Stress echo and Contrast imaging Asynchronous

Question 1

What is a stress echo?

Answer 1

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

Question 2

What is the primary use of stress echo?2

Answer 2

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

Question 3

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

Answer 3

1. CAD symptoms
2. Known CAD

Question 4

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

Answer 4

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

Question 5

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

Answer 5

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

Question 6

What are some contraindications for stress echo?3

Answer 6

1. Acute problems
2. Severe heart problems
3. Severe systemic problems

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

1. DVT
2. Syncope
3. Seizures
4. Pregnancy

Question 10

What happens in a stress echo?

Answer 10

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

Question 11

What is the bruce protocol?

Answer 11

Every 3 minutes 2% grade and speed increase

Question 12

What are clinical reasons to stop a stress echo?2

Answer 12

1. ECG criteria
2. S/S

Question 13

What are ECG criteria for stopping a stress test?3

Answer 13

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

Question 14

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

Answer 14

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

Question 15

What is the treadmill test protocols? 3

Answer 15

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

Question 16

What is the bicycle stress echo protocol?

Answer 16

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

Question 17

What is the pharmacological Stress test?

Answer 17

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

Question 18

What is the benefit of pharamacological stress test?2

Answer 18

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

Question 19

What is the disadvantage of pharmacological stress test?

Answer 19

Expensive and time consuming

Question 20

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

Answer 20

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

Question 21

Stress echo views are displayed in what kind of screen?

Answer 21

Quad screen for comparison

Question 22

Which portion of the ECG is used for stress test?

Answer 22

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

Question 23

Why is the systolic portion of the stress echo used?

Answer 23

Easily compared even with fluctuating heart rates

Question 24

How long do we need to wait before scannig?

Answer 24

2 Minutes post test for monitoring

Question 25

What is the stress test Treadmill steps?3

Answer 25

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

Question 26

Which protocol is this?

Answer 26

Treadmill Stress test

Question 27

What does dobutamine do?

Answer 27

Raises HR and contractility

Question 28

What is dobutamine?

Answer 28

Synthetic catecholamine

Question 29

What is the most common pharm agent?

Answer 29

Dobutamine

Question 30

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

Answer 30

Determine viable, hibernating or stunned myocardium post MI

Question 31

Fill the chart

Answer 31

Question 32

What process does this refer to?

Answer 32

Dobutamine stress echo

Question 33

DSE requires what?4

Answer 33

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

Question 34

What does a stress echo look like?2

Answer 34

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

Question 35

What does a ST depression look like?

Answer 35

Question 36

What is contrast echo?2

Answer 36

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

Question 37

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

Answer 37

Low (MI = 0.5)

Question 38

Why does MI need to be low?

Answer 38

Avoids bursting tiny micro bubbles

Question 39

Fill the chart

Answer 39

Question 40

Which side of the heart can contrast be used on?

Answer 40

RT and LT side of the heart

Question 41

Which patients is contrast used on?

Answer 41

TDS patients

Question 42

Contrast improves what?5

Answer 42

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

Question 43

What is shown here?

Answer 43

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

Question 44

What is agitated saline used to look for?2

Answer 44

1. Shunts 2. RT heart

Question 45

What shunts are found with agitated saline?

Answer 45

ASD/PFO

Question 46

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

Answer 46

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