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Echocardiographic examinations

—Echocardiographic examinations

Transthoracic examination
TEE - views
Stress echocardiography
Contrast echocardiography
Cardiac asynchrony
Strain Imaging
3D | 4D echo
Indications for echocardiography
Training in echocardiography

—Cardiac function and PA pressure

—Examples of pathological

Stress echocardiography

Guidelines and Standards
Recommendations for Performance, Interpretation, and Application of Stress Echocardiography, 2007
Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease, 2019

Echocardiographic examinations under dynamic or pharmacological stress are conducted with strict, and continuous monitoring and documentation of systemic arterial pressures and ECG. Image documentation and archiving are carried out by means of digital softwares, which allow a posterior evaluation of the examination in quad-screen format.

Standard protocols are used for the different stress modalities.

Dynamic stress echocardiogram

Pharmacological stress echocardiogram: Dobutamine


Here a "quad-screen" presentation of the apical four-chamber view at rest (HR = 66/min), low level exercise (HR = 97/min), maximum exercise (HR = 131/min) and recovery (HR = 100/min).

LV contractility does not seem completely normal at rest, but a clear hypokinesia can not be defined. However, already at low level exercise, but especially a maximum exercise, a clear hypokinesia of the lateral LV wall and the apical septum can be seen. Contractility gets better ín the recovery phase.

Besides contractility it is especially important to document tricuspid velocities during examination, with a high sweep speed (150 to 200 mm/s) of spectral CW Doppler for offline measurement of systolic pulmonary artery pressure. Also, the inferior vena cava must be recorded, since an inferior vena cava plethora or with blunted respiratory response leads to a higher right atrial pressure, which must be considered in the calculation.

The assessment of systolic pulmonary artery pressure during stress echocardiography has an inportant diagnostic and prognostic value:

Systolic pulmonary artery pressure assessed during routine exercise Doppler echocardiography: insights of a real-world setting in patients with elevated pulmonary pressures, 2018

A reclining ergometer is the best choice for exercise echocardiography, since post treadmill examination may miss important information.


© Derliz Mereles


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