective endocarditis?

Answer 5

• splinter hemorrhages
• conjunctival petechiae
• osler’s node (tender nodules)
• janeway lesions (purpura)

Question 6

what are risks associated with TEE?

Answer 6

• damage or perforation of the esophagus
• bleeding
• methemoglobinemia- if benzocaine spray is used
• aspiration
• risk of anesthesia and sedation
• damage to upper pharyngeal structures (teeth, throat)

Question 7

• small portable ultrasound device
• allows limited assessment at the point of care/bedside
• LV and RV function
• valvular abnormalities
• pericardial effusion/tamponade
• volume assessment (IVC, lung U/S)
• routinely used in ER, ICU

Answer 7

Point of Care ultrasound

Question 8

what are indications for stress testing?

Answer 8

• Evaluation of chest pain
• assess the significance of known CAD
• evaluate if dyspnea is of cardiac origin
• risk stratification of ischemic heart disease
• determine functional capacity (exercise tolerance)

Question 9

What are the three ways that stress tests can be completed?

Answer 9

• Exercise treadmill test
• exercise + imaging: exercise stress echo, exercise stress nuclear
• pharmacologic: dobutamine, vasodilator stress nuclear

Question 10

what are contraindications to ALL Types of stress testing?

Answer 10

• recent myocardial infarction (< 1 week)
• unstable angina or ongoing chest pain
• decompensated heart failure
• hypertension (SBP > 180mmHg) or DBP > 90mmHg at rest )
• hypotension (usually SPB < 90mmHg)
• acute pulmonary embolism
• inability to consent to the the test

Question 11

Contraindications to exercise stress testing?

Answer 11

• inability to exercise, gait instability
• tachycardia (resting heart rate > 100 bpm)
• significant arrhythmia (ventricular tachycardia, high degree of heart block)
• aortic dissection or aneurysm
• ECG abnormalities

Question 12

• stress echocardiography is used to assess cardiac function with exercise
• stress can either be graded by exercise or pharmacologic (IV infusion of increasing doses of dobutamine
• images of left ventricle are obtained at rest with peak stress
  -new wall motion abnormalities suggest ischemia (poor or blocked blood flow in the coronary arteries)

Answer 12

Stress echocardiogram

Question 13

what are indications for stress echo?

Answer 13

• evaluate for cardiac cause of chest pain or dyspnea
• evaluate patients with known or suspected coronary artery disease
  -evaluate myocardial viability
• Assess the significance of known valvular disease
• Assess for stress-induced pulmonary hypertension