Supine Bicycle Stress Echocardiography

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  • Evaluate intracardiac hemodynamic alterations during exercise.
  • Evaluate for myocardial ischemia.
  • Evaluate exercise tolerance.
  • 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)
  • Bicycle stress ergometer (upright or supine)
  • Ultrasound system
  • ECG machine and blood pressure monitor
  • Oxygen delivery nasal cannula and wall oxygen on hand
  • Resuscitation capability: crash cart/defibrillator with emergency pharmaceuticals

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The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
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  • Links to medical evidence and related procedures

  • Discontinue IV if one is present.
  • Answer any questions for the patient, and discuss follow-up plans.
  • Patient leaves echo laboratory.
  • MD and sonographer complete reporting and finalize report.
  • Patients may experience angina, dyspnea, arrhythmias, or other side effects.
  • Exercise may provoke acute coronary syndrome or life-threatening arrhythmias.

Study images should be reviewed by a trained cardiologist with knowledge about exercise physiology and the expected hemodynamic changes with exercise. Cardiac output increases with exercise, because of an increase in both HR and stroke volume, and this in turn increases transvalvular and transpulmonary flow (and pressure) in normal individuals. Differentiating normal and abnormal response to exercise can thus be challenging. Additionally, when exercise is performed supine, there may be a lower HR response and a greater blood pressure response to exercise because of increased preload relative to upright exercise.

When evaluating bicycle stress echo data, it is also important to interpret the results in the context of the patient’s overall functional capacity. For example, an increase in left ventricular outflow velocity to 4 m/sec may be functionally significant in a patient with hypertrophic cardiomyopathy if it occurs very early in exercise, but it may be less clinically important if it occurs only at above-predicted workloads. In all cases, functional capacity should be determined by comparing with normal reference standards for age and sex.

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