Exercise Treadmill Stress Echocardiography

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  • Evaluate for myocardial ischemia.
  • Evaluate for exercise-induced arrhythmia.
  • Evaluate exercise tolerance.
  • Evaluate for cardiopulmonary symptoms in patients with valvular or other cardiac (congenital) heart disease.
  • Unable to perform exercise stress (mental or physical impairment)
  • Ongoing acute coronary syndrome or acute myocardial infarction within 48 hours
  • High-risk unstable angina
  • Uncontrolled arrhythmia
  • Symptomatic severe aortic stenosis
  • Symptomatic congestive heart failure
  • Severe arterial hypertension (systolic blood pressure >200 mm Hg)
  • Examining table, pillows, backrest, and linens
  • Ultrasound system
  • Treadmill
  • ECG machine and blood pressure monitor
  • Oxygen delivery nasal cannula and wall oxygen
  • Resuscitation capability: crash cart/defibrillator with emergency pharmaceuticals
  • If transpulmonary ultrasound contrast is needed, IV supplies (small-gauge IV, heparin lock) and contrast agent

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  • Discontinue IV line if one is present.
  • Answer any questions for the patient and discuss follow-up plans.
  • Patient leaves echo laboratory.
  • Physician and sonographer complete reporting and finalize report.
  • There are no absolute contraindications for stress echocardiography.
  • Patients may experience angina, dyspnea, palpitations during the study.
  • Absolute indications to terminate the test include progressive decline in SBP of ±10 mm Hg despite increased workload when accompanied by other evidence of ischemia; onset of severe angina; nervous system symptoms such as ataxia, dizziness, near-syncope; signs of poor perfusion (cyanosis, pallor); malignant arrhythmia such as ventricular tachycardia; ST elevation (≥1 mm) in contiguous leads; and technical difficulties in monitoring ECG or blood pressure.
  • Relative indications to terminate the test include ST or QRS changes, such as excessive ST-segment depression (>2 mm of horizontal or down-sloping ST-segment depression) or marked axis shift; significant arrhythmias such as sustained ventricular tachycardia, multiple multifocal premature ventricular contractions, supraventricular tachycardia, heart block, or bradyarrhythmias; excessive patient symptoms that limit exercise tolerance, such as significant fatigue, shortness of breath, wheezing, leg cramps, or claudication; development of bundle branch block or conduction delay that cannot be distinguished from ventricular tachycardia; and a hypertensive response to exercise (SBP >250 mm Hg or diastolic blood pressure [DBP] >115 mm Hg). A number of factors affect exercise echo interpretation and accuracy.
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