Stress echo assesses the areas of ____ that develop while the heart is under stress.
Ischemia (WMA)
What are some stress indications?
- Chest pain of unknown origin
- Shortness of breath
- Abnormal EKG
- Exercise related dysrhythmias
- Previous non-diagnostic EKG stress tests
- Presence of risk factors (age, sex, etc.)
- Pre-operative clearance
LBBB, hypertension, paced rhythm, infarction, and cardiomyopathy are causes of ____ at rest.
WMA
What are considered absolute contraindictions?
- Acute MI (within 2 days)
- Unstable angina (pain > 6)
- Uncontrolled arrhythmias
- Severe AS (symptomatic >50mmHg)
- Acute PE
- Acute aortic dissection
- Acute myocarditis/pericarditis
- Pregnancy
What are considered relative contraindictions?
- Moderate AS
- Severe hypertension
- HOCM
- High Degree of atrioventricular block
- Tachyarrhythmias/Bradyarrhythmias
What is the sequence of ischemic response?
- Decrease perfusion
- Decrease LV compliance
- Increase LVEDP
- Decrease LV contractility
- ECG changes
- Symptoms
The goal of the Bruce protocol is to get the patient to a ____% predicted target heart rate.
90%
____ is a synthetic catecholamine (inotropic) which causes the heart to contract harder at low dose and beat faster at higher doses.
Dobutamine
If a blockage causes reduced blood flow, myocardial oxygen demands will eventually exceed supply and ____ will develop.
Ischemia
In a dobutamine stress echo, dobutamine is infused every ____-____ minutes.
3-5 minutes
In a dobutamine stress echo, images are taken at ____, ____, ____, and ____.
Rest, low dose, peak, and recovery
____ can be given to increase H.R. (used often if patient is taking a beta-blocker)
Atropine
Most stress echoes are analyzed based on ____ ____ ____, comparing wall thickening and endocardial excursion at baseline and during stress.
Regional wall motion
The presence of baseline WMA suggests previous ____.
MI
The normal response to stress is the development of ____ wall motion.
Hyperdynamic
In a stress echo, lack of hyperkinesis is ____.
Abnormal
If wall motion response is normal during rest and hyperkinetic during stress, that is considered ____.
Normal
If wall motion response is normal during rest and hypokinetic/akinetic during stress, that is considered ____.
Ischemic
If wall motion response is akinetic during rest and akinetic during stress, that is considered ____.
Infarction
If wall motion response is hypokinetic during rest and akinetic/duskinetic during stress, that is considered ____.
Infarction and/or ischemic
If wall motion response is hypokinetic during rest and normal during stress, that is considered ____.
Viable - do a different test, something is wrong.
____ is the mildest form of abnormal wall motion and is defined as less than 5 mm of endocardial excursion.
Hypokinesis
____ is the most extreme form of a wall motion abnormality
Dyskinesis
Dyskinesis is defined as ____ thinning and outward motion or bulging of the myocardium during ____.
Systolic; systole
