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Stress echo is more sensitive than the conventional stress testing in the following groups of patients.
- Pts with previous MI's.
- Pts with previous angioplasty or CABG.
- Medications
- Bundle Branch Blocks
- WPW Syndrome
- LVH
- Valvular Disease (MVP)
- Women
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Advantages:
- Non-Invasive
- Cost effective.
- Accurate and reliable in the hands of experts.
- Versatile.
- Requires little space.
- Assessment of multiple parameter, systolic function, valve function (Regurg.)
- Portability.
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Disadvantages:
- Highly dpendent on sonographer skills and interpreter skills.
- Difficult acoustic window can limit imaging, lung disease, or body habitus.
- Excessive breathing during exercise.
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Indications:
- Eval for known or suspected CAD.
- Eval of pt with high likelihood of false-positive stress tests.
- Pts taking anti HTN drugs or anti arrhythmic drugs.
- Eval hemodynamic signif. of valvular heart disease.
- To determine biability for bypass surgery.
- 6 wk f/u of CABG.
- Assess valve gradient and pulmonary arter pressure in mitral disease.
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Contraindications for stress:
- Recent MI
- Unstable angina.
- Acute pericarditis
- Severe HTN
- Acute Pulm Emboli
- Physical limitations.
- LVOT obstruction
- AS
- Thrombus
- Congenital ABNL
- Severe LV dysfunction.
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Ischemic Cascade:
- Imbalance in supply and demand.
- Decrease LV compliance.
- Increase in LVEDP.
- Decrease in contractility.
- EKG changes
- Angina
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Exercise Stress Echo:
Image order at rest...
Image order post exercise...
- PLAX, PSAX, 4CH, 2CH
- 4CH, 2CH, PLAX PSAX
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Reasons to choose a Pharmacological Stress:
- Obesity
- Musculoskeletal or neurological disorder
- amputations
- PVD
- PE
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Agent of choice for Pharmacological stress:
- adenosine
- atropine
- dobutamine
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Contrainidications of Pharmacological Stress:
- Heart Failure III and IV
- High grade AV Block
- Angina at rest.
- Signif arrhythmias
- severe HTN
- Acute MI
- HCM
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