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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?

25
EKG Changes in the Inferior Wall indicate which Coronary Artery?
RCA, LAD
26
EKG Changes in the Anterior Wall indicate which Coronary Artery?
LAD
27
Which EKG Lead will change with ischemia to the lateral wall?
I, AVL, V5, V6 Q Wave T Wave Inversion ST Elevation
28
Which EKG Lead will change with ischemia to the Inferior Wall?
II, III, AVF ST Elevation T Wave Inversion ST Elevation
29
Which EKG Lead will change with ischemia to the Anterior Wall?
V1,V2,V3,V4 ST Elevation T Wave Inversion Poor R wave progression
30
Which EKG Lead will change with ischemia to the Posterior Wall?
V1, V2, Increased R Wave ST depression T Wave Inversion
31
EKG Changes in the Posterior Wall indicate which Coronary Artery?
Posterior Descending
32
Which EKG Lead will change with ischemia to the lateral wall?
I, AVL, V5, V6 | ST Elevation
33
Which EKG Lead will change with ischemia to the Inferior Wall?
II, III, AVF | ST Elevation
34
Which EKG Lead will change with ischemia to the Anterior Wall?
V1,V2,V3,V4 | ST Elevation
35
Which EKG Lead will change with ischemia to the Posterior Wall?
V1, V2, | ST depression
36
Which EKG Lead will change with ischemia to the Posterior Wall?
V1, V2, | ST depression
37
What are the Troponin Values and indications
``` .4 = normal .4-.6 = suggests MI .6 - 1.5 = MI 1.5 = Acute MI (all ng/ml) ```
38
What are the basic steps of the stress echo?
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
What is Dobutamine?
Dobutamine is a synthetic Catecholamine that increases myocardial contractility
40
What are the indications for Dobutamine?
``` patients who are unable to walk on the treadmill Unsucessful TM test Elderly Patients Transplant clearance S/P CABG ```
41
What are the side effects of Dobutamine?
``` slight tremor nausea hypotension hypertension or headache chest pain SOB ```
42
What is the Dobutamine Stress test Protocol?
``` 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
What is the Dobutamine Stress test Protocol?
``` 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
What do these wall motion changes indicate in the Dobutamine Stress Test? Baseline = Normal Low Dose = Increase High Dose = Increase
Interpretation | Normal
45
What do these wall motion changes indicate in the Dobutamine Stress Test? Baseline = Normal Low Dose = Increase High Dose = Decrease
Interpretation | ischemia
46
What do these wall motion changes indicate in the Dobutamine Stress Test? Baseline = Normal Low Dose = Decrease High Dose = Decrease
Interpretation | ischemia
47
What do these wall motion changes indicate in the Dobutamine Stress Test? Baseline = hypo/akinetic Low Dose = Increase High Dose = Decrease
Interpretation | Viable/Ischemic myocardium
48
What do these wall motion changes indicate in the Dobutamine Stress Test? Baseline = hypo/akinetic Low Dose = Increase High Dose = Increase
Interpretation ??? / Ischemic myocardium Hybernating?

2nd Year Echo (9 decks)

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