Week 7 Stress echo, contrast echo, and atrial rhythms

What is Stress Echo?

Method of applying various stressors to the cardiovascular system

What does using pre and post stress evaluate?

• How well the heart tolerates stress

• Function of heart valves

• Likelihood of CAD

• Effectiveness of current cardiac treatment plan

What are the hemodynamic effects of stress on the heart?

• Increase HR

• Increase inotropic state

• Increase systolic BP

• Decrease systemic vascular resistance

• Increased venous return by vasoconstriction

• Increase in stroke volume

What is ischemia?

Temporary lack of oxygen to the muscle and it usually is relieved with rest

What is the main sign of ischemia during stress echo?

Transient regional wall motion abnormality (RWMA)

What are some indications for a stress test?

• Chest pain

• SOB

• Palpitations

• Abnormal EKG

• Eval CAD

• Post and pre op

What are Contraindications for a stress test?

• Acute coronary syndromes

• Severe cardiac arrhythmias

• Malignant hypertension

• Significant LVOT obstruction

• Symptomatic severe AS

What are you looking for in a stress test?

If the walls increase in movement and thickening

What is the patient prep for a stress test?

No caffeine and no certain meds (beta blockers) and bring inhaler

NPO or not (enough to exercise but not too full to be sluggish)

What are indications for pharmacological stress echos?

• Pre-op assessment

• DX of CAD

• Eval of CAD

• Post MI

• SOB

• Palpitations

• Abnormal EKG

• Chest pain

Why do DSE vs. Exercise?

• Peripheral vascular disease

• Orthopedic limitations

• Pulmonary disease

• Valvular disease

• Poor views for exercise echo

• Inability to walk on treadmill for any reason

When should you take the low dose images for pharmacological stress test?

When heart rate reach 100 and every 3 minutes after that

What are the 4 images displayed for a pharmacological stress test?

Rest, Low dose, Peak, Post

What is contrast echo used for?

Opacification of endocardial borders of the left ventricle through the use of a contrast medium

What is considered a suboptimal image when deciding about contrast echos?

At least 2 out of the 6 myocardial segments of the left ventricle cannot be visualized in apical views

What is the contrast made out of?

Gas-filled microbubbles (processed by lungs)

Encapsulated with shells (processed by liver)

What should your mechanical index be set to when using contrast?

<0.3 otherwise the bubbles will burst

What is a bubble study used for?

To look for an intracardiac shunt (ASD and VSD

Rules for wandering pacemaker rhythm?

Slightly irregular and P wave changes from one complex to another.

Rules for Premature Atrial Complex?

Regularity interrupted by PAC. P wave of early beat differs.

Rules for Atrial Tachycardia?

150-250 bpm. Atrial P wave differs, could be lost in T wave

Rules for Atrial Flutter?

Rhythm is regular. 250-350 bpm for atrial rate

What has a sawtooth pattern in the P wave?

Atrial Flutter

Rules for Atrial FIbrillation?

Grossly irregular, Atrial rate >350bpm, and no discernible P waves

Go look at Atrial Rhythms ppt and practice the test strips

OK