The Sonographer Attachment Programme At USA Report : Aurora St Luke's Echo Protocol =Stress Echo=

5.3 Aurora St Luke’s Medical Center:

Protocol For Stress Echo (SE)

Procedure

 

• Stress echo is a procedure that utilizes treadmill stress and cardiac ultrasound images to evaluate systolic dysfunction and valvular heart disease.

• Indication

§  Known coronary artery disease

§  Suspected coronary artery disease

§  Evaluate degree of valvular stenosis

§  Evaluate degree of obstruction

§  Pulmonary hypertension

§  Other

• Equipment

§  Digital ultrasound unit with integrated stress echo

§  Stress monitoring equipment

§  Treadmill

§  Echo supplies (Electrodes, Ultrasound, Contrast)

§  IV kit

§  Emergency medical equipment

• Staff

§  Physician

§  Echo Technologist

§  Treadmill/Monitoring Technologist

• Pre Procedure Instruction

§  No caffeine or decaf products 24 hours prior to test

§  Bring list of medication

§  Anti ischemic medications are not to be taken per physician request

§  Wear comfortable walking shoes

§  No smoking or alcohol after midnight

§  No lotion or powder on chest day of test

§  Diabetics follow regular diabetic routine for medication and eating

§  Bring inhaler if necessary

§  Equipment

• Imaging Guidelines

§  Female patients wear gowns that remain tied and taped at chest level during exercise. A towel is placed over the chest during rest and recovery imaging

§  Baseline images are obtained prior to treadmill stress test

§  Post images are obtained following treadmill exercise, attempting to acquire peak images within one minute

§  Imaging consists of parasternal long and short, apical 4 chamber, apical 2 chamber and apical long axis view

§  Right heart stress echo imaging consists of parasternal long and short and apical 4 chamber, focusing on RV function, tricuspid regurgitation and tricuspid valve velocity

§  Valve assessments is completed for pre and post stress comparison if ordered

§  Monitoring physician and/or echo technologist review and select the pre and post images

§  Use of contrast will be determined by the echo technologist and administered by the monitoring or echo technologist

• Monitoring Guidelines

§  Baseline standing and supine 12 leads ECG

§  Baseline standing and supine blood pressure

§  12 leads ECG at the end of each 3 minutes stage

§  Blood pressure 2 minutes into each stage

§  ECG and blood pressure 6 minutes into recovery or until baseline is reached

§  Pulse ox used per MD request

§  Monitoring physician is present throughout procedure

• Absolute Indication For Termination Of Procedure

§  Acute MI or suspicion of a MI

§  Moderate to severe angina

§  Serious arrhythmias ie Sustained VT or increasing polymorphic PVC’s, A Fib uncontrolled, 2^nd & 3^rd degree AV blocks

§  Unusual or severe dyspnea

§  Signs of poor perfusion, ie pallor, cyanosis

§  Central nervous system symptoms ie ataxia, confusion, etc

§  Inability to monitor ECG (technical problems)

§  Patient inability to continue

• Relative Indication For Termination Of Procedure

 

§  Significant ECG changes from baseline ie >2mm of horizontal or downward sloping ST segment depression

§  Any increasing angina

§  Physical or verbal manifestations of severe fatigues and dyspnea

§  Hypertensive response ie Systolic >260 mmHg Diastolic >115 mmHg

§  Less serious arrhythmias ie Non Sustained VT

§  Exercise induced Bundle Branch Block that cannot be distinguished from VT